As a number of commentators have pointed out, President Obama is rapidly approaching a key moment in the debate over health care reform. He has three basic options, with a number of alternatives within each.

First, he can double down on his current strategy, which is to let the congressional process take its course, probably toward a very liberal bill, with minimal (apparent) interference. In this case, he will hope that the fall’s planned advertising offensive will shift public opinion. After failing to persuade many congressional Republicans to sign on to the $1 trillion-plus big-government health bill, Democrats may push for an all-Democrat solution, which requires (among other things) ramming the bill through the Senate using reconciliation procedures that prohibit filibusters.

This approach must be very tempting to Obama and his party’s congressional leaders, and if the President is as much of an ideologue as he has seemed since January, it is what will happen. It is the path that holds forth the best prospect of victory for a bill closely resembling the bills that have emerged from four House and Senate committees.

It is a high-risk venture, however, in some ways that sober Democrats understand and in others that few have yet mentioned. Unless there is a profound shift in public opinion, Democrats will appear to be (and in fact will be) imposing a radical surgery that has not been approved by the patient. The debate over health care has illuminated important questions about the nature of representation—how much of a duty do representatives have to reflect the views and concerns of their constituents? What of their own convictions and judgment do the representatives owe their constituents in turn? However, there is little question that callous contempt for constituents does not fit inside even the Burkean "trustee" model, and we have seen too much of that this summer for the impression to be wiped away very easily.

Furthermore, Democrats will have full ownership of the product. Unless it ends up working considerably better in practice than it seems likely to, voters will not forget where the taxes, declining quality care, and six-month waits for angioplasties originated.

As well, the political disturbances already caused in and outside of Washington will be dwarfed by those to come. Already, Obama’s standing among independents has collapsed, hurt both by the left-wing substance of his domestic presidency and by the abrupt way Obama’s mask of "bipartisanship" has fallen. Contrary to Obama’s famed 2004 convention speech, it turns out that there is a red America and a blue America after all—it’s just that Obama doesn’t really recognize the red as being part of America.

Not least, the potential procedural gambit in the Senate may come back to haunt Democrats beyond merely enraging Republicans. It is a common mistake by parties in power to act as though they will always be in power. Imagine, though, the conservative policy revolutions—perhaps in Social Security—that would someday be possible with 51 Republican votes in the Senate. George W. Bush’s 2005 Social Security reform effort might have developed very differently had Harry Reid’s threatened filibuster been taken out of the game from the beginning. Both parties should hesitate at the prospect of changing so fundamentally the consensual role of the Senate as an institution.

All of this presupposes that the Democratic push actually succeeds. The final risk is that it will instead implode, as too many Blue Dogs bolt or too few Senate Democrats prove willing to eviscerate the filibuster. If Obama chooses this approach, there can be no guarantee that it will not end in failure.

Second, Obama might accede to the growing chorus calling on him to "start from scratch" and produce his own bill. This would almost certainly produce some big benefits at first, re-energizing the process, seizing a mantle of presidential leadership, and shaking up the debate. The downside would be that Obama would have to make some tough calls that he has been putting off (for example, to keep or dump the "public option"). While he would gain something in atmospherics here, commentators arguing for this approach seem to assume that the current congressional bills don’t actually reflect Obama’s preferences very well. But what if they do? (Indeed, that seems more likely than not.) Then the repackaging will be cosmetic only, and new momentum will likely be short-lived. If the President comes forth with a truly new approach that could gain assent in the center—some insurance regulations, creation of a national market for health insurance, modest subsidies for the uninsured, and some tort reform thrown in for good measure—he would signal a sharp break from the left. This would be better policy, and could be good politics in the long run. However, there are two considerable obstacles. The left has a stranglehold on the congressional Democratic Party, and Obama himself is, at his core, a man of the left. He moved to the center once before, in the summer of 2008, but we are no longer talking about words to get elected by; we are now in the realm of concrete action.

Finally, the President might decide that the best course is to declare that he has heard the concerns of the people and recommends that Congress suspend its legislative process. He could even appoint a Blue Ribbon bipartisan commission to come up with a recommendation. If he wants to reorient the debate, this would be a safer (that is, more risk-averse) option than forging ahead with his own new bill. It would cool emotions of opponents and the anxious undecided, and would appear as a triumph of peace and prudence over partisan steamrolling. It would provide the nation some breathing room for a more careful deliberation, and might also force Republicans to focus on a positive set of recommendations. It would be a highly unsatisfactory course from the standpoint of his strongest supporters, however, and could easily mean no health bill in Obama’s first (and perhaps only) term. It could be taken for granted that nothing would emerge until after the midterm elections; if those elections followed the usual pattern, with Republicans gaining seats, Obama would lose further leverage.

What would be best for the country? The third option, or perhaps the second, if it produces a genuine compromise. No bill is better than a really bad bill—that is to say, any of the bills currently circulating—and the most difficult question will be to ascertain at what point a bill is so much improved that it has become better than nothing. What seems most likely for Obama to select? The first option, or perhaps the second, if it is a repackaged boondoggle. It will tell us something about the future of Obama’s presidency if this disjunction plays out in actuality.

Andrew E. Busch is an Adjunct Fellow of the Ashbrook Center, Professor of Government at Claremont McKenna College, and Ann and Herbert W. Vaughan Visiting Fellow at the James Madison Program in American Ideals and Institutions at Princeton University.