The old saying about civic responsibility is that people who don't vote get the government they deserve. Now it appears that people who have stayed on the sidelines of health care reform debates will get the changes they deserve, which could range from none to compromise proposals so watery no one will feel much effect.

Maybe that's fine. Maybe once the circus has left town, benefit consultants can get back to helping clients work on health care quality and cost solutions applied within the status quo. If nothing else, we can thank Washington for doing more to increase employee satisfaction with their health benefits than anything employers have done in the past 10 years. Remarkably, they did that with just two words: "public option." Who knew employees were so happy with their employer-sponsored insurance? For the most part, all benefit managers and advisers hear about is how terrible the bureaucracy is and how onerous employees find the costs.

But before we celebrate the status quo, let's look at two of the biggest bugaboos about reform and take a reality check. The first is, "We don't want to pay for the coverage of 46 million uninsured Americans." Hey, the uninsured have a health plan - it's called the Emergency Room, and they usually go there after their condition has worsened to the point that care is much more expensive than it needed to be. Anyone who thinks we don't all pay for that care is a fool. Another bugaboo is that Americans don't want "death panels" deciding it's time to pull the plug on Grandma. Me neither, but that doesn't change the fact we live in a world of finite resources, and that someone, at some point is going to be denying claims for certain treatments no matter what.

I blame reform proponents for not addressing these concerns more forcefully. We need development and explanation of meaningful checks and balances that could stop a public option from becoming socialized medicine, or end-of-life counseling from becoming a death panel.

Despite all that, I still believe Americans deserve more in the nature of health care reform. And if they don't get it from Washington, the burden falls back on you and your clients. We won't talk health care rationing, but we will embrace value-based purchasing (paying only for what works) and preventive care (pay now to avoid paying later). We won't talk about a public option, but we'll learn from the cost-control techniques of member-controlled health care co-ops.

The circus will move on, but your work will remain, and as always, you will summon the strength to shoulder a large portion of responsibility for giving America the health reform it deserves.