WASHINGTON – Time growing short, Democratic leaders in the House and Senate still face key decisions if they are to achieve President Barack Obama's goal of passing legislation to remake the nation's health care system by year's end.

In the House, that means setting conditions under which the federal government would sell coverage in competition with private industry. The remaining disagreements among rank and file Democrats revolve largely around the fees to be paid doctors and hospitals under the plan, and whether they should be dictated by federal officials or established in negotiations.

And in the Senate, it means deciding whether legislation will give the government a role in the marketplace at all, and if so, what rights individual states would have in deciding whether to participate...