NEW YORK ( TheStreet) -- Investors trying to find a way to play the health care debate should put away their spreadsheets and focus on political negotiations, arm-twisting and horse trading.

Arcane parliamentary tactics are in play as the congressional leadership looks for a way to deliver a health care bill to President Obama's desk, and even the kitchen sink will be available if it can seal the deal. House Speaker Nancy Pelosi and Rep. Louise Slaughter, (D., N.Y.) have a plan in case that doesn't work, however.

Under House rules, the members can vote on a bill with changes for the Senate bill, while not voting on the Senate bill itself. The House would "deem" the Senate bill to be passed under a "self-executing rule." This approach would allow a vote on changes to the bill, but not be a vote on the bill itself, providing political cover for the politicians.

It's unclear how many votes this tactic could pick up, since it's questionable if it would even work. The intense focus on the health care debate suggests that politicians who argue that they didn't vote for the bill, only its changes, will ring hollow come November. There may be a few marginal votes already close to a yes, however, that could tip over for a fig leaf of political cover.

Either way, this strategic option highlights the lengths politicians are willing to go to pass health care reform. President Obama already delayed his trip to Australia and Indonesia by three days in order to spend more time finding votes. A vote may still be delayed beyond the Easter recess as well. House Majority Whip James Clyburn said he will get the 216 votes he needs, but not until after April 4.

On the other side of the aisle, the no votes are hardened and willing to take steps to ensure the bill is defeated. One of the stubborn voting blocks in the House is the pro-life Democrats who do not like the abortion language in the Senate bill. Pro-life Senate Republicans have said they will vote with pro-choice Democratic Senators on abortion in order to make the bill unpalatable for these House Democrats.

As a political junkie, this may be highly entertaining, but for investors, this is maddening. The outcome of this vote will, in all likelihood, boil down to a handful of votes. Unlike most bills, this vote will have major repercussions, not just on health care but on the president and congressional leadership's agendas. A win will put new life into other bills, such as financial reform, while failure would probably end any chance of controversial legislation being brought before the November election.

The best strategy for investors in this situation is to wait for the outcome. As time goes by, the vote count may become clearer and an opportunity may present itself. iShares Dow Jones U.S. Healthcare Providers ( IHF), which is chock full of insurance and health management companies such as WellPoint ( WLP), Aetna ( AET) and Humana ( HUM), stands to lose the most from passage of the bill. It also stands to benefit the most if the bill fails, because a large weight would be lifted off the firms. Meanwhile, the drug companies are ready to spend millions on pro-reform advertising. The firms making up iShares Dow Jones U.S. Pharmaceuticals ( IHE) should benefit from passage, but failure of the bill wouldn't necessarily result in a large downside, which is why I own this fund in the ETF Action model portfolio.

After the election of Scott Brown in January for the Massachusetts Senate seat, I said iShares Dow Jones U.S. Medical Devices ( IHI) should see upside due to the weakened status of health reform. It was the right call, as IHI has gone on to outperform IHE, IHF, and the broader iShares Dow Jones U.S. Healthcare ( IYH) by about 5% since January 20. I expect it could gain again if the bill fails.

Finally, the best performing health care sector over the short term has been biotechnology, which has been achieving its gains with mergers and successful drug trials. First Trust NYSE Biotechnology ( FBT) has led the pack with a nearly 30% rally, and its possible that the sector will lead health care, whichever way the reform vote is decided.

With a final vote perhaps only weeks away, investors should be cautious about opening new positions, while existing positions can be held. It doesn't make sense to do anything here, because it's about as close to a tossup as it gets. Health care reform will come down to the decisions of a few people, and that's not a situation that favors investors looking to place short-term bets. The president himself may not know the outcome until hours or minutes before a final vote.

Once the result is certain, investors will have plenty of time to position their portfolio for the intermediate and long-term.

-- Written by Don Dion in Williamstown, Mass.
At the time of publication, Dion owned iShares Dow Jones U.S. Healthcare Providers, iShares Dow Jones U.S. Pharmaceuticals and iShares Dow Jones U.S. Medical Devices.

Don Dion is president and founder of Dion Money Management, a fee-based investment advisory firm to affluent individuals, families and nonprofit organizations, where he is responsible for setting investment policy, creating custom portfolios and overseeing the performance of client accounts. Founded in 1996 and based in Williamstown, Mass., Dion Money Management manages assets for clients in 49 states and 11 countries. Dion is a licensed attorney in Massachusetts and Maine and has more than 25 years' experience working in the financial markets, having founded and run two publicly traded companies before establishing Dion Money Management.

Dion also is publisher of the Fidelity Independent Adviser family of newsletters, which provides to a broad range of investors his commentary on the financial markets, with a specific emphasis on mutual funds and exchange-traded funds. With more than 100,000 subscribers in the U.S. and 29 other countries, Fidelity Independent Adviser publishes six monthly newsletters and three weekly newsletters. Its flagship publication, Fidelity Independent Adviser, has been published monthly for 11 years and reaches 40,000 subscribers.