Ezra Klein describes "the central reality of health care politics," namely "most Americans are basically happy with what they have, but worried about keeping it. Policies that guarantee their futures are quite popular. Policies that radically change their presents are not."

Few if any journalists are any better plugged in to Democratic conventional wisdom about the politics and policy of health care than Ezra is, so this nicely encapsulates my mystification about what, exactly, it is everyone's doing. The underlying presumption here seems to be that if you devise a policy that does not, in fact, change anyone's current insurance then you'll be in good job. But if there's a policy that health insurance companies and others think it's worth spending a lot of money to defeat, they'll just say it will change your insurance for the worse and the fact that it's not true isn't going to be especially helpful in beating that argument back. Meanwhile, it puts the Democrats in the slightly bizarre situation of simultaneously arguing that we urgently need to pass a fundamental overhaul of the health care system, but don't worry, the changes won't affect insurance for the vast majority of you.

It seems to me that if it's really true that most people are happy with their health insurance and don't want to see the boat rocked (and since even liberals seem to concede that this is the case) that the prospects for fundamental health care reform are just very very bad and it would be better to settle for a more modest health care agenda and spend political capital on other things. After all, it's not as if the task at hand on the climate change front is so trivial and easy that there's nothing else to do but pass a health care reform that the public isn't demanding.

Alternatively, maybe the plan is to take the already somewhat odd mandate schemes that are currently on the table, then take out their best provisions — the public private competition, the stiff community rating rules, etc. — and wind up with what amounts to a package of subsidies to health insurance companies. Then you defuse interest-group opposition, making public opinion largely irrelevant, and giving your campaign contributors their money's worth.

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