Friday, February 26, 2010

At health-care summit, Obama tells Republicans he's eager to move ahead/Afflicting the Afflicted Sign in to Recommend

At health-care summit, Obama tells Republicans he's eager to move ahead
By Shailagh Murray and Anne E. Kornblut
Copyright by The Washington Post
Friday, February 26, 2010

President Obama declared Thursday that the time for debate over health-care reform has come to an end, closing an unusual seven-hour summit with congressional leaders by sending a clear message that Democrats will move forward to pass major legislation with or without Republican support.

Democratic leaders face a heavy lift in reviving their stalled bill, a process that would involve intricate parliamentary maneuvering and carries no guarantee of success. But Obama signaled that if meaningful GOP cooperation does not materialize in the weeks ahead, he is ready to proceed without bipartisan support and risk the political consequences.

"The question that I'm going to ask myself and I ask of all of you is, is there enough serious effort that in a month's time or a few weeks' time or six weeks' time we could actually resolve something?" Obama said. "And if we can't, then I think we've got to go ahead and make some decisions, and then that's what elections are for."

The remarkable session at Blair House ranged from dull to pointed as it revealed the deep divide between the two parties over health care. It was the same philosophical gulf that led to the collapse of bipartisan Senate negotiations last summer, and the primary reason Congress has resorted to changing the health-care system piecemeal, rather than in broad strokes, over the years.

Republicans said that they share Democrats' assessment that the health-care system is broken, but that they view the pending legislation assembled by Democrats as deeply flawed. They questioned fundamental elements of the Democrats' approach, including whether it is appropriate for the government to set standards for coverage or require individuals to buy insurance.

Obama played the role of active moderator for much of the event, calling on participants to speak and interjecting when he disagreed on specific points. He chided members of both parties for lapsing into campaign rhetoric, but he saved some of his most pointed jabs for Republicans, his voice heavy with sarcasm when he accused GOP speakers of using "good poll-tested language" to describe the Democratic plan as "government-run health care."

Some Republicans were more pleased with the session than others. Sen. Jon Kyl (R-Ariz.) complained as the GOP delegation left the White House that Democrats and Obama had consumed the vast majority of the airtime. But Senate Minority Leader Mitch McConnell (R-Ky.) described it as "a good discussion," telling reporters, "I wouldn't call it a waste of time."

GOP lawmakers arrived at the table with two primary goals: to demonstrate that the party has its own health-care solutions, and to criticize the Democrats' proposal as big-government overreach.

"We Republicans care just as much about health care as the Democrats in this room," said Rep. Eric Cantor (Va.), the No. 2 House Republican. But he added: "There is a reason why we all voted no. And it does have to do with the philosophical difference that you point out."

During a break in the session, Senate Majority Whip Richard J. Durbin (Ill.) deemed a bipartisan deal "a long-shot" prospect, but he told reporters that Democrats are undaunted in their quest to deliver a bill to Obama's desk.

"If nothing comes of this, we're going to press forward," he said. "We just can't quit. This is a once-in-a-political-lifetime opportunity to deal with a health-care system that is really unsustainable."

Democrats are attempting a historic feat in seeking passage of a huge bill that aims to expand coverage to an additional 30 million people, reform insurance industry practices and curb rising health-care costs.

But polls show that voters are skeptical of the ambitious proposal, which carries a 10-year cost of roughly $900 billion and would institute the most far-reaching changes to the system since Medicare and Medicaid were created in 1965.

During Thursday's session, both sides expressed regret about the way the debate has unfolded. What started nearly a year ago as a good-faith effort to find broad agreement quickly devolved into a partisan grudge match, marred by favors to secure votes and deals cut by the White House and Democratic leaders on Capitol Hill with special-interest groups. As several Republicans noted, most key decisions were reached behind closed doors, a breach of Obama's campaign pledge to make health-care negotiations transparent.

"Both of us during the campaign promised change in Washington," Sen. John McCain (Ariz.), the 2008 GOP presidential nominee, said to Obama. "In fact, eight times you said that negotiations on health-care reform would be conducted with the C-SPAN cameras. I'm glad more than a year later that they are here."

If nothing else, the session was an attempt to bring an air of civility and openness to the debate. "Unfortunately, over the course of the year, despite all the hearings that took place and all the negotiations that took place, and people on both sides of the aisle worked long and hard on this issue, and you know, this became a very ideological battle," Obama said.

But he suggested that his hopes for bipartisan agreement are fading. "I don't know that those gaps can be bridged," he said. "It may be that at the end of the day, we come out here and everybody says, 'Well, you know, we have some honest disagreements.' "

The session allowed the parties to draw sharp contrasts that are likely to be echoed throughout the midterm election season. Republicans criticized Democrats for attempting to levy new fees and taxes on businesses to pay for their legislation. They depicted the Democratic proposal as a vast expansion of government authority, and they warned that consumers would have higher insurance premiums and fewer choices.

Democrats countered that health-care problems -- whether related to rising costs or barriers to coverage -- have grown so egregious that the government has no choice but to intervene.

The two parties did find accord in several limited realms. People should be allowed to buy insurance across state lines, lawmakers agreed, although Democrats want to set minimum standards that policies in all states would have to meet. They agreed that forming pools for uninsured people is a good way to lower premium costs. And they conceded that unless costs are contained, Medicare will be bankrupted and employers will stop offering coverage.

As the session concluded, Obama challenged Republicans to offer alternatives to the tax incentives and Medicaid expansion that Democrats have proposed for reducing the number of uninsured, and to the individual mandate they would establish to require people to buy coverage.

Although Obama opposed the mandate as a candidate, he said he concluded it is necessary to achieve another major goal: preventing insurers from denying coverage to people with preexisting conditions.

"I'd like the Republicans to do a little soul searching and find out are there some things that you'd be willing to embrace that get to this core problem of 30 million people without health insurance, and dealing seriously with the preexisting-condition issue," Obama told lawmakers.

Few Democrats expect the request to yield any breakthroughs. Senior congressional aides said Democratic leaders will assess the mood next week, after House and Senate lawmakers spend the weekend at home hearing from constituents. But rank-and-file Democratic lawmakers appeared to be warming to the idea of moving ahead on their own legislation, senior party officials said.

To pass their bill, Democrats must rely on a special budget process known as reconciliation. Under a plan being discussed by senior Democratic lawmakers, the House would approve the bill the Senate passed on Christmas Eve, along with compromise provisions that address their objections to the Senate legislation. The fixes would be written under reconciliation rules to prevent a GOP filibuster, allowing it to clear the Senate by a simple majority.

Republicans often used reconciliation in recent years when they controlled the Senate, but GOP leaders now cite the procedure as evidence that Democrats are prepared to manipulate Senate rules to muscle their bill through despite public opinion.

Sen. Lamar Alexander (R-Tenn.) implored Obama to "renounce this idea." But he received no assurance from the president.

"I don't need a poll to know that most of Republican voters are opposed to this bill and might be opposed to the kind of compromise we could craft," Obama said. "It would be very hard for you politically to do this."

Afflicting the Afflicted Sign in to Recommend
Copyright by The New York Times
Published: February 25, 2010

If we’re lucky, Thursday’s summit will turn out to have been the last act in the great health reform debate, the prologue to passage of an imperfect but nonetheless history-making bill. If so, the debate will have ended as it began: with Democrats offering moderate plans that draw heavily on past Republican ideas, and Republicans responding with slander and misdirection.

Nobody really expected anything different. But what was nonetheless revealing about the meeting was the fact that Republicans — who had weeks to prepare for this particular event, and have been campaigning against reform for a year — didn’t bother making a case that could withstand even minimal fact-checking.

It was obvious how things would go as soon as the first Republican speaker, Senator Lamar Alexander, delivered his remarks. He was presumably chosen because he’s folksy and likable and could make his party’s position sound reasonable. But right off the bat he delivered a whopper, asserting that under the Democratic plan, “for millions of Americans, premiums will go up.”

Wow. I guess you could say that he wasn’t technically lying, since the Congressional Budget Office analysis of the Senate Democrats’ plan does say that average payments for insurance would go up. But it also makes it clear that this would happen only because people would buy more and better coverage. The “price of a given amount of insurance coverage” would fall, not rise — and the actual cost to many Americans would fall sharply thanks to federal aid.

His fib on premiums was quickly followed by a fib on process. Democrats, having already passed a health bill with 60 votes in the Senate, now plan to use a simple majority vote to modify some of the numbers, a process known as reconciliation. Mr. Alexander declared that reconciliation has “never been used for something like this.” Well, I don’t know what “like this” means, but reconciliation has, in fact, been used for previous health reforms — and was used to push through both of the Bush tax cuts at a budget cost of $1.8 trillion, twice the bill for health reform.

What really struck me about the meeting, however, was the inability of Republicans to explain how they propose dealing with the issue that, rightly, is at the emotional center of much health care debate: the plight of Americans who suffer from pre-existing medical conditions. In other advanced countries, everyone gets essential care whatever their medical history. But in America, a bout of cancer, an inherited genetic disorder, or even, in some states, having been a victim of domestic violence can make you uninsurable, and thus make adequate health care unaffordable.

One of the great virtues of the Democratic plan is that it would finally put an end to this unacceptable case of American exceptionalism. But what’s the Republican answer? Mr. Alexander was strangely inarticulate on the matter, saying only that “House Republicans have some ideas about how my friend in Tullahoma can continue to afford insurance for his wife who has had breast cancer.” He offered no clue about what those ideas might be.

In reality, House Republicans don’t have anything to offer to Americans with troubled medical histories. On the contrary, their big idea — allowing unrestricted competition across state lines — would lead to a race to the bottom. The states with the weakest regulations — for example, those that allow insurance companies to deny coverage to victims of domestic violence — would set the standards for the nation as a whole. The result would be to afflict the afflicted, to make the lives of Americans with pre-existing conditions even harder.

Don’t take my word for it. Look at the Congressional Budget Office analysis of the House G.O.P. plan. That analysis is discreetly worded, with the budget office declaring somewhat obscurely that while the number of uninsured Americans wouldn’t change much, “the pool of people without health insurance would end up being less healthy, on average, than under current law.” But here’s the translation: While some people would gain insurance, the people losing insurance would be those who need it most. Under the Republican plan, the American health care system would become even more brutal than it is now.

So what did we learn from the summit? What I took away was the arrogance that the success of things like the death-panel smear has obviously engendered in Republican politicians. At this point they obviously believe that they can blandly make utterly misleading assertions, saying things that can be easily refuted, and pay no price. And they may well be right.

But Democrats can have the last laugh. All they have to do — and they have the power to do it — is finish the job, and enact health reform.


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