One of the reason Democrats are in capable of governing is their tendency to break down into little emperors. Individuals or small groups in powerful positions start to view themselves like the president able to veto legislation or ideas whether they are in the majority or not. Max Baucus and his "gang of six" are a perfect example. A small group of conservative Senators both Democrat and Republican, from very small states (combined less then Ohio) can override 3 committee Bills from the House and a Bill from the Senate HELP Committee, all with a "Public Option".
One thing the Democrats are not is democratic.
If you start with the assumption that you will never get a Republican vote on any type reform. The only reform they like is to let you buy across state lines. But the only thing that would do is allow your health insurance company to act like your credit card company. They would all move there headquarters to the state with the weakest standards. I bet it would be in the south. You better pray it's not Texas.
Anyway, We'll also assume that Mass. sends an interim Senator to fill Kennedy's spot. So what we have is the Democratic Caucus. a majority in the House and sixty vote in the Senate. Capable of passing any legislation.
So do the Democrats go into a room and work out a plan using democratic principles? Do the say everybody for a "Public Option" raise you hand? OK, the Public Option's in, we're going with a public option. Of course not. they break down into their little kingships or small gangs with a minority view, but the power to act like little Dictator and to force a majority of their own party into the position of being the nutty liberal fringe that will just have to learn to compromise.