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"The issue trumps the process." That's what Sen. Christopher Dodd, D-Conn., told The New York Times about health care reform. And that's what Democrats have got to believe. There is no question that the process has been costly thus far. In January, an uninsured 18-year-old waitress in New Hampshire explained her opposition this way to a Times reporter: "If you have to bribe people to vote for it, it can't be good."

The process could get costlier as Democrats try to pass the bill on a partisan majority vote. In his response to President Obama's weekly radio address, Sen. Tom Coburn, R-Okla., charged that congressional Democrats "want to use procedural tricks and backroom deals to ram through a new bill that combines the worst aspects of the bills the Senate and House passed last year."

Coburn was referring to the reconciliation process, whereby a health care bill could pass the Senate with 51 votes without being subject to a filibuster, which can be ended only by a 60-vote supermajority. Questioned about reconciliation at her news conference last week, House Speaker Nancy Pelosi, D-Calif., replied, "What you call a complicated process is called a simple majority."

Foreign observers often ask, if the president is a Democrat and the Democrats have solid majorities in both houses of Congress, why can't the party just govern? The answer is, because the United States is not a parliamentary system.

The president cannot rely on the majority party in Congress, even if it's his own party, to support him. Members of Congress are not foot soldiers in a political party's army. They are independent political entrepreneurs. They're in business for themselves.

That's why the health care bill is such an unusual experience for the United States. Democrats are trying to behave like a parliamentary majority. Coburn and other critics are calling it legislative trickery. What seems extraordinary in the United States -- the reconciliation process -- is just normal politics anywhere else.

It will not be easy for the Democrats to muster even a simple majority, particularly in the House. The health care bill passed in that chamber last November on a 220-215 vote. The lone Republican who voted for it has indicated he will oppose the bill this year. Since November, three Democratic "aye" votes have disappeared (two resignations, one death). That puts the tally at 216-216.

As we get closer to the midterm election, more yes votes seem to be switching to no than no votes to yes. Although health care reform is still a popular cause, the Senate and House bills are not. In a CNN poll in February, only 25 percent of Americans thought that Congress should pass a bill similar to those approved by the House and Senate. The same number felt that Congress should stop working on health care. The prevailing view, held by 48 percent, was that Congress should start working on an entirely new bill.

The public is somewhat confused about the reconciliation process. Last month, in a CBS News/New York Times poll, respondents narrowly approved the idea (50 percent to 44 percent) that the Senate should pass legislation by a simple majority vote rather than requiring a supermajority. But Gallup found most Americans opposed to Senate Democrats' "using a parliamentary procedure that would allow them to avoid a Republican filibuster and pass their health care bill by a simple majority vote" (52 percent opposed, 39 percent in favor). The key difference? The Gallup question specifically refers to the Democratic health care bill.

If the Democrats pass health care reform on a partisan vote, a political firestorm will likely ensue. Congress would be defying public opinion. President Obama said at last week's health care summit, "I think we've got to go ahead and make some decisions, and then that's what elections are for." That's also what makes Democrats in Congress very nervous.

If they pass the bill, Democrats have to hope that the firestorm passes and people discover they are better off. But expanded health insurance coverage will take years to kick in. At the same time, higher taxes are also likely to be some years down the road. The battle over health care reform could go all the way to the polls in November, with politicians still arguing over principles rather than experiences.