When American political discourse has reached the point where a congressman shouts "You lie!" at the president during a nationally televised address, it must be a sign that the stakes are running pretty high.
 
And so they are in the great health debate. Most analysis, though, has focused on only one side of the political poker game now under way: Will lawmakers pay a political price if they vote for a health bill that proves unpopular?
 
There's also a flip side to that question, which is about to get a lot more attention: Will lawmakers also pay a political price if nothing gets done -- that is, if the effort to pass a health bill collapses in failure?
 
There's been much discussion of the political price lawmakers could pay if they support an unpopular health-care overhaul, but what about the reverse: Is there a political price if nothing is done? WSJ's Jerry Seib explains.
The Obama White House certainly argues that inaction would exact a heavy toll, particularly on fellow Democrats. "There's great political peril in not acting," one senior Obama adviser asserts, a message likely to be sent with increasing frequency and urgency.
 
Political scientist Norman Ornstein of the generally conservative American Enterprise Institute agrees. "It seems obvious that the political cost to Democrats will be enormous" if nothing passes, he says. Such a failure, he adds, would "demoralize the Democrats and energize their opposition," and lead to losses in 2010 midterm elections.
 
In the broadest sense, it's probably correct that, for Democrats and maybe even some Republicans, the dangers of failure exceed the risk of doing something controversial. Still, that conclusion isn't certain. Current polling doesn't give clear guidance, and the conclusion likely doesn't hold true for every Democrat in Congress.
 
While the president gave ground to Republicans on some points -- particularly by putting medical-malpractice limits on the table for the first time -- Republicans were arguing Thursday that some of his more barbed language did nothing to improve the chances of bipartisanship breaking out. Democrats, meanwhile, are pointing to South Carolina Rep. Joe Wilson's now-famous "You lie!" shout during the speech as evidence that there aren't a lot of soft edges in Republican opposition.
 
So for Democrats, the question is whether to unite behind something that will remain controversial, or walk away from it. There are dangers either way.
 
That's clear from a new Gallup survey that tries to test the political trade-offs. Gallup found that a hefty 64% of Americans say that their representative's position on health care will be a major factor in their vote in next year's congressional elections.
 
The key finding, though, is that the importance of health care is higher for those who oppose passing a bill than for those who favor it. Among those against passing a health overhaul, 82% said their representative's position on the subject will be a major factor in next year's election. Among those who favor passing a bill, 62% said their representative's position will be a major factor. That suggests that more voters are ready to punish lawmakers for supporting change than are prepared to reward them for doing so.
 
Yet the equation isn't quite that simple. Mr. Ornstein says that, as they watch the health debate, voters are making mental notes on whether the Democrats who control both houses of Congress and the White House can govern effectively. A broad sense that a party is unable to get things done, he argues, may be more damaging than the unhappiness lawmakers generate by doing something controversial.
 
"Voters out there are bundles of contradictions themselves," Mr. Ornstein says. Their attitude, he adds, is, "'We pay you the bucks to go in there and solve problems and act.' They don't want to hear excuses."
 
That, Mr. Ornstein believes, is the lesson Democrats learned, with great pain, from their disastrous flirtation with health care in 1993 and 1994. The Clinton administration proposed a large health overhaul that grew highly contentious and collapsed. Nothing controversial passed -- yet the Democrats who were in control got hammered in the 1994 midterm elections anyway, losing 54 seats. They were neither rewarded for letting a health overhaul die, nor for giving it the ol' college try.
 
An appearance of incompetence or ineffectiveness could be even more damaging this time around, because voters hold the Congress the Democrats control in even lower esteem to begin with. In the latest Wall Street Journal/NBC News poll, just 24% of those surveyed said they approve of the job Congress is doing; by comparison, at the beginning of 1994, Congress's job approval was 33%.
 
Still, not every Democrat will see things that way. Almost two dozen freshman Democrats won narrowly last year in conservative districts that Republicans carried in the presidential vote. They won't be easily convinced that they will benefit from seeing just anything pass. That's why the White House still has work to do when it argues that "failure is not an option."

Gerald F. Seib - WSJ