The Cardinals beat the Packers on Sunday in the sudden flash of a fumble; within seconds, the game was over. Teams can’t afford to fumble in sudden death overtime. So it is with health reform. I still think it will pass. But we’re now in overtime, and the GOP will do anything to force a fumble and kill the bill. In reality, the greater danger comes from Democrats themselves; there are three late-game risks that could deliver a mortal blow to health reform.

First is the controversy over abortion. It’s roiled the debate from the start; but over the Christmas break, Michigan Democrat Bart Stupak, who voted for the House version of reform, issued a threat via the front page of the New York Times to oppose legislation that includes the Senate abortion compromise, which is less draconian than his own amendment. The original House bill passed by only five votes. Stupak claims he has 10 House members prepared to follow his lead and switch if the Senate language isn’t changed. In effect, he’s said he won’t settle for anything less than a system that, in the guise of denying public funding for abortion—something the Senate bill actually does—also prevents Americans from purchasing abortion coverage with their own money.

Stupak noted that his position was a product of his Roman Catholic faith. This is a simple-minded reading of the relationship between religion and the public sphere. As both Ted Kennedy and Mario Cuomo argued a generation ago—Kennedy in the lion’s den of Jerry Falwell’s Liberty Baptist University, and Cuomo at the Catholic stronghold of Notre Dame—in a free and pluralistic society, not every command of faith can be written into secular law. Otherwise, for example, the Catholic bishops might be pushing to outlaw divorce—a cause for which they have lobbied in other countries.

Here in America, the bishops have been unable to persuade a majority to ban abortion. It’s not for lack of trying; they’ve become overt political actors—assailing John Kerry in the 2004 campaign and Joe Biden in 2008 because both are Catholics who refuse to subordinate their judgments on public policy to church doctrine.

This is a long way from the commitment John Kennedy, the first Catholic president, offered during his 1960 campaign—to "an America where no public official requests or accepts instructions...from...any...ecclesiastical source, where no religion seeks to impose its will directly or indirectly on the public acts of officials." Half a century later, the bishops are attempting to achieve by indirection what they cannot achieve outright—a partial ban on a woman’s right to choose. Having abetted thousands of priests in molesting children, they’re now set on abusing health reform.

All this not only transgresses the line drawn by JFK in 1960; it’s also at odds with the social teachings I learned in Catholic school. The bishops would deny health coverage to more than 30 million Americans by blocking a compromise that plainly spends no taxpayer dollars for abortion services. Stupak echoes their hard line. If health reform goes down, he said, "it’s not the end of the world." (Certainly not of his world; he won’t be giving up his own generous congressional health insurance coverage.) 

If the Senate compromise—negotiated by pro-life senators like Bob Casey—finally prevails, and I’m convinced it will, I doubt that all of Stupak’s 10 Democratic colleagues will actually defect. But some probably will, and with few votes to spare, Speaker Nancy Pelosi will eke out a new majority with support from Blue Dog Democrats who objected to other elements in the original House version —including the public option, which has been eliminated, and the overall cost, which has been reduced. Despite right-wing caricature, Pelosi has proved her legislative mastery before and may have to do so again.

I wouldn’t bet against Pelosi and the president. Representative Raul Grijalva, the co-chair of the Progressive Caucus, threatened in December: "Without a public option...this bill is not worth supporting." That purist rhetoric is perhaps psychically satisfying, but in the end it’s unrealistic. It’s beyond belief that, when the roll is called, congressional liberals will commit self-righteous suicide by slaying their own cherished goal of reform, even if they regard the ultimate product as imperfect. Losing the fight would be a devastating blow to Democratic prospects in the midterm elections and to any hope for major progressive change during the rest of Obama’s first term. That’s almost certainly why liberals will swallow hard instead of letting their version of the perfect become the enemy of the good.

To win, the president, Pelosi, and Senate Majority Leader Harry Reid will have to conciliate organized labor, which bridles at the Senate bill’s tax on so-called "Cadillac" health plans. The back and forth here won’t be easy either; but the last thing the unions want is to see another Democratic administration forced into triangulating away its best aspirations after a midterm Republican resurgence.

Third, and finally, there’s one challenge that could force the House to accept the Senate version without a single change. Conceivably —or almost inconceivably—Democrats could lose their hold on 60 Senate votes if Martha Coakley, the Massachusetts attorney general who’s the Democratic nominee for Ted Kennedy’s seat, manages next Tuesday to snatch defeat from the jaws of victory. After winning the nomination, Coakley’s lackluster effort has offered little or no compelling message relevant to the Senate. Suddenly, in recent days, she appeared to be in trouble. Polls have been all over the lot—one even had her Republican opponent leading by a point—but have improved since last week when Vicki Kennedy, former Congressman Joe Kennedy, and interim Sen. Paul Kirk entered the fray to give her campaign some new life and energy. Democrats are preparing to turn up the heat on Coakley’s opponent and turn out their lukewarm voters. They now calculate that even if most undecided voters break against Coakley, she’ll still probably win by seven to 10 points—a relatively narrow margin for a Democrat in Massachusetts.

If Ted Kennedy’s seat stunningly falls to someone committed to vote against what he called "the cause of my life," there would be only one path forward for health reform, assuming lockstep Senate Republicans continue to obstruct the way. The Senate bill would become law if the House simply passed it without change. For House members, this would entail costs in pride and in policy—and amid the aftershocks of a Senate defeat in Massachusetts, some very nervous Democrats would have to hold their nerve. Thankfully, this is a test they probably won’t have to pass.

"We’re almost there," Kennedy said of health care last summer. In the fraught and final mile, I believe the Congress will finish its work. Winning in sudden death overtime counts just as much as a swift and comfortable victory. But we may have to hold our breath as history is made.