You only need 51 senators to pass a bill through reconciliation. But theoretically the main problem with reconciliation is that it can only be used for legislation that affects the budget. So, a public option or Medicare buy-in would definitely affect the budget, but getting rid of insurance practices like barring people for pre-existing conditions or denying them care through rescission could not be handled through reconciliation.
So, if you just want one bill you can't go through reconciliation because you can't keep many of the important elements of health care reform. That's conventional wisdom. But here is a radical new idea - how about we just do Medicare buy-in for anyone who wants it and not bother to pass any regulations about pre-existing conditions or rescission or anything else.
But what about all of the people on private health insurance who are getting screwed by those companies? Well, I guess they'd have to buy in to Medicare, wouldn't they? And if the private insurance companies lost enough customers, my guess is they would all of a sudden see the wisdom in actually providing better insurance. I believe they call that competition.
Medicare does not engage in any of the abuses that we are trying to address with this bill anyway. They don't turn people away. They actually treat you if you're sick. They don't take 20% of your money as profit for their executives and shareholders. It's a policy that a lot of people might feel very comfortable going with.
We know the Republicans can't possibly object to Medicare because they spent the last several months pretending to defend it against what they said were attacks by the Democrats. Great, we're on your side - Medicare it is.
This has the advantage of tremendous simplicity instead of the bureaucratic monstrosity that is the current bill with all of its regulations, mandates and loopholes. The government doesn't have to create a whole new entity. People pay the premiums for this Medicare buy-in, so it's deficit neutral.
And since it can get passed through reconciliation where you only need 51 votes, you remove all of the political headaches. Joe Lieberman can go ... himself. Ben Nelson, you are free to vote with your Republican friends. Olympia Snowe, you get to keep whatever perks you had within the Republican Party. Blanche Lincoln, you are free to be as conservative as you like in Arkansas (see how that works out for you).
Chris Matthews said the other day that passing health care reform through reconciliation would be Armageddon. Why? George Bush passed many bills through reconciliation, including the largest tax cuts in history. He got most of his legislative accomplishments in 2001-2005 when he had only 50 or 51 senators. And there was no Armageddon. In fact, nary a peep was heard.
There are only two groups who lose in this. The insurance companies that are going to see most of their customers walk away when they see how badly they've been getting screwed all of these years. And the Obama administration because they will be all out of excuses on why they can't get real reform passed.