Now that the Senate has moved one-step closer to a vote on pending health care reform, the real and brutal battle begins as the Democrats seek to line up sufficient votes in their caucus. With Republicans appearing unified in their opposition, Senate Majority Leader Harry Reid is working to avoid an intra-party meltdown. Perhaps not since the vote around the Voting Rights Act of 1965 has emotions run this high on Capitol Hill. Senators are making dramatic pleas on the floor and groups on each side are busy hurling accusations at each other.

What is being lost in the rhetoric is the very real dilemma of millions of Americans, particularly the poor and Blacks and Latinos, who are victimized by the inadequacies of the present system. With each passing day, and every new hysterical claim that surfaces it seems lawmakers are forgetting the very reason why universal health care has been at the forefront of the national policy debate for decades. Even the outbreak of the H1N1 flu virus has done little to force lawmakers to lay down their rhetorical weapons and act in the best interests of the nation. While not as volatile as the town hall meetings held over the summer, the larger debate over health care reform still resonates with anger.

One of the most interesting, and vexing, challenges for Senator Reid will be to reconcile the public’s support for some form of “public option” with grumblings in the Senate against the idea of a government-supported plan. President Obama has been lukewarm in his support for a public option and the lone Republican Senator who has supported the “idea” of health care reform, Olympia Snowe of Maine, has made clear her intention to vote against the Senate bill if it includes a public option. A compromise that would allow states to opt-in has not moved the opposition and will likely do little to temper the hysteria over claims of a government “takeover.” Wrapped up in the hysteria has been a series of fabrications by opponents that bear little truth. Perhaps the most egregious claim was that the government would establish “death panels” that would make end of life decisions for the terminally ill. The issue of abortion has been used by conservatives to inflame the debate, with the claim that the Democratic bill would allow federal funds to be used for abortions. Given the tide of emotion surrounding the health care reform debate, it is near miraculous that the Democrats have been able to advance the issue this far.

Of critical importance to Black Americans is the inclusion of a public option. Most Americans who have health insurance receive it through their employers, meaning that benefits are tied to employment. For the poor and elderly, government run Medicaid and Medicare provide coverage. Still, many Blacks are left without coverage because they are unemployed or underemployed, and do not qualify for government coverage. The recession has made matters that much worse as workers who are fired are unable to keep their coverage and some households becoming completely uninsured, as spouses and children lose health care benefits when the primary wage earner loses a job. Making matters worse for Black Americans is the high incidence of chronic diseases. These illnesses often go untreated and lead to other complications. When they are attended to, it is often in emergency rooms, the most expensive health care provided. One undeniable truth is that some form of public program will be necessary to address the tremendous need for health care among Blacks in the United States. The strain on the Black community is such that a number of groups, such as the NAACP, National Urban League and Leadership Conference on Civil Rights, have supported the call of the Congressional Black Caucus for a public option in the final health care bill.

The President will have to expend significant political capital, first within his own party and second, with the public to sustain momentum. Mr. Obama is walking through the ideological forest of the Democratic Party without a compass, and hoping that his tremendous personality and powers of persuasion will help him bind Senate Democrats to the bill. It will require tremendous gamesmanship to use the stature of the Oval Office to curry favor with Senate Democrats who are resisting not-too-subtle arm-twisting to support the bill. President Obama will have to contend with members of the CBC in the House of Representatives who will likely confront him on his indifference toward a public option. It may be the first, real public spat that Black lawmakers have with the nation’s first Black President, and could foreshadow a looming debate over Black joblessness.