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What happens to healthcare if the Republicans take the Massachusetts senate seat?

It would be a blow to lose the seat that was Teddy Kennedy's for years, in Democratic hands ever since JFK took it in 1953. It would be worse coming just as Obama celebrates a year in office.

But this is not just a symbol. It would have huge political impact.

It would deprive Obama of the 60 votes he needs to stop a filibuster in the Senate, creating serious implications not only for healthcare but also environmental legislation and any other new laws the president might want.

If the Republicans win, none of the options for healthcare reform are palatable for the president and all carry considerable dangers.

These are how I see them:

• Speed up the merger of the House and Senate bills and push it through the Senate before Scott Brown takes his seat.

Downside: it looks grubby and plays into the hands of Republicans arguing Obama is forcing health care down people's throats.

• Get the existing Senate bill through the house.

Downside: this depends on the House voting for it. Democrats who are liberals or anti-abortionists don't like the bill as it stands. Those in vulnerable seats may be put off backing healthcare reform at all by the Massachusetts result.

• Change the votes of a couple of Republicans in the Senate.

Downside: not a single Republican voted for the bill at Christmas and it is hard to see what would change their minds now.

• Admit defeat: the Democrats could argue they did all they could to carry out Obama's mandate, got further than ever before, but were stopped by Republicans.

Downside: it is accepting defeat on a major part of the president agenda. It just looks dreadful.

• Make the mid-terms a referendum on healthcare: simply a politically bold way of the above. Argue that the people have an opportunity to get rid of the Republican road block in November.

Downside: it would certainly give the mid-terms a real focus. But it is too bold, too dangerous. The danger for Democrats is that the people would vote against them and against reform, turning a defeat into a self-created disaster.

There will also be talk among left wing Democrats of the Senate being a drag on change - as indeed it is meant to be constitutionally - and changing the rules on filibuster. But is a long term solution.

I can't see any other options.

But political brilliance consists of cutting your own swathe.

A commando recently told someone I know how to enter a potentially booby trapped house: "Don't use the door. Blow yourself a new door."

Good advice for the president, perhaps.

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