The problem is in the House, not the Senate.

Pelosi needs to pick up roughly a dozen votes to pass health reform. Where will she get them? It would make sense to start with Rep. Dennis Kucinich, D-Ohio, and Eric Massa, D-N.Y., who voted against health reform last fall because they thought the bill was too conservative. Kucinich probably knew when he cast his nay that it wouldn't decide its fate. Might he be willing to rescue it now? Apparently not. Kucinich told the Wall Street Journal last week that Obama's proposal "starts with a wholly unacceptable Senate health care bill and, with a few exceptions, continues to make it worse. It's a much better bill for insurance company investors than it is for the American people." Maybe she'll have better luck with Massa, but I wouldn't bet the farm on it; Massa used his nay vote to raise campaign funds among single-payer supporters.

Next there are House Democrats who are retiring. Rep. Bart Gordon, D-Tenn., voted for the bill in the Energy and Commerce committee before he voted against it on the House floor. Also retiring are John Tanner, D-Tenn., and Brian Baird, D-Wash. They voted against health reform, too. The theory goes that if these three no longer have to run for re-election, maybe they'll support health reform as a favor to Pelosi. But if they no longer plan to serve in the House, what practical reason would any of them have to do Pelosi any favors now?

The least promising recruiting pool of all are the conservative Democrats who voted against the bill. Arguably last week's bipartisan meeting at Blair House (morning session, afternoon session) was held entirely for their benefit. But are they grateful? Don't count on it. After the November House vote, the New York Times assembled a very revealing chart that showed no fewer than 31 of the 39 House Democrats who voted nay represented districts that went for John McCain in the 2008 presidential election. Subtract Gordon, Tanner, and Baird, and you're left with five potential targets: Scott Murphy, D-N.Y.; Glenn Nye, D-Va.; Larry Kissell, D-N.C.; John Barrow, D-Ga.; and Artur Davis, D-Ala. 

Let's assume Pelosi picks up all five. She's still short by about six votes. Let's suppose she picks up all five, plus the three retiring members, plus the two dissenting liberals. (That isn't going to happen.) That's 10 votes, which still probably isn't enough.

This is why I wrote the pope to request he give health care reform a papal dispensation. Without one, the bill will almost certainly fail.

Update, 9 p.m.: I may be too optimistic when it comes to Davis, who is running for Alabama governor. The blogger Daniel Nichanian says that makes him a lost cause. Nichanian also thinks that Rep. Marion Berry, D.-Ark., a retiring member who voted yea, may switch to nay because he's pissed off  at the White House. I think that's unlikely. In general, Nichanian seems a smidgen more optimistic than me about the bill's prospects. His rundown has a lot of excellent fine-grained detail. Charles Babington of the Associated Press has another helpful rundown identifying as possible yeas 10 of the 39 Democratic nays from November. But to get into that category, all you had to do was decline to state your position (though some affirmatively called themselves, or had their spokespeople call themselves, undecided).

Update, March 2: Hoyer proposed an alternative sequence  today. The House would still vote on reconciliation before the Senate (as it's apparently bound to by law). But it would vote on reconciliation first. ThentheSenate would pass reconciliation. Then, and only then, would the House vote for the Senate version of health care reform. In effect, it would come pre-amended. This works great from a strategic point of view (the House doesn't have to accept "trust me" assurances from the Senate), but would it pass parliamentary muster?

Update, March 3: Add Massa to the roster of retiring Democrats who voted against health reform. Massa says he won't seek re-election because he's had a recurrence of non-Hodgkins lymphoma. Politico suggests another reason may be a House ethics committee investigation of allegations that he sexually harrassed a male staffer. Massa's retirement loosens his obligation to pro-single-payer contributors who gave to his campaign based on his opposition to health reform from the left. Conceivably an ethics committee investigation will make him more pliant to Pelosi's wishes. But the fact that he won't run in the fall means he has little long-term reason to do Pelosi any favors, and since his opposition appears 100 percent based on principle, his retirement may have little relevance.

Update, March 5: Gordon is starting to sound  like he'll switch from nay to aye. So is  Rep. John Boccieri, D.-Ohio. But on the minus side, Deal, the Republican who was going to quit effective March 8 to run for governor of Georgia, was persuaded by the GOP caucus to remain until the health reform vote. That prompted Michael Tomasky to observe ruefully, on his Guardian blog, that the Democrats don't have anything like the Republicans' party discipline. Indeed, Abercrombie, the Democratic yea vote who quit to run for governor of Hawaii, didn't even show up  for his going-away party!

Update, March 5, 4:30 p.m.: Massa, the nay-voting Democrat who earlier this week said he wouldn't run again, has now moved his departure date up  to next week. Democratic leaders may not be good at getting departing Democrats they'll need on health reform to stay, but apparently they aren't too bad at persuading Democrats voting against them on health reform to get lost! Massa's district is pretty Republican (weird, because Massa's pretty left; maybe his being a career Navy officer helped) but it's doubtful a special election will replace him before the health reform vote. So Massa's departure almost certainly means the Democrats will need one less vote to prevail.

Correction, March, 5, 2010: An earlier version of this column failed to account for the fact that these dozen votes include Stupak and Cao. The numbers have been adjusted accordingly. (Return to the corrected passage.)

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E-mail Timothy Noah at chatterbox@slate.com.