Jon Chait sums things up succinctly:
Why are liberals so confused? Well, the news coverage has been pretty poor at explaining the institutional dynamics. Yet some blame also has to rest with the poor design of our political systems. Americans have come to think of presidential elections as the be-all, end-all of political change in America. Not only is the Senate a malapportioned, counter-majoritarian institution with arcane procedures, it's practically designed to prevent accountability. Obama supporters who want the agenda they voted for to be enacted into law need to be exerting pressure on figures like Max Baucus and Kent Conrad. Yet these characters are accountable only to tiny, unrepresentative slices of the population. So they get angry at Obama instead, which only makes him less popular and which makes the Baucuses and Conrads even less likely to support him.
I still think there's a pretty good chance at passing significant health care reform. But if health care reform fails, liberals need to understand who to blame and how to fix it. They need to start knocking off Democrats like Conrad and Joe Lieberman, who seem to be trying to kill health care reform, even if this temporarily costs the Democrats some seats. They need to commit the party to reconstituting the rules of the Senate along majoritarian lines--yes, even if this helps Republicans pass their agenda when they're in charge. If health care reform can't pass now, then a filibuster-proof Democratic majority isn't worth having. At that point you have to consider blowing up the party and waiting a decade or two to rebuild a new one that's able to address the country's actual needs.
I'm with Chait; I'm still cautiously optimistic that we're going see a decent bill, quite possibly with a public option, clear the senate, and if it can clear the Senate it will become law. As mcjoan pointed out on Tuesday, Chuck Schumer is becoming more vocal about the possibility that the Senate Dems will go it alone and pass a bill without any Republican support. That's the kind of reality-based thinking the White House and the Democratic leadership needs to embrace, because passing significant healthcare reform that provides universal coverage and addresses people's insecurities about health costs will most likely lock in Democratic dominance for decades. The Republicans know this, and view a good healthcare bill as an existential threat, and there's no way they'll support it.
So it's good that Schumer and others are starting to indicate an awareness that healthcare reform won't be bipartisan, not due to lack of Democratic will, but Republican obstructionism. The White House looks to be preparing for a Democratic-only bill. But if nothing happens, lack of White House leadership may be a contributing factor, but the main reason will be the one identified by Chait: the undemocratic Senate and the ability of a few senators, including Democrats, to block the intentions of a majority of senators and the desires of a majority of Americans.
Again, I'm optimistic that the Democratic leadership will deliver a decent bill. But I increasingly find myself hesitant to even consider what happens if we don't get a good bill, because I don't know that there would be an easy solution to the root problem: the dysfunctional Senate. Too often senators appear to act as if their greatest allegiance is to the institution of the Senate, to its current rules (where only since the 1960's has it been accepted that 60 votes are necessary to pass almost any legislation), and to their 99 colleagues, when instead they should be acting in the best interests of their constituents and the the rest of the citizens of the United States of America.
In the 1930's Democrats passed and implemented the New Deal. In the 1960's Democrats in Congress and the White House passed and implemented the Civil Rights laws and the initiatives of the Great Society. Today we have sufficient majorities to do address the challenges of health care, the economy, energy and the environment. But it's possible that too few Senate Democrats will choose to meet our most pressing domestic challenge because they care more about preserving the collegial comity and predictable functioning of the Senate.
If that happens, if the majority of Senate Democrats allow the country to be held hostage by a minority of Senators, maybe even including a few Democrats, it will be hard for me to sustain my confidence that we still have the institutional and political capacity to respond to the challenges we have to address to protect our prosperity, security, opportunities and optimism about the future.