It's not yet clear if Martha Coakley officially killed federal health care reform. But her loss in the Massachusetts Senate special election last week temporarily derailed it. Thanks to her atrocious campaign, a surge of conservative tactical and financial support, and general wariness about the economy, Republican Scott Brown is headed to Washington, vowing to unite with 40 other Republicans to oppose virtually any Democratic-sponsored health reform initiative.

This development doesn't leave the Obama administration or congressional Democrats with many enticing options. They could write a new and smaller bill, passing only those provisions that are broadly popular in Congress. But from a policy standpoint, this approach makes little sense. First, writing a new bill is time-consuming and Congress has other urgent problems to address. Many of the bill's planks are also interdependent. If you prohibit insurance companies from denying coverage based on pre-existing conditions, you need an individual mandate so healthy people don't drop their insurance entirely, driving up the cost of premiums for the sick. But if you have an individual mandate, you need to provide robust subsidies so people who are forced to purchase insurance can afford it. And increased subsides requires sufficient revenue.

One solution some Democrats have bandied about, for example, would separate the current package into four bills, one of which would extending Medicaid to an additional 15 million people. But here, the same problem arises. Currently, there aren’t enough Medicaid providers to service the current beneficiaries. That's a problem that the current legislation addresses, by increasing funding for community health centers, providing scholarships and loan repayment to recent medical school grads  who agree to work in areas with health professional shortages, and by boosting payment rates to providers. There's no guarantee that a new bill would include any of those elements that are central to the success of any Medicaid increase.

Democrats could just move on, vowing to take up health care reform at a later date when the economy recovers. But putting reform on the back-burner, especially after lawmakers threw so much time and political capital into the fight, would be a disaster. Abandoning an issue that has stood at the center of the party's platform for over 60 years is one surefire way to keep the base at home this November. It's unlikely that Democrats will have majorities this large after the 2010 midterm election. And maintaining the status quo will lead to more needless deaths, medical waste, and personal bankruptcies. Nobody can campaign on that.

This leaves one remaining option: The House could pass the Senate bill as is and the upper chamber could agree to iron out some of the differences through the budget reconciliation process. That's the approach favored by a wide coalition of 50 health policy experts, who sent a letter -- penned by the University of Chicago's Harold Pollack -- to the House leadership on Friday:

While the House and Senate bills differ on specific points, they are built on the same framework and common elements—eliminating health status underwriting and insurance abuses, creating functioning insurance markets, offering affordability credits to those who cannot afford health insurance, requiring that all Americans act responsibly and purchase health insurance if they are able to do so, expanding Medicaid to cover all poor Americans, reforming Medicare payment to encourage quality and control costs, strengthening the primary care workforce, and encouraging prevention and wellness. [...]

The Senate bill accomplishes most of what both houses of Congress set out to do; it would largely realize the goals many Americans across the political spectrum espouse in achieving near universal coverage and real delivery reform.

This is also the preference of various Illinois health care activists and wonks, 100 of whom participated in a conference call held by the Campaign for a Better Health Care Monday afternoon. According to Jim Duffett, the group's executive director, the mood on the call was angry. Already, organizers are gearing up to pressure Illinois' congressional delegation on the issue next week.  (Here's a list of the issues CBHC wants addressed in the final health care reform proposal.) They plan to praise those lawmakers who are continuing to fight for a bill and to remind "whimpering Democrats" that they block reform at their own risk. "If you balk," Duffett warns, "we will guarantee that you lose in November." Some form of civil disobedience, we're told, is being considered.

House Speaker Nancy Pelosi is going to need the Illinois Democratic delegation on board if she wants to hold together her loose coalition. Only eight Democrats can vote against the legislation without it going down in flames, and various factions within her caucus are expressing concerns. There are the abortion foes, many of whom only supported the House version because it included the last-minute Stupak amendment limiting elective abortion coverage from both private and public insurers on the health insurance exchanges. There are the weak-kneed moderates, spooked by the recent Massachusetts upset.

Finally, there are the progressives, whose concerns with the Senate bill are generally substantive.  Thankfully, most of these issues -- the scope of the excise tax on high-cost insurance plans, the size health insurance exchanges, and the breadth of insurance subsidies -- can be improved by a simple majority through reconciliation. (Ezra Klein offers the details, per some procedural experts, here.) But before that can happen, the Senate needs to signal that they are willing to cooperate.

After a week of panic, the same choices face national Democrats today. Pass a bill or don't. If they take the latter course, thousands of uninsured Illinoisans will suffer.