When the House votes on the health reform bills today, every Republican will be voting no based on a dishonest Frank Luntz caricature of a bill that doesn’t exist. A minority of Democrats will be voting no in the belief that the false caricature will stick in voters minds and end their careers. Good riddance.

But the majority of Democrats will be voting yes for Dr. Jekyll, while ignoring or discounting clear warnings that Mr. Hyde lurks in the private insurance industry bailout they’ve foolishly assumed is the only path towards eventual universal health care.

Dr. Jekyll’s fans are right to argue there are many worthwhile features in these bills, many of them premised on expansions of successful public insurance and public health programs.

– We’ll eventually expand Medicaid to some 15 million more people and extend SCHIP several more years, and we’ll divert hundreds of billions to allow the Federal government to cover 100 percent (phasing down to 90 percent) of the costs of these expansions. Budget-strapped states — most recently Arizona — are facing cutbacks in these programs today.

– We’ll provide over $11 billion in new funding to expand public community health clinics, many serving rural and poorer communities.

– There are a few seeds of possible state public programs, though no assurance they’ll take root.

– We’ll reduce subsidies to private Medicare Advantage plans and use those billions to help close the doughnut hole, guarantee better primary care and extend the Medicare trust fund several years.

If the reform bills were just about these and other expansions in public health programs, as well as various efforts to reduce Medicare costs, passing them would be a huge victory.

Where Dr. Jekyll begins to morph into Mr. Hyde is when the bills try to "reform" the health insurance industry by expanding it and the reach of its worst elements. The bills purport to end or limit the most hateful practices of private insurers, such as excluding coverage for those with prior conditions and rescinding coverage when people get sick. But they still leave far too much discretion with private insurers, pushed by Wall Street profit demands, to discriminate against those who are older and sick. All the incentives that drive insurers to exclude or discourage sick people remain.

Given that framework, the billions in credits and subsidies to help low-to-middle income Americans purchase insurance coverage are necessary, but they send us down a dark alley. The concept would have been defensible if people could use those credits to escape the private system, if it served them badly, and buy in to a viable public health plan such as Medicare.

But by excluding any credible public option from the exchanges, the bills force us to bail out and sustain the private insurers with little or no accounting for where the money goes or how high rates can go. If we want these uninsured Americans covered, we’re forced to perpetuate subsidies to a highly concentrated, non-competitive industry with little control over their rates and practices.

Is it astonishing to me that serious economists are so enthralled with the expanded coverage they’re willing to ignore the flawed market structure. You’d expect a Paul Krugman, for example, to draw a graph showing what happens when you have a steeply sloping supply curve controlled by an oligopoly and a near vertical demand curve defined by a mandate with no viable alternatives. Did economists not teach us this is a breeding ground for market power and a huge incentive for withholding and price extortion?

Armed with a mandate to force us to purchase his wares, Mr. Hyde is in full control when we get to all of the corrupt deals the industry got from the White House and Senate. We see daily reminders that the largest drug makers are little more than America’s least accountable criminal class, whose executives view large criminal fines as just a cost of doing business. And yet this White House cut a deal shielding them from competition and government bargaining. The deal to limit PhRMA’s "savings" contribution was nothing less than a massive price fixing scheme.

Meanwhile, the White House deal to exclude a viable public option ensures the government cannot use its market power to force price concessions on drug makers, hospital cartels and other providers. And executive orders banning the funding of abortion? In which dark alley was this thought a good idea? The stench of these unprincipled sell outs and corporate bailouts is everywhere.

How one feels about these bills depends on what you think would happen if they failed. If we’ve learned anything about this Administration and its Party, its that they’ll fight like hell to round up the votes for a Jekyll and Hyde plan while pretending it’s only Dr. Jekyll’s prescription, but they’ll never make the same effort to bring Mr. Hyde to justice.

We live in a deeply compromised system where the choices are sickening. At the moment, the choice is to given in to Mr. Hyde’s extortion as the only way we’ve been offered to rescue millions of uninsured and get them into Dr. Jekyll’s public programs. Or we can let the current rotten system fester and hope — or is it pretend? — that something better will emerge at some undefined future date through some political transformation yet to be explained and whose leadership may not exist.

I’ve lost faith in America’s capacity to govern itself. If it were my kids, I’d pay the ransom, but then I’d watch for every opportunity to kill Mr. Hyde.