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Here's a good indicator of just how free-wheeling the health care debate is right now. There's a serious effort underway to bring back the public option. The idea of a government-run health insurance plan has died and come back several times during the health care saga. People who want to resurrect it now point out there's still wide support among the public and this time it would take fewer votes to pass in the Senate.

NPR's David Welna has this update.

DAVID WELNA: Speaker of the House Nancy Pelosi has long been a supporter of the public option, which was in the health care bill the House passed last year. But that bill went nowhere, and instead it's the Senate's health care bill with no public option - that's made it to the final round of the health care prize fight.

Late last year, Senate Democratic leaders got rid of the public option they had in their bill to sew up the 60 votes it needed to pass. But now that Congress is using an expedited procedure known as reconciliation to finish the health care bill, only 51 votes are needed to get a revised version of that bill through the Senate. But first that revision has to pass in the House, and that's why some are demanding that Pelosi put the public option in the revised bill.

Asked about that a few days ago, she showed little inclination to do so.

Representative NANCY PELOSI (Democrat, California; Speaker of the House): We're talking about something that is not going to be part of the legislation, so why don't we talk about what is going to happen? Because I'm quite sad that a public option isn't in there. It isn't in there because they don't have the votes to have it in there, or they would have had it in there to begin with.

WELNA: That's an argument supporters of the public option aren't buying. To challenge Pelosi's contention that the Senate doesn't have the votes to pass a bill with the public option in it, several activist groups are airing this ad today on MSNBC and CNN in Washington, D.C. and San Francisco, Pelosi's home district.

(Soundbite of TV ad)

Ms. ARIANNA HUFFINGTON (The Huffington Post): We have 41 Democrats who said they'll vote for it.

Unidentified Man: Obviously I want the public option.

Unidentified Woman: Those who want to make sure we have no public option, I don't think that's going to happen.

WELNA: The ad is an exercise in political math: It tallies 41 senators who've pledged to support a bill with a public option with 10 others who've expressed support for it in the past. That's a total of 51 the exact number of votes needed for final passage in the Senate.

Adam Green is co-founder of the Progressive Change Campaign Committee, one of the groups sponsoring the ad. He still hopes Pelosi can be swayed into adding the public option.

Mr. ADAM GREEN (Progressive Change Campaign Committee): That's what grass-roots pressure is all about; every day, thousands of people are calling Congress saying we want a public option. Nothing is final until it's final, and the public option has been declared dead so many times, it's hard to count. But every single time, a grass-roots uprising has put it right back on the table.

WELNA: The senator who last year demanded the public option be stripped from the health care bill before he'd vote for it was Connecticut Independent Joe Lieberman. He says putting it back in the health care legislation would be a mistake.

Senator JOE LIEBERMAN (Independent, Connecticut): I mean, the fact that they removed the public option was very important to me and I think a lot of other senators here.

WELNA: Even some senators who support the public option oppose its revival. West Virginia Democrat Jay Rockefeller is one of the senators the TV ad says is a potential yes vote.

Senator JAY ROCKEFELLER (Democrat, West Virginia): They're on the mark in saying that I'm for it, but they miss the larger point, which is that it would take down the passage of health care.

WELNA: Other senators, though, are bent on resuscitating the public option. Oregon Democratic Jeff Merkley says if the House doesn't add such a measure, he'll offer an amendment to add one when the Senate takes up a final bill.

Senator JEFF MERKLEY (Democrat, Oregon): There are going to be many folks who are going to hang back from the debate until they're forced to a vote, and so sometimes you need to go forward with a vote. Democracy requires that you declare your position, and sometimes that requires a vote to make that happen.

WELNA: But the Senate's Number 2 Democrat, Dick Durbin, who personally supports the public option, is urging colleagues to vote against adding one to the bill the Senate would receive from the House.

Senator DICK DURBIN (Democrat, Illinois): We have to tell people: You just have to swallow hard and say that putting an amendment on this is going to stop it or slow it down, and we just can't let it happen.

WELNA: In the end, caution may rule. Too much is riding on the bill, Durbin says, to risk it sinking under the added weight of a public option.

David Welna, NPR News, the Capitol.

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