I suspect serious health insurance reform is over for yet another generation.

Even if Coakley wins – and my guess is she’ll lose by a double digit margin – the bill is dead. The most Obama can hope for is a minimalist alternative that simply mandates that insurance companies accept people with pre-existing conditions and are barred from ejecting patients when they feel like it. That’s all he can get now – and even that will be a stretch.

[He's] right only if the Democrats start thinking like him. There are perfectly viable ways to pass a major health care reform without taking another vote in the Senate. The easiest is just to have the House pass the Senate bill, and promise to use a reconciliation bill, which requires just a majority vote, to smooth out any changes. It’s very, very doable. It’s also in the interest of the Democrats in Congress. They already cast a vote, might as well reap the benefit of having an accomplishment.

The only question is whether they can keep their heads.