I’d love to be wrong, but health care reform is dead.

I know, I know, the process is not over. In a week or so there will be a flurry of activity when Senate Majority Leader Harry Reid brings a compromise bill to the floor. There will be starts and stops and a pitch for 60 votes. There may even be enough to pass a bill of some kind.

But consider the process. I smile when I think of legislative “process” because I remember the cartoon from my youth, Schoolhouse Rock, where the bill itself explains the odds against it by saying, “I may die.” That phrase is the key to understanding the legislative maze: There are far more ways to kill a bill than to enact one. Every step through that labyrinth requires choices designed to attract enough votes to make one more step.

Such was the case in the House of Representatives when it voted to prohibit either a government insurance program or a private one that accepts government subsidies from spending money to cover abortion services. This was considered critical to passing the bill because so many Democrats who were anti-abortion rights said it was either this or no bill. It worked: The House passed H.R. 3962 by five votes, 220 in favor, 215 against. Even then, nearly 40 Democrats were on the “nay” side, including South Dakota’s Rep. Stephanie Herseth Sandlin. She told the Rapid City Journal: “I think they’ve had a sense, just as they did on other legislation, that my priorities for South Dakotans were not being adequately addressed.” But she should have qualified her statement to read: Some South Dakotans because her no vote also was a rejection of the Indian Health Care Improvement Act.

The thing about Congress is we don’t know the real strength of the Democratic vote. Once the leadership had enough votes to ensure passage, they likely let members in swing or Republican districts vote the other way for show. The idea is it will help them preserve their jobs (and a Democratic majority).

But the real change in the debate was the abortion amendment. There had been a truce keeping abortion rights at status quo. The sponsors of health care reform picked this approach early. President Obama said in August: “You’ve heard this is all going to mean government funding of abortion. Not true.” The thought was the Hyde Amendment prohibiting the use of federal funds for abortions would stay firmly in place.

That was true until the congressional vote last week. Now the House bill is even more restrictive on abortion rights than any federal program or on current health insurance policies for federal employees. It’s particularly important in 17 states that permit the use of state Medicaid money for reproductive health, including abortions.

If the politics of this looks familiar it’s because the abortion debate is why the Indian Health Care Improvement Act failed last year. Sen. David Vitter, R-La., added an amendment to explicitly restrict abortion, ultimately dooming the bill. Leaders in the House wouldn’t even take up the bill after that amendment passed.

Vitter said he did this to block “legislative loopholes” that permitted some abortions in the Indian health care system. “It is time for that to change,” he said, “and it is time to finally close this loophole.”

But what Vitter really did was to demonstrate that he and his allies are willing to sacrifice anything – including health services for American Indians – in order to score points on the abortion issue. His amendment was called a poison pill. It’s still there – and is now why health care reform is over.

The good news, the hope, is that health care reform will surface again and again until it does pass. The combination of economics and demographics will continue to drive reform legislation forward. It might even be better next time because there will be many, many more reasons to go further.

I’d love to be wrong, but health care reform is dead.

Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment at www.marktrahant.com.