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Ever since the beginning of this year's health care debate, it was clear that there were two basic ways President Obama was going to be able to pass major health care legislation. The first way was that the force of his personal popularity, huge majorities in the House, overwhelming public support, the cooperation of industry groups, a fractured opposition, and an overall air of inevitability would help him to win over moderate Democrats -- and maybe even some Republicans -- thus allowing him to sign a sweeping bill with a strong government-run plan modeled after Medicare. If that strategy failed, the second way was that he would have to be able to convince his own side to accept a scaled back bill that did not include a government-run plan.

At this point, it's become quite apparent that the first option is no longer an option. Obama's own approval ratings have plummeted over the past several months, as has support for his health care effort. The opposition has become united, and activists campaigning against reform have out-hustled his much-vaunted campaign apparatus, as well as the well-funded unions and liberal activist groups. The air of inevitability is gone, and not only has the effort failed to attract Republican support, but Democrats are running away in droves. The Hill reported yesterday that 23 House Democrats  said they would vote against health care legislation in its current form. Since that article was published, Democrat Mike Ross -- who just before recess agreed to a compromise in committee that included a government plan -- released a statement telling his constituents, "An overwhelming number of you oppose a government-run health insurance option, and it is your feedback that has led me to oppose the public option as well." On the Senate side, Kent Conrad has said there simply are not the votes for the government plan, and he called the focus on it a "wasted effort."

If Obama has any hope of passing meaningful health care legislation he's going to have to start the process of convincing liberals that they'll have to be less ambitious. Policywise, he has to argue that if liberals were to drop their insistence on a government-run plan, Democrats could pass a bill that bars insurers from denying coverage to those with preexisting conditions, mandates that everybody purchases insurance, expands Medicaid, and provides subsidies for individuals to purchase government-designed insurance policies on a government-run exchange. Obama will have to persuade liberals that this moves the ball down the field, covers millions of uninsured, and doesn't rule out the possibility that a government-run plan gets introduced on the exchange at some point down the road. Politically, Obama will have to make liberals understand that if the health care effort is a total failure, it would be devastating to Democrats' electoral prospects next November.

I don't think this will be easy for Obama. From the point of view of liberals, their support for an optional government-run plan was itself a compromise, because what they really want is a fully government-run, single-payer system. Without the government plan, they believe, there will be no way to control costs or check the power of the insurance industry. While many pundits have treated the debate over the so-called "public option" as a sideshow, to liberals who are actively fighting for Obama's health care agenda, it is the most essential element of reform.

So, winning over liberals is not the easy path, but it's the only path now left to Obama. And if Obama is going to convince liberals to accept less, tonight would be a good time to start.