WASHINGTON -- One of the tragedies of the viciously politicized battle over health care reform is the defection of the nation's Roman Catholic bishops from a cause they have championed for decades.

Indifferent to political fashions, the bishops were the strongest voices in support of universal health coverage, a position rooted in Catholic social thought that calls for a special solicitude toward the poor.

The Hill reports on the state of negotiations in the House:

House Speaker Nancy Pelosi just declared that the public option is dead. Again. And she's right. Again.

Jonathan Bernstein calls health care reform almost a done deal:

The White House on Tuesday released a letter from President Obama to the congressional leadership of both parties. In it, Obama urges them to incorporate a handful of Republican ideas into health care reform and then get on with passing a comprehensive bill, even if the Republicans still refuse to support it.

Ben Nelson may be making trouble again. According to The Hill, the Democratic senator from Nebraska told a local radio station, KLIN, he's not sure Congress can still pass health care reform:

Who says bipartisan good feeling is dead? The big question hanging over health care reform right now is whether House Speaker Nancy Pelosi can get enough Democrats to vote for the Senate bill and an accompanying set of amendments that would move through the budget reconciliation process. Rather than make Pelosi and her lieutenants go to the trouble of counting all those votes, Republican House Whip Eric Cantor has generously done the work for her.

When Senators like Bernie Sanders or Sherrod Brown say Democrats need to finalize health care reform through the budget reconciliation process because of Republican obstructionism, that doesn't mean much.

When Senators Evan Bayh, Mary Landrieu, and Ben Nelson say their more liberal colleagues may be right, that means a lot.

Via Politico's Carrie Budoff Brown, here's Bayh:

Republicans Olympia Snowe, Susan Collins and Scott Brown voted to defeat a GOP filibuster of a $15 billion tax break for businesses that hire workers. Ben Nelson voted with the Republicans.

What does this tell you? It tells you that these Senators recognized that the legislation is essentially symbolic, and therefore a good time to burnish their moderate credentials rather than spend political capital to advance their party's agenda.

WASHINGTON--If you want to be honest, face these facts: At this moment, President Obama is losing, Democrats are losing, and liberals are losing.

Who's winning? Republicans, conservatives, the practitioners of obstruction, and the Tea Party.

The two immediate causes for this state of affairs are a single election result in Massachusetts, and the way the United States Senate operates. What's not responsible is the supposed failure of Obama and the Democrats to govern as "moderates."

Everyone remembers that George W. Bush’s first tax cut was contentious when Congress considered it back in 2001. So contentious, in fact, that the Bushies didn’t even try passing it under normal Senate procedures. The GOP leadership, worried that it couldn’t collect 60 votes to overcome a Democratic filibuster, relied on reconciliation, the Senate rule that allows budget-related measures to pass with a simple majority.

One way to judge the health of our political system is to divide the president’s agenda into three categories. First are the items that seem like they’d be hard to accomplish and actually are hard—health care reform and cap-and-trade come to mind. Then come the items that sound easy to the uninitiated but turn out to be pretty hard—like eliminating wasteful farm subsidies or obsolete weapons systems. Lots of presidents have taken on these programs only to find that they have powerful, well-organized defenders. Finally, there are some legislative goals that sound easy to accomplish, and normally are easy, until some unique brand of dysfunction intervenes—say, some senator takes a special interest in an obscure appointment.

President Obama is going to address another Congressional gathering today. The audience will be more friendly this time: It will be the Senate Democratic caucus. But the stakes will be just as high as they were when Obama spoke to Republican House members last week.

Health care is bound to come up at the meeting. I assume Obama will raise it during his prepared remarks; if not, he'll get questions about it. And the big controversy right now is whether the Senate is willing to amend its bill through the budget reconciliation process. It's the only way to make changes to health care at this point, since the Republicans have vowed to filibuster the final vote--and, thanks to the election of Scott Brown in Massachusetts, they have the forty-one votes necessary to sustain it. (In reconciliation, a minority can't block the final vote.) And such changes appear to be necessary, because the House has made clear it won't approve the Senate's bill without some changes.

The problem is that Senate Democrats aren't very happy about taking a reconciliation vote right now. Some worry that the move smacks of partisan politics at a time when the public wants, or says it wants, bipartisanship. Some worry it will seem like trying to bend legislative rules, at a time when voters are clearly angry about the deals Democrats made with special interest groups and some of their own members in order to pass the original bill. And some just want to be done with health care reform, because voters are clearly tired of it and want to hear about jobs instead.

The anxiety is, as you might expect, most pronounced among senators who represent more conservative states and/or are up for re-election this year. Arkansas Senator Blanche Lincoln, who is probably the most vulnerable Democrat running this year, has made clear she'd prefer not to take a reconciliation vote on health care. Her Arkansas colleague, Mark Pryor, has said similar things, as have Indiana Senator Evan Bayh and Louisiana Senator Mary Landrieu. The Democrats can afford up to nine defections and still prevail. But you can conjure up five possible to probable "no" votes pretty quickly--in addition to Bayh, Landrieu, Lincoln, and Pryor you'd include Connecticut's Joe Lieberman.*

The best arguments for moving forward are the ones all of us have been discussing over the last week. All of these senators voted for health care reform already. Republicans will attack them for it no matter what. Their best bet is to pass the bill into law, since that will give them an accomplishment they can tout and clear tangible benefits they show to voters. (As Kevin Drum noted in a must-read analysis, this isn't merely speculative. New polling data suggests Democrats do no worse--and perhaps a little better--politically if they pass a bill. And I'd argue the poll question actually understates the jump, since there's no way for people to know how they'll vote ten months from now.)

Voting for reconciliation will also change the media narrative and clear a path for passing more legislation going forward, even with a "mere" majority of 59 votes.

But there is at least one other reason the Senate ought to go forward with reconciliation.

In the days immediately after the special Massachusetts election, which gave Senate Republicans the ability to block votes on legislation, the prospects for reform looked so bleak that one reliable source emailed me a one-word message: “Dead.”

But within 24 hours, that same source had emailed me another one-word message: “Alive.”

And that’s a pretty good description of where things stand today, at least based on what I've gleaned from conversations with insiders over the last week.

According to these sources, Democrats have made progress--more progress, certainly, than might be evident from all the dire headlines of the past few days. There seems to be a plan in place for enacting reform, even with the Massachusetts setback.

But it’s not an easy plan to execute, at least in this political environment. And it’s not clear--to me and to many of the people I’ve interviewed--whether Democrats in the House, Senate, and administration are sufficiently committed to making it work.

As I've said, Democrats can afford to lose Ben Nelson (and seven other moderates) and still use a reconciliation measure to fix health care. But it sure helps when Nelson says things like this:

President Obama’s speeches have always been notable for both their exquisite prose and their unusually high intellectual level. Tonight’s speech, while probably as effective as such speeches can be, was neither.

How does this president handle a crisis? Thus far, the answer is not at all encouraging. The current crisis is the election in Massachusetts of Scott Brown, now the forty-first Republican senator. His arrival in Washington has sent Democrats into panic mode--fearful that they too will be swallowed by a seething electorate--and caused many of them to flee in the other direction from health care reform.

Critics of health care reform have been hammering away at its substance for months. But, since last week's election in Massachusetts, they’ve been focusing their attacks more on the way reform has come together in Congress. As the argument goes, Democrats wrote the bill on their own and in secret, producing proposals full of shady back-room deals that aren’t in the public interest. The symbol of reform’s hidden corruption is the so-called Cornhusker swindle: A promise, extracted by Nebraska Sen.

Talking Points Memo has done a terrific job of reporting on the health care fiasco on Capitol Hill. But I think their latest report may be conveying a misleading impression. The headline reads, "Pelosi: We Can't Do It." The lead reads:

Credit where credit is due:

Pulling back just a bit, I feel like the long-term implications of Republicans winning the Massachusetts Senate seat have been oversold. The short term-implications -- creating the real potential to kill health care reform for another generation -- are real. But people are getting carried away with what it means about the political environment.

The Wall Street Journal runs through the options. It suggests hurrying through a new vote in both houses will be difficult:

One liberal Democrat, Rep. Anthony Weiner (D., N.Y.), said many lawmakers have decided that, if she loses, the party would have no choice but to cram a plan through as quickly as possible, while working to delay Mr. Brown's arrival to the Senate.

My Washington decoder ring isn't the most finely tuned. But I think it's good enough to translate the message House leadership was trying to send yesterday: Don't take us for granted.

The message came most loudly, and most clearly, from Ways and Means Chairman Charles Rangel. For the last few weeks, observers (this one included) have been suggesting that keeping the requisite sixty senators in line will be difficult--and that, as a result, final legislation will look a lot more like the Senate version than its House counterpart.

That would mean, regrettably, covering fewer people and guaranteeing less comprehensive coverage than the House bill would. It'd also mean a lesser requirement on employers, taking less money from the drug and insurance industries, and accepting some sort of tax on the most expensive health benefits.

But Rangel, in an interview with Roll Call, suggested that straying too far from the House bill could also threaten the bill's success, because the original House bill barely passed--and House liberals, in particular, are in no mood to roll over for the Senate.

We’ve got a problem on both sides of the Capitol. A serious problem. ... The difficulty in hashing out an agreement between the two chambers is largely due to there being so many different factions with a stake in the matter ... Normally you’re just dealing with the Senate and they talk about 60 votes and you listen to them and cave in, but this is entirely different ... I’m telling you that never has 218 been so important to me in the House.

It wasn't just Rangel saying this.

WASHINGTON -- Reaching agreement on a health care bill is harder in theory than it will be in practice.

Between now and the day the measure goes to President Obama's desk, there will be many crisis points, much posturing and dire warnings of impending failure. There are real differences between the bills passed by the House and the Senate. The last few votes are always the most difficult to get.