Republican critics have a fiercely argued list of reasons to oppose health care reform. One that is resonating is that the nation cannot afford in tough economic times to add a new trillion-dollar health care entitlement.

We understand why Americans may be skittish, but the argument is at best disingenuous and at worst a flat misrepresentation. Over the next two decades, the pending bills would actually reduce deficits by a small amount and reforms in how medical care is delivered and paid for  begun now on a small scale  could significantly reduce future deficits. Here is a closer look at the benefits and costs of health care reform:

STATUS QUO IS UNSUSTAINABLE More than 46 million Americans have no insurance, and millions more have such poor coverage that a severe illness threatens bankruptcy. Small employers are dropping coverage because of the cost. Those lucky enough to have insurance are struggling with higher premiums and co-payments, and worry that if they are laid off they could lose coverage.

Without reform, that bad situation will only get worse. The Commonwealth Fund, a respected research organization, warned that the average premium for family coverage in employer-sponsored policies would almost double in the coming decade, from about $12,300 in 2008 to $23,800 in 2020, with part paid by workers and part by employers. Premiums are also soaring for individuals who buy their own coverage directly.

BUT A TRILLION DOLLARS? Both the House and Senate bills would cover more than 30 million of the uninsured, and fully pay for it  in part by raising taxes (either on wealthy Americans or high-premium health plans and certain manufacturers and insurers) and in part by cutting payments to health care providers and private plans that serve Medicare patients.