In a televised broadcast from the White House President Obama on Thursday forcefully repeated the case for healthcare reform, urging Congress to finish its work so he could sign the reform into law.

Flanked by lab-coat adorned physicians and nurses who literally stood behind the bill, Mr. Obama said every idea about healthcare reform had been put on the table.

Reflecting upon the year-long debate on the reform proposals Mr. Obama said, “Every argument has been made. Everything there is to say about health care has been said and just about everyone has said it. So now is the time to make a decision about how to finally reform healthcare so that it works, not just for the insurance companies, but for America's families and businesses.”

In the clearest indication so far that time for wrangling over the bill with an intransigent Republican opposition was running out, Mr. Obama said it deserved the same kind of up-or-down vote that was cast on welfare reform, the Children's Health Insurance Program, COBRA health coverage for the unemployed, and both Bush tax cuts.

Given that these bills were passed in Congress with a simple majority rather than a supermajority it would appear likely that the Democrats are hoping to get the bill signed into law through reconciliation, the legislative procedure that allows bypass of the supermajority requirement for ending opposition filibuster.

Republicans, including Senate Minority Leader Mitch McConnell voiced their strong opposition to the Democratic move towards reconciliation.

Speaking a few minutes after Mr. Obama's address Senator McConnell said, “I assure you that if this bill is somehow passed, it won't be behind our Democratic friends, it'll be ahead of them because every election in America this fall will be a referendum on this issue.”

However, as in an open letter to Republican and Democratic leaders written on Tuesday, Mr. Obama highlighted areas of agreement that transcended the divide.

Agreement

Among these areas of agreement, which the President has indicated would be part of the final bill, are included a comprehensive set of initiatives to combat fraud, waste, and abuse, funding to states to finance demonstrations of alternatives to resolving medical malpractice disputes, raising Medicare reimbursements to doctors in states where they fall short and the expansion of Health Savings Accounts.

Yet it is evident that Mr. Obama's patience with the process is wearing thin. Highlighting the main outcome of the rare bipartisan debate held in Blair House last week he admitted, “Now, despite all that we agree on and all the Republican ideas we've incorporated, many– probably most- Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies.”

Throwing down a direct challenge to the Republican leadership, he said “And if they truly believe that less regulation would lead to higher quality, more affordable health insurance, then they should vote against the proposal I've put forward”.

If a last-ditch measure for bipartisan support does not emerge within the next few weeks — and that is unlikely judging by the tenor of the Republican response — it would remain for House to pass the Senate version of the bill and then all the additional measures in the final Democratic bill would need to be passed — and it is for the latter step that reconciliation may be invoked.

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