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Is It Really 60 Votes or Bust for Health Care?

One question I had while reading Jonathan Cohn's excellent item about the legislative status of health care reform. It comes from this section of his account:

But if Snowe signs on, according to nearly every person I consulted, it’s quite possible the legislation she supports would become the Senate’s bill with very little change--and that, in conference, the Senate bill would prevail. She’d hold the leverage, as long as the administration and Democratic leadership prefer to pass pass legislation with 60 votes. And that certainly seems to be the inclination of Obama and his advisors. (It's harder to tell about Congress, particularly the House, but they're unlikely to challenge the White House openly on this.)

Unless, of course, it never gets that far. Snowe may not sign on; even if she does, one source close to the process notes, she "may not bring a sufficient number of conservative Democrats" to reach 60. If that happens--if consensus proves elusive, for whatever reason--then Obama and his allies would focus on trying to pass a bill through reconciliation. And they would move quickly.

Now, Jonathan is very well-sourced on this subject, so I'm fairly certain this is the view of key decision-makers in the White House and on the Hill. I guess the question is: Why does it have to be 60 votes or reconciliation? If we don't get 60, why can't Democrats just take the 54,55, 56 votes they have and dare Republicans to filibuster? (Or, better yet, dare moderate Democrats to filibuster, since you'd probably need one or two of them to sustain it, and since they'd suffer a lot of the fallout if health care reform failed.) As I've said before, I really don't think there are enough votes to sustain a filibuster on this issue, though I'm willing to reconsider if someone can show me where I'm going wrong.