The demise of health care reform in the California Senate is a crushing setback for the 6.7 million Californians who lack health insurance.

It's a staggering defeat for Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Núñez, and for an unlikely mix of business groups, labor unions, hospitals and consumer organizations that rallied behind the plan these two leaders brokered.

But more than anything, the defeat of this reform package represents a sad final legacy for Senate President Pro Tem Don Perata. The Senate leader helped negotiate the legislation, Assembly Bill X1 1, that the Senate Health Committee killed Monday. Until December, he had a chance to shape it, and alter its finances, in any manner he chose.

Yet instead of seizing that opportunity, Perata stalled for time, asked the Legislative Analyst's Office to further vet the health plan, and then vacillated on where he stood. Finally, on Tuesday, he announced his opposition, citing reasons that didn't seem to jibe with his past positions.

As the Senate leader noted, the LAO found risks with the health care proposal, particularly if per-person costs were to rise above $250 a month. "If premiums are higher or grow faster than projected, the program could be severely underfunded," Perata wrote in a position letter Tuesday.

Concerns about costs are legitimate, but they are not unique to AB X1 1. Medical inflation would equally threaten the solvency of Senate Bill 840, Sen. Sheila Kuehl's single-payer plan, which Perata voted for in the past. It also would have been an issue for Assembly Bill 8, a bill that Schwarzenegger vetoed last year after it sailed through the Assembly and Senate, with Perata's support.

In his letter Tuesday, Perata claimed that the Núñez-Schwarzenegger health plan depended on an "unusual" combination of legislation and initiative – with the latter seeking voter approval for the financing of the plan.

Well, yes. But SB 840 was also premised on such a combination of legislation and ballot initiative. Perata supported it then. Why not now?

Perata can argue the circumstances have changed since his earlier votes, and they have. The state is now staring at a $14.5 billion budget deficit.

Yet, as Perata knows, approval of the Núñez-Schwarzenegger bill might have helped the state weather this downturn. Among other things, the bill would have placed $4 billion in fees on hospitals to leverage an equal amount of federal money to cover the uninsured. Such funds would have relieved pressure on Medi-Cal and the Healthy Families programs, which are otherwise likely to get slashed with state budget cuts.

It's hard to know why Perata felt the need to play the role of Brutus in this knifing, or why so many other senators – et tu, Darrell Steinberg? – abstained or voted against the bill.

Some possibly had unresolved policy concerns or were settling old scores with their Assembly counterparts. Some possibly were swayed by the tobacco industry, which opposed a tobacco tax to help pay for the plan.

Whatever the cause, the Senate let history slip through its fingers. That further hurts the Legislature's standing and leaves Californians wondering if lawmakers can ever deliver on the promise of health care reform.