Washington ? In Congress these days, the health care debate is as much about patience as patients.

In a closed-door meeting of feisty House Democrats this past week, Speaker Nancy Pelosi, D-Calif., served notice that in these final days before the Senate and House present comprehensive bills to overhaul the nation’s system, hers is running short.

Rep. Earl Pomeroy, D-N.D., had interrupted Pelosi’s presentation about one version of the bill with questions about its cost. According to Pomeroy and others, she cut him off — twice — with a question of her own:

Is there any version you could support?

Yes, Pomeroy said, but not the one most likely to succeed.

Pelosi moved on.

To the White House and Democratic leaders, Pelosi’s question is the only one that matters at this late date. The answers help divide lawmakers into two columns: “yes” and “yes, if” under certain conditions. In another private meeting Friday, Pelosi forced her rank and file on the record by asking for a show of hands to register support for the public option plan she prefers which would reimburse doctors at Medicare rates plus 5 percent.

In the Senate, Majority Leader Harry Reid, D-Nev., select committee chairmen and senior White House officials are meeting nightly in search of a bill that could win the 60 votes needed to overcome a Republican filibuster.

At the White House, President Barack Obama is willing to play lobbyist in chief, but first he needs a bill.

So close to that pivot point and getting close to year’s end, it’s no longer a debate about whether there will be a health care bill. The questions are when, how — and who can compromise.

Democratic leaders expect their members, looking ahead to next year’s elections, to vote for a health care bill despite any misgivings. But the vote-counters have no real way of knowing until each chamber produces a bill.

That’s why negotiators have slogged through months of hearings, hundreds of amendments and meetings with members that require interminable listening, waiting, reassuring, cajoling and answering questions from the recalcitrant.

For Reid and Pelosi, that process continues. Making a member feel heard — and promising something he or she can boast about at home — can pay off.

Sen. Mary Landrieu, D-La., sent out a blaring news release Friday after her meeting with Reid, saying she raised “the unique challenges Louisiana is facing in terms of Medicaid and the special concerns I have about teaching hospitals.” She said he understood these challenges and considered ways to address the problems.

Patience is limited, however.

Reid and Sen. Charles Schumer, D-N.Y., had a testy exchange after Schumer made comments on cable news that some saw as pressuring the Nevada Democrat to make up his mind about putting a government-run insurance option in the Senate bill.

Senate Finance Committee Chairman Max Baucus, D-Mont., said Friday that patience among negotiators runs out “a little more often now” than earlier in the process.

“I say, ‘Hey, we are in this together. Sixty votes. Let’s keep our eye on the ball,”‘ he said.

The pressure on Democratic lawmakers is enormous.

The success of a health care bill is largely the success of the Democrats who control Congress and the president they helped elect. In a time of lingering recession, there is no more compelling pocketbook issue than health care overhaul. It’s an effort that’s intensely personal because it could affect every American.

Much depends on each lawmaker’s needs — political, substantive, even temperamental — leading up to an election in which all 435 House members and one-third of the 100-member Senate face election. The calculus is different for each member on the fence.

The vote of one might hinge on fear of voters’ cries about government-run health care. A lawmaker with an eye on growing deficits might want to know about containing costs. What someone might really want is the ego-stroke and the political cover of a personal appeal from the president.