The issue is reform of health care delivery in the USA.
It has been well established that the present system is unacceptable and unsustainable. More than that, it is a barbaric and destructive attack upon the American middle class, including unavailable insurance, unaffordable insurance, non-portable insurance, denials of coverage, discriminatory pricing against the uninsured, and a billing jungle.
On the other hand, the present system has been a profit bonanza to the insurance companies and the major pharmaceutical companies. Why is that a major impediment to reform? Because money speaks loudly in the Congress of the USA. There will be a lot of scary ads and a lot of "principled" talk opposing the federal option. It is really all about the money.
We shall soon see, in the votes for cloture in the Senate and in the votes for passage, who owns whom. It may be that the outcome will be a certainty, given the Democratic super-majority. If passage should fail, there will be a political firestorm in 2010.
Many people have been, and will continue to be, conned into voting against their own interests. That is not so likely to happen when the results are financial ruin, foreclosures, disability for health reasons, or premature death.