So it looks like the public option’s gone. Kaput. Nothing but a big honking bone to be thrown to the insurance companies, Teabaggers and everyone too lazy to find out what it actually was.While this is a blow to the left, to be fair to the democrats, their inability to tackle health care in a coherent and united fashion is not all their fault.  Some structural and geographical factors are working against them. The Democratic gains in 2006 and 2008 came at a cost — a large contingent of Democratic congressmen ran to the center to win the votes in their more moderate states.  These centrist democrats are unwilling to imperil their chance for re-election for, you know, the health and wellbeing of the country.Max Baucus, a Senator from Montana and a key figure in the debate, is likely haunted at night by the specter of a campaign ad running, “Max Baucus says he’s for fiscal restraint, but as the Chair of the Senate Finance Committee…” In Montana that stuff can really hurt.As frustrating as these politicians can be, I still find myself vacillating between attitudes of optimism and pessimism. The whole process has been so confusing and long, it’s hard to really know whether to be hopeful or not.On the one hand, the Senate bill will be merged with elements of the House plans before going to final vote.On the other hand, we all know that the more conservative, less representative, filibuster-having Senate is where the real battle will be.The New Republic, a political magazine, offered an optimistic solution to salvage the public option.  While stopping the filibuster requires 60 votes, the actual bill only requires 50. Let democrats from more moderate states vote to end the filibuster but vote against the bill. Of course, that would require organization and discipline — from democrats. I think you see where the pessimism comes in.The most optimistic point that can be taken out of the debate is that reform need not end now. What we’re seeing is a major icebreaker. Social Security, Medicare and Medicaid were all extremely controversial when they were proposed. They’re now politically untouchable. Health care can be reformed gradually once the claims of a communist agenda seem pathetic next to the actual reality of reformed health care.Still, the Democrats will never have the chance to improve health care if they appear weak, easily bullied, and unorganized when 2010 rolls around.Whatever happens, one thing’s for certain — health care reform is going to be as convoluted and confusing as the process that created it.