The House Energy and Commerce Committee on Friday evening voted 31-28 for a health-care reform plan that uses a relatively robust “public option” and other strategies to insure the nearly 50 million Americans who currently lack health-care coverage.

The plan, which would cost $1 trillion over ten years, would be financed by controlling Medicare and Medicaid costs and by taxing businesses and the wealthiest Americans.

With the House breaking for its August recess, the roughly 1,000-page Energy and Commerce plan will become an improtant focus of an intense month of grassroots campaigning for reform and high-stakes lobbying against it.

The tenuous nature of the reform push was highlighted by the extraordinary wrangling in the committee late Friday.

Committee chair Henry Waxman, D-California, had to scramble to win support for the measure from progressive Democrats on the committee, after he cut a deal with conservative “Blue Dogs” who wanted to undermine existing protections for low- and moderate-income Americans.

Waxman did this by agreeing to provisions that place more demands on businesses to cover their employees while expanding support Medicaid programs that aid the poor. He also got House Speaker Nancy Pelosi to agree to allow a full House vote on the single-payer reform that more than 85 House Democrats have endorsed.

Congressman Anthony Weiner, D-New York, worked with Waxman to get the deal on single-payer and declared a sort of victory Friday, saying that: “Single-payer is a better plan and now it is on center stage. Americans have a clear choice. Their Member of Congress will have a simpler, less expensive and smarter bill to choose. I am thrilled that the Speaker is giving us that choice.”

Even if single-payer is not likely to carry the day, its on the table.

And that’s an indication of the extent to which House leaders had to move to keep progressives on board.

That movement did not please more conservative Democrats.

Five of them voted with the Energy and Commerce Committee’s 23 Republicans to block the bill Waxman advanced, which includes a relatively robust public option. The Democrats who voted with the “party of no” were all conservatives or moderates who thought the measure was too progressive: Representatives Rick Boucher of Virginia, Bart Stupak of Michigan, Jim Matheson of Utah, John Barrow of Georgia and Charles Melancon of Louisiana.

Still, Waxman, a liberal chairman whose struggles to gain the votes of a handful of conservative Blue Dog Democrats almost blew up the process, said, “We reached compromises and brought together a very diverse group of conservatives, moderates and progressives… I am confident we will pass [the legislation] when it reaches the House floor.”

The Energy and Commerce measure is the most up-to-date and detailed of three health-care reform bills backed by different House committees, and various plans are in play in the Senate.

But none will be voted on until September.

That means that the Energy and Commerce Committee vote was not the end of any process, but rather a beginning.

According to the Washington Post:

The House legislation’s centerpiece is a government-financed alternative to compete against private insurance in an effort to drive down health-care costs. Special interests on both sides of the issue expect to spend millions of dollars in the roughly 50 to 60 congressional districts that are considered swing votes, in an effort to define the “public option” proposal on their terms.

Sensitive to the hard-hitting advocacy campaigns already targeting some members, Democratic leaders gave lawmakers marching orders to promote the plan in their congressional districts during the recess or face the prospect of its defeat once it comes to the House floor.

“If we want the public option, we have to sell it to the American people,” House Speaker Nancy Pelosi (D-Calif.) said Friday.

Actually, activists — working in conjunction with the only serious reformers in Congress, members of the Congressional Progressive Caucus (CPC)– are going to have to use the August recess to make the case for it.

Progressive Democrats of America, which has worked closely with CPC members, is pledging to organize during the congressional recess to get more Democratic members of the House and Senate to back real reforms — not conservative compromises that make the “cure” worse than the disease.

It will be frustrating work in some senses, as the public option is itself a compromise.

It falls short of the single-payer plan that is needed to bring real reform.

But the Energy and Commerce bill as it is now formulates is a better proposal than what was on the table at the start of the week, when conservative Blue Dogs in the House and corporate Democrats in the Senate got close to killing off the public option altogether — and to undermining Medicare and Medicaid.

The bill that got through Energy and Commerce ended up better than had been expected because progressive members of the House and activists across the country objected to conservative compromises.

The demands will have to be louder in August — much louder — if there is to be hope for anything akin to real reform.