The most controversial US domestic policy debate – how to reform a healthcare system that currently leaves 47 million people uninsured – is at a crucial crossroads as President Barack Obama and congressional lawmakers prepare to return to work.

Though Obama has not proposed a specific plan, he has pushed Congress to draft legislation meeting criteria that would dramatically overhaul the US health system – including the introduction of a government-run insurance option.

But the recent death of Edward Kennedy, a long-serving senator who called healthcare “the cause of [his] life”, has added new urgency to reform efforts, bringing into focus various possibilities of how stalemate-locked Democrats and Republicans might proceed.

A more civil debate?

This summer has seen the healthcare conversation reach an unprecedented pitch of partisan vitriol: Republican voters furious at the idea of a more active government role have brandished banners ranging from "Hands Off My Healthcare" to "Impeach the Fascist," and have come to blows with reform supporters. Many Democrats blame conservative talk show hosts and high-profile Republicans like former Governor Sarah Palin for stoking the fires by charging that Democratic reform would amount to a Socialist takeover. Opponents to reform also claimed that the result of a publicly funded service would be huge debt and poor care, pointing to Great Britain's National Health Service (NHS).

But Kennedy had friends on both sides of the political aisle, and some hope that the passing of a beloved proponent of healthcare reform will, as Democratic Senator Robert Byrd said, “stop the shouting and name-calling” and lead to “a civilized debate.”

Others say Kennedy was uniquely qualified to generate the broad support Obama would need to achieve his goal of bipartisan healthcare legislation. Republican Senator Orrin Hatch, whose friendship with Kennedy yielded notable legislative collaborations, remembered him as “willing to compromise” in order to get things done.

Yet despite cross-party affection for Kennedy, Republicans signing on to healthcare reform seems unlikely given their constituents’ increasingly incendiary demonstrations. US political commentator and correspondent for “The Nation” Ari Melber says such protests “have clearly united Republicans and strengthened their resolve.”

Ironically, though healthcare reform has galvanized Republicans against Obama, it hasn’t necessarily helped their case. Melber explains that staunch Republican opposition has only resulted in White House and congressional Democrats being “more focused on a party line vote than at any other time in this process.”

Democrats’ renewed determination

In light of hardening Republican positions and the death of a cherished ally, Democrats are poised to abandon bipartisan negotiation and push through reform using their majority weight.

Some on the left see passing healthcare reform now as an important homage to Kennedy. "Ted Kennedy’s dream of quality healthcare for all Americans will be made real this year because of his leadership and his inspiration," Democratic House Speaker Nancy Pelosi said hours after his death.

But there are divisions in Democratic ranks, particularly over the public health insurance option championed by Kennedy and considered by the party’s left wing as the essential element. Analysts have speculated that Kennedy’s death could move more conservative Democrats resistant to the public option to change their minds in tribute to their colleague. As prominent political blogger Rich Boatti explains: “Kennedy's death may provide cover for Democrats who remain on the fence, allowing them to tell constituents they couldn't vote against the Kennedy Health Reform Bill.”

Even assuming all Senate Democrats vote for whatever legislation is drafted, Kennedy’s death leaves them one shy of the 60 needed to overcome procedural blocks from Republicans (known as filibusters). Hoping to avoid that, Democrats are waiting to hear whether a temporary successor to Kennedy's seat will be appointed in time for the vote. They are also eyeing Republicans known to break with their party and vote with Democrats.

If Democrats still find themselves short of 60 votes, their last resort could be a legislative loophole called “reconciliation”: a procedure that averts Republican obstruction, but would inevitably produce a less ambitious reform and is seen as the kind of partisan manoeuvering that doesn’t sit well with Americans.

Obama, ‘cheerleader in chief’

Many on both sides in Washington are saying the president should take a more authoritative stance, rather than simply rallying lawmakers to follow his healthcare guidelines. Republican Bob Dole has led those calls, criticizing Obama for being a “cheerleader in chief” and urging him to restart reform from scratch by submitting a detailed plan to Congress.

Democrats have also spoken out against what they see as Obama’s willingness to sacrifice the public healthcare option for the sake of achieving smaller-scale improvements.

Obama was a protégé of Kennedy’s and has made healthcare the signature issue of his first year in office, raising the stakes not only for his mentor’s legacy, but his own.