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Democratic leaders face a major decision now on health care reform-- yet another one this year that will throw into relief the interests that compete in American representative democracy. They have to choose between either closing the "doughnut hole" and offering full coverage for millions of low-income seniors on Medicare who need to buy prescription drugs or sticking to a deal they made with the nation's major drug companies. According to the deal, the government agrees not to use its bulk buying power to lower the cost of drugs, so long as the drug companies dole out $80 billion over the next decade to subsidize health reform.