Liberal health reform advocates have talked about ramming a reform plan — including a Medicare-like public insurance option — through the Senate with only 51 Democratic votes. But a leading Senate player says it won’t work.

[IMGCAP(1)]If an attempt is made to pass health reform under “reconciliation— rules — requiring just a simple majority vote — Senate Budget Chairman Kent Conrad (D-N.D.) told me, the bill would be so pared down, “you’d be left with Swiss cheese.—

Conrad also serves on the Finance Committee, which will mark up its version of health care reform in July.

Reconciliation rules, he said, require that a bill be scored as deficit-reducing over six years and that any substantive policy change in it also have a fiscal purpose.

The result, said Conrad, is that “you’d be left with a dramatically reduced package— that would fall short of comprehensive health reform.

“You would have a very hard time expanding coverage to the 46 million who don’t have it,— he said, and the “Byrd Rule— — requiring fiscal germaneness —could strip the bill of many of its policy provisions.

So, Conrad said, “health reform needs to be passed on a 60-vote basis, and that means it needs to be bipartisan.—

And that, he said, all but certainly rules out including a government-run “public plan— like Medicare designed to “compete with— — or replace — private insurance companies.

Conrad said he expected it will require up to six Republican votes to pass health reform in the Senate, but only one Republican — Sen. Olympia Snowe (Maine) — has indicated she’d support any sort of public plan, and then only as a fallback.

Conrad has proposed a compromise plan that would create nongovernmental co-ops as an alternative to the public plan.

With the expected arrival soon of Al Franken from Minnesota, Democrats will have 60 Senate votes, theoretically enough to break a Republican filibuster and pass whatever legislation they want.

But, Conrad pointed out, Sens. Edward Kennedy (D-Mass.) and Robert Byrd (D-W.Va.) have been absent from the Senate because of illness and at least two Democrats have publicly stated they won’t support a public plan.

They are Sens. Ben Nelson (D-Neb.) and Mary Landrieu (D-La.). And, Conrad said, “there are probably more.—

So, doing the math, even if Kennedy, Byrd and Franken were all present, Democrats would need two Republicans to break a filibuster — and would need more if moderates like Sens. Evan Bayh (D-Ind.), Mark Pryor (D-Ark.) and Blanche Lincoln (D-Ark.) opposed the public plan.

The difficulty of getting to 60 is what has inspired liberals — and the Obama administration — to contemplate using budget reconciliation rules to pass health reform with just 51 Democratic votes.

Last week, White House Chief of Staff Rahm Emanuel reiterated, “We want to pass health reform under regular order … but reconciliation is in reserve.—

The rules were set up in the Congressional Budget Act of 1974 to ease the way for deficit-reduction measures to pass if authorized in Congress’s annual budget resolution.

This year’s resolution did allow for health reform to be considered under reconciliation rules — but Conrad said advocates of the strategy have not studied its difficulties.

“The problems are two-fold,— he said. “Number one, everything has to be deficit-neutral — and actually have to produce $1billion in deficit reduction over six years.

“Since one of the six years is this year, and this year will almost be over by the time we do it, it’ll have to reduce the deficit over five years and every year thereafter,— he said.

“In the alternative, using regular order, it only has to be deficit-neutral over 10 years. That’s a big difference in what kind of reform you write.—

The second problem with reconciliation rules, he noted, is the Byrd Rule, named for former Senate Appropriations Chairman Byrd, making any provision in the bill subject to being removed if it does not have a budget effect — and requiring 60 votes to sustain it.

“When reconciliation was developed, it was solely for the purpose of deficit reduction. It was never intended for substantive legislation.—

Conrad said that “all kinds of things would be vulnerable to striking, including insurance market reforms, all the changes designed to encourage wellness and prevention — all those kinds of things.—

A key player in determining whether an item were struck would be Senate Parliamentarian Alan Frumin, who’d be under enormous pressure from Democrats to find that provisions satisfied the Byrd Rule.

“There’s no question in my mind that he’d call it like he saw it,— Conrad said. “He will not be giving liberal interpretations. He’s a stickler for precedent. … He’s impervious to pressure.—

Republicans have served notice that they would regard an attempt to use reconciliation rules for health reform as a “declaration of nuclear war,— leading to a procedural close-down of Senate business.

Conrad is also telling his fellow Democrats: You won’t like the health reform that emerges from this process, so make it attractive to some Republicans.