Howard Dean and Jacob Hacker, if you read the top-line reports, have been on the opposite sides of the reform debate which has exploded this week. Dean has marshaled opposition to the Senate health care bill, while Hacker gave his assent. If you actually read their statements or listen to their speeches, however, they’re actually saying mostly the same thing. Here’s Dean on Meet the Press yesterday:

Well, let’s start with the positive things. Over the last week, there were things that were improved. There were some cost containment mechanisms that were gutted. They got restored. I would certainly not vote for this bill if this were the final product, but there are, the House bill is quite a good bill. This bill has improved over the last couple of weeks, I would let this thing go to conference committee and let’s see if we can fix it some more…so there are a lot of things that need to be fixed, but if they are fixed you may actually get the foundation of a bill, coming out of the House. If most of the House provisions survive, then we can have a bill that we could work with….I hope this isn’t the compromise that’s been achieved. I think we have yet to see the compromise that we could achieve.

Here’s Hacker’s piece at the website of The New Republic:

These are not politically unrealistic goals. Most are already embodied in the House bill. In bridging the differences between the two bills, Democratic leaders and the President must insist on a final bill that delivers on these fundamentals.

If it does not deliver–if the new options offered through the exchange do not attract broad enrollment, if insurers continue to undermine health security with impunity–then the worst fears of progressives will come true. Coverage will be too expensive because only those with the highest health costs will sign up. Fewer Americans will obtain insurance than expected. Small employers won’t want to take advantage of their ability to buy insurance through the exchange. And Americans will become increasingly disillusioned with the promise of reform.

Progressives have good reason to be angry. Yet we should harness our anger to fix the bill–now and every year from now. The current bills in Congress do too little to help Americans immediately; their main actions are delayed for years. If and when legislation passes, progressives should demand immediate concrete actions to make the promise of a reform a reality more quickly and more effectively.

I’m trying to see the daylight between these two statements, but to be honest there isn’t that much. The fundamental difference is one of approach – Hacker is much more conciliatory to the process, while Dean is more aggressive. And what we have seen over the past several months of this debate is that the aggressive voices get heard.

The myth of the “bill killers” is that Dean et al. want no reform to occur at all, which was never true. They objected to the Senate reform bill, and in the process, extracted significant changes to the manager’s amendment, to which Dean alluded above. The annual limits loophole was mostly closed, the nationwide plans that could pre-empt state regulations were sacked, changes were made improving funding for community health centers and Maria Cantwell’s basic health care plan. None of these would have been possible without aggressive pushback from progressive opinion leaders. And those same leaders will at least give some help to guide the hand of Congress during the conference committee.

So liberal opinion columnists and bloggers freaked out by the words “kill the bill” need to understand that it’s a matter of approach, and the literal rendering is hurting proven practices to improve the final product.