In medicine, the Golden Hour is the short window of time in which to save a patient or, at least, to apply treatment for the best possible outcome. The Golden Hour of health care reform is upon us. What you and I do now--within the next two weeks--will either jumpstart meaningful reform this year or see it die on the operating table.

It took a recent visit to my own Missouri senator, Claire McCaskill, to convince me that reform is already on life support. When I and other constituents met with her during the regular Thursday morning "Coffee with Claire" meeting in her Senate office, McCaskill made clear she was committed to only one position on health care reform: lowering public expectations.

I returned Friday to St. Louis from a grassroots lobbying and rally trip to Washington, D.C. I had tagged along with a group of others traveling by bus (one from the 9th circle of hell, but that's another story).

Chomping at the bit for McCaskill to finish her opening pitch, I led the questioning by asking if she would vote for final health care legislation even if it did not include a government-run public option. I did not take notes, so I will paraphrase her answer. She said there were many proposals out there and that the Finance Committee was working on a bipartisan compromise that held promise--referring to Sen. Max Baucus's attempt to craft a bill bereft of a government-run public option.

I have to call her lily-livered response an injury to the 75 percent of Americans polled who want, at bare minimum, a real public option.

Next, I asked McCaskill about health coverage for all Americans. She said that would be an expensive proposition, citing a "$3 trillion" price tag that, if I'm not wrong, is twice what either the CBO or OMB scored as the likely cost of any current proposal. She said there was hope that Congress could "make progress" by extending coverage to "some" of the uninsured.

McCaskill's weak-kneed response added insult to injury. And then, in an unprovoked and utterly spineless moment of honesty, she pulled the sheet over the corpse of reform: It might not even be possible to pass a bill this year. "We might need to wait a few more years" for a better Congress, she said.

Representatives of SEIU and others puzzled over the import of McCaskill's apparent abandonment of principle. Did she really just say what we heard her say? they asked each other.

Yes, she had. A vote that many observers were counting as a shoe-in had just made the Senate passage of health care reform more problematic.

I am curious to know how many insurance industry dollars McCaskill has received for her campaign coffers. But the question I want most to ask her is this: "Who do you think your replacement will be in 2010?"