Health reform negotiations have moved behind closed doors in Congress, but chances are high that a bill will pass this year -- even if it doesn't do all that much to revamp the nation's swelling $2.5 trillion health care system.

Reform was thrown under the bus months ago, said Ethan Siegal, an analyst at The Washington Exchange. The healthcare legislation is significant. It's going to affect almost every healthcare ... sector, but it is not game changing.

Democratic leaders are hammering out two bills to bring for a vote in the U.S. House of Representatives and Senate before finalizing a single plan for President Barack Obama to sign into law. Democrats have said they will pass it this year.

I do think it is a slow moving freight train, Siegal said at the Reuters Washington Summit, adding that a bill by December is likely even if Obama does not actually sign it until early next year.

Although it is not yet clear what the final bills will look like, Obama has said he wants to expand the number of people with insurance while controlling costs.

More than 46 million people living in the United States lack health insurance, while healthcare costs make up roughly 16 percent of the nation's economy and are growing twice as fast as inflation.

But critics and even some supporters say the various bills ultimately do little to tackle spiraling healthcare costs or change the inefficiencies in a system bogged down by paper records, multiple doctor visits and unnecessary tests.

Many of the provisions in the bills also do not take effect for several years and so any large-scale impact on health or savings could take more than a decade.

There's baby steps to reforming the way we deliver health care, Washington Analysis Corp's Beth Mantz Steindecker said in a separate interview.

The bill does make some major changes, especially in terms of coverage, but I do question whether 10 years from now we'll have just moved all the chairs around the table, she said, adding that negotiations could drift into January.

Debate in the Senate and the House is expected to begin sometime in November.

Valerie Jarrett, a senior aide to Obama, told the Reuters summit there was optimism that Democrats would pull together.

We are so close to being able to get this done ... There's 90 percent overlap with the bills (from the committees). How can you not get this done?


Part of that remaining 10 percent -- whether to include a government-run public insurance option.

Recent polls have shown a mixed view of the public's support for such an alternative to private health insurance companies. Older Americans get care under the Medicare program, while the poor are covered by Medicaid. But most everyone else must rely on their employer or buy their own policies.

Of the five congressional proposals, the Senate Finance Committee's plan is the only one without a government option, instead offering a so-called cooperative exchange for consumers to compare and buy plans.

Senator Olympia Snowe, the lone Republican to vote for the Finance Committee's proposal, wants a public option to be triggered only in certain circumstances, while others want state-run public plans rather than a single federal one.

Exactly what form it takes is still under discussion, said Representative Chris Van Hollen, a member of the Democratic leadership.

Democratic Senator Carl Levin said his party should consider Snowe's proposal to help bring other Republicans on board, calling it a reasonable way to go.

Aside from Snowe, most Republicans show no sign of bending in support of the plan and plan to target various pieces of the bill rather than offer their own alternative.

We are not going to offer such a thing, said Republican Senator Lamar Alexander. Both he and Senator Charles Grassley said they would instead fight for issues such as medical malpractice reform and allowing people to buy health insurance across state lines.

But with a Democratic majority in Congress, Senator John McCain said there was little doubt a bill would ultimately pass. They're going to jam something through, I just think the votes are there, he said. If they don't get something through, then it would be viewed, appropriately, as a huge defeat.

And whatever is included in the final bill is likely to stand for a while as Congress moves on to other issues.

There will be refinements as we go along, but ... I don't envision another major (health) bill like that, van Hollen said.

Another reason for that? Fatigue, according to both Siegal and Mantz Steindecker.

This town is going to be totally exhausted from health reform, Siegal said.

(Additional reporting by Matt Spetalnick, Editing by Chizu Nomiyama)