I’ve heard many people say it won’t be possible to pass a bipartisan health care bill in today’s poisoned environment.

But we will ultimately have real health care reform in this country for a very simple reason: We have no choice and both Democrats and Republicans understand that. More importantly, the American people know it.

If there is one common lesson in the collapse of the Democratic health care efforts in 1994 and 2010, it’s that something as big, complex and controversial as reform has to be done in a bipartisan way.

Was the recent debate hyperpartisan? Were the Democrats arrogant in thinking they could ram through their liberal health care agenda? Did lots of Republicans demagogue the Democratic efforts as soon as the debate clearly turned partisan? Isn’t it true the Republicans haven’t had a serious health plan of their own?

Yes to all of the above.

But if the Democrats and Republicans are serious about being bipartisan, there are opportunities. There are at least 10 Republican senators who have a track record of good faith on health care issues. They include the Senate Finance Committee Republicans who worked hard to get a deal last summer; Orrin Hatch, who co-wrote the children’s health plan; John McCain, who co-sponsored the patients’ bill of rights with Ted Kennedy, and the Republicans who support the Wyden-Bennett bill.

Can we achieve something bipartisan and modest in this election year? It isn’t likely but it is not impossible. True, the Republican base isn’t going to support any efforts to reach out to Democrats who are dangling on a political meat hook.

And liberals are going to have to swallow a lot of the hubris that is at the root of Democrats’ current political fix.

Republicans also need to understand that voter anger at the Democrats is not the same as support for Republicans. In 1994, Gingrich and his team had new and fresh ideas. In 2010, these Republicans are the guys we threw out in 2006 and 2008 — and they certainly haven’t offered any new and intriguing ideas lately to fix the health care system.

Both sides could benefit from behaving themselves and actually accomplishing something tangible. A few modest first steps could do a lot to begin to build some bipartisan trust — and actually help some Americans who need it.

Calls to deal with insurance reform — eliminating pre-existing conditions and medical underwriting limits — would not likely be part of these first steps. To make those changes, we would have to get both the sick and the healthy into the health insurance risk pool. And that means mandates and hundreds of billions of dollars in subsidies; those provisions aren’t possible without reconstructing the same big bills now on the table.

In fact, President Barack Obama and Congress have already taken some important steps on health care. They have, for example, expanded and extended the Children’s Health Insurance Program, and promoted  health information technology and comparative effectiveness as part of the stimulus bill.

Now they should take some other good bipartisan steps:

Approve lesser health insurance reforms that are in the Democratic bills. Bar policy rescissions for immaterial and inadvertent consumer mistakes and provide federal funding for state-based high-risk pools serving the uninsured.

Create subsidies for small businesses to buy health insurance. The number of small businesses that provide coverage is melting in the face of the high cost of insurance. The small group market would be a good place to begin to spend subsidy dollars; it already has less- restrictive underwriting rules because it is generally a guaranteed- issue market. Most of the working uninsured don’t have coverage because their small employers can’t offer it. This would be a very efficient way of making progress toward covering people.

Expand Medicaid in a modest way. The House bill would expand Medicaid coverage to people with incomes up to 150 percent of the federal poverty level; the Senate bill, 133 percent. What can we afford now? From the existing state average of 65 percent of the poverty level, there might be enough money available to fully fund an expansion of Medicaid to 80 percent or 90 percent.

A huge bipartisan step would be to grant the Republicans some commonsense tort reform.

Would enacting this list constitute health care reform?

No.

But it could be the beginning of a process to rebuild bipartisan effectiveness, trust between the parties, voter confidence and actually help millions of people.