Politics often comes down to a choice between half a loaf or none at all. That is the position in which America's Democrats find themselves as the Senate approaches a series of momentous votes next week on healthcare reform.
The Senate bill as it now stands after weeks of haggling and horse-trading is far from perfect, and a shadow of the root-and-branch overhaul liberals had hoped for. It contains no government-run scheme to, in President Obama's words, "keep the private insurance companies honest". In too many respects special interests, such as the insurance and pharmaceutical industries, have had their way. In the short term, the measure may even push up the cost of health coverage, rather than reduce it.
But the bill still does many excellent things. It will extend coverage to more than 35 million Americans who have none. It bars insurance companies from denying coverage to people on the grounds of existing medical conditions, and provides help to those not covered through their employer, and who currently have to buy exorbitantly expensive individual policies on the private market.
Even now, after weeks of debate, and any number of concessions, the Senate's Democratic leadership cannot be sure of rounding up the 60 votes needed to overcome the threatened Republican filibuster – at least in time to meet the President's goal of passage by the end of this year. If all goes well, the final vote will be taken on Christmas Eve, but Republican obstructionism could push the date into the New Year.
Liberals, understandably, are furious. Howard Dean, the former presidential candidate and a doctor himself, says it is a sell-out to the insurance companies, and should be abandoned. House Democrats vow to unpick the Senate version when the two chambers meet to agree a final bill to go to the White House for signature.
The harsh truth, however, is that the only measure with a chance of making it to the President's desk is whatever emerges from the Senate. Liberals should hold their noses and accept it. Half a loaf is better than none. Another chance for desperately needed reform will not quickly come again.