As health care reform enters its final stages in the Senate, Majority Leader Harry Reid (D-Nev.) faces a paramount question: to what extent, if any, does he allow four conservative members of his caucus to trump the will of the 56 others?
The Nevada Democrat, up to this point, has sought to keep the debate moving forward with hopes that enough momentum would build behind reform to ensure its passage in a form acceptable to the overwhelming majority of his caucus. But as the finish line approaches, the schisms have only gotten more pronounced.
Over the Thanksgiving break, Reid talked to those four senators -- Ben Nelson of Nebraska, Joseph Lieberman of Connecticut, Mary Landrieu of Louisiana, and Blanche Lincoln of Arkansas -- to begin charting out compromise approaches to reform, a leadership aide said.
So far, however, the only issue closer to being resolved is which amendments will be considered in the days ahead. Negotiations have begun on the public plan -- with the latest variation being a system that would allow states to opt in to a federal program, while simultaneously establishing economic triggers that could force the plan on those states that don't opt in of their own will. But these conversations remain in their preliminary stages and have not been seriously considered by leadership.
"I don't know of any liberals or progressive in the Senate who would be on board with that," said one high-ranking Senate aide. Sen. Sherrod Brown (D-Ohio) recently said that four Democratic Senators shouldn't determine a bill that 56 others support -- and the aide said "that was the same rationale that went into choosing the public option opt-out in the first place."
Still, at this juncture, there is a noticeable absence of panic among Reid and his Senate lieutenants - perhaps because Reid , aides and outsiders suggest, does have cards he has yet to play.
"Each of these Senators have things they may want in the bill and concerns beyond the public option that Reid and others can address," said Richard Kirsch, national campaign manager for the pro-reform group, Health Care for America Now.
And leadership aides don't consider it a given that conserva-Dem opposition to the public option is 100 percent concrete. Nelson, for one, has said he would consider the opt-in alternative and he has not definitively ruled out allowing a floor vote on the more robust proposal. The compromise that Democratic strategists hope can win his vote would be to insert language that prevents the federal government from bailing out the public plan down the road.
Landrieu, meanwhile, signed a "statement of common purpose" before the 2008 elections in which a public option for insurance coverage was one component. Her office has said the she was endorsing the spirit, not fine print, of the letter. Last week, as the Senate voted to bring health care legislation to the floor, she expressed her "concern" over "the current version of the public option included in this bill" and asked Reid to consider adopting the trigger approach.
Aides on the Hill say her hesitancy is based on pure political calculations. Obama lost the state of Louisiana by more than 18 percent in the 2008 election. But if Reid adds enough sweeteners to the legislation, it might make it worthwhile for Landrieu to vote for it - and hard for her to vote against it. The bill already includes $300 million in emergency Medicaid funds for her state. The addition was enough to make Landrieu the target of conservative vile -- something that Democrats say may actually make her more open to reform.
As for Lincoln, the Arkansas Democrat made a giant show of her opposition to the public plan during her floor speech last week even though, as progressive groups were quick to note, that contradicted the views on her own website, which listed the proposal as a desired aspect of health care reform.
An aide to the Senator told the Huffington Post that: "the website's page on health care was taken from a guest column that appeared in the Arkansas Democrat-Gazette on July 8, 2009, which posed various options that could be used to compete with private plans." The entry was updated late last week with Lincoln adding that back in September she had determined that "a robust, government-run public health care plan would expose taxpayers to too much risk."
The change of heart, observers say, is predictable but not irreversible. "What changed was millions of dollars of spending from pharmaceutical and insurance companies and Republicans in the state that turned the idea of universal health care into something evil," said Max Brantley, editor of the Arkansas Times. "But by dithering, she made the situation worse for herself. She became the dramatic final vote on something that used to be routine... If it was deliberate, it was one of the stupidest moves in political history.
"I think she early on should have said she recognized she would get some heat but said she would work to getting health care done in the end," he added. "Now, I don't think necessarily that her vote will be determinative... I think a lot of that depends on how successfully the Democratic leadership and the administration are able to sell the once-popular notion of better health care."
As Brantley noted, by moving further and further away from the public plan, Lincoln has only managed to enlarge the target on her back. It's coming to the point that the danger is not solely from the Republicans.
"Lincoln is going down for sure if there is no public option," former Democratic National Committee chair Howard Dean said in an interview with the Huffington Post last week. "There is already talk of a primary for her. The question is just settling on the candidate."
The thorniest senator of the recalcitrant bunch may, in the end, be the one who technically isn't a Democrat at all. Sen. Joseph Lieberman was the first to express his opposition to the public option. To make matters more difficult for leadership, he has said he opposes the trigger compromise as well.
But Democrats both on and off the Hill are not giving up. One high-ranking strategist predicted that Lieberman's support could yet be won on by focusing on issues outside of the health care debate.
"It's not just health care goodies," the strategist said. "There are clearly issues that he really cares about. There are some issues, like Afghanistan, Iraq, and Israel [on which you could get his support]... This could just turn out in the end to be an old-style horse race about what happens."
There is also the potential for recriminations if he votes to uphold a Republican filibuster. One lawmaker hinted that Reid and others already have made it clear that Lieberman would risk his chairmanship on the Senate Homeland Security Committee if he were to do so.
"Nothing focuses the mind like a death sentence," the lawmaker said.
In the end, the cards that Reid still has to play -- limited but still potentially effective -- are enough to persuade Democrats that he has a shot at cobbling together the 60 votes needed to get a strong bill past the Senate.
But for some progressive, the history of leadership caving to the demands of those who hold out the longest -- along with the White House's desire to simply get some bill passed -- loom large over the debate's remaining weeks.
"They are going to do what they can to get the votes," said Joe Trippi, a long-time Democratic strategist. "It is really a question of who is going to blink first. And I have to believe that even if they earnestly, all-out fight for [the public plan] they are going to cave in the end."