Ezra Klein explains that scaling back the current health care bill doesn't work -- the whole thing would fall apart. He's right. He then argues that starting from scratch would look different:
If you want to pare back, you need a different approach altogether. You could reduce the cost, the size of the bill, the complexity of the legislation, and the number of regulations by just expanding public programs that helps the most vulnerable groups: Let people over age 50 into Medicare, expand Medicaid to people under 200% of the poverty line, and pay for it through a tax on the rich.
He's right that this would advance some policy goals. But the chances of this, or something remotely like it, passing into law are approximately zero. The Democrats biggest worry right now, I have been reliably informed (Yes -- reporting! I try not to make a habit of it), is that they think health care has just taken too much time. The want to pivot to an economic message. Writing a new, even smaller health care bill takes a lot of time. There are delicate compromises with interest groups who have the power to destroy legislation if they feel threatened. There are negotiations in two chambers. The senate is feeling incredibly skittish right now and probably unwilling to vote for anything stronger than a resolution saying that if anybody dies because they couldn't afford medical treatment it would be a darn shame. (And that resolution would come after months of begging Olympia Snowe to cast the filibuster-breaking vote.)
There are only two options on health care: Something that involves passing the Senate bill through the House, and nothing. There's no fantasy moderate bipartisan alternative. Once Congress gets that through its head, I think -- I don't know but I think -- they'll make the obvious choice.