LOSING OLD FRIENDS BEFORE FINDING NEW ONES…. For all the renewed sense of optimism and momentum surrounding health care reform, never, ever, overlook Democrats’ capacity to shoot themselves in the foot.

If health care reform stands any chance at all, it can’t afford to lose Dems who voted for reform when it came up in November. The task, at this point, should be investing time and energy into switching “nay” votes to “aye,” not convincing “aye” votes to finish what they started.

And yet, a non-trivial number of confused, craven Democrats are openly considering betrayal — and facing a razor-thin margin of error, the total is hard to overlook.

Rep. Steve Kagen (D) of Wisconsin voted for reform, and is now hedging.

“I have made the case to the speaker and also to the White House that we should take small pieces, small bites,” Kagen said. “In the practice of medicine, I can’t give a child a big pill. What do we do? We cut it up into pieces. Let’s find things we can agree on.”

I have no idea what that means, but it sounds pretty idiotic. Likewise, Rep. John Spratt (D) of South Carolina voted for reform, but is also considering betrayal. Rep. Jerry McNerney (D) of California endorsed reform in November, but sounds awfully close to a “no” vote now. And it’s not just these three.

Remember, all of these guys already voted for health care reform, and can only reap the reward if they follow through and deliver. Inexplicably, they seem ready to turn tail — hurting their constituents, their country, their party, and their own electoral prospects.

So, is it game over? Will the status quo and insurance companies win because, at gut-check time, Democrats found it easier to be cowards? We’ll see soon enough, but it’s worth emphasizing why each individual hint from every possible lawmaker may not be grounds for panic.

Ezra had an item today about why he doesn’t trust, and tends to ignore, stories about lawmakers hedging on reform.

Since I can’t see into the souls of legislators, I don’t waste time trying to parse this stuff. The final weeks before a close vote feature a lot of congresspeople making statements of unbending opposition and then cutting deals which turn them into qualified supporters of the legislation. This appears to be happening with Bart Stupak, for instance, even though he’s spent the past few weeks grabbing headlines with his vocal opposition to the bill. So my stance on all this is that we’ll know soon enough, but until there’s solid evidence, I’m not going to spend time chasing statements that may or may not mean what they appear to mean.

That’s entirely reasonable. But for those hoping to influence the outcome, and organize pressure on and cover of various wavering lawmakers, these public statements, at a minimum, signal who needs the most attention.

So, for example, when Steve Kagen in Wisconsin or Jerry McNerney in California signals their willingness to let the nation down and side with far-right Republicans on health care, it’s a signal that their constituents need to get in touch with them. It’s one thing for media professionals monitoring the debate not to overreact to every quote from every vacillating lawmaker, but for Americans desperate to see reform pass, overacting to discouraging quotes is very likely a good idea.

Also note the larger context here. Insurance companies and their allies are going for the kill right now, investing $10 million in a new round of vile attack ads, hoping to rally Americans to oppose legislation that the public desperately needs, while scaring Democrats into rejecting a reform package they’ve already supported.

If ever there was a time for health care reform supporters to give it all they’ve got, this is that time. A once-in-a-generation opportunity is on the line, and if supporters fail to fight, reform will very likely fail to pass.

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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.