I have no expertise with respect to the Senate rules but my understanding is that George W. Bush enacted virtually all of his signature legislative laws through reconciliation and there is general agreement that it is usable.
The biggest hangup to date has been the unwillingness of the Obama administration to do anything that does not look bipartisan and according to well established constitutional principles, and his basic philosophical belief in making progress through collaboration rather than confrontation. Since health care bills have already been adopted by both the Senate and the House it would appear especially appropriate to have the conflict between them resolved by simple reconciliation.
