Evan Bayh said on CBS Washington Unplugged said that if fifty senators were dead set on getting a real public option they could always do that by using reconciliation. Reconciliation measures can't be filibuster, so a bill being passed through reconciliation would only need a simple majority to pass (50 votes plus the VP).
Evan Bayh said, “If the people want the public option in its fullest form are just adamant about that they can always just get that with fifty votes.”
Fifty Democratic senators could pass all of health care reform using reconciliation or in theory pass just the public option using reconciliation. Trying to pass all of reform using reconciliation could potentially face problems because of the Byrd rule, which could strip individual provision is they are not properly related to the budget. Passing just the public option through reconciliation should be easier because it is less likely to run afoul of the Byrd rule.
The option of using reconciliation does provide Congressional progressives with some leverage. If they determine that the most conservative Democratic senators are demanding too much they can always bypass them and still get a bill passed. The question may come down whether a bill which would be watered down by the strange Byrd rule would still end up a better bill than one watered down to fulfill the whims of Joe Lieberman, Blanche Lincoln, or Ben Nelson.