For Dems, it's back to the drawing board

With Scott Brown's stunning victory in the Massachusetts Senate race last night, many today will be quick to declare health reform dead. After all, once Brown is seated, the Republicans will have 41 seats in the U.S. Senate giving them the opportunity to block anything that the Democrats try to do.

In the coming days and weeks, much will be written about the irony of how the successor to long-time health reform champion, the late Senator Ted Kennedy, is the one to drive the nail into the coffin of health reform.

But is health reform really and truly dead? The massive, complex 2000 plus page version that we've been talking about for the past year is almost absolutely certainly dead. I say "almost absolutely certainly dead" only because, with Congress, it's best to never say never but yes, I'd agree that you could probably shred your copy.

What they could do. The Democrats, of course, are not without options. It's just that, at this point, none of these options look very good for them.

--The Democrats could try to beat the clock and race to suddenly resolve all their differences, get a speeded-up Congressional Budget Office scoring, and pass reform before Senator-Elect Brown is seated. Putting aside the legal, ethical, and political issues, this just won't happen. On a practical level, how could they ever become so unified, overnight?

--Because the Senate Democrats passed health reform on Christmas Eve, they don't really need to vote on it again. In theory, the House could pass the Senate version and then send it on to President Obama for his signature. Again, very unlikely. Though there are many similarities between the House and Senate versions, there are substantial, and key, differences and it seems doubtful that the House would just cave in on this.

--The Senate Democrats could go ahead, reconcile their differences, and attempt to bring a bill to the floor, forcing the Republicans go beyond a mere filibuster threat to actually conduct a full-scale Mr. Smith goes to Washington-type filibuster. Again, extremely unlikely, though possible, I suppose.

--The Senate Democrats could try to convince a moderate Republican to join their side. It could happen, though it almost certainly won't.If this were possible, they probably would've done it by now.

--Democrats can use the reconciliation process to pass a scaled-back version of the finance-related health reform provisions with only a simple majority in the Senate. Possibly not though this is a distinct possibility, not some theoretical possibility.

--Democrats can abandon health reform, altogether, for probably another generation. Again, this is a distinct possibility, though, due to all the time and effort they put into health reform during the past year, this would be extremely embarrassing to them, politically, this fall, in the mid-term elections.

--Democrats could attempt to pass small healthcare reforms, on a piecemeal basis, declare victory, and then move on to something easier, such as trying to achieve world peace. Personally, I think this is the most likely option. Pass the noncontroversial reforms that are easy for the American public to understand--this might just happen.

What's next? Only time will tell what the future holds for health reform but it's been a wild and entertaining ride so far. Somehow, I don't think we've seen the last of health reform.