Should Democrats Drop Conservatives? No.

If you don't want to offend anybody who is making money off the health-care system, you can't do much. The fight for a public option, which would curb and contain insurance-company profits, seems destined to fail as the Senate Finance Committee debates hundreds of amendments with industry lobbyists looking on. It appears unlikely President Obama will win over any Republicans, and Democrats are beginning to waver, worried that cutbacks in Medicare will hurt them with seniors, and that middle-class voters will bear the brunt of reform when insurance companies pass along increased costs in higher premiums.

Yet some liberals are optimistic, even gleeful, believing that with bipartisanship all but dead, Democrats can enforce party discipline and muster the necessary 60 votes in the Senate to overcome procedural roadblocks mounted by the Republicans. This rosy scenario envisions Senate leader Harry Reid threatening to withdraw plum committee assignments if Democrats don't fall in line behind a party-line vote that would clear the way for health reform to pass by majority rule. One former state legislator, a proponent of this strategy, says that in every Podunk legislature in the country, leaders expect members to take one for the party or suffer the consequences.

Liberals are in no mood to give moderate Democrats a pass. Indeed, liberals sound a lot like Republicans did when Pennsylvania Sen. Arlen Specter switched parties—good riddance, and don't let the door hit you on the way out. Imagine how much nicer life would be without all these apostates blocking reform. Purge the caucus, as many on the left would like to see, and there goes the majority. The price of acquired power for the Democrats is more conservatives on their side of the aisle and fewer liberal Republicans to offset the influx. Republicans are a lot more unified now, having purged their ranks of the more sensible members; they're also a minority party.

Obama has to deal with the Congress he has, not the one that liberals wish he had. The irony is that all those red-state lawmakers giving Obama fits are a result of a strategy set in motion by Rahm Emanuel, who as White House chief of staff now must search for a consensus that can keep enough of them together to pass Obama's agenda. Emanuel recruited candidates best suited for their district and state, which means they won, but they are not reliable votes for Obama.

The challenge for Democrats is whether they can turn their arithmetical majority into a governing majority, says Bill Galston, a veteran of the Clinton health-care fight who is now a senior fellow at the Brookings Institution, a center-left think tank. Calling it "a test of liberal maturity," he points out that it's the minority of the majority—the newer,more conservative members—who make the Democrats a majority. "The simple fact that in the House liberals outnumber conservatives three to one doesn't mean they get three quarters of what they want," says Galston.

So where does that leave health-care reform? Obama's media blitz stopped the hemorrhaging, but the uptick in support for major overhaul barely beats the statistical margin. It's hard to make big changes in social policy when the country is divided, but the cost to the Democrats of coming up empty-handed means something will come out of this process. In American politics, that's how progress is made—in small steps, sometimes agonizingly small steps. The White House should have intervened three months ago instead of leaving it to Obama to mount a one-man rescue mission in the fall. It made sense to give Congress a few months to sort through policy options, but Obama gave them longer than was useful for them—or for him. Finance committee chairman Max Baucus has taken a lot of spears, and a final verdict on his leadership will be rendered when and if he is able to muster the votes to get a bill out of committee.

Then Democrats must rely on Harry Reid, a leader with modest skills who is in a reelection fight that he may not survive. He's looking after his own prospects, and they don't necessarily mesh with passage of a health-care overhaul that shifts billions out of Medicare. Nevada is home to a high number of retirees, and they won't look kindly on Reid if he leads a fight that affects their benefits.

All the focus on the public option has obscured the real problem with reform, and that is how to pay for it. Doug Elmendorf, the head of the nonpartisan Congressional Budget Office, spoke the truth when he told lawmakers that ending $120 billion in government subsidies to insurance companies that offer Medicare Advantage plans could lead to reduced benefits, higher premiums, or private insurers withdrawing from the plans.

And whose fault is that? The insurance industry is, in effect, holding the government hostage. Any hint that seniors might take a hit has the politicians running for cover. If there are enough unpopular provisions in the final bill and unemployment is still at 9.5 percent, liberal optimism over getting a health-reform bill could be short-lived, along with their hard-won House majority and a fragile Senate 60 more at odds with itself than the opposition.