Rocky road

The vote, even though most people were otherwise engaged on Saturday night, had the feel of something big.

It was, after all, the first time a chamber of Congress had approved a major expansion of health coverage since LBJ was twisting arms during the Medicare debate.

But the White House didn't even get a good one-day news cycle out of the House vote, given the late hour. By Sunday morning, Lindsey Graham was pronouncing the measure DOA in the Senate. Newspapers were offering very mixed assessments of its chances. And indeed, given the byzantine ways of Washington, the House vote was more like the first leg of a relay race.

President Obama and Nancy Pelosi were quick to pronounce the vote historic, and perhaps it was. But the fact that 39 Democrats defected and the thing passed by a measly two votes was not an encouraging sign.

So let's have a reality check: Health care was always going to be harder to pass in the Senate, where the Democrats need 60 votes. The Pelosi public option probably won't fly there amid the talk of opting-out and triggers. And remember, any senator can gum up the works by holding out for his or her pet issue, garnering loads of media attention in the process. If the president is unusually persuasive and the Dems are uncharacteristically pushy, maybe they can cobble something together that can hold 59 members of their party and Joe Filibuster-Threat Lieberman.

But then the Democrats will have a bill that differs significantly from Pelosi-care. That means weeks of wrangling in a conference committee, where the big lobbies may be more effective than out in the sunlight. And if a patchwork quilt of a bill survives that process, each chamber has to pass it again.

Now that will be historic. But I doubt it will be anytime soon.

Health-care reform would be hard to pass even if the economy were humming along. But there are so many conflicting interests -- politicians worried about federal spending, doctors' payments, public plans, states' rights, mandated coverage, medical device taxes, abortion, immigration, and on and on -- that it's a wonder the thing is alive and kicking.

"Liberals furious over a last-minute deal that secured passage of healthcare legislation in the House by restricting abortion coverage threatened Monday to derail the massive overhaul bill," the L.A. Times reports.

"At least 40 House members pledged to reject the final bill if the abortion provision survives in the Senate and the conference that joins the Senate and House versions into a single piece of legislation."

That's not all: "As health care legislation moves toward a crucial airing in the Senate, the White House is facing a growing revolt from some Democrats and analysts who say the bills Congress is considering do not fulfill President Obama's promise to slow the runaway rise in health care spending," the New York Times says.

In fact, "experts -- including some who have consulted closely with the White House, like Dr. Denis A. Cortese, chief executive of the Mayo Clinic -- say the measures take only baby steps toward revamping the current fee-for-service system."