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Sixty liberal Democrats in the House have sent a letter to HHS Secretary Kathleen Sebelius saying that they would not vote for any health care bill that did not include a government-run plan. It reads, in part:

We stand in strong opposition to your statement that the public option is “not the essential element” of comprehensive reform. The opportunity to improve access to healthcare is a onetime opportunity. Americans deserve reform that is real-not smoke and mirrors. We cannot rely solely on the insurance companies’ good faith efforts to provide for our constituents. A robust public option is essential, if we are to ensure that all Americans can receive healthcare that is accessible, guaranteed and of high-quality.

And by "robust" liberals typically mean a plan that pays low, Medicare-like reimbursement rates to doctors and hospitals. 

On Sunday, Democratic Sen. Kent Conrad said, "The fact of the matter is there are not the votes in the United States Senate for the public option. There never have been...So to continue to chase that rabbit I think is just a wasted effort."

Put this together and we could be heading toward a scenario in which a bill can't get through the House without a government-run plan, and can't get through the Senate with one.