The intense and often bruising health care debate has exposed a deep divide in the House between the Blue Dog and progressive blocs of the Democratic Party. But is it insurmountable?

Wisconsin Rep. Tammy Baldwin, a leading progressive, and Pennsylvania's Jason Altmire, a Blue Dog whose district went for Sen. John McCain last fall, can at least agree that Congress will probably pass health care reform this year.

The two spoke at a breakfast event at the Charlie Palmer steakhouse in Washington moderated by Atlantic Media Political Director Ronald Brownstein and sponsored by National Journal and United Technologies.

While the two lawmakers expressed cautious optimism that a bill would pass, they had different priorities for what that bill would contain. Baldwin, who has been an advocate of a single-payer system, emphasized the need for a public insurance option. Altmire said that the House bill, as it stands, doesn't include enough cost-control provisions or help for small businesses, and he balked at the income tax increase to cover health care costs. He does not support the bill coming out of the Education and Labor Committee, on which he sits, and signaled that he may vote against it on the House floor as well.

"When you have a bloc that says, 'We can't support this unless...,' that's a huge amount of leverage," Baldwin said, referring to the Blue Dogs. She suggested that the Progressive Caucus would be less willing to take a similarly hard line. "But we have to come together since it appears that we can't rely on any Republican votes on final passage," she added.

Baldwin said that some of Altmire's concerns, including those about effects on small business, had already been addressed in the markup of the House Energy and Commerce Committee, of which she is a member.

Baldwin and Altmire did show where Democrats' positions align. Both agreed that a coverage mandate was necessary, and both expressed reservations about implementing parts of the malpractice tort law reform proposed by President Obama in his recent joint address before Congress.

Though Altmire said that the public option isn't his "line in the sand," he indicated that he could support it and that it would help lower costs for consumers by providing competition, especially in areas of high market concentration. He and Baldwin agreed that the issue of competition is important and too-little discussed. "If you don't have a public option at the end that's going to bring down costs, we are going to need another way," Altmire said.

Neither was optimistic about the House bill making it intact through conference with the Senate. Baldwin guessed that there would be a provision for a state-by-state public option in the final bill. Altmire predicted that there will be a trigger for the public option. Altmire's chief complaint about his own chamber's bill was the inclusion of a surtax on the wealthy. But he said he didn't expect that provision to make it through, and he signaled that excluding it would allow him to vote for the final bill.

When asked to name the biggest obstacle to passage, Altmire responded, "the Senate." Baldwin noted that the Finance Committee bill still needed to be reconciled with the HELP Committee's version. "They almost need a conference in the Senate to cobble it out," she said.

At the root of the discussion was a common belief that the need, both politically and otherwise, to pass health care would override differences in opinion. While Baldwin and Altmire acknowledged the potential for negotiations to melt down, they said there was a more than 50-50 chance Congress would present the president with a bill by the end of the year. "The worst would be to pass a bill that makes it worse," Altmire said. "But a close second is to pass nothing at all."

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