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If, at last, both houses of Congress unite to pass health-care reform legislation, the bill emerging from the conference committee will have to be the result of still further compromising. Though some Who’ve struggled long and hard for health-care reform—such as former Vermont governor Howard Dean—now seem ready to abandon the current effort because they feel betrayed by the compromises made so far, the way toward reform is not likely to be advanced by waiting for more favorable circumstances.

With the Republican pickup of Ted Kennedy’s old Senate seat, health insurance reform is on the ropes.

By the time this issue of the magazine is in your hands, the fate of health-care reform may have been decided by Congress. The legislative process, like the proverbial production of sausage, is not neat or pretty. If a bill passes, it will not be all the Obama administration hoped for and it will be a lot more than the Republican opposition wants.