Health care scrum

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Sen. Harry Reid's decision to include a government-run plan as part of health-care reform cheered progressives who have long embraced the idea, but the majority leader's pronouncement lacked one critical proviso: the necessary votes.

While Reid asserted that Senate Democrats would coalesce around the public plan option, they haven't yet. In fact, it's unclear whether he can amass the 60 votes needed to head off a Republican filibuster just to get the bill to floor debate. Olympia Snowe, the only GOP senator open to supporting the bill, said Tuesday that she would oppose the legislation because it contains the public plan.

Reid thought that by including an escape clause for states to opt out he could gain the support of moderate Democrats cool to the government-run plan. But some of them favor an opt-in option or nonprofit cooperatives and Snowe prefers a "trigger," in which the public option would take effect only if private insurance companies fail to foster enough competition in certain states.

Although Democrats in the House can't match the disarray in the Senate, they too are struggling to forge a majority around one bill. While there's more support in the House for a public plan, members differ about how robust it should be and the conservative Blue Dog Democrats continue to have qualms.

While the Democrats squabble, the insurance industry has unwittingly given reform a boost. Its selective analysis, warning of steep hikes in premiums if the legislation passed, backfired and gave fresh impetus to the public plan, which is supposed to be cheaper than private insurance. In addition, insurance companies have been sharply hiking premiums for small businesses, which drives home the unsustainabiity of the status quo.

The legislative scrum obscures the components of a reform bill, but the momentum for passage is building and Democrats realize that failure is riskier to their political futures than success.