by Theda Skocpol

Fellow Americans, and fellow Democrats and Obama supporters, we are at a moment of truth, a pivotal turning point -- in the form of what happens in the next days and weeks with robust, universal health reform. A fork in the road socially, economically -- and politically. It could go either way depending on Obama and the Democratic officeholders many of us worked so hard to elect. They have the power to act, but will they use it -- or lose it?

If at this remarkable juncture Obama and the Democrats cannot enact a robust health care reform -- with a strong nationwide public option, cost controls, and nearly universal coverage -- I would not want to be in charge of fundraising and mobilization for them in the 2010 and 2012 elections! Most of us who supported them last time will of course not vote for a Republican.. But if Obama and the Democrats cannot act now on a once in a half century challenge and opportunity, they are not worthy of extra energy. And those of us who wrote big checks last time will tell the Democrats -- especially in the Senate -- to hold pharmaceutical fundraisers instead.

Key leaps forward for U.S. public social provision -- Social Security, Medicare, etc. -- have NEVER happened through "bipartisan" compromises and they always happen in close votes. They have always sqweaked through after gargantuan effort, strong presidential pressure, and refusal to allow eviscerating compromises. Think of Social Security if the Clark amendment -- allowing corporate opt-out -- had passed in 1935. We would not have it. And conservatives and the medical and insurance establishments cried "socialism" in 1965, too. We would not have Medicare if we had listened.

Obama and the Democrats are coming off a historic, landslide election. They have all the popular support for robust reform they will ever have. Good policy design as well public desire for change and considerations of social justice and economic efficiency insist that they enact health care reform with a strong public plan in the mix. That is the only way to move toward cost control and guaranteed access with quality to all -- especially for Americans in lower economic strata or in rural states where one or two private insurers call the tune. There is no need for "bipartisanship" and the calls for it from some weak-kneed Democrats are merely excuses for doing the business of the medical-insurance establishment. Senators Baucus, Conrad, Feinstein, Nelson, Landrieu, Bayh -- this means you. All of you come from states where people really need robust reform and you should step up.

The stakes here in political-economic terms are NOT between a "free market" and "government control." They are between two alternative uses of government regulations and subsidies: We will in America continue on the path set over the past thirty years: using government regulations and subsidies to distribute income and security upward, to guaranteed private profits; or will we redirect government interventions toward expanding popular security and leveling the economic playing field for various businesses? So-called conservatives seeking "compromise" on health care reform want more subsidies for their buddies' profits, and want to force more Americans to buy inefficient products (through a mandate to buy private insurance). If Obama and the Democrats agree to such compromises under the name of "reform" they will have squandered the country's future economically -- and undercut their own political fortunes for the future.

Because let's not kid ourselves: WHATEVER passes this year will make the Democrats owners of the health care mess going forward. If they just throw more subsidies and piecemeal regulations into the current system, they will ensure galloping public costs for residual arrangements and for subsidies to private insurers who will easily find ways to avoid sick or costly patients. Businesses and citizens will grow more and more irritated as time passes, and will blame the Democrats. Rightly so.

And to return to my theme at the start: no matter if Senate Democrats still think they are operating in the world of the 1980s or 1993, they are not. Activist Democrats -- mobilizers, volunteers, bloggers, analysts, and donors -- are watching them. We will know exactly who blocks or eviscerates real reform here. We WILL blame the Senate and the responsible individual Senators. And many of us will blame the Obama adminsitration if it does not take a strong stand on the public option and real reform, starting right now. Whatever he says in public, Obama needs to draw lines in the sand with Democrats in private -- and get tough. If he does not, and this fizzles into no legislation or reform in appeance only, energy will dissipate from the Demorats and the Obama movement. There will be the wrong kind of turning point for them -- and for America.

So step up now, Obama and the Democratic Party. Your moment is here and now.