The influential conservative Democrats who are combating their own party's efforts to overhaul health care could ironically wind up being among the biggest losers if the effort to pass comprehensive legislation founders too badly.
Health care reform is so central to the Democratic agenda that its collapse could gravely damage the party's stature in 2010.
The self-styled fiscal conservatives who call themselves Blue Dogs in the House fear the effects of being labeled as liberals in their predominantly right-leaning districts. But history suggests that they should be more afraid of fueling a Republican electoral resurgence.
"If [President] Obama's popularity and the Democratic party's approval rating goes downhill, that will hurt the Blue Dogs and those in conservative districts more than anybody else," Mike Lux, a progressive political strategist, told the Huffington Post.
In previous elections, the prospects of conservative Democrats in both the House and Senate have been strongly linked to the overall popularity of their party.
In 2006 and 2008, the fiscally conservative Blue Dogs, gained 15 seats -- mostly in conservative districts -- while capitalizing on high Democratic popularity across the nation. During the same period, 11 of the 14 Democratic gains in the Senate were in conservative or toss-up states. By contrast, in the 2002 and 2004 elections, when Republicans added to their majorities in both chambers, their pickups were mostly in conservative and swing states.
There's also a precedent for health care being a make-or-break issue for Democrats.
"The reason we lost so badly in '94," said Lux, who was an adviser to Bill Clinton at the time, "was that working class voters of medium and low incomes -- who turned out in big numbers in 1992 -- were incredibly discouraged by us not delivering on health care."
The failures of Democrats to overhaul health care under Clinton and Harry Truman both led to dramatic Republican gains in the following elections, with Democrats losing their control of Congress both times.
"A lot of the conservative Democrats who voted against [Clinton's health care] bill got swept out in 1994," Lux said. Republicans gained 54 additional seats in the House of Representatives and eight in the Senate that year -- mostly in conservative states and swing districts -- regaining control of Congress for the first time in half a century.
Meanwhile, Michael Tomasky writes in the Guardian that most of the Blue Dogs shouldn't be so fearful, period.
"To hear them talk sometimes, you'd think if they depart one iota from a basically conservative agenda, the voters will toss them out," he writes.
But Tomasky's elaborate analysis of the 2008 election results suggests that very few of them are really in danger of being voted out of office for being too liberal.
"Yes, some Democrats have to be very careful and not be seen as casting a liberal vote. But they're a comparatively small number," he concludes. "A very clear majority of these people have won by large enough margins that it sure seems to me they could survive one controversial vote if they [put] some backbone into it."