I have never been a fan of Reid's, I must confess. But this week I almost feel sorry for him. The health care reform battle was destined to be a tough fight for all Hill Democrats and the White House, but for Reid even moreso than Speaker Pelosi or President Obama. The president can speak and decide unilaterally. And although Pelosi cannot, she at least has more favorable chamber rules, a generally more ideological coherent majority, and basically the same size (59 percent of seats) majority. (Bigger, in fact, if you don't count Lieberbulwark and Bernie Sanders)

And thus it was always destined to be a grim outcome for Harry Reid as he carried this bill to passage. And now Harry's Carry is starting to look like political-electoral Hara-Kiri.

That specific tweet, and the broad sentiment that underlies it, is generating quite a bit of response. The WaPo's Ezra Klein writes on his blog:

The core of this legislation is as it always was: $900 billion, give or take, so people who can't afford health-care insurance suddenly can. Insurance regulations paired with the individual mandate, so insurers can't discriminate against the sick and the healthy can't make insurance unaffordable by hanging back until the moment they need medical care. The construction of health insurance exchanges so the people currently left out of the employer-based market are better served, and the many who will join them as the employer system continues to erode will have somewhere to go.

That's all policy. And as I spent yesterday arguing, it has a tendency to overshadow the lives in the balance. You can choose your estimate. The Institute of Medicine's methodology says 22,000 people died in 2006 because they didn't have health-care coverage. A recent Harvard study found the number nearer to 45,000. Since we talk about the costs of health-care reform over a 10-year period, may as well talk about the lives saved that way, too. And we're looking, easily, at more than a hundred thousand lives, to say nothing of the people who will be spared bankruptcy, chronic pain, unnecessary impairment, unnecessary caretaking, bereavement, loss of wages, painful surgeries, and so on.

A lot of progressives woke up this morning feeling like they lost. They didn't. The public option and its compromised iterations were a battle that came to seem like a war. But they weren't the war. The bill itself was. When liberals talked about the dream of universal health-care insurance 10, 20 and 30 years ago, they talked about the plight of the uninsured, not the necessity of a limited public option in competition with private insurers.

Salon reached out to others with strong opinions on this issue, and we will be updating this post as reactions come in, so stay tuned.

In contrast to Klein, Stephanie Taylor, co-founder of Progressive Change Campaign Committee, told us:

The "Joe Lieberman Senate Bill" is ugly. Democrats stand on the verge of ushering in a world of nearly unregulated mandates, in which we're all forced by the state to hand over our money to failed private monopolies, with no cost control in return. Without a public option and no hope of expanding Medicare coverage, this bill is not worth supporting.

We got to this point due to a complete failure of leadership by President Obama--who chose to negotiate with out-of-touch senators instead of rallying their own constituents against them. It's also a failure of leadership by Harry Reid, who failed to exert any leverage over Joe Lieberman--by threatening to take away his committee chairmanship or use reconciliation to make his vote irrelevant.

When Democratic leaders refuse to fight, they can't then ask progressives to cave with them. The Progressive Change Campaign Committee is continuing to fight for the best health care bill possible, and we're intent on holding Democrats' feet to the fire. But we need to think very seriously about whether there will be a moment when it is clear that the bill does more harm than good--we need to be prepared to kill the bill.

Part of being a great negotiator is being able to walk away.

 Jonathan Cohn, author of Sick and writer for the New Republic, more closely echoed Klein's view:

Is health care reform without a public option still worth passing? Unequivocally, unambiguously yes.

The case for is simple and straightforward: 30 million additional people, maybe more, will have health insurance. Many more who have insurance will see their coverage become more stable. The ability of insurers to exclude people based on pre-existing conditions will diminish significantly, if not disappear. And that's on top of a host of delivery reforms which should, in combination, help make medical care less expensive over time. The bill could be much better, for sure, but to argue that it's worse than nothing you have to make the case that nothing will somehow lead to more progress in some reasonable frame of time.

I don't see that. Failure to pass health reform won't lead to a progressive revival or resurgence. It will cripple the Democrats, hand the Republicans more political power, and likely to send health care reform into hibernation for another ten to twenty years. It's theoretically possible we could get a better reform at that point. But the historical trend is in the opposite direction. Every new effort is a less ambition version of the old one. Meantime, millions of more people would suffer.

Pass this bill now. Improve it later. That's the way we do things in America, for better or for worse.

Paul Starr, c0-founder of the American Prospect and no liberal he, seems to be squarely in the Klein/Cohn camp:

The moment of decision on health-care reform is arriving for progressives in Congress. Some of them have insisted they will refuse to vote for any bill without a public option, and that is now the only bill that has any chance of passing. If they hold to their position, the most significant social reform on behalf of low-income Americans in 40 years will go down to defeat.

It should hardly be surprising that we have come to this point. The requirement for 60 votes in the Senate to pass ordinary legislation was always going to empower the most conservative members of the Democratic caucus or the few moderate Republicans who might support a bill. For a while this past week, it seemed as though a provision to allow 55- to 64 year-olds to buy in to Medicare might provide an acceptable alternative to the public option and secure the 60th vote for the bill. But when both Joe Lieberman and Olympia Snowe said they wouldn't support a Medicare buy-in, that hope dissolved.

None of this, however, affects the central provisions of the legislation, which would extend health coverage to an estimated 33 million of the uninsured, raise standards of protection for millions whose coverage is limited, eliminate some of the most hated abuses of the insurance industry, and create a new system of insurance exchanges that would enable people who buy policies individually or through small groups to get new choices and better prices for coverage....

Strategists will argue about whether it ever made sense to include a public option in the bill, ...[b]ut the attention lavished on the public option meant that pressure from the left did not come to bear on other provisions of the legislation such as the slow timetable for implementation (under the Senate bill, most of the extension of coverage would not occur until 2014). The danger now is that some liberals in Congress may not be able to shift gears and vote for something they earlier pledged to oppose. Some of the Democratic base may also become demoralized about reform because it lacks a provision they were mistakenly told was essential.

Frequent Salon contributor Ed Kilgore, ever the stragetist who can see the whole board, doesn't so much take a side as lay out five options progressives have in front of them:

...the fact remains that there are only 58 reasonably assured votes for cloture on the recently negotiated Team of Ten "deal" for health care reform. Assuming Ben Nelson can be brought aboard without highly divisive concessions on the abortion issue, that still leaves one vote to be secured from a universe of just three senators: Lieberman, Snowe and Collins. So what are the options left to the White House and the Democratic congressional leadership?

(1) Forget about Lieberman and go after Snowe and/or Collins. It would obviously be satisfying to most Democrats to deny Joe Lieberman the opportunity to be King of the Senate and Arbiter of Health Reform, or more to the point, the chance to screw up or kill the legislation down the road....

(2) Give Lieberman what he wants and then fix the legislation later. The key argument here is that the very items Lieberman is objecting to--an option for some younger Americans to buy into Medicare, and any sort of public option--are budget savers which could without question be added later (say, next year) via the budget reconciliation route, which only requires 50 votes....

(3) Threaten Lieberman with loss of his seniority unless he votes for cloture. Without question, it was a major mistake for the Democratic Caucus to allow Lieberman to maintain his seniority after the 2008 elections without an ironclad pledge that he would support the Caucus on all procedural votes, including cloture votes....

(4) Reframe the bill to use reconciliation. This is the strategy many progressives have been urging all along, for the obvious reason that it gets rid of the need for more than 50 Senate votes and also would make it vastly easier to craft a Senate bill that's close enough to the House bill to avoid friction in a House-Senate conference....

(5) Go back to the drawing board. Before resorting to any of the above unsavory options, health reform supporters will undoubtedly make some effort to devise yet another compromise that can obtain that 60th vote without losing existing supporters....

Maybe I'm missing something, but these seem to be the options at present, and none of them are particularly good. We may be once again at a crucial juncture where progressives--and most of all, the President--simply have to decide what percentage of a loaf is acceptable.

According to Greg Sargent, former DNC chair Howard Dean reportedly says kill it:

In a blow to the bill grinding through the Senate, Howard Dean bluntly called for the bill to be killed in a pre-recorded interview set to air later this afternoon, denouncing it as “the collapse of health care reform in the United States Senate,” the reporter who conducted the interview tells me.

Dean said the removal of the Medicare buy-in made the bill not worth supporting, and urged Dem leaders to start over with the process of reconciliation in the interview, which is set to air at 5:50 PM today on Vermont Public Radio, political reporter Bob Kinzel confirms to me.

The gauntlet from Dean — whose voice on health care is well respsected among liberals — will energize those on the left who are mobilizing against the bill, and make it tougher for liberals to embrace the emerging proposal. In an excerpt Kinzel gave me, Dean says: "This is essentially the collapse of health care reform in the United States Senate. Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.”

The incomparable Paul Krugman says swallow hard and grudgingly, but pass it:

 

Ugh. It grates terribly to have the health care bill seriously weakened out of pure spite — and that’s clearly what’s happening, as Joe Lieberman demands the withdrawal of a feature he himself was advocating just three months ago.

Paul Starr — a veteran of the Clinton attempt — says that we should just pass the thing and try to fix it later. I guess I grudgingly agree — unless Lieberman demands further changes, gutting the bill. And I have a sick feeling that he’ll do just that.

But no more. On the next big challenge, financial reform, I say do it right or not at all. And we really need to talk about changing the way the Senate works; at this rate we’re well on our way to becoming a failed state.

Must-read Digby says kill it:

If this is the only chance for reform in generations, wouldn't it have made more sense to fight for a truly comprehensive bill that actually solved the problem? If you've only got one bite of the apple every couple of decades, it seems remarkably foolish not to really go for broke. To end up with a bill like this as your once in a generation liberal accomplishment is about as inspiring as a Bobby Jindal speech.

And Obama can say that you're getting a lot, but also saying that it "covers everyone," as if there's a big new benefit is a big stretch. Nothing will have changed on that count except changing the law to force people to buy private insurance if they don't get it from their employer. I guess you can call that progressive, but that doesn't make it so. In fact, mandating that all people pay money to a private interest isn't even conservative, free market or otherwise. It's some kind of weird corporatism that's very hard to square with the common good philosophy that Democrats supposedly espouse.

Nobody's "getting covered" here. After all, people are already "free" to buy private insurance and one must assume they have reasons for not doing it already. Whether those reasons are good or bad won't make a difference when they are suddenly forced to write big checks to Aetna or Blue Cross that they previously had decided they couldn't or didn't want to write. Indeed, it actually looks like the worst caricature of liberals: taking people's money against their will, saying it's for their own good. --- and doing it without even the cover that FDR wisely insisted upon with social security, by having it withdrawn from paychecks. People don't miss the money as much when they never see it.

The ad has a limited buy, but you can be sure a lot of folks will be watching it on YouTube and it should get ample play on the cable networks tonight. HuffPo's Sam Stein, who reminds us that Emanuel didn't take kindly to this sort of stuff back in August, has more.

Lieberman, of course, announced late Sunday that no matter how much support the idea of a Medicare buy-in might have garnered from other Senate moderates, he's not interested in playing along. Never mind that he supported a very similar plan only a few months ago.)

House Democrats have, generally, been pretty irritated by the Senate's inability to move forward even with a version of legislation well to the right of the bill the House has already passed. "The caucus is frustrated in general with the Senate that was bringing this health bill up in June and here we are Christmas, and they're still laboring over the package," Larson said. "Any time, whether it's Joe Lieberman or [Nebraska Sen.] Ben Nelson or someone who is critical to obtaining 60 votes -- or whether it's the Gang of Four or the Gang of Six, you name it, whatever gang is operating at the time -- the thing is, any one of them, or a collection of them, can hold up the process. And I think that's extraordinarily frustrating for our caucus."

But Lieberman, who endorsed John McCain last year over President Obama and escaped without much retribution, presents a special case. "It's certainly beyond frustration," Larson said. "In terms of the concern over an issue that's critical to the nation and President Obama, as Social Security was to FDR and Medicare was to Lyndon Johnson -- that's why people are beyond frustrated." Asked what other Connecticut Democrats could to about Lieberman, Larson laughed. "Pray," he said.

Still, hope springs eternal in the hearts of high-ranking House Democrats. "In the final analysis, I think most senators are going to be hard-pressed to stop healthcare from having a vote," Larson said. "It does go back to 'Mr. Smith goes to Washington.' The general public has a sense that you may disagree on policy, but certainly people are entitled to a vote in the Senate on healthcare... This is too big of an issue, too big of a historic moment, to say that a bill can't be voted on."

Whether Lieberman shares Larson's sense of the importance of the issue, of course, remains to be seen.