The small-town Democrats, however, worry about the cost and the government's reach. The 52 members of the House's conservative Blue Dog Coalition have threatened to derail any plan with a public option unless costs are reined in.
Last month, five Democrats on the House Energy and Commerce Committee, including Melancon, opposed the leadership's overhaul bill, saying he feared it would wound the private sector and help encourage publicly funded abortions.
Waxman insisted the 31 Democrats voting for the bill represented a broad coalition of "conservative, moderate and progressive Democrats." Passage came only after four conservative Democrats won changes in the bill they considered more fiscally responsible.
"We came to the table wanting to squeeze out costs," said Rep. Mike Ross, D-Ark.
However, the conservatives realize that more may have to be squeeze out to win eventual congressional approval, which is why many embrace the idea of co-ops.
Conrad's plan would have Washington "guide the creation of co-ops by setting standards and providing the seed money," though just how much is unclear.
To a lot of urban lawmakers and their constituents, the co-op concept is foreign.
"I don't think cities understand co-ops as well as rural areas and the South where cooperatives are prevalent," said Donna Christensen, a Democratic delegate from the U.S. Virgin Islands and a physician.
A lot of analysts think these differences can be resolved. The political problem isn't among Democrats, said Eric Davis, a political science professor emeritus at Vermont's Middlebury College.
"Co-ops aren't an option because Republicans will never approve it and Democrats may hold their nose and support it, though they would prefer a public option," he said.
Pollack added "there's a good case to be made" that the regional differences are slight. Lawmakers have agreed to many changes in health care — Dodd estimates there is agreement on about 80 percent of the proposals.
It's that other 20 percent that's proving problematic, however, and much will depend on whether the warring sides of the party can come together.
"There are three political parties in this country — Republicans, Southern Democrats and the rest of the Democrats," said Thomas Whelan, associate professor of social science at Boston University. "And the Southern Democrats are always in play. They have enough people that they have leverage."
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