The Public Policy Polling survey on health care has a number of interesting pieces, but the top line is pretty clear:

The political repercussions for Congressional Democrats of not passing a health care bill could be severe. Our newest national survey finds that Democrats lead 46-38 on the generic Congressional ballot. But asked how they would vote if no health care bill is passed respondents split 40-40 between saying they would vote Democratic or Republican in next year’s election.

In some sense the Democrats may be in a damned if you don’t or damned if you do position on health care. Asked how they would vote for Congress next year if a health care bill with a public option is passed respondents said they would go Democratic by a 46-41 margin, still more narrow than before any hypotheticals about health care outcomes were introduced into the questions.

I would say that Democrats are much more damned if they don’t. A 40-40 split is a far worse position going into 2010 than a five-point lead. And since there is no question in the PPP poll on passing a health care bill WITHOUT a public option, which other polls have shown would crater Democratic support, the best-case scenario for Democrats would be passing the health care they have touted during the 2008 campaign and throughout this year.

Howard Dean, the former chair of the DNC, said today that Democrats are in “deep trouble” on health care, because they have few opportunities for compromise that would satisfy the entire range of opinions:

“I think if you passed the Senate bill tomorrow it would be OK. But then the problem is they don’t have any defense for their members in 2010,” Dean said, noting that the public option would not become operational until 2014. “On the other hand, if they drop the public option [to placate moderate members], I think they lose seats.”

“So this is really tough. I didn’t anticipate being in this position. I thought it would pass. Maybe Harry has some magic up his sleeve. But I don’t see how he gets those four votes [Sens. Joseph Lieberman (Conn.), Mary Landrieu (La.), Blanche Lincoln (Ark.) and Ben Nelson (Neb.)] without compromising the bill,” Dean concluded.

The former Vermont governor warned that if the party allowed the four moderates to further water down the bill (or defeat it altogether) it could lead to primary challenges or a drop in fundraising from the party’s base.

“If you have members refusing to vote for Reid on procedural issues you will have a revolt in the party,” Dean said. “What is the point of having a 60-vote margin? This is going to be death for the [Democratic Congressional Campaign Committee] and the [Democratic Senatorial Campaign Committee]. Why would anyone donate to them if they’re supporting candidates who defeat the Democratic agenda?”

It’s clear from past experience that those conservative Democratic members in swing districts would bear the brunt of the losses in the midterms, particularly without a health care bill around which they can rally.