To briefly summarize--over the past few weeks, Republicans have shown themselves to be assholes of such epic proportions that using words to express thoughts to argue a point--ie, that which makes us human--has proved predictably futile. The GOP has never had any desire whatsoever to engage in health care reform in good faith (with the potential exception of Nixon, amazingly). That much has been obvious since the Truman administration, and now, a mere 60 years later, the Democrats have finally come around.
As a quick tangent, it's worth noting that in 1945, when Truman proposed a national health insurance program--at a time when most of Europe was nationalizing their health care--his plan was criticized as being "socialized medicine." (Follow link above.) That gives you a pretty good idea of how Sisyphean is the task of advocating for national health insurance in America.
Back to the subject at hand. For the Senate Dems to go it alone, they must invoke a parliamentary procedure known as Reconciliation, which is primarily a budget tool. To pass a Reconciliation measure, however, takes only 51 votes, instead of the 60 it takes to override a filibuster. What this means is that the Dems can pass a health care bill with 51 votes, as long as it substantially alters the federal budget. I know this is all kind of dry, but we're getting to the good part.
SO! One would think, "hey, if they only need 51 votes, Dems can really flex some muscle! Then, if the House bill is perfect, we might get a fucking public option!" That is certainly tempting fantasy, but, again, if you have to bet whether or not the Democrats will advance the wishes of their constituents, or the companies who fund them, it's safer to bet on the companies coming out just fine.
In this instance, that means that Senate Dems are split between those who want a robust public option, which will affect the federal budget in big ways. But more conservative Dems don't want a robust option, which means that it will have a smaller impact on the budget, which makes it less likely to pass the standards required by Reconciliation. From TPM:
According to Martin Paone, a legislative expert who's helping Democrats map out legislative strategy, a more robust public option--one that sets low prices, and provides cheap, subsidized insurance to low- and middle-class consumers--would have an easier time surviving the procedural demands of the so-called reconciliation process. However, he cautions that the cost of subsidies "will have to be offset and if [the health care plan] loses money beyond 2014...it will have to be sunsetted."
And there the irony continues: Some experts, including on Capitol Hill, believe that a more robust public option will generate crucial savings needed to keep health care reform in the black--and thus prevent it from expiring. But though that may solve the procedural problems, conservative Democrats have balked at the idea creating such a momentous government program, and if they defected in great numbers, they could imperil the entire reform package.
What this means is that there is an internal division in the Senate Dems between those who are in favor of small but actual health care reform, and those who simply are not. Without a public option, you are not talking about reform. So even when the requirements for passing a vaguely progressive bill are reduced to a simple majority, not a super majority, the Dems STILL might not have the balls to get it done.
It is pure speculation as to how the Senate Dems split will play out, but the fact that it's even up for debate proves that as an institution, the Democratic Party is fundamentally untrustworthy to lead the country towards meaningful reform. Those House and Senate members who refuse to turn away from advocating for corporate interests should be challenged at the primary level, either by better local Democrats or by third parties. Only by threatening their job security will they respond to the demands of those who put them in office.