Nancy Pelosi Fights for Health Care Reform

ABC News video of Nancy Pelosi unveiling House health care bill.

She has raised hundreds of millions of dollars for Democrats over the years, so it goes without saying that Speaker of the House Nancy Pelosi knows how to pack -- and work -- a room.

But on one of the biggest mornings of the California Democrat's career, the RSVP list was thin. As she led a line of fellow Democrats to the west front of the Capitol to unveil a long-awaited health care reform bill, conspicuously absent were the conservative Blue Dog Democrats who think the bill is too expensive and liberal progressives who want a stronger public option.

In many ways, the bill is a $1 trillion compromise. But you'd never know it listening to Pelosi, who kept a fixed smile while allowing ABC cameras to follow her momentous day.

VIDEO: Bill Weir sits down with Speaker on day her health care bill debuts in House.
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"It is a day that is really historic for us, and it is really crossing a threshold," she said. "I am from Maryland, and I am always talking about horse racing. So we are rounding the bend, getting ready to go into the final stretch. I think it just gets better from here."

After months of closed-door bargaining, horse trading might be a better analogy. It has been 16 years since Hillary Clinton brought a 1,000-page document to Capitol Hill, where her plan for health care reform died a slow, infamous political death.

Pelosi's bill is nearly 2,000 pages, but it does not contain what she hoped would be a "robust" public option -- a government-run insurance plan paying rates similar to Medicare's. Instead, the government plan would negotiate with doctors and hospitals just like any other insurance company, an idea Ted Kennedy advanced before his death.

"He wrote a bill which we took the language from," Pelosi said. "So, we had a robust public option, and a relatively robust public option. Either one of them will keep the insurance companies honest through competition. I think it's important to note that this Kennedy public option is the only option that would probably pass in the Senate. So, we never represent it to anyone that we would get the more robust [option] and that that would prevail at the end of the day. We just wanted to go to the table as strong as possible."

Speaker Grateful for 'Drumbeat Across America'

After announcing the bill, Pelosi spent much of the rest of her day trying to sell it, in person and on the phone at her small, bare desk overlooking a spectacular view of the National Mall.

"I want you to know how grateful the members are to you for taking the message out there to create a drumbeat across America," she told members of Rock the Vote, Families USA and the AFL-CIO gathered in an ornate conference room. "Because without that outside drumbeat and outside mobilization, it is impossible for us to do the inside maneuvering to get the votes out to pass a bill."

If this bill does pass a House vote, which could come as early as next week, Pelosi will enter a new round of negotiations with the Senate and its majority leader, Sen. Harry Reid, D-Nev. Pelosi insisted that the two have a good working relationship, despite some interesting body language after a recent meeting at the White House. When Reid tried to put his arm around Pelosi while addressing cameras, she pulled away and rolled her eyes in obvious annoyance.

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