It seems to me that the "public option" is dead.
There's talk about co-ops, which are not-for-profit private insurance companies, but I don't think there's the capital or national interest in starting those up nationwide.
But with no public option alternative to compete with the for-profit insurance companies, I don't see much in the way of actual reform. Insurance companies will still hold all the cards, and be able to carry on their practice of "pre-existing conditions" and cutting off your benefits right when you need them.
The problem with the Obama strategy lay at his early approach. As Jon Stewart insinuated, this should have been treated like the War in Iraq. An impending national matter of utmost urgency. Not supporting health care reform should have been a proxy for "hating American" (or, at least, willing to let Americans die). But Obama didn't do that — instead, he went with the kumbayah bi-partisen approach, and got rolled.
Eugene Robinson at the Washington Post:
Clearly, the White House feels itself on the defensive. But why?
Consider the political landscape. Democrats control the White House and both houses of Congress. No matter how disciplined Republicans are in opposing any reforms — even if Republican objections are accommodated — they don't have the votes to kill a final bill.
If conservative "Blue Dog" Democrats are successful in nixing a public health insurance option and watering down other reforms, progressive voters have a right to ask why they went to such trouble to elect Democratic majorities and a Democratic president. But the Senate can still resort to a parliamentary maneuver that would require only 51 votes, rendering most objections irrelevant. Historical trends indicate that it's unlikely the Democrats will expand their majorities in 2010. Politically, therefore, there's not likely to be a better moment for health reform than right now.
It's pretty pathetic admitting that you can't even get 51 votes in your own party. But I believe you can. You just have to lead.