Republicans desperate to halt health care reform at all costs are turning to a new gambit. To Democrats intent on passing a Senate bill with a 51 vote simple majority via the reconciliation process, Republicans for months have warned the move would trigger a "holy war" (Hatch), a "nuclear war" (Kyl) or even "end the Senate" (Alexander). Now, John McCain hopes to foreclose that option with an amendment that would prohibit the use of reconciliation to change the Medicare program. Of course, as NPR documented last week, for decades both parties have revised Medicare using the reconciliation route.
As McCain told David Gregory on Meet the Press, he will propose that obstructionist Republicans facing defeat by a simple majority in the Senate simply move the goalpost on Democratic health care bills that feature restructuring the Medicare Advantage program as a key ingredient:

MR. GREGORY: But, Senator, you have voted for bills through reconciliation nine times since 1989.
SEN. McCAIN: Yes. Yes, I have voted for them, but I objected strenuously to us changing the rules so the Senate--so that 51 votes would prevail. And let me also say that Robert Byrd also in the '70s exempted Social Security. Social Security cannot be considered in reconciliation. We should do the same thing with Medicare. Lindsay Graham and I will be introducing legislation. Entitlements should not be part of a reconciliation process, i.e., 51 votes. It's too important.

Leave aside for the moment that McCain's Republican Party tried to kill Medicare in the 1960's, tried to gut it in the 1990's, is now trying to privatize the system and that McCain himself in 2008 called for cuts of $1.3 trillion over 10 years in Medicare and Medicaid. The record shows, which John McCain conveniently ignores, that the reconciliation process has been the route of choice to alter the Medicare program serving 46 million American seniors.
As National Public Radio documented on February 24th, "Health Care No Stranger to Reconciliation Process." As Sara Rosenbaum, who chairs the Department of Health Policy at George Washington University, put it, "In fact, the way in which virtually all of health reform, with very, very limited exceptions, has happened over the past 30 years has been the reconciliation process." That includes the popular COBRA benefit for workers trying to purchase health insurance after leaving - or losing - their jobs. As Rosenbaum put it:

"The correct name is continuation benefits. And the only reason it's called COBRA is because it was contained in the Consolidated Omnibus Budget Reconciliation Act of 1985; and that is how we came up with the name COBRA."

And to be sure, as NPR described in detail, Medicare has repeatedly and routinely been updated via the reconciliation process:

"Going back even close to 30 years, if you start say in 1982, the reconciliation bill that year added the hospice benefit, which is very important to people at the end of life," says Tricia Neuman, vice president and director of the Medicare Policy Project for the Kaiser Family Foundation.
Over the years, budget reconciliation bills added Medicare benefits for HMOs, for preventive care like cancer screenings; added protections for patients in nursing homes; and changed the way Medicare pays doctors and other health professionals.
Because the point of budget reconciliation was usually to cut the deficit, the huge Medicare program was nearly always on the chopping block. But there's another reason it became the bill of choice for other far-reaching changes.
"This happened primarily because it was the only train leaving the station, so if policymakers wanted to make a change in health policy, the only way to do it would be to amend a reconciliation bill, and that's really why it happened," says Neuman, a former congressional health policy staffer.

The claim of Orrin Hatch that "the use of expedited reconciliation process to push through more dramatic changes to a health care bill of such size, scope and magnitude is unprecedented" is simply wrong. The Bush tax cuts, which passed via the reconciliation process, dwarfed the price tag for health care reform. And when it comes to health care legislation and reconciliation, as NPR concluded, almost the exact opposite is true:

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.