Speaker Pelosi will soon ask at least 12 of the conservative Blue Dog Democrats in the U.S. House, who voted against the Health Care bill in December, to fall on their proverbial swords and cast a 'yea' ballot for the Senate bill.

     Among the 37 targets of her party's pressure will be local Democrats like Louisiana's Charlie Melancon and Mississippi's Gene Taylor. And, asking them to switch sides could be potentially fatal electorally.  Melancon is running double- digits behind Republican David Vitter for the U.S. Senate, and both he and Taylor represent districts that went for John McCain by substantial margins and are difficult for a Democrat to hold under the best of circumstances.

     The same can be said of the Speaker's other targets in her party's conservative wing, who represent GOP-leaning seats in a year when the tide is distinctly against the Democrats. In other words, it is not unreasonable to expect that she would be quite open to providing substantial political cover to the switched votes as the reconciliation bill "fixes" are negotiated.  After all, its just a few more pages in the over 2300 page bill she and her leaders posted on the web Sunday night.

    Pelosi, in the end, has no choice. The 11 votes that Congressman Bart Stupak of Michigan holds are firm against supporting any legislation that does not include a firm prohibiition against any insurance policy in the federal exchanges possessing abortion services. Under the reconciliation bill, the Speaker has no leverage to include those prohibitions, and even if she could, they would die from Senatorial opposition from Democratic pro-choice activists in the Upper Chamber like Barbara Boxer and Barbara Mikulski--critical votes to pass the reconciliation fixes.

    The U.S. House will not pass the Senate Health Care bill unless certain measures are addressed for the next decade, including a suspension in the Cadallic Tax for labor unions (a make-it or break-it demand of pro-labor congressmen), extension of the so-called "Cornhusker Kickback" of full Federal funding of Medicaid expansion to every state in the nation, and a few other less publicized changes of funding policy that have drawn public ire.

    In all the process-conversation of Reconciliation, Democrats have often failed to emphasize that the plan for the House is to pass the Senate Health Care bill, approved under normal rules by 60 votes already, and then the House could pass its funding changes as part of a budgetary reconciliation vote that can not be blocked by the GOP's 41st new vote, Scott Brown.

    Most of the proposed changes are budgetary matters of taxes and spending (such as the eight year suspension of the Cadillac Tax for labor unions) and follow GOP precedent on the Bush tax cuts--which passed under reconciliation rules when the Administration was able to only garner 58 Senatorial votes initially--and 50 votes for their second phase two years later.

   With Republicans having used reconciliation for tax cuts and yearly for budgetary spending (as with any Congress, the reason reconciliation exists is to pass a yearly budget without a filibuster), the GOP's options to block the bill under a Senate Rule vote are limited.

   Still, that does not mean that Pelosi will get the votes she needs for the overall bill, unless she is willing to address three areas that are of prime concern to swing voters in the reconciliation bill, and could help defend endangered Democrats in November.

   First, nearly a quarter of seniors entering Medicare eligibility sign up for the Medicare Advantage program. Despite the added cost, the private insurance option under Medicare is widely popular. Doctors who refused to accept patients under the limited repayments of Medicare generally do take patients under Medicare Advantage, if for no other reason that they fear losing conventional service from Insurance providers. And, the repayments for Doctor visits are better.

   Consequently, the program is universally popular in swing districts with large proportions of elderly voters. And, old people vote, as all Congressmen know. For that reason, in fact, Florida US Senator Bill Nelson had the residents of three South Florida counties grandfathered in to the program, a special deal that has drawn national condemnation.

   The simple thing to do politically is to not cut Medicare at all, thus reducing the political danger to Democrats of cutting a popular entitlement. However, just as the so-called "Cornhusker Kickback" on Medicaid funding has been extended to all 50 states in the reconciliation bill, so then, grandfather all current recipients of Medicare Advantage.

    Speaking of Medicare, while funding will be increasing from Federal coffers under the compromise to 150% of the poverty level, many of the program mandates still make the bill very unpopular in the halls of state legislators. California Governor Arnold Schwarzenegger, an inital supporter of the President's plan, turned against the Health Care proposal for this reason. So why not include a provision allowing automatic wavers for state legislators to re craft the Medicaid program to their state's specifications--as long as it meets the coverage goals now in place for the S-Chip legislation, 150% of poverty.

   Since such a change would be up to the State legislators, federalism critiques of conservative Democrats would be minimized, yet liberals seeking a greater federal role would not likewise gain damage in their home districts. The legislation would be in place, unless other changed by the state capitols.

   Lastly, the most poignant critique of the legislation by Conservatives and Liberals is the individual mandate. It forces many struggling families to pay for health insurance with dollars they frankly do not have. And since, under the Senate bill, subsidies tend to phase out for families making more than $42,000, this appears to be a tax increase on the middle class--something the President specifically pledged not to do.

   And, as these subsidies are directed to Insurance Companies, few people see their benefits in their pocketbooks. As such, steal a popular Republican idea. For families making less than $250,000, give a refundable tax credit of $6000 per family to help pay health insurance costs, if they do not receive insurance from their employers.

   This has a huge fiscal note, but it empowers many middle class taxpayers caught in the system, and begins the fiscally necessary process of detaching health care from employment, a necessary move for eventual cost control. It also provides wavering Democrats with the talking point, "We gave you the biggest middle class tax cut in history..."

   These three proposals are not cheap, but in the end, the protestations of fiscal rectitude are something that has been overblown in this legislation. The real cost of Heath Care Reform is closer to $2.1 Trillion over ten years. These proposals would add roughly $500 billion to the price tag, but would equally help with long term competition and therefore cost control.

   They also protect Democrats from the three strongest charges that Republicans would have in the fall, and maybe necessary if Speaker Pelosi has any hope of getting 216 votes for Health Care reform.  Regardless, if these changes are unworkable, they would expire in the 10 years under reconciliation rules--just as the Bush Tax Cuts soon will.    Consider the modifications to be transition costs to full Health Care Coverage rather than transition prices that midwife the election of a Republican Congress. 

Christopher Tidmore and David Gereighty are on the radio in morning drive from 7-8 AM on WSLA 1560 AM New Orleans and KKAY 1590 AM in Baton Rouge, archived and streamed online at www.gtmorning.com.