Charles Krauthammer, in essence, divides health-care reform into two acts. On Act I of health-care reform:

Reforming the health-care system is dead. Cause of death? Blunt trauma administered not by Republicans, not even by Blue Dog Democrats, but by the green eyeshades at the Congressional Budget Office.

But then there is Act II. He surmises:

To win back the vast constituency that has insurance, is happy with it, and is mightily resisting the fatal lures of Obamacare, the president will in the end simply impose heavy regulations on the insurance companies that will make what you already have secure, portable and imperishable: no policy cancellations, no preexisting condition requirements, perhaps even a cap on out-of-pocket expenses.

And there will be an individual mandate, he predicts — so the insurance companies won’t be driven out of business quite yet.

Well, it could turn out that way. Or the Democrats could continue to rip one another apart and wait for 2010 as a “mandate” election on health care. Or the coalition of Blue Dogs and Republicans might get together to try passing targeted reforms (e.g., tax credits, some litigation reform, health-spending accounts) and dare the president and congressional leadership to block them.

But what is clear, as Krauthammer points out, is that barring some leftward lurch of the electorate that can be induced in 2010, there simply isn’t a constituency outside secure liberal congressional districts for a government takeover of health care. That reality will have to be digested and accepted by the Democratic leadership in the House and Senate. Obama will need to realize that his presidency will crumble if he insists on the unattainable. And then we can better assess what type of “reform” (if any) we might get.