Janet Hook

As Congress adjourns for a summer recess, Democrats are in the uncomfortable position of trying to defend a plan for vast change in the nation’s healthcare system that has not yet been written. Critics have ramped up their protests, and disruptions of lawmakers’ town hall meetings have dominated news coverage.

And yet, the Democrats also find themselves in a surprising place: When they return after Labor Day, they will be well-positioned to pass a bill that would touch the lives of almost everyone in America.

Many questions remain, including how to pay for insuring the 47 million in the U.S. who now do not have coverage, and how to corral health cost inflation. Legislation from three House committees will have to be blended; and the House bill will have to be reconciled with still-evolving legislation in the Senate. An effort in the important Senate Finance Committee to craft a bill with the support of several moderate Republicans is likely to continue until Sept. 15, a deadline imposed by Democratic leaders.

Still, just seven months into the Obama administration, there is an emerging consensus among the majority Democrats about what is wrong with the healthcare system and what can be fixed.

Sen. Evan Bayh (D-Ind.), a centrist, said after a recent party caucus that broad agreement had developed to shore up Medicare subsidies for prescription drugs and to make it harder for insurance companies to limit coverage based on preexisting conditions.

“The prospects for incremental improvement are still reasonably good,” said Geoff Garin, a Democratic pollster close to the congressional leadership. “But there’s a lot more realism about how hard this is.”

One focus now is the Senate Finance Committee, the panel charged with deciding not just how to reshape health policy but how to pay for it. All previous committee votes on healthcare this year have been along party lines. The finance committee, where talks will continue in the coming month, is the last forum in which Democrats hope to forge a sturdy bipartisan compromise.

The political price: Any bipartisan agreement would probably abandon a proposal from liberals to create a government-sponsored insurance option as an alternative to private health insurance.

The August congressional recess is a crucial period. Democrats hope to use the time to build support for the healthcare bill by telling voters what’s in it for them. Conservative critics are packing town hall meetings with people arguing that President Obama’s plans amount to a government takeover of healthcare.

Democrats have said that those crowds have been organized by Republicans and their allies, and that they do not reflect genuine grass-roots opposition. But national polls indicate that Democrats have a real political problem: The more people learn about the healthcare legislation, the less they seem to like it.

And confusion about what the legislation will ultimately say is a major complication.

House Democratic leaders have yet to resolve the differences among bills passed by three House committees. For example, the House Energy and Commerce Committee wants to limit the proposed subsidies that would help needy people buy insurance, an effort designed to win support from fiscal conservatives.

The ways and means committee, meanwhile, has proposed paying for expanded access to insurance with a surtax on the very wealthy -- an idea that many Democrats oppose.

The biggest differences, however, will probably not be among House committees but between Democrats in the House and Senate. As a group, House Democrats tend to be far more liberal than the Senate Democratic Caucus, and Senate rules make it much harder to pass legislation without some bipartisan support.

Throughout congressional debate, Obama has kept his hands off the details of the legislation. He has laid out general principles of what he wants but has given Democrats wide latitude to craft the legislation -- including the politically dicey measures for how to pay for it.

The Obama administration is expected to get more involved later, when House and Senate negotiators sit down in a conference committee to write the final bill.

In the end, Democratic strategists say, it would be a huge political problem for the party if Congress came up empty-handed.

“We have passed the point of no return,” said a senior Senate Democratic aide, who would not be quoted by name while discussing strategy. “We are too heavily invested in this. We will do something on healthcare.”

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janet.hook@latimes.com