Luke Sharrett/The New York Times
Senator Harry Reid, the majority leader, and Speaker Nancy Pelosi have identical goals on health care but different approaches.
Across the Rotunda, Senator Harry Reid, the majority leader, is trying a different tack, acting like what one participant in closed-door sessions described as a coach, urging key chairmen not to get bogged down in pride of authorship and to keep their eyes on the legislative ball.
While they may have different styles and different sets of Democrats to assemble behind separate proposals, Ms. Pelosi and Mr. Reid have an identical goal: passage this year of a major health care overhaul.
Achieving that end and enacting a top priority of President Obama will present perhaps the stiffest test yet of the skills of the two Congressional leaders. How they perform could influence not only the political fate of their own colleagues, but the standing of the administration as well.
No one expects it to be easy.
“It is not painless to do this,” said Senator Christopher J. Dodd, the Connecticut Democrat who oversaw the legislation generated by the Senate health committee.
Mr. Reid and Ms. Pelosi are at the moment working independently to merge sweeping health care bills produced by two committees in the Senate and three in the House into bills each must squeeze through the respective chambers. Then, Democrats hope, they will negotiate one final version between them before sending it to Mr. Obama’s desk.
Ms. Pelosi, who has been meeting incessantly with fellow Democrats on health care, said she was now focused on producing the strongest possible legislation that can pass the House to provide her side of the Capitol with as much leverage as possible in future talks with the Senate.
“I’m not into dealing with the politics of the Senate,” she said last week. “They do their policy and their politics. We meet them at the conference table, and that’s where we will deal with that.”
Mr. Reid, similarly, said that he was focused on devising a bill that could win the 60 votes needed to overcome a likely Republican filibuster and could not yet turn to any task beyond that.
The challenge for Ms. Pelosi is to write a measure with sufficient coverage and benefits to appease the left wing of her caucus without alienating too many of the moderate and conservative Democrats whose votes she needs.
“She’s tough,” said Representative Steny H. Hoyer of Maryland, the majority leader. “She’s a great negotiator. She knows at some point in time, she has got to get to 218.”
Mr. Reid may have the more difficult job since Ms. Pelosi, of California, has a larger majority as well as stricter House rules that limit opportunities for Republicans to slow the process.
Mr. Reid has to come up with a bill that can win at least procedural backing from virtually all 58 Democratic senators and two independents aligned with his party, which will necessitate navigating divisions between the majority of his members who are pushing for a public option and centrist Democrats opposed to the idea. All while holding Republicans at bay.
“It requires the wisdom of Solomon and the patience of Job,” said Senator Evan Bayh, Democrat of Indiana and one of the centrists whose support Mr. Reid is struggling to win.
At the same time, Mr. Reid is facing what could be a difficult re-election contest next year in Nevada, where his poll numbers are lagging. He cannot afford to be seen as the architect of a bill that creates a public uproar or alienates his allies in organized labor. The competing demands were evident this weekend as Mr. Reid left the health debate in the Capitol on Thursday to fly home for a series of events.
As the health fight enters the next stage, his notoriously independent colleagues are complicating his political life even more. A significant number of them are stepping up their push for some form of public health insurance option to be included in the Senate version of the bill — a potential deal breaker for a few other Senate Democrats.
“There are 52 solid Democrats for the public option,” said Senator Tom Harkin, the Iowa Democrat who is chairman of the health committee. “Only about five Democrats oppose it. Should the 52 give in to the five? Or should the five go along with the vast majority of the Democratic caucus?”
Mr. Reid is working with the chairmen of the health and finance committees as well as his leadership team, in regular consultation with the White House, in trying to meld the two bills.
“We’re going to work very hard with the two chairmen and the White House to see what, if anything, we’re going to do,” Mr. Reid told reporters.
He could choose to leave more contentious elements out of the measure he brings to the floor and allow backers of the public option, for instance, to try to add it through an amendment. If they can assemble the necessary votes, it would be a triumph; if they lose, they would have had their chance.
House Democratic leaders are determined that their initial bill will include some type of government insurance plan, leaving Ms. Pelosi facing difficult choices in deciding what this public plan should look like.
Liberals say it should be modeled on Medicare and should use Medicare fees as a basis for paying doctors and hospitals, as in the bill approved by the House Ways and Means Committee.
But centrist and conservative Democrats say the public plan should negotiate rates with doctors and hospitals, as private insurers do.
Supporters of a government plan say it would hold down costs by putting competitive pressure on private insurers. Medicare rates are normally much lower than private insurance rates, so using them could save money for the government and allow Congress to direct more money to help low- and middle-income families buy insurance.
In the end, Ms. Pelosi and Mr. Reid will not have to go it alone. Senate and House leaders say Mr. Obama must weigh in at some point and put his heft behind the eventual legislation, a move the leaders hope will eliminate any last doubts among both liberal Democrats who fear the emerging plan does not go far enough and conservative Democrats who worry about costs and other potential complications.
But at the moment, it is Ms. Pelosi and Mr. Reid who are on the spot.
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