In The Washington Post, E.J. Dionne, Jr. argues that final consensus on the health care bill among Democrats is much more difficult “in theory than it will be in practice.” It is widely believed that it Democrats believe there are fairly obvious concessions their colleagues in the Senate will be willing to make while still guaranteeing the 60 votes necessary to block a filibuster.

Dionne believes that the hype about reform failing at this stage is…well, over-hyped. Democrats know that nothing less than a bill on the President’s desk could mean disaster in the 2010 midterm elections. They need to successfully pass this bill.

Over the past week, I’ve talked with key figures in the House, Senate and White House, and the outlines of a deal are becoming reasonably clear. The public option is, alas, dead. But the idea of setting up a national insurance exchange — alongside state exchanges — where the uninsured can buy coverage is very much alive. The House is demanding this as the price for giving up on the public plan, and a national exchange would provide for much more consumer-friendly regulation of health insurance policies.

Almost everyone in both houses wants to find ways of making insurance more affordable. Steps in this direction would include more generous subsidies for the purchase of insurance than those in the Senate bill and expanding its Medicaid provisions. The bill’s price tag will grow from the Senate’s $871 billion over a decade, probably to somewhere between $930 billion and $950 billion.

The tax on “Cadillac” insurance plans, opposed by both organized labor and the insurance industry, is likely to be scaled back but not eliminated. Currently, the Senate bill includes a 40 percent excise tax on high-end health insurance plans — those at or above $23,000 for families and $8,500 for individuals.

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