By Earl Ofari Hutchinson, New America Media

President Obama, House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid, key House and Senate Democrats and Republicans, and most importantly the major pharmaceuticals and private insurers know one thing, and they've known it from the start of the health care debate: The Senate, not the House, will decide what, if any, health care reform plan is finally approved.

The pharmaceuticals and private insurers have repeatedly and forcefully made it clear that they flatly reject a true public option, any enforced restrictions on their right to charge whatever the freight will carry for health care, or dump or summarily exclude anyone who's too sick, poor, or too old from coverage. They also made it abundantly clear that they'll only accept a bill that requires millions to be covered by them at government (taxpayers) expense and that slaps penalties on those who refuse to go along with it.

The full enactment of the main provisions of whatever health care bill is passed won't take place for nearly another decade, and that gives private insurers time to hike prices to cover any added costs in policy and coverage changes they must make under reform. They've fielded an army of lobbyists, health insurer flacks, held secret deal-cutting meetings at the White House, stuffed millions in the campaign coffers of leading Democratic senators (including one time senator Obama), and poured more millions into ads and planted articles to get their way.

The Senate, and even more specifically, the Senate Finance Committee, has been the target of the insurers' relentless, prolonged, and well-oiled campaign to get the most generous industry health care plan possible, or no plan at all. Their time, effort and money has been well-spent. The finance committee quickly killed the public option, slapped penalties on non-buyers, and imposed no tough regulations to compel the private insurers to keep their bargain to insure everyone. It did not impose tight cost-containment measures to insure that private insurers keep their prices down.

Senate leaders did not raise a peep at the crude, naked blackmail threat by America's Health Insurance Plans, the private health insurance industry group. It publicly waved around a study it commissioned that claimed that private insurers would have to sharply increase the prices families would pay if the House version of the health care reform plan passed.

The actual House vote is far from the great victory that Pelosi and Democratic leaders declared. The Democrats had a crushing majority, had poll after poll that showed the public wants a real public option and full affordable health coverage for all, and no cuts in Medicare services (the cuts are in the House and Senate bills). Yet, the House bill still barely squeaked through and then only after Pelosi and other House liberals shamefully back pedaled and excised abortion coverage from the bill. This all guaranteed that the resistance to the most liberal provisions of the House bill will be even more ferocious in the Senate.

Even if none of these factors came into play in the Senate, the Senate still more often than not has been the graveyard for House passed legislation that the Senate considers too liberal, too pro labor, too expansive, too costly, and too non-industry friendly. In the past couple of years, the Senate has killed House bills to toughen energy standards, to scale back contributions to the IMF, increase education spending, and decrease war spending in Iraq and Afghanistan. Ditto immigration and major banking reforms. It also bottled up for years the House's expanded hate crimes bill.

Industry groups dead set against the House bill have one more trump card, and that's the conference committees. The Senate can amend, change the language, or red pencil out anything in a House bill. It then tosses it back to the House to amend, change the language or excise things that the Senate wants tossed out. The conference committee negotiations on controversial legislation are long, tedious and drawn out. When or even if agreement is ever reached, it then goes back to both the full body of the House and Senate for a vote. There's no time frame for completion for any of this. Nor is there any requirement the Senate take a final vote. This was the case with other pieces of "landmark" bills the House passed.

The House vote on health care reform was historic only in that one body of Congress took the hotly contested first big step toward reform. The Senate hasn't spoken. And it, not the House, is the name of the game on health care reform.

Earl Ofari Hutchinson is an author and political analyst. His forthcoming book, How Obama Governed: The Year of Crisis and Challenge (Middle Passage Press) will be released in January 2010.