It’s open season on Blue Dogs. For insisting on applying their trademark concern for fiscal responsibility to the health care reform debate, the coalition of moderate-to-conservative House Democrats now finds itself in an ideological crossfire.

Sniping from the left is New York Times columnist Paul Krugman, who this week accused the Blue Dogs of ideological incoherence. By opposing an employer mandate, Medicare cuts and the “public option,— Krugman says, the moderates are actually making reform more costly.

Charging in from the right is Reihan Salam, who called the Dogs “preening bozos— in a spirited if confusing screed in the Daily Beast. It turns out that Salam agrees with the Blue Dogs on the merits of health care reform but thinks they are undermining Democratic unity and setting up President Barack Obama for a huge political failure.

Apparently, the Blue Dogs’ stance would be smart and principled if they were Republicans but smacks of “crass opportunism— because they have the temerity to run (and win) as Democrats.

Other observers suspect that the Blue Dogs simply don’t want to vote for the House bill, with its controversial tax surcharge, only to be hung out to dry if the Senate, as seems likely, drops the provision.

For their part, the Blue Dogs say they are trying to help President Obama achieve his basic health care reform goals.

Said Rep. Mike Ross (D-Ark.), their health policy point man: “We are not trying to kill health care reform. We are trying to save it. We are committed to providing the American people with the quality, affordable health care that they need and want, and we will continue to forge ahead in an honest effort to reach this goal.—

They have a point. The president has said he will not sign a health bill that deepens the federal deficit or stokes medical cost inflation. Thus far, none of the bills being crafted in Congress comes close to meeting those threshold tests.

And that’s a problem. The public is watching Democrats closely. Spending more than $1 trillion to cover the uninsured — without holding down premiums for working families or constraining the surging costs that are overwhelming public budgets — would only reinforce public cynicism about government’s ability to solve the nation’s toughest problems. It would also be a political boon to the GOP.

To the extent that the Blue Dogs hold out for reforming, rather than simply expanding, America’s health care system, they are performing a valuable service to their party.

Instead of criticizing them, liberals ought to join with the Blue Dogs to find realistic “pay-fors— and to radically restructure the way health care is delivered in both the public and private sectors.

While Krugman may have a point about the employer mandate, which is aimed at preventing business from dropping coverage for millions of workers once the new system is set up, the public option is another matter.

A public plan may provide consumers with choice in areas dominated by one or a few private insurers. But there’s scant evidence that a government plan would deliver less expensive care unless its premiums were heavily subsidized, which of course would add to the nation’s overall health bill.

Members of the House Progressive Caucus (which is bigger than the Blue Dog Coalition) have made the option a non-negotiable demand, even though it’s a deal-killer with many moderate Democrats and Republicans.

Health reform isn’t destined to fail. But if it does, let it be over truly vital matters, like whether it’s paid for, and whether it constrains runaway health care cost growth, not over a distracting “public vs. private— debate.

But Blue Dogs should also take seriously the charge of opportunism leveled by Krugman and Salam.

To build a progressive majority for health care reform, the Blue Dogs will have to make hard choices and run political risks, too.

They are right to be wary of the public option, and of House liberals’ proposal to pay for reform with narrowly tailored taxes on the ultra-rich.

But the question then becomes: What are the Blue Dogs proposing in the alternative?

Their push for an Independent Medicare Advisory Board to depoliticize decision-making and force efficiencies in Medicare makes sense. Unfortunately, the Congressional Budget Office won’t credit it with major savings.

In the end, somebody’s taxes will have to go up to pay for universal health care. The best way is to limit or eliminate the exclusion of employer-paid health benefits.

But labor is strongly opposed, and many Democrats are worried that the idea will be caricatured by Republicans as a “tax on your health benefits.—

There are alternatives, including Obama’s original proposal to reduce the value of tax deductions for the wealthiest taxpayers.

The point is, everybody is going to have to make sacrifices for health reform, Blue Dogs included. The burden is on them to show they can and will produce the votes for a fiscally responsible approach to coverage for all.

Will Marshall is the president of the Progressive Policy Institute in Washington, D.C.