Ideological purists do not believe in reconciliation. Conservatives would rather rely on private acts of kindness than the state to deliver health-care services. Hence their characterization of bureaucrats as cold and remorseless (such as when they're on "death panels"). Liberals, for their part, believe that it is heinous to make a patient in need of care wait for private charity. Hence their tremendous faith in the helping hand of the state. For the conservatives, the market is benign but the state is monstrous; for liberals, the state is virtuous and the market is immoral.
Partisans and political parties, on the other hand, must reconcile themselves to median voters and therefore to each other if they are to have any chance of survival. That is why in their discussion of health-care reform, most Republicans and Democrats have ceded fundamental tenets of their ideology. In their concurrence with the Republicans in addressing a social issue in cost-cutting and job-creating terms and in eschewing a single-payer system, Democrats have proven that they are not really socialist. In reminding seniors of the potential cuts to Medicare should the Democrats try to cover the uninsured, Republicans have shown that they are not pure laissez faire anti-statists either.
It is in this muddied ideological context that we should view the parliamentary measure called Reconciliation which Democrats are bracing to deploy in the weeks to come to pass health-care reform. Reconciliation may be procedurally draconian because it bypasses the Senate filibuster, but it crystallizes the idea shared by Congressional leaders who pushed through the Budget and Impoundment Control Act in 1974 that legislative output (sound or unsound, one might add) is more important than consensus. It is no wonder that Reconciliation has often been used to pass legislation on the divisive issues in American politics which typically straddle the state/market-solution divide. These include health insurance portability (COBRA, 1985), expanded Medicaid eligibility (1987), welfare reform (1996), the Children's Health Insurance Program (CHIP, 1997), and Temporary Assistance for Needy Families (TANF, 2005). Perhaps the Democrats could have saved themselves a year of trying to make history and a lot of political capital if they had realized that almost every welfare and health-care bill passed in the last three decades was achieved via Reconciliation.
Although Republicans say it is the nuclear option, no real destruction followed after each of the 22 times the measure has been used (with two-thirds of the time by Republicans.) Reconciliation doesn't only reconcile items on the federal budget, but its supporters on either side of the aisle (when it suits them) also believe that the measure also reconciles the Founders' sometimes contradictory commitment to deliberation and debate and their desire for legislative output and government. Reconciliation has been used before, and it will be used again, rather soon.