Reconciliation

Apparently the Democrats are steeling themselves to go it alone and pass health care reform via reconciliation (link):

...Obama is saying that unless Republicans support comprehensive reform as Obama and Dems have defined it — dealing with the problem of 30 million uninsured and, by extension, seriously tackling the preexisting condition problem — they will almost certainly move forward with reconciliation.

As they do, I'm sure the claims that they're ramming an unpopular bill down our throats or ramming it through Congress will only get louder.  Here is what I think is important to keep in mind (hats off to Ezra Klein and Greg Sargent)...

The health plan is unpopular.

That plot illustrates the enormous success that the opponents of reform have had in shifting public opinion.  Much of that unpopularity comes from people who think it goes too far, but a significant fraction from people who don't think it goes far enough...who think single-payer or a public option is a necessary element of real reform, for example.  On the other hand, the individual components of the bill are quite popular (link):

percent_supporting_-thumb-450x277As Klein puts it (link):

Health-care reform is unpopular. But if you actually tell people what's in the health-care reform bill, then it becomes quite popular.

This says to me that the polling that says that health care reform is "unpopular" is not a strong argument for killing Obamacare.  Furthermore, (link):

If polls are so important to the Republicans, why aren't they for the public option?

Although it's not in the Senate bill, most Americans support the public option (a health insurance plan offered by the U.S. government) (link, link).

Obamacare gets portrayed as a radical, partisan plan...but "Republican" ideas are prominent in it (link), and the current Senate bill is much closer to 1993's proposal by moderate Republican Chafee than Boehner's plan is (link).  Again from Klein (link):

We've got a situation in which Democrats are essentially pushing moderate Republican ideas while Republicans push extremely conservative ideas, but because neither the press nor the voters know very much about health-care policy, the fact that Republicans refuse to admit that Democrats have massively compromised their vision is enough to convince people that Democrats aren't compromising.

Republicans are generally wary of allowing the federal government to define the characteristics of minimally-acceptable health insurance.  Klein points out that this philosophical opposition doesn't prevent them from defining minimum standards of their own  (link):

Philosophically, Republicans do have a disagreement with this. It's regulation, after all. But in practice, they accept it. When Republican passed health savings accounts into law, they included definitions of the minimum standards a plan had to meet to qualify. When they passed the Medicare Prescription Drug Benefit into law, they defined what a plan would have to do to qualify for the program.

Klein makes another good point today (link):

There's a difference between the statements "America has the best health-care system in the world" and "With enough money, you can purchase the best health care in the world in America." But that difference gets run over in political conversations. Sen. John Barrasso, for instance, just mentioned that a Canadian premier recently got heart surgery in Miami. Best health care in the world, baby!

America has about 50 million uninsured people within its borders. Canada has exactly 13 premiers. People should ask themselves a very simple question: Do they think they are likelier to lose their job and fall into the health-care situation of the uninsured or become an influential politician and enjoy the health-care options available to the most powerful people in the world?

The complaint that I expect hear most in the coming days is that it will be a travesty to pass Obamacare via reconciliation (i.e. with a 51-vote simple majority rather than a 60-vote supermajority in the Senate).  For example, Bill Frist in today's Wall Street Journal (link):

Senate Majority Leader Harry Reid has announced that while Democrats have a number of options to complete health-care legislation, he may use the budget reconciliation process to do so. This would be an unprecedented, dangerous and historic mistake.

Budget reconciliation is an arcane Senate procedure whereby legislation can be passed using a lowered threshold of requisite votes (a simple majority) under fast-track rules that limit debate. This process was intended for incremental changes to the budget—not sweeping social legislation.

Using the budget reconciliation procedure to pass health-care reform would be unprecedented because Congress has never used it to adopt major, substantive policy change. The Senate's health bill is without question such a change: It would fundamentally alter one-fifth of our economy.

However, as Julie Rovner pointed out (link), during the past 30 years reconciliation has been used many times and is actually the norm for major changes in health care.  A quick summary:

1982 — TEFRA: The Tax Equity and Fiscal Responsibility Act first opened Medicare to HMOs
1986 — COBRA: The Consolidated Omnibus Budget Reconciliation Act allowed people who were laid off to keep their health coverage, and stopped hospitals from dumping ER patients unable to pay for their care
1987 — OBRA '87: Added nursing home protection rules to Medicare and Medicaid, created no-fault vaccine injury compensation program
1989 — OBRA '89: Overhauled doctor payment system for Medicare, created new federal agency on research and quality of care
1990 — OBRA '90: Added cancer screenings to Medicare, required providers to notify patients about advance directives and living wills, expanded Medicaid to all kids living below poverty level, required drug companies to provide discounts to Medicaid
1993 — OBRA '93: created federal vaccine funding for all children
1996 — Welfare Reform: Separated Medicaid from welfare
1997 — BBA: The Balanced Budget Act created the state-federal childrens' health program called CHIP
2005 — DRA: The Deficit Reduction Act reduced Medicaid spending, allowed parents of disabled children to buy into Medicaid

As another example, Timothy Noah chronicles how welfare reform was accomplished (link). 

Finally, Ezra Klein makes another good point on this topic (link):

It's a bit annoying, though, that Democrats keep justifying the reconciliation process based on the fact that Republicans have done it, too. The reconciliation process makes sense because majority votes make sense.