Here we go again.

Whenever conservative stalwart Jesse Helms didn't like something in a bill, he would pull out an abortion amendment to slow things down. Helms is dead and gone but the tactic is alive and well and may just kill health care reform.

On the Senate side, the hurdle is the public option. For 30 years, Jesse Helms, the former senator from North Carolina, was the biggest thorn in the Democrats' side. Now that title goes to the senator that many call "Traitor Joe" Lieberman.

While many Democrats were declaring victory last Saturday night with the passage of a health care reform bill, Republicans, too, had a victory of sorts. They may have successfully passed the "poison pill" that will kill health care reform down the road.

One of the culprits this time was Rep. Bart Stupak (D-Michigan). He co-sponsored an amendment to the health care bill with Rep. Joe Pitts (R-Pennsylvania). The amendment would require women to buy separate "riders" to cover abortions, even if they otherwise paid for a full insurance plan. Even before the amendment was voted on, the Democratic leadership was signaling that there was no reason for alarm; if the amendment passes, it won't survive conference with the Senate was the spin.

So, the amendment passed with the help of dozens of Democrats; later in the night, the full bill passed 220-215. After the euphoria settled, a stark realization set in for many supporters of health care reform. The margin of victory was not large enough to guarantee final passage if the bill comes back from conference without the abortion amendment. So, the question in the House is did the Democratic leadership make a huge blunder when they allowed the Stupak amendment a vote on the floor?

There wasn't time to see what the real impact of the Stupak amendment will be. Groups like the National Abortion Rights Action League (NARAL) are cranking up efforts against the amendment. Which raises another question: If the amendment remains in the bill, will Democrats be pressured by their base to oppose the conference report?

Either way, with or without the abortion amendment, the bill is in trouble. Jesse Helms would be proud of Stupak and Pitts.

While the abortion controversy could find its way down the hall to the Senate, at this time the biggest hurdle is opposition to a "public option." The Senate will begin debating their version of health care reform next Tuesday, if they can muster 60 votes to authorize the start of debate. In the Senate, you need 60 votes to start debate, and 60 votes to end debate. If even one of the 60 members of the Democratic caucus defects, a Republican will have to join the Democrats to overcome the procedural hurdles.

"Traitor Joe" Lieberman has threatened that he will not vote to end debate if any form of the public option is in the bill. Lieberman has indicated he will vote to allow the debate to begin. His opposition to ending debate is what has the bill stalled in the Senate.

When Lieberman announced his plans to join a Republican filibuster, many responded by saying, "Let him do it; he will look like a fool." I think people had images in their mind of Jimmy Stewart standing on the floor for hours bringing the Senate to a standstill. That is not how this filibuster would work. For, as long as 41 senators vote against ending debate, the bill cannot be brought up for a vote. The rest of the business of the Senate would continue; only health care would be delayed.

The Republicans are united in their opposition, with the exception of Sen. Olympia Snowe (R-Maine), who will only support a public option with a "trigger."

A "trigger" means that there would only be a public option if private insurance companies don't meet certain goals. The goals would be deadlines for covering a certain percentage of Americans that currently don't have health care. The problem is, initially, Americans would be required to buy health care without an affordable public plan as an option. We would be depending on the private insurance companies to lower their rates without competition from a public plan. The insurance industry has already released reports threatening to raise rates if health care reform passes.

A health care bill without a public option would lead to a political nightmare for Democrats.

That being said, the trigger may be the way to go to get a bill out of the Senate. It would be a disaster if the trigger wasn't removed in conference, but as the Democratic leadership concluded in the House when allowing a vote on the Stupak amendment, clearing procedural hurdles now and revisiting the language in conference may be the best way to get a bill to the president's desk that has a public option and does not have anti-abortion language. Nancy Pelosi gambled in the House; now Harry Reid may have to take the same gamble in the Senate.

If these gambles are to succeed, members of Congress and the president will need the support of the people. As President Obama said during his campaign, he cannot do it alone. He needs the people to stand against politics as usual in Washington. For the last year, Obama has faced an entrenched power structure in Washington that resists change.

"Traitor Joe" and the ghost of Jesse Helms are part of that structure; they are not going to voluntarily move aside and cede power, we have to take it from them.

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