The three groups involved in the healthcare debate are the progressive Democrats (the largest group but not a majority) the republicans (the minority party and shrinking as their positions get crazier and less popular) and the centrist Democrats (Digby calls them the "sell-outs") who hold the deciding role in the mess. The Republicans could get the crappy pro-business bill with the help of the centrist Democrats and the Democrats would have to get that bill if it is all the centrist Blue Dogs would go for. But the Republicans refuse to give the Blue Dogs any support for that pro-insurance bill. The Democrats from conservative districts and states are targeted no matter what they do. Those center-right districts and states are the Republican Party's only possible route back to majority party status.
Digby suggests that this will be the margin that forced the Democratic Party to pass a real health care reform bill that actually does address America's health care problems, but it'll only happen if the Republicans continue to stonewall the centrist Democrats. Here's Digby's description of the situation:
The sell-outs are almost begging the Republicans to help them pass the terrible, insurance company giveaway bill they want so badly --- and the Republicans just won't cooperate. They are making the Democrats go this alone, which is the last thing they want to do because they [The sell-outs] have to face their own voters after passing something that won't work --- and now they know the Republicans will kill them no matter what they do. They have nowhere to hide.An intriguing scenario. The Republicans could weaken the Democrats by getting them to pass the insurance company's bill, but they put a higher priority on winning back the more conservative districts and states they have lost to the Democrats, especially in the last two elections. There are two factors which I think account for most of that. First, I'd guess that the Republicans who are left in Congress all represent strongly gerrymandered Congressional districts or come from states dominated by social conservatives, so that if they want to keep their elected positions, they have to toe the radical right-wing line. If they don't, then Limbaugh and the other right-wing talk-radio hosts will gang up on them along with Grover Norquist's Americans for Tax Reform will come down on them with both feet. So the Republicans in office do not dare to provide any room for the "blue dog" centrist Democrats.
The other factor is that most of the conservatives in office today are the true-believers who seriously believe that America is a right-wing nation, and they have just had a string of bad elections recently. If that's true, then the conservative states and districts are ripe to be retaken by the Republicans. All they have to do is overcome the liberal brainwashing of the electorate which has resulted in so many voters blaming Republican policies and the Bush administration for the current Recession (and near-Depression.) along with countering the Democratic actions with organizations like ACORN to steal elections. Those who thoroughly buy into the right-wing culture and world view really can't accept that America isn't truly a center-right nation at heart.
If Digby's scenario is accurate at all, that would be the reason why. As I said - an intriguing scenario.