Hanging on by a very tenuous thread, the Senate’s health care reform bill is in trouble.

Susan Collins and Rand Paul have each said they will not vote for it, though for drastically different reasons. Paul, taking a principled, conservative stance, disagrees with any effort to change the current system set up by the Affordable Care Act without repealing it outright and starting over. Collins, taking a more liberal stance, doesn’t want Medicaid to suffer under the bill.

So, if we were to take a vote right now, we’re looking at 49-50… because one man is considering his options.

Mike Lee, who is still reviewing the bill, hasn’t said publicly which way he’ll go on this. His hesitation is understandable. The Cruz-Lee amendment to the original Senate version as not included in this one. It’s just a version of it that doesn’t exactly do what Cruz and Lee wanted. However, Cruz is on board with the bill as it is.

I believe Cruz being on board with it is a mistake, however, and I think Lee is right to be undecided right now. For that matter, I would not for a minute begrudge Lee opposing the bill.

Mitch McConnell needs Lee’s vote to get the bill to a 50-50 deadlock, allowing Mike Pence to come in and vote to break the tie in the Republicans’ favor. The two Republican defections make this tough on both McConnell and Lee.

From a conservative standpoint, this bill is nowhere close to ideal. The fundamental premise of the Republican position on health care has been to repeal Obamacare. During Barack Obama’s presidency, Republican controlled chambers passed numerous repeal bills, each one vetoed and unable to be overturned. Now that Republicans have the presidency, they simply do not want to do it.

I suppose it’s a bit understandable, what with the scary CBO numbers about the millions who will lose… er, not be forced to buy insurance and all. Still, the legal and foundations infrastructure set up by Obamacare has done nothing to help our health care system and has done major damage to our health insurance markets. Conservatives in Congress should be looking at repeal as the first step.

And it is very clear that Lee knows this. What it comes down to is mathematics – what does the most Americans the most amount of good? Leaving Obamacare in place until a new, better, and more conservative option comes forward? Or start undoing some of the damage now and whittle away at it legislatively?

Tough questions to answer, because they all rely on a Republican-controlled Congress to do what it is supposed to do in the future, and we all know their track record on such.

I do not envy Lee, and I do not envy the hatred and vitriol that will come his way regardless of the choice he makes. However, I do admire his ability to remain principled and not just join a bandwagon for the sake of being liked. We need more of that.