By Bob Morgan, Jr.

As Congress heads out for its August recess, the fate of the health care overhaul proposed by the Obama Administration and Congressional Democrats remains very much in limbo.

The current state of play is that neither the House or the Senate has voted on a health care bill, although three different House committees have reported out legislation. In the last few days, the House Energy and Commerce Committee passed a compromise bill that satisfied a number of the more conservative "blue dog" Democrats while disappointing more liberal members. In the Senate, negotiations are continuing between three Democrats and three Republicans to come up with a bipartisan measure. A key issue is the role of a "public option", a government insurance plan that would compete with private plans.

So far, the Obama plan has run into significant opposition. For example, a Gallup poll taken July 17-19 showed that 50% of national adults disapproved of President Obama's handling of healthcare issues, while 44% approved. Even more striking is the divide between persons who have healthcare and those who do not. In an NBC/Wall Street Journal survey taken on July 17-20, American adults with healthcare disapprove of Mr. Obama's plan by a 51-38% margin, while those without health care approve by 52-29%.

The fundamental problem for Mr. Obama and the Democrats is that they are not able to articulate to the 170 million Americans who already have private health insurance exactly how the proposed changes will improve their quality of care. Most Americans, especially those who have insurance, are satisfied with their care, and are not enthusiastic about being transferred into a public option plan.

While estimates of how many people actually would move to the public option vary, the Lewin Group, an actuarial firm, has published an estimate that about 119 million people, about two-thirds of the total, would eventually be transferred over to the lower cost public plan. Indeed, in candid moments, a number of proponents of the "public option" have indicated an eventual goal of enacting "single payer" insurance, in effect a government run plan. It is not hard for opponents to conjure up images of an governmental health care agency with all of the efficiency and sensitivity of the Department of Motor Vehicles.

The Obama Administration had planned to appeal to insured Americans by arguing that the health care reform would significantly reduce health care costs. However, that argument was dealt a significant blow by a report of the Congressional Budget Office that the plans proposed by Congressional Democrats would not curb government spending on medical care. The report said the proposals lacked the fundamental changes necessary to control costs.

What will happen? Right now, Congress is in recess and many of the members, especially in conservative areas, are hearing from strident opponents of the plan. On the other hand, Democratic members have a strong vested interest in the success of the Obama Administration and do not want the President's major domestic initiative defeated. A complicating factor is that the Democrats in the Senate probably do not have the 60 votes needed to pass a partisan bill without invoking the highly controversial budget reconciliation process, which is not normally used for legislation of this kind. (A bill can pass with 51 votes under budget reconciliation.) This explains the search for bipartisanship in the Senate, but it is not clear if any significant number of Republicans will climb on board.

The best guess is that something will likely pass, but the Democrats may have to declare victory under the circumstances without gaining the sweeping changes they once envisioned.