Two things are holding up the passage of health care reform right now. One is the raw vote count in the House, particularly the Stupak bloc. The other is the procedural hurdle of which chamber votes first on what bill.

It seemed that this hurdle had been surmounted last week when House leaders agreed to pass the Senate bill first, then move to a reconciliation bill with agreed-upon fixes. When independent whip counts secured 50 votes in the Senate for a reconciliation sidecar bill, this paved the way for such an ordering. But liberals in the House simply don’t trust the Senate to follow through on any promise. They worry that they could pass the Senate bill, have that signed into law, and then wait endlessly for a reconciliation fix that never comes.

As a result, some members want greater guarantees that only a reform bill with all the sidecar provisions will make it into law.

House liberals want to tie a series of fixes to the Senate healthcare bill to a vote for the actual bill, Rep. Anthony Weiner (D-N.Y.) suggested Monday.

Weiner, an informal leader of a bloc of House Democrats who have demanded changes to the Senate bill in exchange for the House passing it, said many Democrats want to tie the votes together out of a fear that the Senate may renege on passing a separate measure making changes to its original bill.

“We’re not just going to go ahead and hope for a package of improvements, we’re going to have to have something pretty much in hand, and there are many of us who are saying we want a vote on both things at once,” Weiner said Monday during an appearance on Fox News Radio.

The easiest way to ameliorate these concerns is for the reconciliation bill to pass both houses of Congress first. There are credible reasons, mainly related to CBO scoring, why that may not be a viable option. But the political reasons for waiting on passing the Senate bill are far greater, especially if the Weiner bloc cannot be moved to pass that bill blind.

The biggest problem here is that the reconciliation bills passed by the House and Senate are almost certain to differ, and setting up a conference report would subject the fixes to the filibuster that the reconciliation process was designed to circumvent. One way or another, the House will have to eat some bad provisions, unless the Senate installs major party discipline on everything not already worked out by agreement.