That is not all. President Obama and I know we have to put our fiscal house in order. This is why those who claim they oppose reform because they fear for our country’s fiscal stability should finally acknowledge what the nonpartisan Congressional Budget Office makes crystal clear: not only is the Senate bill paid for, it is this country’s single largest deficit-reduction measure in a dozen years.

I share the frustration of other progressives that the Senate bill does not include a public option. But I’ve been around a long time, and I know that in Washington big changes never emerge in perfect form.

Those in our own party who would scuttle this bill because of what it doesn’t do seem not to appreciate the magnitude of what it has the potential to accomplish. Howard Dean was head of the Democratic Party. I respect his leadership on health care, and I understand his criticism of the bill. But it is worth noting that on some of the key health reform issues  like ensuring that Americans have access to stable, affordable coverage, and doing away with abusive practices by insurance companies  the reforms in the Senate bill would do even more than Vermont, the state he governed, has done. And they would do it for the entire country. What’s more, this bill would expand both choice and competition in an insurance market that, for many Americans, has offered far too little of either.

The issues in the health reform bill are complicated, but the consequences of failing to pass it are straightforward. Those who would vote no on this bill need to look into the eyes of Americans who don’t have health care now and tell them they’re going to be better off without this bill  better off continuing to live without health coverage. They should explain to all those Americans who are denied coverage because they have pre-existing conditions or whose insurance ran out because of lifetime caps that they don’t need this bill. And they should tell the families who have insurance and the small-business owners who provide it that the relentless rise in their premiums without this bill will somehow make them glad it didn’t pass.

Is America better off today because a chance at a compromise health bill was missed in 1993? For my friends on the left, the rising toll of the uninsured provides an emphatic no. For my friends on the right, the soaring share of federal spending on health care likewise provides a no. Let’s not make the same mistake again.