John Brummett reassures his 79-year-old mother that Democrats aren’t out to cut her Medicare. That she’d ask — and that Democrats have utterly failed at communicating what they are about — is the story of the moment in the health care debate. Probably the permanent story.

Obama’s message seems only to be this: Pass something on health care and send it down here.

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That can’t begin to compete with powerful television commercials that saturate a state with a weak Democratic swing voter in the U.S. Senate. Arkansas, I mean. Blanche Lincoln, I mean. And commercials in which good ol’ Arkansas folks warn plaintively of cuts in Medicare, I mean.

Meantime, Republicans play a cynically effective game. On this very Thursday, they were proposing an amendment to the Democratic health bill to “restore” proposed cuts in Medicare over the next 10 years. But the purpose was not remotely to make policy. It was to force a few vulnerable Democrats — again, read Lincoln — to vote against the amendment so that they could be set up for the kill of attack ads back home.

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UPDATE: Reader HenryS raised a question about whether reductions in the growth of Medicare spending won’t necessarily mean reductions in service. Fair question. Today, the NY Times explores it at some length related to home health services. The thinking is that it’s hard to achieve greater productivity (and thus the same services for the same or less cost) in such a labor-intensive service that, ironically, saves a lot of money by avoiding expensive hospital care.

I repeat what I’ve said all along. I favor a single-payer system with universal care cradle to grave such as you find in most other civilized western countries. We’re not going to get that. I’m with Bill Clinton. We need to pass the best thing we can pass (which undoubtedly means inclusion of some unpalatable provisions) to get started. Otherwise, the status quo and Republicans win.

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