But reconciliation is allowed only on proposals that deal directly with the budget or are primarily fiscal in nature. So Democrats could use reconciliation to pass parts of the health care bill that have a direct fiscal effect, but not other measures creating things like health care supervision agencies. If Democrats try to pass measures that are deemed “extraneous,” Republicans could object and have the measures stripped from the bill…

But there’s another way of looking at it. Sure, Democrats can’t get everything they want if they have to go through reconciliation. But look at health care reform as an unfinished building. There are plenty of examples of past legislation that began somewhat modestly and expanded as the years went on. The State Children’s Health Insurance Program, or S-CHIP, has been enormously expanded. Medicare and Medicare are far bigger today than when they were created. Programs grow over time as lawmakers add features and increase eligibility.

The story could be the same for the current health care proposals, through which Democrats, with no Republican support, could put in place the basic structure of a national health care plan. It doesn’t have to be gold-plated, or even finished. That could come later.