NOW WHAT?…. Thanks to Sen. Joe Lieberman’s (I-Conn.) latest betrayal, the health care reform bill that appeared to be a likely victory is now very much in peril. A Senate Democratic aide conceded to the NYT that Lieberman’s decision to reverse his position “leaves us in a predicament as to what to do.”

Sam Stein summarizes the available alternatives, none of which holds much promise.

The first is to convince the senator to support Democrats in breaking a Republican filibuster before casting a vote against the bill. This would allow for the legislation to pass with Lieberman still registering his opposition. Lieberman, however, has said he considers the procedural vote to cut off debate to be of the same significance as a vote on the bill itself.

The second path is to try and pick up a Republican moderate. But this too seems unlikely, as Sen. Olympia Snowe (R-Maine), Reid’s best bet, has also expressed opposition to the Medicare buy-in provision.

The third path would be to appease Lieberman and wipe the provisions that he deems controversial from the bill. This, however, would likely lose Reid several progressive votes — advancing the cause no further.

The final path would be to try reconciliation, the parliamentary procedure that would allow Democrats to pass chunks of health care reform by a simple up or down vote. There are a host of hurdles that come with going down this route, including questions over what, exactly, could be passed. And both the White House and Reid’s office seem hesitant to use the procedural tool, even after Lieberman’s latest round of opposition.

The first isn’t going to happen. The second offers little hope — even if Snowe could be convinced on the Medicare buy-in, Dems would still be a vote short in light of Ben Nelson’s opposition.

Reconciliation continues to bring its own complications, most notably months of additional delay (limiting Congress’ ability to move on the rest of its agenda), the likelihood of having to break the bill apart, the unpredictable whims of the parliamentarian, the need to still get 60 votes on non-budget-related provisions, and the expiration date that comes with reconciliation (the notion of doing all of this again in 2015 is unappealing).

Which leaves the third alternative: pass the reform bill with no Medicare buy-in and no public option. Given how new the Medicare buy-in provision is — it wasn’t part of the equation until six days ago — Lieberman’s betrayal more or less brings us back to where we were two weeks ago, which is where we were two weeks before that, and two months before that.

The nation needs a health care bill. If it includes a public option, it can’t overcome a Republican filibuster and the bill dies. If it doesn’t include a public option, it can’t overcome opposition from the left and the bill dies. Countless Americans will continue to suffer; costs will continue to soar; the public will perceive Democrats as too weak and incompetent to act on their own agenda; the party will lose a lot of seats in the midterms and possibly forfeit its majority; and President Obama will have suffered a devastating defeat that will severely limit his presidency going forward. No one will even try to fix the dysfunctional system again for decades, and the existing problems will only get worse.

So, what happens next? Your guess is as good as mine.

Steve Benen

Follow Steve on Twitter @stevebenen. Steve Benen is a producer at MSNBC's The Rachel Maddow Show. He was the principal contributor to the Washington Monthly's Political Animal blog from August 2008 until January 2012.