If You Want Health Reform, Reconciliation Must Be On the Table

The debate over the use of the “budget reconciliation” process has taken on a weirdly circular quality. On the one hand, folks say that going through reconciliation will wreck the chances of Republican cooperation. On the other hand, reconciliation proponents maintain that if Republicans would do more cooperating there’d be no need for talk of reconciliation. Meanwhile, the key moderate Democrats who hold the balance of power in the Senate have shown a tendency to twist in the wind on this.

But with the Senate GOP acting yesterday to block a vote on Kathleen Sebelius’ confirmation on the grounds that she’s pro-choice, it’s time for a little Real Talk. There’s no indication that Republicans have any serious desire to cooperate on a serious health care reform bill. Instead, they seem to be interested in using the carrot of cooperation as a way to get Democrats to unilaterally abjure procedural methods and revenue sources that would make reform possible.

Igor Volsky surveys the record:

Of course, if you don’t give, you’re not gonna get and Republicans have shown only limited willingness to cooperate with Democrats on health care reform. Key Republicans voted against the popular SCHIP legislation, eight Republican senators (including health care heavy weights Grassely and Hatch) voted against Gov. Kathleen Sebelius’ nomination to head the Department of Health and Human Service, Republicans misrepresented the intent of health information technology and comparative effectiveness research in the stimulus, encouraged smear groups to lie about CER and health IT, invited Easter special Sally Pipes to testify about health care reform, and have already taken the public option off the table.

Bipartisan outreach is, at times, a necessity. When the same party controls concurrent majorities in both houses of congress and the White House and is discussing an issue that’s eligible for reconciliation treatment, it is not a necessity. It’s a tactical option. But it’s just that — a tactical option, not a first-order concern of substantive policy.


What I worry is that there are a certain number of Democrats who, deep down, just join their Republican colleagues in not wanting to see health care reformed. But they don’t want to say that. So they may first block efforts to prevent the GOP from blocking reform, and then let the GOP block reform, all the while posing as reformers. Keep your eyes open.