Did health care reform die at the ballot box? I’ve been reading on Twitter how pleased Republicans are with Scott Brown’s win for Ted Kennedy’s Senate seat. It’s a game changer.

The best way to catch the wave of that particular thought is to search Twitter using the hashtags #hcr or #tcot (health care reform and True Conservative on Twitter). The comments boil down to a push to “slow down” the government “take over” of the health care system.

Unfortunately “slow down” in this context means kill. Starting over is a process measured in years, not the months ahead before a new round of congressional elections.

Democrats say they’d still like to press ahead with a health bill, but it’s likely to be smaller. The House could, in theory, pass the current Senate bill without changes, sending it directly to the president. But that seems to be unlikely because those Democrats who weren’t all that excited about health care reform now have an easy exit. It’s scurry time in D.C.

The really tough thing about the chain of events is that it will be tricky to keep the Indian Health Care Improvement Act as part of any larger package; that likely means starting over as its own bill. Senate Indian Affairs Chairman Byron Dorgan told the Bismarck Tribune Jan. 13 that the Indian Health Care Improvement Act remains a priority. Perhaps he can find a way to restart the bill on its own.

Washington moves from a game of “if, then” construction to one of blame. The president should have done this, the Senate leadership that, or the House could have. … You get the picture.

There were strategic choices made along the way that focused the debate in ways that didn’t pay off. Rolling the Indian Health Care Improvement Act is a good example. It would have been a smart move – if the bill passed. Now, not so.

One of the most interesting strategic choices was the framework of the debate itself. Health care reform, at least to me, is about solving two important problems: coverage for all Americans and controlling future costs before our system collapses. This debate was mostly about covering all Americans (or as many as we could, given the politics). But the second issue, I think, is the one that must be dealt with soon. The system we have is not sustainable.

As the Congressional Budget Office noted recently: “ … if current laws do not change, federal spending on Medicare and Medicaid combined will grow from roughly 5 percent of GDP today to almost 10 percent by 2035. By 2080, the government would be spending almost as much, as a share of the economy, on just its two major health care programs as it has spent on all of its programs and services in recent years.”

Imagine the competition for federal dollars (or, conversely, the pressure to increase taxes) based on those numbers. It will be an even angrier debate than the one we’re having now.

Now that Republicans have 41 votes in the Senate will they work with Democrats to solve the problem? Good luck with that. We’re too close to the next election season.

This is a problem we can solve. Other countries have figured this out and reached consensus. Some have opted for single payer, others for a private based system that still controls costs. But reading the anger on Twitter (or hearing from angry constituents in the town halls last summer) you have to wonder, how can we even have the right conversation?

We must find a way to work together – Democrats, Republicans and independents – with a clear purpose. If we can’t do that (and soon) we’ll shift from the health care debates to a bigger philosophical question: Have we lost our ability to govern ourselves?

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment at www.marktrahant.com.