Nothing simple about reform

The issue, as President Barack Obama sees it, is simple: Congress owes the American people a final vote on health care reform. If only it were that simple.

Both the House and the Senate have passed health care legislation, but they have substantive differences. And now Obama has weighed in with a bill of his own.

Even its most ardent Republican opponents concede a final bill would pass if it were a matter of a simple majority. But in the Senate, it's not. The Democrats have only 59 of the 60 votes they need to shut off debate.

There is a way around that obstacle, but it's controversial, and getting there is complicated. Under a process called reconciliation, the Senate can pass bills with significant budgetary impact by a simple majority of 51 votes.

The Republicans, who freely resorted to the practice when they were in charge, say this would be an outrageous abuse of the legislative process. Senate GOP leader Mitch McConnell, perhaps overestimating the voters' appetite for congressional arcana, says, "Once reconciliation is explained to them — it will be the issue in every single race in America this fall."

A tentative plan taking shape would have the House pass the Senate's health care bill, ensuring that, come what may, there will be a law. The House would then enact what's being called a "cleanup bill," incorporating the House Democrats' major objections to the Senate version and portions of Obama's bill, including concessions he made this week to the Republicans.

Those concessions entail stepped-up efforts to root out fraud in Medicare and Medicaid; and health savings accounts as part of any insurance exchange.

The cleanup bill would then be sent to the Senate for a simple majority vote under the reconciliation formula. It sounds simple enough but here, too, there's a problem: Baldly put, the House Democrats don't trust the Senate Democrats.

Obama summed up the state of the debate this way: "Everything there is to say about health care has been said, and just about everyone has said it." So vote already.