A few weeks ago, I suggested we might need to have an obituary ready just in case. Well, it isn't looking good.

The public insurance option seems to be dissolving from the legislation. From CNN:

Democratic Sen. Kent Conrad of North Dakota said it was futile to continue to "chase that rabbit" due to the lack of 60 Senate votes needed to overcome a filibuster.

"The fact of the matter is there are not the votes in the United States Senate for a public option. There never have been," Conrad said on "Fox News Sunday."

His comment signaled a shift in the health care debate, with Obama and senior advisers softening their support for a public option by saying final form of the legislation is less important than the principle of affordable coverage available to all.

But how do you provide affordable coverage to all without an alternative to private insurance? Conrad's idea --- health insurance cooperatives. They'd work like other co-ops. People would join up, and the co-op would try to negotiate coverage for the members:

Conrad said such cooperatives would provide the competition sought by Obama and Democratic leaders to force private insurers to hold down costs and improve practices. The government would put up initial funding to provide required reserves but would have no other role, he said.

"It's not a public plan at all in terms of government running it," Conrad said...

However, Democratic Rep. Eddie Bernice Johnson of Texas told CNN it would be "very, very difficult" to support a bill that lacked a public health insurance option.

"Without the public option, we'll have the same number of people uninsured," Johnson said in a "State of the Union" interview. "If the insurance companies wanted to insure these people now, they'd be insured."

There's the crux of the problem. This debate has been about two things (at least), and it really should've been about one. Is the goal of health care reform to make health insurance available to everyone? Or is to drive down costs in the health care system?

Those things may not be mutually exclusive, but they sure sound that way. Whenever he explains his plan, the president always starts with -- if you're happy with your health insurance, you get to keep it. If you don't have it, you'll have choices for coverage, and they'll be reasonably priced. And we'll cut costs. And we'll have competition. And the government won't be in charge of your health care. And leprechauns on unicorns will deliver the health care right to your doorstep.

Who can believe that pitch? I just wrote that from memory, but here it is again in print, from a New York Times editorial:

First, if you don't have health insurance, you will have a choice of high-quality, affordable coverage for yourself and your family...

Second, reform will finally bring skyrocketing health care costs under control, which will mean real savings for families, businesses and our government. We'll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid...

Third, by making Medicare more efficient, we'll be able to ensure that more tax dollars go directly to caring for seniors instead of enriching insurance companies....

Lastly, reform will provide every American with some basic consumer protections that will finally hold insurance companies accountable....

If he could've focused on just one thing (cutting costs, for example), people might still be listening. I don't blame the president for wanting to think big, but with Washington's track record on this stuff, a small, encouraging step forward might be the ceiling. It's better than another massive failure.

Here's another take on what happened. It's from MSNBC's The Grio, a news community site targeting an African-American audience. Dr. Willmer Leon writes this:

The White House entered into the discussion with a great idea but no real specifics on how the plan would work. A plan devoid of specifics left the door wide open for the opposition to control the message with crafted political talk based on misinformation, lies, and distortions. The opponents of health care reform have been able to change the debate into a forum on health care for illegal immigrants, abortion, and other wedge issues....

Having lost control of the message, the president's health care reform initiative is now on life support.

I'd love to hear what you're thinking...