The latest health care scenarios just released by researchers from a respected think tank offer grim food for thought as health reform moves toward final passage in Congress.

If the legislation doesn't pass, the worst-case projection is that the number of Americans without coverage will climb from 49.4 million to 67.6 million in 2020, meaning that nearly one in four Americans too young for Medicare will be uninsured.

The best-case scenario doesn't exactly inspire confidence, either. Should economic conditions improve over the next decade, there will be 57.9 million people without coverage 10 years from now -- about one in five Americans younger than 65. The research was funded by the well-regarded Robert Wood Johnson Foundation. The authors of the report, which was released Monday and titled "The Cost of Failure to Enact Health Reform: 2010-2020,'' were from the nonpartisan Washington, D.C.-based Urban Institute.

It's against that backdrop that America now finds itself embroiled in the latest saga of the long-running health care soap opera: whether to use a maneuver known as "deem and pass" that would allow final passage of reform through the House without requiring its members to directly vote on it a second time. Both the House and Senate passed health reform last year; the House had been poised to vote on the Senate version through a process called reconciliation before Democratic rumblings began this week about an alternative path to passage.

To the Republicans now howling about "deem and pass,'' come on. The GOP has used this parliamentary parlor trick before to pass hefty policy, including a $40 billion deficit reduction package. The party even defended its use in court. Its sudden attack of principles feels awfully convenient.

Democrats, who whined about the GOP's previous use of "deem and pass,'' have done their own ignominious about-face on this issue. "Deem and pass" is hardly an ideal or courageous way to enact an overhaul of the nation's $2.4 trillion-a-year health care system. Still, let's put this procedural spat in perspective. It's a distraction from the real issue: the catastrophic consequences of the health care status quo.

"The Cost of Failure" report outlines what could lie ahead if nothing gets done. The ranks of the uninsured already include many lower-income families. Over the next decade, many in the middle class will join them. At the root of this is the skyrocketing amount employers will have to pay for their employees' health insurance premiums. That total amount could rise from $430 billion to $851 billion in 2020, an increase of 98 percent, according to the report.

Many employers simply won't be able to afford health plans. Those most likely to drop coverage in the next decade: small firms with fewer than 50 employees. But many medium-sized firms, those with 50 to 999 employees, could also stop offering insurance. Under the report's worst-case scenario, only 74.8 percent of these companies would provide coverage in 2020, vs. 90 percent of them right now.

Health care reform is a costly fix, to be sure, but it's one that will provide coverage to 30 million Americans, protect those who currently have coverage, and start to reorganize the system to reward quality and efficiency, the key to bringing down costs. If the political courage isn't there now to tackle health care, when will it ever be?