He gives a number of scenarios that he thinks are the likeliest approaches to take to make reform a reality. His first is, I think, right on the money. As he points out, it wasn't Bill Clinton who was hurt most by the failure of health care reform in 1992. It was Congressional Democrats. These blockheaded assholes on the Hill need to be reminded of that.
http://www.fivethirtyeight.com/2009/07/rumors-of-demise-of-obamacare-have-been.html1. Whip Democrats Into Submission. This is probably the closest thing to the default approach. So long as there are a dozen or a half-dozen different iterations of health care floating around Capitol Hill, individual Democratic Congressmen can afford to bargain for their preferred version. "Progressive" Democrats from rich districts can object to the plan of raising taxes on the very wealthy to pay for expanded coverage. Labor-backed Democrats can try and play hardball on any proposal to remove the benefits tax exemption. The Blue Dogs can howl at the moon for whatever it is they want -- probably some kind of sweeteners for rural districts, like the ones given to farm-state Democrats on the climate bill. And advocates of the public option can continue to treat it as a sine qua non and threaten to oppose any bill that doesn't include one.
Once a particular bill is put up to a vote, however, the overwhelming majority of Democrats are going to have a difficult time voting against it. Health care reform remains quite popular in theory and at least marginally popular in practice. It will probably do the most good for those districts where conservative Democrats tend to reside.
And then there is the oldest motivator of all: survival. The failure of health care reform in 1994 may have damaged Bill Clinton -- but it really damaged the Congressional Democrats, who lost 54 seats in the House and another 8 in the Senate. Of the 36 incumbent Democrats who lost that year, only four (North Carolina's David Price, Ohio's Ted Strickland and Washington's Maria Cantwell and Jay Inslee) would ever return to the Congress (whereas Clinton, of course, was re-elected). Any Democrat who votes against health care, moreover, can expect to be permanently shut off from the Obama-run DNC and from most or all grassroots fundraising drives, and many of them can probably expect a primary challenger.
There are probably some Democrats who would be better off if health care went away. But once it comes up to vote, I'd imagine there will be very few who are actually better off voting against it.
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