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Health care now 

It is as simple as this: If you think universal health insurance is essential and urgent — and the vast majority of Americans do — you have to support the notion of doing it right away by majority rule.

That means embracing the idea of using the budget reconciliation process in the Senate to pass health-care reform, which would avoid a certain Republican filibuster and the necessity of lining up 60 percent of the Senate to halt it and permit a vote. A majority in the Senate and a majority in the House of Representatives would make it law, just like the founding fathers intended lawmaking to work.

If it doesn't happen that way, it is not going to happen at all, at least in the political cycle that ends with the 2010 elections. If health care spills over into the election year, the forces opposing a universal system will gain the upper hand just as they did in 1994 when election-year maneuvering stymied the last real effort to achieve it.

There is a sense in the land that universally affordable health care is a done deal because everyone — Republicans and Democrats, the insurance industry, medical providers, every business association and every other interest group with a stake in health care — is finally for it. But that is an illusion, just as it was in 1992 when presidential candidate Bill Clinton said in one of the debates that a universal system was unavoidable and only the niggling details in question because the whole country was behind it.

The details that might guarantee affordable coverage for everyone and not just more Band-Aids are the ones that important people don't agree on. They will block any bill that includes those details, if they can.

The big one is President Obama's central plan to include the option of a government basic insurance plan alongside private insurance plans. If there is going to be competition for health coverage, much of the insurance industry is not going to allow the legislation to pass, if they can help it. Remember the Harry and Louise commercials by the Health Insurance Association of America that blanketed the country in 1994 and sank Clinton's program?

Last week, the nation's largest health insurer made 3 million computer-generated telephone calls to Californians to get them roiled up about Obama's sweeping plan. Its major concern, though it wasn't communicated, is the government insurance plan. The company also is sore about the Senate avoiding a filibuster. Two years ago, the company provided the decisive muscle and a $2 million ad campaign that torpedoed Gov. Arnold Schwarzenegger's plan to mandate health insurance for all Californians and force insurers to sell policies to anyone regardless of pre-existing conditions.

Arkansas's Sen. Blanche Lincoln and Rep. Mike Ross, who are key figures in the health-care drive, both deplored using the reconciliation process to pass health care. They want to take lots of time to get it right and not ram it down the Republicans' throat, they said. It is a disturbing but not surprising development. They have said they wanted broad health-care reforms and Ross particularly has usually supported modest reforms, but they have not committed to the basic idea of an optional government insurance plan for those who cannot afford or get a private policy. If the insurance industry opposes it, it is a good bet that Lincoln will, too.

Despite the national consensus for health reform and the big Democratic victories, giving them 58 votes in the Senate by counting two leaning independents, it is not a cakewalk. They can expect three Republicans at most to join them and to lose six to eight Democrats on a cloture vote, maybe including Lincoln. Using the budget process they will need 50 senators. Vice President Joe Biden could provide the majority.

Republicans and the insurers say they wouldn't get a chance to debate the plan. Using the budget rules to pass health care doesn't impede debate or participation in any way. It just clears the way for an up-and-down vote when the time comes, probably this fall.

The idea of passing major legislation by a mere majority vote is not a radical one, as the Republicans proclaimed last week. That is how nearly every piece of major legislation in the nation's history was passed until conservatives began using the filibuster after World War II to block civil rights and then other reforms.

Ronald Reagan and both Bushes used the budget to pass their biggest bills when Democrats set out to block them, including George W. Bush's big tax cuts for the rich and corporations in 2001 and 2003.

This week, Sen. Judd Gregg of New Hampshire said the Democrats' use of the reconciliation process to pass health care reform was radical and he compared it to the strong-arm tactics of the Venezuelan president, Hugo Chavez.

But back when he and the Republicans were using reconciliation to pass President Bush's programs over Democratic objections, Gregg said the Republicans were merely using Senate rules and he asked wryly, “Is there something wrong with majority rules?”

Of course there isn't. He was as right then as he was wrong this week.

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