“The Chicago approach to governing” is what Republican senator Judd Gregg calls the White House’s tactics on health-care reform: “You’re talking about running over the minority, putting them in cement, and throwing them in the Chicago River.” Gregg is referring to the administration’s plan to use reconciliation, an obscure parliamentary procedure, to pass health-care legislation this year. He isn’t alone; Republicans are up in arms over reconciliation. But the White House itself should be worried about the plan, which could result in reforms far more radical than it envisions.

Reconciliation, employed just a couple of dozen times since 1980, was created in the Congressional Budget Act of 1974. It limits debates and amendments and prevents filibustering, meaning that Senate Democrats would need to muster just 50 votes, not the usual filibuster-proof 60, to pass health-care legislation. Some question the fairness of such a move, since reconciliation was originally intended for budgetary issues. That’s partly why Senator Robert Byrd opposed President Clinton, back in 1993, when Clinton flirted with the idea of using reconciliation to pass health reform.

Fair or not, Congress made reconciliation part of the final budget bill that was approved in late April. The White House has been key in pushing the idea. From a distance, this may seem to be overkill. The president’s approval ratings remain robust, his opponents disorganized. With Senator Arlen Specter’s defection, the Democratic Party is on the cusp of having 60 seats in the Senate. Democrats, in other words, would seem to need no Republican help in reforming American health care. So why all the talk about reconciliation?

Perhaps because the White House’s health-care agenda is too radical to appeal to moderate Democrats. Take the idea of a public health plan modeled on Medicare and open to all. Since public programs have a competitive advantage over private plans—they employ wage and price controls, leading to artificially low premiums—many people, perhaps tens of millions, would doubtless opt for a Medicare-style plan over their usual private insurance. Needless to say, this proposal has already sparked sharp resistance from some Republicans, but when specific legislation (along with a big price tag) comes forward, it’s likely that opposition will grow, not shrink, with the addition of more conservative Senate Democrats like Bill Nelson and budget committee chairman Kent Conrad. The usual 60 votes needed to pass legislation in the Senate may not be so easy for the White House to obtain. And thus the administration’s embrace of reconciliation.

The catch, though, is that without the support of Republicans and, potentially, of moderate Democrats, the White House will depend heavily on liberal Democrats like John Conyers, a congressman from Michigan, who are well to the left of the administration on health care. In the last Congress, Conyers proposed a bill that would create a Canadian-style socialized health-care system; it won the support of almost 90 House Democrats. Without the need for Republican and moderate Democratic support when their legislation reaches the Senate, these representatives will have a free hand to write a bill that even the White House could find too radical.

Senate Republicans have a choice. They can try to stay relevant by compromising, or they can play their own hardball—avoiding any White House talks so long as reconciliation is on the table. That tactic is risky, since it depends on a White House rift with liberal Democrats, but it has one advantage: it could save American health care from Conyers and his allies.


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