The Senate has been called the world's greatest deliberative body, a distinction not always appreciated in the modern era. With strong Democratic majorities in both houses of Congress, most of a year should be time enough to pass a health-care-reform bill, even with unified Republican opposition. Yet more weeks of deliberation lay ahead before lawmakers vote, and it will be Thanksgiving or perhaps Christmas before a bill reaches President Obama for his signature.

For the millions of newly engaged voters who supported Obama and believed his promises about change, the process is taking too long. Everything takes too long on Capitol Hill, but for once, time is on Obama's side. Congress is poised to pass major reform. And in a stunning turnabout from the summer when conservative critics ruled, it's becoming evident that legislation will not pass Congress without a public option in some form.

It may not be the robust, Medicare-like plan that liberals want, but it will be something significant, and that couldn't be said three months ago. "Obama and his team have been very clever keeping their foot on the gas without running everybody over," says a health-care lobbyist and former Senate aide familiar with the eccentricities of how Congress works. A proposal to allow states to opt in (or opt out) to a federal plan, or create a statewide public option, has gained momentum in the Senate.

Polls show public sentiment increasing for a public option. A Washington Post-ABC poll found nearly six out of 10 favor a public option; 73 percent of doctors want it, too. A specialist on call roused in the middle of the night to tend to an accident victim without insurance doesn't get reimbursed, but she would be if everyone had insurance. A public option is the right thing to do morally, and would also assure physicians' payment. Obama's voter base is getting riled up, too. Organizing for America (OFA), the Obama arm of the Democratic National Committee, mobilized 100,000 phone calls to lawmakers on a single day, its first real show of muscle in the health-care fight.

For a time this past August, it looked as though Obama might join the list of presidents who tried getting health-care reform and failed. Obama wanted legislation before the August recess, and when Congress missed the deadline, Republicans and their allies organized town meetings that caricatured Obamacare as a government takeover with bureaucrats presiding over death panels for seniors. The summer spectacle drove up negative attitudes about a health-insurance overhaul, and about Obama's lax leadership. The public option looked dead, and dispirited liberals wondered where Obama stood.

Senate Majority Leader Harry Reid was caught off guard and underestimated the Republican opposition. The GOP looked like it was headed for the dustbin of history after the last election. But its leaders in the Senate are still shrewd players in knowing how to delay legislation, and they put Obama on the spot in terms of his commitment to the public option. Would he fight for the public option, the core of meaningful reform, or would he settle for much less? He refused to say; he still refuses to say.

Our system is designed to take a long time. The Founding Fathers didn't think big changes should be made easily. Legislation generally follows public sentiment, and once a consensus of 60 to 65 percent is reached among the people, Congress will act. Support for a public option is reaching that tipping point. When Congress acts outside of or ahead of public sentiment, the results can be disastrous. In 1989 lawmakers passed long-term care for seniors paid for by a surcharge on their Medicare premiums. Seniors rebelled, banging their canes on the hood of House Ways and Means chairman Dan Rostenkowski's car. Congress repealed the legislation.

The effort to achieve reform has a long and tortured history. President Nixon proposed an employer mandate in the 1970s that went nowhere. Democrat Ted Kennedy later regretted not supporting Nixon's idea. A generation passed before President Clinton made a major push for universal health care in 1993 and came up empty-handed. In the context of these past efforts, the drive for reform has taken a very long time. But by legislative standards, especially for a bill as far-reaching as the one before Congress now, health-care reform is moving with reasonable speed.

Once the two Senate bills are reconciled and the nonpartisan Congressional Budget Office reports on the cost of the blended bill, floor debate can begin in the Senate with amendments voted on. Assuming the bill passes, it will then go to conference to be melded with the House bill. Obama has played his hand just about perfectly. "By delaying so long, they made Obama look weak," says Stephen Hess, a presidential scholar at the Brookings Institution and a veteran of the Eisenhower and Nixon administrations. "It's hard for those of us on the inside to say, 'No, that's how it's supposed to be.' " It takes patience and perseverance to outlast, and outwit, the barons and baronesses of Capitol Hill, but Obama has done it.

© 2009