Because of the insular nature of Washington politics, elected officials run the risk of losing sight of who is really in charge. Massachusetts voters reminded Washington what the answer is to that question. Voters are in charge.

So now what do Democrats and Republicans do when it comes to health care, which was on the verge of becoming law? While the path is still a bit cloudy, we should have a pretty good idea in the next 48-72 hours.

There are several paths they could travel.

• Drop health care reform altogether: highly unlikely. The president and Democrats have invested a huge amount of political capital in passing legislation. Dropping reform would be the equivalent of waving the white flag. Republicans would use their “victory” in defeating reform in the 2010 November elections as part of their attack on Democrats. There is this to also consider, many Democrats believe that the reason they lost the majority in the House of Representatives in 1994 was not because the Clinton health care bill was a weight around their necks, but was because they failed to pass the bill. If that’s true then surrendering now makes no sense.

• Bring the current Senate bill to a vote in the House paired with a reconciliation bill that reflects the results of the current House-Senate negotiations. This path is very unlikely. More and more moderate Democrats were expressing discomfort with the whole process before the election. With the election of Brown, opposition to such a move is growing, and I would guess privately they are concerned they could be the next Martha Coakley. There are also too many issues they could not settle (i.e. abortion, exact nature of exchanges, excise tax, etc.) through a reconciliation bill.

• Wait (a few weeks or months) and pull together a consensus bill that is directed at those with health insurance who felt they were getting nothing out of the current bill and move it forward. Such a bill would have to be much less expensive, and I mean much less. I’d also talk about the annual cost, not the 10-year cost. This strategy would likely happen as part of a bigger bill, or even as part of a couple bills, such as a jobs bill and/or reconciliation. This is the most likely path Democrats will follow. In President Obama’s first public reaction during an interview with ABC News he indicated this was the way forward. What will be interesting is watching what Republicans do. What path they will take, cooperate or continue to oppose.

For Sen.-elect Brown, he was clear in his campaign that he was not opposed to reform, what he was opposed to was the legislation under consideration in Washington. That bill is now no longer under consideration. So what does he think reform should look like? He has about a week or so to shape this debate. Once he is sworn in, his power and influence will begin to diminish as he makes choices and stakes out positions through his votes. What is also interesting and important—politics aside—when you look at policy issues there are many that Democrats and Republican generally agree on.

The basic political issues that will determine which path is followed are:

• For Democrats, the question is which choice will hurt less or conversely benefit them politically/electorally? Failing to pass a bill or passing a bill? Many Democrats feel they cannot let this issue go by given all they have staked on passing reform. The president, based on his most recent remarks, seems to fall into this category.

• For Republicans, it is a similar question: Do they genuinely cooperate on a consensus smaller bill, or do they continue to oppose? Which strategy helps them most at the polls in November?

If Republicans continue to oppose, Democrats could make them take some painful votes by teeing up the most popular provisions, i.e. the insurance reforms including eliminating pre-existing conditions clauses, for votes. So this decision will not be easy. Also, given that the Senate was where bi-partisanship was most likely, Democrats could pursue this route with not only the Senator-elect from Massachusetts, but also with Sens. Olympia Snowe, Susan Collins and Chuck Grassley and perhaps other wild cards such as Sens. George Voinovich, Lindsay Graham and John McCain.

The wild card is this: The wave Scott Brown rode into office is not a wave that Republicans control. While he rode the wave, he did so barely running as a Republican. This wave could change direction before next fall and/or it could throw the GOP off at any point.

Finally, Democrats are still working out what path to follow. Watching it unfold is similar to the various stages of grief: denial, anger, bargaining, depression and acceptance. While the political version is not exact there is still a process they must go through, which is why there is still discussion about trying to salvage the current bill despite the fact there is no way they can pass it. Some Democrats, specifically those on the far left have not yet accepted what happened and are in denial, others have moved on and are trying to figure out a bargain, while some are just plain angry and are looking for someone to blame. In the end, they’ll either accept what happened and move on to a new bill and path, or they won’t and health care will be dead for this year.

William Pierce is Senior Vice President for APCO Worldwide, Inc.