Now that the Senate Finance Committee has voted down two versions of a public option for health care reform, many progressives will undoubtedly start focusing on the possible use of the budget reconciliation process for this legislation to reduce the threshold for passage (in theory, at least) to 51 votes.
Anyone tempted to say “Reconciliation or Bust!” should give a gander to a post by Mark Schmitt at The American Prospect that reviews the history and purpose of the reconciliation process in some detail.

This wasn’t originally meant to be a grand process for big policy changes. Rather, it was designed to “reconcile” the modern budget process with the arcane congressional process. In 1981, Ronald Reagan’s budget director, David Stockman, figured out that the process could be used to package together and force a vote on the big budget cuts they envisioned. Later that decade, Sen. Byrd created the rule that bears his name to put some boundaries around the process, although it has still been used for both bipartisan (1990 and 1997 budget deals) and single-party bills, including welfare reform and tax cuts. But even in those cases, legislation has been sharply trimmed to accomodate the constraints of the process — for example, that’s why the Bush tax cuts had to be set to expire.
The reason this history is important is because it is a reminder that reconciliation was not designed to create a “50-vote Senate.” It was really a limited scheme intended to connect the old spending process with the new.

In other words, any health reform bill enacted via reconciliation would almost certainly have to be “sharply trimmed to accomodate the constraints of the process.” It’s not just a convenient way to brush aside filibusters.
And for the same reason, as I’ve argued myself on occasion, the decision whether or not to utilize reconciliation for health reform is not just a matter of how bold or audacious or progressive you are. It’s a question of risks and tradoffs.
Schmitt’s even more impatient than I am with the “damn the torpedos” approach to reconciliation, using a rather arresting analogy:

In the lead-up to the Iraq War, there was a saying among neoconservatives: “Everyone wants to go to Baghdad. Real men want to go to Tehran.” Now, among progressives, one might say, “Everyone wants to do health reform. Real men want to use reconciliation” to cut out all Republicans and a few Democrats. But legislative strategy, like foreign policy, is not a test of manhood. It’s a very arcane and limited process that will leave many key provisions behind, and a weak and limited health plan.
One way or another, we’ll have to compromise. We’ll either compromise with the most conservative Democrats and one or two Republicans, or we’ll compromise with the limits of a process that was designed for a totally different purpose. The political question is simply going to be which compromise is worse.

To put it more positively, health reform supporters have several strategic options remaining for getting acceptable legislation through this Congress and onto President Obama’s desk. The reconciliation process is but one of them, and the fact that it would theoretically make it possible to bypass “centrist” opinion, while perhaps emotionally satisfying, doesn’t necessarily recommend it as the best way forward.