President Barack Obama will return from his trip to Asia just in time to see the Senate cast a procedural vote to begin debate on a sweeping health care reform bill. It may take quite a while before the world’s most deliberative body gets around to final passage.

Earlier in the year, Obama signaled that he wanted to sign a health care measure by October. Then the goalpost was moved to the end of the year. Now it looks as if he might not put ink to legislative parchment until January.

Health care reform’s momentum has been sapped in large part by doubts about its price tag. The gross cost of the bill the House narrowly passed November 7 is more than $1 trillion. House Speaker Nancy Pelosi could only cobble together a 220-215 victory for the nearly 2,000-page bill, losing 39 Democrats along the way.

Senate Majority Leader Harry Reid, D-Nevada, faces a monumental challenge in coming up with 60 Senate votes to pass health care reform despite the fact that his caucus totals 60. The Congressional Budget Office estimates that the Senate bill will cost $849 billion over 10 years.

The problem for Obama and the Democrats is that independent voters who swept them into office in 2006 and 2008 now look askance at the massive federal spending that has occurred over the last few months. They also don’t perceive that they’re getting anything for their money, as unemployment has soared to a 26-year high at 10.2 percent.

Although Congress has extended unemployment payments several times and enhanced COBRA benefits, it is now considering doing more, like increasing spending on infrastructure projects, extending unemployment benefits again and helping small businesses.

The jobs rhetoric also is set to ramp up. Obama will host a Forum on Jobs and Economic Growth on December 3 at the White House.

“We’ll gather CEOs and small-business owners, economists and financial experts, as well as representatives from labor unions and nonprofit groups, to talk about how we can work together to create jobs and get this economy moving again,” Obama said in a statement before he left on his trip to Asia.

He’ll follow the forum with a campaign-style Main Street Tour that will kick off in Allentown, Pennsylvania, on December 4. The White House said Obama will travel the country to “take the temperature on what Americans are experiencing during these challenging economic times.”

What Obama may hear on his road trip is that most Americans are either looking for a job or are concerned about keeping the one they have. The problem that he and other Democrats face is that those worries are not directly addressed in health care reform, the centerpiece of Obama’s first-term agenda.

In all of the praise and scorn of the health care bills that have emerged on Capitol Hill in the past several months, no one has claimed that the measures would create enough jobs to make any discernible difference in the unemployment rate. They usher in a massive overhaul of nearly 20 percent of the economy, but they don’t directly add to the economy.

But jobs are directly linked to health care. In our system, the best route to getting health insurance is through your employer. The more people are working, the fewer of them lack coverage. So, when you lose your job, you also put your health at risk, as friends of mine are discovering.

Even if the health care reform bill that finally hits Obama’s desk in January does increase health care coverage for the unemployed, the provisions won’t take effect until Obama’s second term, if he gets one. There won’t be any particular comfort in the bill for the currently unemployed.

It’s too late now, because Obama has already put all his chips on health care. But maybe he should have made jobs his priority for his first year. Instead, Democrats are trying to make massive policy changes—health care, energy—while they have large Senate and House majorities.

Americans may be getting confused. Here’s how Pelosi explained it at a press conference on Thursday, November 19: “When the [health care] bill emerges from the Senate, we’ll be prepared to go to the table as soon as possible to pass this important legislation. As I say, simultaneous with all of this, the issue of jobs, jobs, jobs, jobs, has been our mantra. Jobs and deficit reduction.

How do we grow the economy, increase revenues coming in to reduce the deficit?”

Got it? The Democrats are doing everything at once—and taking a huge risk. They’ll either achieve a spectacular success or spectacular failure by Election Day 2010.

Late in the evening on November 7, I was driving through McLean, Virginia, listening to C-SPAN Radio coverage of a press conference by House Democratic leaders following the chamber’s narrow approval of a comprehensive health care bill.

At the time, it’s likely that I was passing the large homes of at least a couple business lobbyists who live in the tony Washington suburb.

No doubt they were still up and following closely the House vote that occurred during the 24th hour of that fall Saturday. They must have been relieved by the outcome.

Despite having 258 members, the House Democratic majority garnered only two votes more than the minimum to pass the bill—and one of those was from a Republican representing a liberal district. The employer mandates contained in the measure, along with its other provisions, are on somewhat shaky ground.

The legislation has something less than irresistible momentum as it heads into conference committee negotiations with whatever Senate bill emerges. As my colleague Jeremy Smerd points out, employers have a better chance of getting what they want in the Senate.

Business community criticism of the House health care measure is similar to what I heard at recent hearings on bills that would provide workers with paid sick days and prohibit sexual-orientation discrimination in the workplace.

Employers are leery of Washington telling them how to run their businesses and manage their employees. They want the flexibility to design health care and leave policies that best fit their workforces.

“SHRM has strong concerns with the one-size-fits-all mandate encompassed in the Healthy Families Act [the sick leave bill],” said Elissa O’Brien, vice president of human resources at Wingate Healthcare, who testified at a November 10 hearing on behalf of SHRM. “At a time when employers are facing unprecedented challenges, imposing a costly paid leave mandate on employers could easily result in additional job loss or cuts in other important employee benefits.”

O’Brien outlined her Needham, Massachusetts-based company’s generous paid-time-off policies. SHRM asserts that employers like Wingate should be exempt from federal leave directives.

At the November 5 hearing on the discrimination bill, witnesses acknowledged that the vast majority of Fortune 500 companies have policies that protect homosexual workers, who are seen as a key component of the talent pool.

Most Democrats in the House and Senate majorities, however, don’t want to depend solely on the market to provide sick days to employees and protect them from discrimination. They believe that achieving those social gains requires the intervention of Congress and the courts.

In some cases, they may be right. In other cases, they may be imposing overbearing government.

But it’s hard to deny one of their ripostes to employer criticism of the legislation: The economy has consistently prospered even after companies have warned that particular bills would undermine their ability to turn a profit.

At the hearing on paid sick days, Rep. Rosa DeLauro, D-Connecticut, noted that business was in a lather about the Family and Medical Leave Act before it was signed into law in 1993. There were predictions of job losses and other setbacks.

“We haven’t seen that to be the case with FMLA,” DeLauro said.

Another frequent argument against employment legislation is that it will open the floodgates to lawsuits. Sen. Al Franken, D-Minnesota, pushed back against that trope, noting that Minnesota has had a sexual-orientation discrimination law in place since 1993 and has not had its courts filled with related cases.

“Minnesota’s sky has not fallen,” Franken said at the November 5 hearing.

Employers sound convincing when they say that FMLA causes administrative nightmares. Heads nod when they maintain that some employment laws generate costly lawsuits.

But if their arguments are going to resonate in a Congress with strong Democratic majorities, they have to show examples of real job losses or investment that was spiked because of Washington mandates.

Otherwise, the natural skill, resilience and ingenuity of American corporations fosters the notion that they can survive any bill that comes out of Washington.

President Barack Obama won Virginia and New Jersey last year on his way to capturing the White House. But on Tuesday, November 3, voters in those states put Republicans in their respective governors’ mansions.

Republicans say that the results were a referendum on Obama; Democrats counter by pointing to their party’s victory in a special election for an upstate New York House seat.

The meaning of Election Day 2009 may not be determined for a while. But one thing is clear. Democratic losses in two Obama states increase the “fierce urgency of now” for the party on health care reform.

Certainly health care advocates see overhaul as good policy and even a moral imperative. Remember that there also is a strong political catalyst for the effort. Democrats control the White House and both chambers of Congress by large margins. But their sway will hold in its current form until next November.

When voters go to the polls in 2010, they only have to increase the number of Republicans in the Senate by a couple to completely change the political calculus. Right now the GOP has 40 seats while the Democratic caucus numbers 60, just enough to stop a filibuster.

Democrats enjoy a commanding majority of 256 on the House side. But a loss of 20 or so seats could force House Speaker Nancy Pelosi to slow the breakneck speed at which bills can move through the chamber thanks to rules favoring the party in power. She and her Democratic colleagues have to get health care reform done now.

In fact, Pelosi has had to work hard to come up with 218 votes for the health care reform bill that she and dozens of other Democrats introduced last week to great fanfare on the west front of the Capitol.

It’s a melding of the three bills passed over the summer by various House committees and costs either $894 billion or $1.2 trillion over 10 years, depending on which Congressional Budget Office numbers you use.

As the House leaders approached the assembled crowd—composed most of advocacy groups and interns—strains of a U2 song blared over the loud speakers: “You make me feel like I can fly so high,” Bono sang in the refrain.

They have descended closer to earth as they move toward a debate in the full House late this week. The bill text (H.R. 3962) and has been posted on the Web. Good luck wading through that 1,990-page behemoth.

As they build up to floor action, House leaders must deal with recalcitrant Democrats who have concerns about federal funding of abortions in medical plans, coverage of illegal immigrants and a government-run insurance program.

So far, liberals are holding their fire on the so-called public option. They favored the “robust” version that would use Medicare reimbursement rates. Instead, the final bill lets hospitals and doctors negotiate rates with the government.

The revision likely will put many conservative Blue Dog Democrats on board and help ensure approval. “This change now gets us over the top,” said Rep. Earl Pomeroy, D-North Dakota.

It’s also a near certainty that no Republican will vote for the bill. The GOP has offered its own alternative.

Over in the Senate, Majority Leader Harry Reid, D-Nevada, has melded the two Senate bills and included a public option that allows states to “opt out.” It’s not clear yet whether he has the 60 votes needed to move the bill to the Senate floor and the 60 required to bring it to a final vote.

The Senate is waiting on a CBO cost estimate before proceeding to floor debate, which could drag into next year.

But don’t hold your breath. In the end, Democrats will approve some kind of health care bill. They must for the sake of the Democratic president. It’s debatable whether gubernatorial losses in Virginia and New Jersey reflect poorly on Obama.

If his signature domestic issue—health care reform—fails, it will be tantamount to a vote of no confidence. The administration won’t be brought down, as it would in a parliamentary system, but it could suffer lasting damage.