The patient is still in the operating room, and the prognosis is not good.

That's where health care reform lies today, according to many business groups that hoped for a better outcome. Their view is shared by most Americans: 54 percent of U.S. adults don't think Congress will pass health care reform this year, according to a survey conducted this month by the Deloitte Center for Health Solutions.

This is a dramatic turnaround from earlier this year, when most experts inside the Beltway thought health care reform was inevitable, and the concept had overwhelming support among the general public.

Many lobbyists for small businesses and other employers blame Congress for overreaching. It should have focused on insurance-market reforms aimed at lowering premiums and ending the ability of insurers to deny or price coverage because of health status. Instead, Congress embarked on a complete overhaul of the health care system that would give the federal government too much power and cost hundreds of billions dollars more than was necessary, they contend.

"That's why this whole thing is blowing up," said James Gelfand, senior manager of health policy for the U.S. Chamber of Commerce. "They have to start over."

"We're kind of disappointed that Congress has wasted so much time with overblown bills that had no hope of enactment," said Neil Trautwein, senior vice president and employee benefits counsel for the National Retail Federation.

"I think Congress blew it, basically," said Karen Kerrigan, president and CEO of the Small Business and Entrepreneurship Council.

Political pressures may drive Congress to pass some modest reforms just to get something to President Barack Obama's desk, but it's not clear whether those reforms actually would reduce the cost of health insurance for employers, Kerrigan said.

Amanda Austin, the lead health care lobbyist for the National Federation of Independent Business, said "it's too early to tell" where Congress will end up on health care reform. She notes the "concerted effort" that President Barack Obama has made for health care reform in recent weeks and predicts he will get a bill to sign, "but it may not be comprehensive at this point."

Others Optimistic About Reform

Dave Mason, legislative and policy director for the Main Street Alliance, still expects Congress to pass comprehensive health care reform. The alliance strongly supports including a government-run plan in new health insurance exchanges that would be created by the legislation. A public plan is needed to provide competition in small-group markets that are dominated by a few insurers, Mason said.

Other business groups, however, fear the public option would undercut the private insurance market.

America's Health Insurance Plans, a trade association representing insurers, is fighting the public option, but otherwise supports health care reform.

"We're still optimistic that we can get something accomplished," said AHIP spokesman Robert Zirkelbach.

Health insurers said they will support insurance-market reforms, such as guaranteeing coverage for preexisting conditions, as long as all individuals are required to buy insurance. Without an individual mandate, some people would wait until they are sick to buy coverage, which would result in higher premiums for everyone else, he said.