Most polls show that a majority of Americans want a health care overhaul to include a public option — a government insurance program that competes with private insurers.
So it might seem logical that Senate Democrats, with their 60-vote majority, would include a public option in the bill that's headed for the Senate floor. But no decision has been made yet, because it's not clear how many Democrats would back a public option.
Earlier this month, Vermont independent Sen. Bernie Sanders and 29 Democratic colleagues sent a letter to Majority Leader Harry Reid, who is leading the effort to blend the bills of two committees — the Finance Committee and the Committee on Health, Education, Labor and Pensions.
The HELP Committee's bill includes a public option, while the Finance Committee's does not.
Sanders and the others, who make up half of the Democratic caucus, want any bill Reid sends to the full Senate to include a public option.
"This is an overwhelmingly Democratic bill," Sanders says. "How, if you are the Democratic Party presenting your bill, do you say no to over 80 percent of the people in your own party, and expect there to be grass-roots support for real health care reform?"
But centrist Democrat Mary Landrieu of Louisiana says, "I'm not for a government-run national taxpayer subsidized plan, and never will be."
Landrieu says it makes no sense to create a third government health care program when Medicare and Medicaid are already headed for insolvency.
Still, Landrieu sounds as if she could eventually be persuaded to back some form of a public option.
"In some states at the end of the line, they don't believe they're going to have the kind of choice that we think consumers and businesses need," Landrieu says. "If the costs are still too high, then perhaps a fallback or a trigger, but something that is on a level playing field."
Another Democratic holdout has been Arkansas' Blanche Lincoln. She voted against including a public option in the Finance Committee's bill.
She faces a potentially difficult re-election bid next year, and hesitates when asked whether she'd vote for a health care bill that has a public option.
"It all depends on how it's gonna be written," Lincoln says. "I think the most important thing we can do is provide choice and competition, and that's gonna help us bring down the price and make sure everybody's got good options."
But Lincoln says she has ruled out a government-funded and a government-operated plan.
Max Baucus, the Democrat who chairs the Finance Committee, also voted against putting a public option in his panel's bill. Asked Tuesday whether the bill the Senate takes up should have such an option, Baucus said his aim is to get legislation that passes.
"What provisions help push it over the goal line should be in," Baucus adds. "Provisions that don't allow us to get 60 votes should not be in."
Other Democratic senators say the only public option they're interested in would be run by each state.
Among those holdouts is Nebraska's Ben Nelson, "It makes a lot more sense to me to have the states involved in this than not to have them involved, and try to do it all at the national level."
And then there's Connecticut independent Joe Lieberman, a member of the Democratic caucus who opposes a public option. Lieberman says he's inclined to vote with his caucus against any GOP filibuster aimed at blocking a health care bill with a public option from coming to the Senate floor, "because our country needs health insurance reform," he says. "But if I decide in the end the bill that is about to leave the Senate is gonna do more harm than good, then I won't vote for cloture at that point."
In other words, Lieberman might be willing to help Republicans filibuster a health care bill when it comes up for a final vote.
Further complicating matters is Illinois Democrat Roland Burris, who says he won't vote for a health care bill unless it does have a public option.
"If it doesn't have a public option, it's not a bill," Burris says. "It's not going to solve any problems. If it doesn't have that, it isn't gonna help anybody but the insurance companies."
However Democratic leader Reid decides on a public option, he'll have his work cut out finding 59 other senators to back him up.