Washington ? The patient isn’t dead yet.

A few more months of wrangling and indecision, and health care legislation to remedy America’s coverage and costs problem could be drawing its last gasps.

As Congress returns to work this week, President Barack Obama and lawmakers have three broad options — competing treatment plans for a patient whose vital signs are growing weak. It’s not clear which one, if any, will work.

Democrats — and liberals in particular — want heroic measures and large scale intervention. They think the legislation needs big new ideas such as a public insurance plan that would have government offering coverage to middle-class workers and their families.

Republicans want a conservative treatment to relieve the worst symptoms of America’s health care malaise. They’re proposing help for small business owners and the self-employed, and some GOP lawmakers probably could go along with expanding current programs that cover the poorest of the poor. But no new government plan and no guarantees that everyone would be covered.

A third group, including moderates from both parties, supports a holistic approach that would put the country firmly on track to coverage for all. They believe government should help some middle-class people through subsidies for private coverage, but that a federal insurance plan isn’t needed. Some are willing to include malpractice changes that appeal to conservatives.

Obama will say which way he wants to go when he addresses a joint session of Congress on Wednesday night.

Above all, the president wants to avoid failure. But an argument on the merits may fail to persuade lawmakers polarized by the town hall brawls of August.

If nothing gets done, “it’s a disaster politically” for the Democrats, said Gerald Shea, the AFL-CIO’s top health care policy expert. “Unfortunately, I think that’s what’s behind a lot of the Republican opposition.”

The action will speed up once Congress is back.

The chairman of the Senate Finance Committee, Sen. Max Baucus, is ready to march ahead. For months, Baucus, D-Mont., has tried to reach a compromise within a small but influential group of senators from both parties. He faces a Sept. 15 deadline, and has signaled he could move even sooner than that — with or without a deal.

His committee would be the last one to consider health care legislation before the full House and Senate take over. Deliberations in the Finance Committee are seen as a critical test because it reflects the composition of the Senate as a whole.

In the House, Democratic leaders have indicated they will not schedule a vote until the end of September. Many House members don’t want to stick their necks out if it looks like the Senate is hopelessly deadlocked. Still, once House Democrats decide to go forward, they should be able to pass their bill.

There won’t be any guarantees in the Senate, where 60 votes are needed to pass legislation of any consequence. It doesn’t look like Democrats have them right now.