Ever since health care reform flamed out in the 1990s, Democrats thought lots of things might derail their longtime dream this time around. Losing a Senate seat in liberal Massachusetts was not on the list. 
 
 But that is the harsh reality sinking in among Democrats — that a Republican victory Tuesday could spell the end of health reform because there is no good option to rescue the plan from this latest brush with political death. 
 
 Publicly, the White House and top Democrats held firm to their stance that health care reform will pass this year. And Speaker Nancy Pelosi (D-Calif.) said Monday that Democrats will need to figure out a way to proceed if Republican Scott Brown wins, “but that doesn’t mean we won’t have a health care bill.” 
 
 “Let’s remove all doubt that we will have health care one way or another,” Pelosi told reporters in San Francisco. 
 
 But privately, Democrats are getting cold feet about pushing ahead full bore on health care. Moderate Democrats who have long been skeptical of the administration’s focus on the issue could begin to peel away in the face of a convincing loss for Democrat Martha Coakley, dealing a fatal blow to legislation that had no room for error in either chamber. 
 
 Democrats have options to salvage reform following a Brown victory, but all have serious deficiencies. 
 
 One idea that looked promising a week ago — passing a bill through the House and Senate before Brown was seated — has dropped down the list of alternatives, as Democrats fear it would look like a partisan power play that ignored the will of Massachusetts voters. 
 
 The White House-favored option is to ask the House to adopt the Senate bill, with a promise to make additional changes later through the budget reconciliation process. But House Democratic liberals, as well as some conservatives, don’t like key parts of the Senate bill and don’t want to make it their own. 
 
 Ron Pollack, a longtime health care insider and executive director of Families USA, has floated a variation on this theme with the administration and congressional aides: a two-step process that would reassure House members their wishes would be met in the bill. 
 
 Under Pollack’s proposal, the House would take up the Senate bill only after the White House and congressional leaders struck a deal on key issues, such as taxes and the subsidies to purchase insurance. They would incorporate those changes into a separate budget reconciliation bill. 
 
 The House would pass both the Senate bill and the reconciliation bill, possibly on the same day. The Senate would then take up the reconciliation bill, which would require only 51 votes for passage. 
 
 “It is eminently doable — and quickly,” Pollack said Monday. “It is the combination of two things that wouldn’t work separately but, when done in tandem, make a lot of sense.” 
 
 This approach, however, would prevent any fixes that did not have a direct impact on the federal budget, such as changes to language on abortion and immigration and, possibly, even the insurance exchanges. The exchange question could be particularly problematic for House Democrats who have sacrificed the public option in return for the national insurance exchanges under the House bill. 
 
 “Progressives and conservatives in the caucus won’t go for it,” one aide predicted Monday. But they may not have a choice. Another aide acknowledged a Brown win would force party leaders to recalibrate and said that Obama and Pelosi would have to convince a skeptical rank and file that this was the only course of action. ||||| Democrat Martha Coakley's struggle to stave off a potentially devastating defeat in Tuesday's special Senate election in Massachusetts marks a critical turning point in the year-long debate about health-care reform. Regardless of the outcome of the race, the two parties appeared headed toward a monumental clash over the issue in the coming midterm elections. 
 
 A victory by state Sen. Scott Brown, who was given little chance of winning only a few weeks ago, would give Republicans 41 votes in the Senate and further embolden them to challenge the core of President Obama's agenda. Democrats could face an internal battle over how or even whether to proceed with the legislation, as well as how to deal with the issue in the fall races. 
 
 House Speaker Nancy Pelosi (D-Calif.) sought to head off possible talk of retreat, vowing to press ahead with the legislation. "There is no 'back to the drawing board,' " she told reporters Monday in San Francisco. She said there will be a final health-care bill "one way or the other." 
 
 But Republicans were warning of a political backlash if Democrats proceed in the face of a Brown victory. 
 
 Obama did not directly mention health-care reform when he campaigned Sunday on behalf of Coakley, the state attorney general, who is running to fill the seat of the late Edward M. Kennedy. Even before the polls opened, White House officials sought to blunt the narrative that the race was a referendum on the president's health-care initiative, in part by arguing that Massachusetts already has universal coverage. 
 
 "Massachusetts is completely unique, because the health reform law passed a few years ago," White House communications director Dan Pfeiffer said. "It makes it an imperfect example and impossible to extrapolate." 
 
 Other Democrats argued that Coakley, rather than health-care reform or Obama, bears principal responsibility for allowing the race to become so close, noting that in many of their private polls in the state, both the president and his initiative are more popular than the attorney general. 
 
 Republicans scoffed at the assertion that health-care reform has not been a driving force, noting that Brown has campaigned hard on the message that he would be the 41st vote against the legislation in the Senate and that the anger and discontent about Obama's agenda has helped fuel the Republican's rise in the polls. 
 
 "Health care has transcended issue status," GOP strategist Mary Matalin said. "It now represents something quite irregular in American politics: The obsession of a liberal minority thwarting the will of an intense supermajority for the better part of a year now." 
 
 More oppose reform 
 
 
 
 A new Washington Post-ABC News poll found that 44 percent of Americans support the proposed changes in the health-care system being debated in Congress, while 51 percent oppose them. Opposition is more intense than support, with 39 percent saying they strongly oppose the legislation and 22 percent saying they strongly favor it. 
 
 Fifty-three percent said the changes would mean higher personal costs, and 50 percent said the quality of their health care would be better if the measure did not pass. Fifty-six percent said the overall cost of the initiative nationally would be higher under the plan advanced by the president and the Democrats. 
 
 Congressional negotiators agreed last week to tax high-cost health plans, as the Senate bill proposes, rather than raising taxes on the wealthiest Americans. The public, however, favors raising taxes on the rich by 58 percent to 22 percent. Americans are closely divided over whether those covered by a government-sponsored insurance option should be allowed to buy coverage for abortions.
– With polls showing the majority of Americans opposed to the Democrats' health care reform bill, a victory for Scott Brown in Massachusetts today could sound the death of the party's yearlong effort at health reform. If Dems try to proceed with the reforms in the wake of a Brown victory, the GOP will have a strong case that a liberal minority is ignoring the will of voters to push its own agenda, the Washington Post reports. Democrats are rehearsing options for salvaging reform in the face of a Brown victory—a quick-fix House-Senate reconciliation bill, for example—but all of these either would spark serious turmoil within the party or have other major deficiencies, Politico reports. Dem leaders are putting on a brave face, but privately they're confronting the difficult-to-fathom possibility that a Senate loss in liberal Massachusetts may be what sinks health reform this time around.