"Too big to fail" is the tagline that health lobbyist Fred Graefe applies to the health care reform effort, and he's got it dead right.
The failure of an overwhelmingly Democratic Congress to pass President Barack Obama's No. 1 priority would be a political disaster for the president and his party.
It would also be a disaster for the country to continue with mounting numbers of uninsured people — soon to top 50 million — and mounting, unconstrained costs that employers, premium-payers and government can't afford.
So Graefe, a Democrat who represents hospitals, pharmaceutical and related companies, and device manufacturers, bravely predicts that "President Obama will sign a healthcare reform bill by Christmas."
Let's hope. But producing a bill in the current superheated ideological and special-interest environment is going to require a lot of heavy lifting from the president and a willingness to compromise by a lot of Democrats and at least a handful of Senate Republicans.
The likeliest vehicle for legislative success — though far from an ideal policy outcome — is the bill being developed by six bipartisan negotiators on the Senate Finance Committee.
That measure is designed to cost less than $1 trillion over 10 years, have a phased-in individual mandate, foist considerable costs of covering lower-income workers onto the states by expanding Medicaid and the State Children's Health Insurance Program, and pay for itself through a combination of Medicare provider cuts and taxes on high-end insurance plans.
It will contain stiff new regulation of the insurance industry but no government-run "public plan" of the kind that liberals are insisting upon, which is why heavy lifting will be required to pass it.
The Senate Finance bill — assuming Chairman Max Baucus, D-Mont., can reach an agreement with Republican Sens. Charles E. Grassley, Iowa, Mike Enzi, Wyo., and Olympia Snowe, Maine — conceivably could garner 65 votes on the Senate floor.
That is, Democrats — some of whom, mainly liberals, will have to swallow hard — would vote for it, plus Republicans Grassley, Enzi, Snowe, Sen. Susan Collins, Maine, and, possibly, retiring Sen. George Voinovich, Ohio.
In the Senate, heavy pressure is being applied to Grassley and Enzi by fellow Republicans to stop cooperating with Baucus. And fellow Democrats are mad at Baucus for consorting with Republicans.
In a different environment — which Obama might have established were he truly a post-partisan figure — health reform could have had broad support if it included GOP-sponsored elements like medical malpractice reform, consumer choice and competition to lower costs, and options to buy insurance across state lines.
But that's not happening. Nor is Congress likely to turn to other worthy bipartisan proposals like the Healthy Americans Act sponsored by Sens. Ron Wyden, D-Ore., and Bob Bennett, R-Utah, or the Bipartisan Policy Center plan of former Sens. Tom Daschle, D-S.D., Bob Dole, R-Kan., and Howard Baker, R-Tenn.
At this late date, the Senate Finance bill — if it emerges — likely will be the only viable vehicle with bipartisan support.
If Baucus, Grassley and Co. hang together and produce a bill that becomes the Health Reform Act of 2009, they could go down in history like President Lyndon Johnson and Sens. Mike Mansfield, D-Mont., and Everett Dirksen, R-Ill., who passed the Civil Rights Act of 1964. But, before the Champagne is uncorked, the going will get dicey.
Once a Senate bill passes, Obama will have to convince House liberals to drop their insistence on a public plan, the generous subsidies included in current House legislation and pay-fors derived from surtaxes on rich people.
Liberals want the president to pursue a different strategy: Bulldoze the handful of moderate Senate Democrats who oppose a government-run insurance plan.
The moderate group is led by Sen. Ben Nelson, Neb., and includes Sens. Evan Bayh, Ind., Mary Landrieu, La., Arlen Specter, Pa., Blanche Lincoln, Ark., and Mark Pryor, Ark., plus Joe Lieberman, ID-Conn.
Liberals haven't given up on the idea of ramming a government-heavy bill through the Senate under budget reconciliation rules, requiring 51 votes, not 60, even if it means firing a Senate parliamentarian who might try to keep the chamber honest.
That might lead to a total Republican revolt and a shutdown of further Senate business, but it's in the nature of ideologues to go for broke and damn the consequences.
The liberal Congressional Progressive Caucus, 80-plus strong, far outnumbers moderate Democratic groupings, and 57 of its members have threatened to vote against health reform if it doesn't include a "robust" public option.
But Speaker Nancy Pelosi, D-Calif., once chairwoman of the Progressive Caucus, seems to understand what's required to pass a bill.
She infuriated her fellow liberals by telling reporters last Friday, "Are you asking me, 'Are the progressives going to take down universal, quality, affordable health care for all Americans?' I don't think so."
The smoothest scenario for passing a health-reform bill would be for the House to forgo a lengthy, contentious House-Senate conference and pass the Senate's bill.
For that to happen, Obama would have to use every last ounce of his persuasive skill on his fellow Democrats — plus the arm-twisting acumen of Chief of Staff Rahm Emanuel.
Obama will spend much of August trying to persuade the American people that his health plan won't lead to rationing, more costly coverage, higher taxes for the middle class and exploding deficits.
He's got to beat back Republican arguments that he's promoting "a government takeover of health care" and maybe even "government-promoted euthanasia."
But his bigger test comes when Congress returns in September. Liberal groups will have spent August pounding on moderate Democrats on behalf of a government-run insurance program, no doubt strengthening progressives' resolve to hang tough.
And that will make Obama's autumn task even harder. But his success as president rides on passing a health care bill. And, if he fails, he won't be able to blame either Republicans or insurance companies. His own party will have done it to him — and themselves.