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. Play

"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.

"I was more reacting to what he was saying than his arm on my shoulder," Pelosi said. "He was saying that we were all going to support whatever the president said about troops to Afghanistan, and which, well, remains to be seen until we see what the president puts forth. A colleague putting an arm on a shoulder, no, it's, more was made of that. And perhaps I, you know, again, he was saying something and doing that at the same time. I was more reacting to what he was saying."

After a wide-ranging discussion, the 69-year-old led a stroll to her office where the mantle held two photographs. In one, a teenage Pelosi, daughter of Baltimore's mayor, beams alongside President Kennedy. In the other, she stands alongside President Obama, who took the oath of office a few feet away on the speaker's balcony.

"I was right there next to the president, and what was interesting was the stillness. The people listened, the silence was palpable," she said.

What happened to the sense of national unity shared on that day?

"I think it's still there," she said.

Even after all the raucous town hall meetings?

"Oh, yeah," she said. "Well, the town hall meetings were really an orchestration. What is out there's where people who want to stop a progress, exploit and hijack the good intentions of people who have legitimate concerns. So you have to be able to differentiate among those who are obstructionists and those who have real concerns."

Pelosi Targeted by Oponents Over Job, Gender

She pointed to the grass at the foot of the Capitol.

"On any given day, I'll have all these people out here chanting or marching or singing or something," she said.

Asked if they ever get through to her, she said, "Well, I kind of know what's coming. ... I always listen, am always receptive. Numbers are eloquent. Maybe when more people show up, it means a great deal. But usually when people are showing up here they are taking a position that is already well known to us."

What is well known is the Republican resistance to her and her ideals.

Pelosi didn't run for office until she was a 47-year-old state party chair, mother of five and wife of a millionaire businessman. She won that election and has enjoyed nine consecutive landslides.

While she no longer needs to campaign, she makes regular cameo appearances in GOP attack ads around the nation as the embodiment of San Francisco-style liberalism.

"I don't pay too much attention to it," she said. "I find that one of the reasons they do it is to try to get me to get my eye off the ball and answer them. But the fact is, I have a job to do -- to get done. I'm the speaker of the House, first woman speaker of the House. As such, I am a target for both of those reasons. And it goes with the job. I have no complaints."