Public option — yes or no — has been at the heart of the debate on health reform all year, but Harry Reid and Nancy Pelosi were reminded Wednesday that the obstacles to getting a bill done are even bigger than that.

In the Senate, Reid got a taste of just how hard it will be to corral his famously fractious caucus — as a dozen Democrats joined with Republicans to vote down the so-called doc fix to Medicare physician reimbursements because it would add $247 billion to the deficit.

The vote served as a test of the majority leader’s ability to hold his caucus together for a health care vote — and in the end, he couldn’t even muster a simple majority of Democrats or persuade a single Republican to come on board; not even Sen. Olympia Snowe (R-Maine)...