Editorial: The First Showdown on Health Care (New York Times)

Republican senators are hyperventilating over the possibility that Democrats might try to pass health care reform with only a majority vote — depriving them of the chance to try to block legislation with filibusters that can only be overcome with the votes of at least three-fifths of all senators.

How quickly they forget. When the Republicans controlled Congress they used the same expedited procedure to ram through controversial measures, including the enormous tax cuts for the wealthy that plunged the federal budget deep into deficit.

There are reasons to be wary about resorting to the expedited process, known as budget reconciliation. But it is a weapon that the Democrats would be foolish to give up without evidence that Republicans will truly cooperate in fashioning meaningful reform. Not one Republican in the House or the Senate voted for the budget resolutions, and only three supported the stimulus bill.

Other than dealing with the economic crisis, health care reform is the most essential item on the Congressional agenda. It is imperative to lower the cost of health care, improve its quality, and cover tens of millions of uninsured Americans.

The Obama administration has proposed sensible ways to finance broader coverage and to improve some aspects of the health care delivery system but has left it to Congress to thrash out most of the issues. Members of both parties are trying to reach consensus. But on some issues, like how much to rely on public or private plans, they remain far apart.

The House version of the budget resolution has authorized the use of reconciliation for health care reform; the Senate's has not. Soon after Congress returns to work on April 20, a conference committee will have to decide which view will prevail.

If reconciliation is endorsed, the budget resolution will direct relevant committees to prepare health care legislation that can be merged into a single bill and then passed by a simple majority of those voting. That would make it easier to adopt such important measures as a tightly regulated insurance exchange for those without group coverage, a new public plan to compete with private plans, and mandates that employers contribute to the cost of covering their employees.

The reconciliation approach is not bulletproof. It is primarily designed to deal with spending and revenue issues that affect the deficit. Under current rules, senators can seek to remove any provisions deemed extraneous or "merely incidental" to such budgetary concerns. Nobody is quite sure how the Senate parliamentarian would rule on such items as tighter regulation of private insurers or creation of a new public plan or incentives to improve the coordination of care.

Republicans are also complaining that reconciliation limits the hours of debate and the opportunity for amendments. But Congress has already been wrestling with health care reform in multiple committees, so the need for more posturing in floor debate is not apparent. There are also dire warnings that resorting to reconciliation will poison the atmosphere for bipartisanship. That may well happen, but so far most Republicans have shown little appetite for cooperation on anything.

Reconciliation is not a weapon that should be deployed immediately. The conferees should agree on language that would allow it to kick in by a date in the fall if the two parties cannot agree on a reform bill. A bipartisan agreement would be nice, but what the country needs right now is effective health care reform.