When it comes to the budget reconciliation process in the Senate, the truth is not setting Republicans free. On Sunday, John McCain vowed to end the use of reconciliation to change Medicare, despite the GOP's repeated deployment of that same tactic for 30 years. Now, Utah Senator Orrin Hatch, who previously warned Democrats that resorting to the 51 vote simple majority to pass health care would trigger a "holy war," ignored his own voting record to declare in the Washington Post that "reconciliation on health care would be an assault to the democratic process."
Sadly for Orrin Hatch, as Ezra Klein explained, "Reconciliation has, in general, been a Republican endeavor":

Political scientist Joshua Tucker looked at the 19 times reconciliation was used between 1981 and 2005, and found that 14 of them were Republican initiatives. If you extend that analysis out to 2008, then 16 of 21 reconciliation bills were Republican.

And as National Public Radio documented last week, for decades both parties have enacted health care reforms, including numerous changes to Medicare, via the reconciliation route:

In fact, over the past three decades, the number of major health financing measures that were NOT passed via budget reconciliation can be counted on one hand. And one of those -- the 1988 Medicare Catastrophic Coverage Act -- was repealed the following year after a backlash by seniors who were asked to underwrite the measure themselves. So using the process to try to pass a health overhaul bill might not be easy. But it won't be unprecedented.

Certainly not unprecedented for Orrin Hatch.
As ThinkProgress reported," what Hatch fails to mention is that he has voted for bills passed through reconciliation every single time a bill was offered through the process during the Bush years, including to pass massive tax cuts for the wealthy that served to do anything but 'balance the federal budget.'" Over at Plum Line, Greg Sargent detailed Hatch's hypocrisy, citing the Utah Senator's yea votes on the 2001 and 2003 Bush tax cuts, reductions to Medicaid spending and allowing parents of disabled children to buy into Medicaid in 2005, and a 2005 extension of the Bush tax cuts for some income brackets. As Sargent rightly concluded:

"It's one thing to argue, as Hatch and many others have, that previous reconciliation votes were somehow different from the vote Dems are preparing. It's taking things to a whole new level to completely omit any mention of a whole series of votes you took because they inconveniently reveal that your entire argument is bogus."

The hypocrisy of Republicans like Orrin Hatch (who warned in January that health care reconciliation would be "one of the worst grabs for power in the history of the country")and Lamar Alexander (who said it would "end the Senate") reveals one other thing. As Hatch himself told CNS, he's not afraid of permanent damage to the institution of the Senate, but instead fears a permanent Democratic majority:

HATCH: ...If they get there, of course, you're going to have a very rough time having a two-party system in this country, because almost everybody's going to say, "All we ever were, all we ever are, all we ever hope to be depends on the Democratic Party."
Q: They'll have reduced the American people to dependency on the federal government.
HATCH: Yeah, you got that right. That's their goal. That's what keeps Democrats in power.

At the end of the day, what Republicans like Orrin Hatch fear about reconciliation is simple. The GOP is worried not that Democratic health care reform might fail the American people, but that it will succeed.