WASHINGTON -- The question circulating through the Capitol since Tuesday's special election in Massachusetts killed the Democrats' Senate supermajority has been: Is health care reform finished?

The response of Rep. Tim Murphy, R-Upper St. Clair: "It's just beginning."

Yesterday morning, Mr. Murphy convened a meeting of the GOP Doctors Caucus to hear a variety of perspectives on health reform. The public hearing was initially intended to chide Democratic leaders for merging the health reform bills passed by the House and Senate in private.

But as the discussion pivoted yesterday to Republicans' desired approach to reform -- break it into pieces and approve the popular parts first -- the ideas gained new momentum and relevance as Democrats scrambled to figure out what to do.

House Speaker Nancy Pelosi, D-Calif., yesterday said she does not have the votes to pass the Senate bill as is in her chamber. That route would prevent the Senate from having to vote on a merged version of the bill.

Republican Scott Brown, Massachusetts' newest senator, who met with Republicans and Democrats in the Capitol yesterday, has vowed to vote against the health bill, leaving Senate Democrats one vote short of the 60 they need to break a filibuster. They could go back to Sen. Olympia Snowe, R-Maine, who voted for the bill in the Finance Committee but against it on the floor, but Ms. Snowe has indicated that she will not be easily courted.

"It think we have to really peel back the layers of the onion here, so to speak, and go back to the drawing board to see what essentially could be a basis for consensus," Ms. Snowe said yesterday, adding that she hasn't heard from the White House since Tuesday.

President Barack Obama, in an interview Wednesday with ABC News, suggested support for a scaled-back health bill, while Ms. Pelosi, in a news conference yesterday, did not entirely endorse that approach.

"I don't think anybody disagrees with, 'Let's pass the popular part of the bill,' but some of that popular part of the bill is the engine that drives some of the rest of it," Ms. Pelosi said, according to a transcript of her remarks. "But again, we are not in a big rush; pause, reflect upon what our possibilities are, see what the support is in the [Democratic] caucus. We have to always go where we can build consensus."

Consensus means Republican votes, which means the minority party gained new relevance with Mr. Brown's win.

Republicans continued yesterday to urge Democrats to start over with a smaller package of health reform legislation. Mr. Murphy, a child psychologist, said in opening his party's doctors caucus hearing that the pillars of health reform should be to break down state barriers for insurance coverage, create new groups that people can buy into to get coverage, overhaul Medicare and Medicaid, subsidize low-income citizens' purchase of insurance and end insurance practices like discrimination based on pre-existing conditions.

Hearing testimony included a range of views. Dr. Christopher Hughes, co-director of critical care services at St. Clair Hospital in Upper St. Clair and Pennsylvania director of Doctors for America, voiced support for the health bills passed by both chambers. "So much work has been done, it seems silly to throw it all away," he said after the hearing, blaming feckless Democrats for not completing the process. "I would have thought, with the majorities we had in both houses of Congress, we could have annexed Canada if we wanted to. And yet here we are, struggling to get a bill passed. It just boggles my mind."

On the other end of the spectrum was Jim Martin, president of the 60 Plus Association -- a conservative counterweight to the AARP, which supports the bills -- who said Medicare cuts proposed in the Democrats' legislation are untenable, and that a mandate that all Americans buy insurance is unconstitutional.

What the five panelists could agree on is that no one's plan, at the moment, would significantly stem the nation's soaring health costs.

Mr. Murphy agreed that moving toward managed care, rather than a structure where doctors are paid for each service they provide, should be the goal. The Democrats' bill creates demonstration projects that could lead to such reforms, but he said he wants action sooner.

Mr. Murphy proposed bringing managed-care models to Medicaid to deal with the chronically ill, saying demonstration projects have already proven successful. For example, he said, paying a nurse $20 for each visit to a diabetes patient to be sure he is fulfilling his care plan might save the $50,000 cost to the medical system to later amputate his foot.

Such savings, Mr. Murphy said, could support insurance subsidies for low-income citizens, rather than cutting Medicare and expanding Medicaid. The Democratic plan does those things, along with sliding-scale insurance subsidies to lower income families, to achieve near-universal coverage.

Democrats have long set their sights on giving all Americans health insurance. Although Republicans yesterday said it was a laudable goal, they focused on smaller steps, like ending unpopular insurance practices, increasing competition among insurers and creating new ways to pool risk for consumers. Spurred on by the Massachusetts results and the changing congressional calculus, that approach is looking more likely.

"Since Tuesday, it has taken on even a greater emphasis," Mr. Murphy said. "This is what the American public wants to hear about: What are the parts you can fix and start from there."

Washington correspondent Daniel Malloy writes the "Pittsburgh On The Potomac" blog exclusively at PG+, a members-only web site of the Pittsburgh Post-Gazette. Our introduction to PG+ gives you all the details.