A problem that seems to be getting lost in the current confusion over the fate of health reform legislation is something that has little to do with party or ideology, much less with the details of health policy. It's cameralism. To put it simply, members of the U.S. House and the U.S. Senate have very different perspectives, mistrust each other's motives, and rarely communicate. In general, they don't much like each other. They live and work in two very different institutional cultures, and with the exception of House veterans serving in the Senate, they don't go to much trouble to find out how the other chamber functions.

Much of the time this "cameralism" is background noise in the legislative process. But when it comes to the kind of highly complex, trust-based maneuvers that health care reformers are talking about this week--you know, House passes Senate bill with assurance that Senate passes bill "fixing" their own bill via budget reconciliation, somewhere down the road--it's a real problem that can't just be wished away. And that's particularly true in an environment requiring almost total agreement among Democrats in both Houses. Maybe that's one reason the White House is talking about a "cooling off" period on health care reform.