Sept. 30 is the very last day that the Senate can approve a health-care reform bill under the reconciliation rule that avoids filibuster. No Democrat is likely to support the block grant model, so it must rely on Republican votes alone. All funding formulas — Medicare, Medicaid, subsidies, and grants — can be tweaked later, and Senate rules will require bipartisan agreement. But for now, the primary focus should be on structure. Every Republican senator should support the transformational, long-term benefits of block granting the program rather than running health care as a monolithic federal program.