Today's Washington Post reports that Sens. Enzi and Grassley have asked Sen Baucua to consider a lengthy list of changes to his health reform bill, changes that include elimination of state funding for the expansion of Medicaid, reduction or elimination of the penalty for failure to obtain health insurance, and myriad other modifications.

As I noted before the President's speech last week, these two Senators are the key to health reform's passage. With the revelation that there's much they don't like about the Baucua effort, it is growing increasingly clear that reform's chances are grim indeed. Recall that the Baucua bill doesn't have a public option, specifically prohibits the use of tax dollars to fund care for undocumented workers, and is not exactly abortion-friendly either. In sum, this is NOT a liberal bill.

Yet the gang of two remain unsupportive despite Baucus' efforts to present them with a bill that avoids most of the really contentious issues.

The net is this. If two of the more moderate GOP Senators are this unhappy with the Baucus bill, the Dem choices are stark. Either compromise so much that the final bill becomes all but meaningless or pick the reconciliation option.

Come to think of it, there is a third choice; use the reconciliation process to ram thru narrow, specific bills targeted to drastically cut reimbursement for pharma, hospitals and , medical devices; slash Medicare Advantage funding; and revamp Medicare's provider reimbursement to end fee for service and move to episode of care over time.

That may be the best option. The threat alone may force stakeholders to get serious.

And it sure would be fun to watch!