If the public option really is in serious trouble -- and I've heard from a number of people on Capitol Hill that it is -- then liberals like those in the Congressional Progressive Caucus will supplant the Blue Dogs as the key players in the health care debate. A scaled-down plan that includes insurance exchanges, an individual mandate, expanded Medicaid, and other subsidies would actually get the Democrats a good way toward reshaping health care policy along the lines they prefer, with the public option remaining as the next incremental step.
But would liberals in Congress vote for such a stripped-down bill? Almost as important, would liberals outside of Congress rally behind such a plan? It would leave single-payer advocates once again in the position of having to support something like Bill Clinton's "managed competion" idea from the 1990s. If the public option is a tough sell now, it would be even harder to pass after the Democrats lose at least a few seats in 2010 and so soon after a health care bill of some kind has been passed. Finally, if progressives outside of Washington make the public option their litmus test, the grassroots activism will all end up being against the bill rather than for it. Which means that in addition to having problems winning over liberals, some Blue Dogs might end up voting against a more modest reform anyway.
All of this would probably be unwise, because the slow and steady march toward a greater federal role in health care has always been more successful than attempts to pursue sweeping reforms in one fell swoop. But there are good reasons to wonder if the more politically possible version of Obamacare might actually prove to be politically impossible.