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WASHINGTON - Moderate Democrats in the U.S. Senate were threatening to scuttle health-care legislation if their demands aren't met, while more liberal members warned their party leaders not to bend.
The dispute among Democrats foretells of a rowdy floor debate next month on legislation that would extend health care coverage to roughly 31 million Americans, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally.
Republicans have already made clear they aren't supporting the bill.
Final passage is in jeopardy, even after the chamber's historic 60-39 vote Saturday night to begin a full debate after lawmakers return from a recess for Thursday's Thanksgiving holiday.
"I don't want a big-government, Washington-run operation that would undermine the ... private insurance that 200 million Americans now have," said Sen. Ben Nelson, a conservative Democrat, said Sunday on ABC television.
The United States is the only developed nation that does not have a comprehensive national health care plan. Nearly 50 million of the country's more than 300 million people are uninsured. The government provides coverage for the poor and elderly, but most Americans rely on private insurance, usually received through their employers.
Nelson and three other moderates - Democratic Sens. Mary Landrieu and Blanche Lincoln and independent Joe Lieberman - agreed to open debate despite expressing reservations on the measure. Each of them has warned that they might not support the final bill.
One major sticking point is a provision that would allow Americans to buy a federal-run insurance plan if their state allows it. Moderates say they worry the so-called public option will become a huge and costly entitlement program and that other requirements in the bill could cripple businesses.
"I don't want to fix the problems in our health care system in a way that creates more of an economic crisis," Lieberman told NBC television Sunday.
The sway held by such a small group of senators has annoyed their more liberal colleagues, who could vote against a final bill if it becomes too watered down.
Sen. Sherrod Brown said he didn't think rank-and-file Democrats would feel compelled to go that far. At the same time, Brown warned Democratic leaders not to make too many concessions.
"I don't want four Democratic senators dictating to the other 56 of us and to the rest of the country - when the public option has this much support - that (a public option is) not going to be in it," Brown told CNN on Sunday.
The Senate bill would require most Americans to carry insurance and provide subsidies to those who couldn't afford it. Large companies could incur costs if they did not provide coverage to their work force. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage on the basis of pre-existing medical conditions.
Congressional budget analysts put the legislation's cost at $979 billion over a decade and say it would reduce deficits over the same period while extending coverage to 94 per cent of the eligible population.
The House of Representatives approved its version of the bill earlier this month on a near party-line vote of 220-215.
Sen. Dick Durbin, the No. 2 Democrat in the Senate, said the health care bill must be passed by the end of the year so that President Barack Obama and lawmakers can shift their attention to the economy and improving employment rates.
Such a timeline also would enable Obama to claim victory on a major domestic priority when he delivers his State of the Union speech in January.
But with one-third of Senate seats up for election in 2010, politics will factor heavily into the outcome of the debate on health care.
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Associated Press writers Lolita C. Baldor and Philip Elliott contributed to this report.
