George Harris Kansas City Star Reader Advisory Panel 2008

The U.S. House of Representatives on Saturday passed a health insurance reform bill by a vote of 220 to 215. One Republican, Rep. Joseph Cao of Louisiana voted in favor, while 39 Democrats joined the Republicans.

At first glance, chances for success in the Senate seem slim since all 60 Senate Democrats would be needed to block a filibuster. And passage through the reconciliation process may not be allowed for many parts of the bill not having a direct impact on budget issues.

The so called public option is sure to draw fire, and majority leader Harry Reid is said to be counting on the appeal of allowing states to opt out of this provision.

The political choices of the vote were tricky in the House and will be in the Senate. Some Democratic representatives refused to vote for a bill that allowed payment for abortions through the public option, saying that government subsidies amounted to government funding of abortion.

So Speaker of the House Nancy Pelosi agreed to remove this provision. Pro-choice Democrats objected but in the end mainly voted approval, vowing to continue the fight when the bills are merged in Congress.

The abortion funding problem, no doubt, will be an issue in the Senate as well. But money issues also affected votes with many fiscally conservative House Democrats voting no because of the cost of the legislation, an issue that the Senate will certainly face.

Legislators from districts with moderate and conservative leanings are worried that a vote for expensive health care reform may cost them their seats in the next election. Democrats likely counted their votes and allowed some of their politically vulnerable members to vote no in anticipation of the next election.

But it is difficult to predict with certainty how the public will view health insurance reform a year from now. If House and Senate bills are successfully merged and signed by the president and if voters perceive that their existing insurance is intact while the problem of the uninsured starts to be resolved, will a vote against health insurance reform be a liability?

Remember, Hillary Clinton might be president today but for her vote to support the war in Iraq. Her vote at the time seemed politically shrewd but haunted her in the presidential primaries as the public became disgruntled with the decision.

And as politically risky as voting for health insurance reform may seem for some Democrats, the failure to pass health care reform is a political nightmare for all Democrats, who without a victory would be perceived by Independents and Democrats (not to mention Republicans) as feckless incompetents with large majorities in both House and Senate.

The choice for Senate Democrats is to hang together or to hang separately. Let's see who has the courage of their convictions.