There has rightly been a lot of attention given to the New York Times article, in which anonymous senior Senate aides float the idea that Harry Reid will not include the public health insurance option in the combined bill that is brought to the floor for a vote. Reid’s office has denied that this is the case, but the proof will be in the pudding. We will likely know in the next week or two what the bill Reid brings to the full Senate for consideration is and the contents of that bill will almost certainly be determinative of its outcome.

The reason for this is that we are approaching the point in time where substantive changes to the content of the legislation are able to be made. The big ticket item is obviously the public health insurance option, though there is no doubt the fate of provisions relating to access, affordability, and employer responsibility will be determined by the contents of Reid’s bill, too.

The reason that Reid’s decision is so crucial is that any amendment on the floor to controversial parts of the bill will likely require 60 votes to pass. This is not because it is in the Senate rules that controversial provision take 60 votes. It is not. But what has been the rule since Lyndon Johnson’s tenure as Majority Leader is that unanimous consent agreements are used to set ground rules for debate, amendments, and voting. To make a deal so things move forward, anything controversial like amendments which would add or remove the public health insurance option, will require 60 votes. And such, any amendment is almost certainly doomed to failure.

Chris Bowers highlights this in a run-down of the legislative state of play on health care reform:

No good strengthening amendments will pass on the Senate floor. If there is no public option in the bill that passes through Kent Conrad’s Budget committee, don’t expect one to emerge from the Senate via amendments. The 60-vote culture will be in effect for all amendments to the health care bill when it arrives on the Senate floor, and so there won’t be enough votes for the public option–or any other significant strengthening amendment-if it is not included in the bill that comes out of the Budget committee.

Republicans will not find 20 Democratic votes to strip the public option and while there are certainly more than 51, it is doubtful there are 60 votes to insert the public option in via an amendment.

The Times article reports on Reid’s decision making process:

“None of these decisions are going to be made without significant presidential input,” said Jim Manley, a spokesman for Mr. Reid.

And so, it is up to Harry Reid and, on the tough calls, President Obama. They will determine what the Senate votes on later this year. If the public health insurance option is in the bill, it is because Reid and Obama have decided that they want it to be, for they will know that it will not be stripped via amendment. And if it is not, it is because Reid and Obama expressly decided that they do not want it to be part of health care reform legislation. It is that simple.

What’s worse is the inevitability of it all. The inevitability of Reid and Obama refusing to wrangle conservative Senate Democrats to force them to stand up for the party and this presidency…and the expressly right policy. The inevitability of advocates of the public option trying to put a bright sheen a bill without it. I can see Schumer, Rockefeller, Brown or Dodd saying now, “We will get a chance to vote on it via an amendment and that’s the best we could have hoped for.” As if leadership could not have made a different choice…

At the end, though, there’s something reassuring about this process. If it goes as predicted above, with the public option sent by Harry Reid and Barack Obama to die the death of a failed amendment to a crappy bill then I will know exactly what I can expect when it comes to leadership from Obama and Reid. But if they do the right thing, if they push for policies that will literally affect every single American, then I can look forward to having a real Democratic presidency, after all. As I keep saying, time will tell.