It’s not looking good for President Obama’s goals for health care reform this year. Since this year is arguably the best opportunity the Democrats in Congress are going to have, the news is pretty grim.

While House Resolution #3200 providing comprehensive health care reform has been making its way through the House, the majority status of Democrats in the Senate, thought once to be a filibuster-proof majority, has proven otherwise for the Democratic Party. Senator Kennedy’s recent passing has left a hole that may not be filled until next year. Senator Byrd of Virginia has been suffering his own illness that has made his appearances in the Senate erratic this year, so Senate Democrats are already two votes short of cloture.

There is only one Republican Senator, Johnny Isakson from Georgia, who has publicly expressed general support of a Public Option, but his own website clearly states his opposition to the idea. The bigger problem is the fact that thus far only 45 Democratic Senators have stated a willingness to vote for a plan with a public option. 60 Votes are needed to move any bill to vote.

Republicans and Democrats in the Senate are both typically blaming each other for the Senate’s failure to come up with a bipartisan plan of their own, but the responsibility to do so lies on the Senate Finance Committee’s Health Subcommittee, better known as the ‘Gang of Six’. Within the ‘Gang of Six’ things haven’t been working out too productively.

The fact is that Republicans are naturally opposed to health care reform for a couple of different ideological reasons. Legislation which they would consent to would be very limited, and far from meeting the goals laid out by President Obama.

The Democrat side of the bipartisan effort is weighed down by subcommittee leader Max Baucus. His close, personal and well financed ties to the health care industry cannot be motivating him to get too much accomplished. Baucus has received from health related industries more campaign contributions than any other senator excluding the three who ran for president last year. Nobody bites the hand that feeds him.  

And of course, politically speaking, the Republicans would like to see Obama and the Democrats fail. If the Democratic party succeeds at passing successful legislation and accomplishing effective health care reform, then there's less reason for American voters to vote for the Republican party. Conversely, if the Republicans can hem and haw and drag their heels on this issue, all the while posturing as though they are acting in good faith and protecting the American people from the plans of the evil Democrats, then a higher percentage of the public become impatient with the Democratic Party and more likely to give the Republicans another chance at majority rule.

Some feel that the President himself has failed to provide adequate leadership on this issue, and that stepping back and letting Congress do what Congress is intended to do may have left the ballpark too wide open. Of course, had the President sent to Congress a bill drafted by the White House, that too would be criticized.

It is probably true that his belated public support for the House bill’s public option, combined with the White House reportedly making a secret deal with big pharma has annoyed those within the Democratic Party. There’s also the fact that the Democratic voting base has been disheartened by these actions and the perceived lack of progress for reform. Therein lies the rub, and the extended danger for the Democratic Party.

If Democrats don’t get comprehensive health care reform passed before it’s too late, they’ll lose in the midterms. Voters gave Obama and the Democrats a mandate last November largely based on comprehensive health care reform, and they won’t be too excited if the Democrats fail to deliver. Lack of faith will result in low voter turnout, which the midterms always suffer from anyway.

At the same time, the Republican base will see health care reform failure as a victory to themselves and their party. Their leaders and right-wing pundits will urge them to the polls in 2010, and the voters will be more than happy to push that advantage.

If getting anything accomplished now is tough, it will be impossible later. If the Democrats want to maintain their majority, they have to act now.

Which brings us to the Senate process known as Budget Reconciliation. Originally designed to reconcile conflicting budget votes, it has been more broadly used by the Republicans in the Senate over the last two decades to push through legislation unfavored by the Democrats. The Bush tax cuts for the rich in 2001, 2003 and the legislation to push back their expiration dates in 2005 are good examples. Threatened by Democratic filibuster, the Republicans exercised Budget Reconciliation.

What makes Budget Reconciliation useful is that it drastically limits excessive debate, which avoids stalling tactics, and it doesn’t require the 60 yes votes needed for cloture, which is the move to close debate and get on with the voting. In essence, Budget Reconciliation is a filibuster-buster.

With 45 likely yeas in the Senate, and a good 14 or 15 more maybes, a majority vote of 51 is a more attainable goal than the 60 needed for cloture without using Budget Reconciliation. Using this method, the Democrats could enact several of the more pertinent aspects of a health care reform bill, including the public option. Other aspects, such as regulations of the insurance industry, would still need to be worked out.

The sticking point of using Budget Reconciliation are the so-called ‘Byrd Rules’, named after Senator Byrd. To restrict excessive use of Budget Reconciliation, rules were enacted to limit its use to matters actually directly affecting the budget. Because of this, if Budget Reconciliation is used, the Democrats will have to do one of three things.

If Democrats can push through the most controversial points of reform using Budget Reconciliation, which legally they can, then they shouldn’t have too much difficulty gaining public support to pressure Republicans into passing most of the rest of their desired legislation after the fact. The public mandate to purchase some form of insurance might still be an issue, since Americans aren’t too keen on the idea of forcing people to buy health care insurance. But Americans are vastly in favor of forcing insurance companies to be more consumer friendly and ‘play nice’, and most of what cannot be passed via Budget Reconciliation due to the Byrd Rules will fall into that category. This is the first option.

Additionally, though it’s going to be nearly impossible to achieve 60 votes for cloture when those against know that doing so will give the Democrats a victory on the vote, it may be possible to convince enough not quite willing Senators to vote in favor of temporarily suspending the Byrd Rules. Changes in Senate procedure require a two thirds majority vote, so again the magic 60 is needed. But, if these unwilling moderates see that the parts they are unwilling to vote for -such as the public option- are going to be passed anyway, then enough of them may be willing to facilitate the process by suspending the Byrd Rules long enough to allow the whole kit and caboodle to go through at once via the Budget Reconciliation process. In doing so, they wouldn’t be supporting the controversial aspects of the bill, but they wouldn’t be labeled obstructionists either. If the baby’s already out of the tub, they may as well toss out the bathwater. That’s the second option on the table, and the most desirable scenario.

A third option concerns the non-elected Parliamentarian. The Senate Parliamentarian is there to interpret the Senate rules. The task of determining what all within the health care reform bill constitutes matters directly affecting the budget and what doesn’t will fall to the Parliamentarian. This person’s decisions are pretty much arbitrarily given, and final. If the Democrats cannot achieve enough votes to suspend the Byrd rules, then they’ll work with the Senate Parliamentarian to pass as much as they can under Budget reconciliation, and like in the first option leave the rest to be worked out later.

The Democrats do have options before them, and the truth is that they can most likely accomplish more of their goals this way than by trying endlessly to compromise with unwilling Republicans.

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