Suppose there was no filibuster at all. 50 votes, plus the VP, is all it takes to run the Senate. How different would the health care debate have been?
We don't know, but the biggest unknown is really the outcome of the real-world, 60 vote Senate, where things have certainly taken a turn for the worse over the last week (the WaPo has a good summary). If the whole thing blows up, then I think it's fair to say that the filibuster is to blame.
Let's say, however, that they manage to get across the finish line, somehow or another. How is the likely bill from that process going to compare with a 50 vote bill?
It's not as different as you might think. The bottom line is that there were never 50 votes for a strong public option. The version of the public option that passed the House -- restricted to a small number of Americans, and without the strong cost-cutting mechanisms that public option advocates really wanted -- was the ceiling, not the floor. I do think that it's possible that the House might have gone for a somewhat stronger version if they thought the Senate would bite, but the key vote in Senate Finance on the Schumer amendment showed that the Senate would not bite.
And then...things get tricky. Because the 60 vote requirement hasn't only protected bill opponents; it's also protected the Democats in their goal of keeping a coalition together.
Here's what happens. In a 50 vote Senate, the public option remains in the bill, albeit only a weak public option. That probably loses Lincoln and Landrieu (as well as Holy Joe and the Benator, and the Maine Duo). That leaves 56 votes.
Drug reimportation may pass today; it certainly passes in a 50 vote Senate. That probably kills off another couple of votes...Carper of Delaware is strongly opposed to it, and not exactly enthusiastic about the rest of the bill, and let's say Bayh. That leaves 54.
Now, the problem is that the remaining moderates -- Webb, McCaskill, Conrad, and Pryor are likely the next four, but Hagan, Baucus, Tester, and a few others could be on the fence as well -- are now looking at a bill with zero GOP support and with a bunch of "moderate" Dems in opposition. In other words, they're looking at a bill that's going to be widely seen as very liberal. And they'll have a lot of leverage, if the work together. What they would be asking for is a deal that can get, at the very least, some of the defecting Dems back on board.
In other words, the dynamic is going to push for a bill that can get most of the Dems, and it's not clear that the liberals would have enough votes to prevent it. Indeed, that's part of why they're trying to avoid reconciliation: just as there may not be sixty Dems for a Democrats-only bill, there probably aren't fifty Democrats who want to be seen supporting a liberals-only bill.
Meanwhile, a fifty vote Senate also means a Senate in which GOP amendments stand a much better chance. Already, the Republicans were able to muster 50 (but not 60) to strip out the CLASS Act, so that would probably be gone in a 50 vote Senate. I don't know what else Republicans would go after if they had a reasonable chance to get amendments accepted, but I think there's a lot of mischief that could be done; the 60 vote requirement is a powerful tool for the majority party in a body that allows unlimited (including non-germane) amendments.
There is one huge advantage that a 50 vote Senate would have over the current situation. There are probably somewhere north of 55 Democrats who really do want to have a bill -- that can be seen in the pattern of floor voting, with most Dems sticking against GOP amendments. I'm very confident that a bill would pass in a 50 vote Senate. I'm just not convinced that it would look a lot better to reform supporters than whatever winds up emerging from the 60 vote Senate. Assuming, again, that something does make it through.