By Martha Lynn Craver, Associate Editor July 10, 2009 Health care reform is not dead in Congress...yet. It's too early to say that, for sure. And a serious effort continues to pass a landmark reform affecting all Americans. But if it were a patient in the hospital right now, it's looking a bit pale and the prognosis for getting out alive is uncertain at best.Expect an all-out effort this month by key committees to craft a workable and passable plan. Perhaps there is no other more critical piece of legislation President Obama is counting on and that Democrats want to deliver as a sign they can get things done and are worthy of their majority. Sponsored Content Trouble is fissures are appearing in the Democratic party, and Democratic lawmakers will need to be largely united for something major to pass. A large compromise or weakening of central parts to appeal to Republicans could end up causing support to drop among Democrats. Plus, pro-reform coalitions are starting to fret over the scope and details, including questioning of the public provider option and whether it can work as intended. A vote in the House and Senate before the August congressional recess is unlikely, and odds of reform are starting to lengthen. Other spending and budget bills will dominate much of the work in Congress this fall, meaning much of the heavy lifting will have to be done by committee chairmen while the congressional leadership attends to other matters. Advertisement Employer groups are also growing disillusioned as details emerge. The number of worrisome provisions -- a mandate for employer sponsored plans, the public provider option to compete with private plans, taxation of some employer health benefits to help pay for expanding coverage and so on -- keep growing. Then there's the issue of the ultimate cost of a major reform, both the cost to taxpayers for expanding coverage and the cost borne by private providers who would be asked to do more for less. Also, the day-to-day absence of ailing health panel chairman Sen. Ted Kennedy, D-MA, hurts prospects, too. Noone else is as capable of bringing divergent members together, forging the large compromises and locking in support from wavering members. Another ailing senator, Robert Byrd, D-WV, may not be well enough to participate, either. An overhaul is far from a lost cause, though. The president is committed, and he and his top White House staff and cabinet will probably become much more involved with lots of personal meetings and private dealmaking in store. He'll use the presidential bully pulpit and hold some more health care town halls. He'll argue that lack of action and more delay will result in a much worse outcome as health care costs rise more and the pool of uninsured grows. He may even consent to a last-resort procedural tactic in the Senate called budget reconciliation that would nullify a GOP filibuster, even though it would inflame the minority and threaten other parts of his agenda, such as energy legislation. Advertisement He'll need to be tactful and direct at the same time. Among voters, there is also growing unease. Only a few months ago, employers, consumers, insurers and much of the health care industry felt the status quo is ultimately a road to ruin and were willing to risk considerable change. Now there's a gnawing worry that the cure may be worse than the disease.