With the Republicans becoming locked into being the party of No/Hell, No/Not Ever/Nada/Absolutely Not/Never Ever, Democrats are going to need to seriously consider revising the rules of the Senate at the beginning of next term. The gritty reality of the Senate rules minefield is making the passage of health care reform way too complicated. But it's virtually impossible to change the Senate rules in the middle of a term, so we are stuck with getting this thing done with the rules we have.
Fortunately, the Democratic leadership on Capitol Hill and at the White House are completely bound and determined that they will pass a health care reform bill by any means necessary. We have come too far, spent too much time and political capital, to turn back now. I think almost everyone in the party (except maybe 3 or 4 Senators) understand the disastrous consequences of not getting a bill passed.
There are, however, two realities that in combination make getting the deal done really complicated.
The first is that the progressive wing of the party is as dug in as I have ever seen them on having some form of a public option in this bill. This reality, which has been building for months now because of stronger progressive leadership in Congress and a powerful grassroots campaign to push for the public option, has been slow to dawn on the Washington elite, but my sense is that progressives are getting more determined on the issue every day , not less, and that with their rhetoric, their promises to activists, their signatures on letters promising to oppose anything without a public option, that their willingness to give on the issue has gone out the door.
The other reality is that getting the final four or five moderate Senators to vote to let this bill get passed at the end of the process -- whether to take it to conference committee or for final passage -- is extremely difficult. Between a range of factors including genuine policy and ideological concerns, worries about conservative home state politics, fears about money being cut off from the insurance industry for their campaigns, desire to extract every possible concession on every possible subject, and the egos of being a Senator, getting every last Democratic Senator is a massive challenge. This would be true, by the way, with or without the public option, but the high-profile symbolism of the public option just raises the degree of difficulty with some of these Senators.
I actually think Harry Reid is doing a remarkable job working with the holdouts. He has gotten a lot of criticism over the past few months, but given the Senate rules, he is doing a remarkable job working every last angle to get this bill moving (beginning of next term, you gotta get the rules changed, though, Senator). He is now really close to getting the 60 votes to get this bill to the floor for debate, and I think that will happen.
The biggest question, though, is what happens next. No one wants to go the reconciliation route because given those ugly Senate rules, it is just a convoluted mess to do things that way. It would take more time, create enormous logistical hassles and tie-ups, and almost certainly force the bill to be broken into two parts, one that would go through the reconciliation process and one that could not because its provisions aren't directly related to the budget. I can understand why Reid and the White House would rather not go down that path unless they absolutely must.
Unless all 60 Democrats stick with Harry Reid, though, that's what they will have to do. Getting this omelet done may require breaking a few Senatorial eggs. Having talked with some Senate staffers, I know they are preparing for every contingency, including reconciliation, and that's a very good thing, because I think that's what this will probably come down to in the end. I know it's a messy, irritating, uncomfortable way to get the deal done. But if any of those Senators decide they want to say no, and don't want to be players on the most important piece of legislation in at least 50 years, so be it. This legislation is too important not to pass.