It's not clear if the Democrats have the votes to get health care reform through Congress. Earlier versions of the bill have already passed both the House and the Senate—and, in the Senate's case, passed with a supermajority of 60 votes. Because the Democrats can use the reconciliation process, which allows them to avoid the threat of filibuster as long as they only amend budget-related provisions of the bill, they should be be able to pass a version of the bill both the House and Senate can agree on with just a simple majority in the Senate. But even though they actually need fewer votes to pass the final version of the bill, it's going to be tough to do.

That's in large part because Scott Brown (R-MA) managed to win the special election for the late Ted Kennedy's old Senate seat by campaigning against health care reform. That's a bit of an irony, since Massachusetts' popular health care system is actually more liberal than the proposal before Congress—and even includes a government-run health plan. But Massachusetts voters nevertheless voted for Brown in part because of their dissatisfaction with the health care reform process in Congress. With the 2010 elections approaching, many Democrats who originally voted yes have begun to fear that passing health care reform could cost them their own seats—even though, of course, if they do vote against the final bill they will be attacked both for having voted for the bill originally and for flip-flopping.

Republicans, meanwhile, are attacking the Democrats for using the reconciliation process to revise the bill, saying that the Democrats are using a procedural trick to force the health care bill through Congress. In fact, most of the bill has already passed both houses of Congress, and any provisions that are altered using the reconciliation process would still require a majority vote to pass. The only reason the Democrats have to resort to reconciliation in the first place is to stop the Republicans from using another procedural trick—the filibuster—to block a vote on the bill with a minority of just 41 senators. Although it has now been around for a while, as Ezra Klein points out, far from being a part of the Constitutional design of the Senate, the filibuster is actually a byproduct of Senate rules created for other reasons. And reconciliation has been used many times since it was created in 1974 to get around the filibuster—including 16 times by Republican-controlled Senates. It has even been used for major legislation, including welfare reform in 1996 and the enormous Bush tax cuts in 2001 and 2003. Nevertheless, the Republican attacks have made some Democrats nervous that voters will see them as contributing to the ugly partisanship of this Congress.