In an effort to rescue the drowning ObamaCare bill, Barack Obama will hold a televised meeting with leaders in Congress to attempt to advance some kind of reform effort this year. The White House has set half a day aside on February 25th for an open meeting on fresh ideas for a compromise that can pass both chambers of Congress and get to his desk for a signature. However, leaders of both parties feel pessimistic about the chance for anything other than a photo op
Jonathan Cohn at TNR:
A White House official, speaking on background, stressed that the meeting in no way signals a retreat from Obama’s commitment to push ahead with comprehensive health care reform. He’s interested in hearing out Republican ideas, the official said, but when the discussion is done he wants to see a bill move forward–and pass.
And Obama’s rhetoric in the Couric interview was consistent with that. Citing recent premium hikes in California, he stated that the need for reform was only becoming more urgent with time. Later in the interview, when Couric asked him about deficits, he brought the discussion back to health care–reminding viewers that controlling health care costs was the surest way to reduce deficits in the long run.
The move makes sense, given the political moment. As my colleague Jonathan Chait noted the other day, Republicans have been complaining that Democrats locked them out of the process. And large swaths of the public seem to agree, even though the argument seems plainly untrue, given the exhaustive efforts Obama and Senate Finance Chairman Max Baucus made to accommodate Republicans. The public forum will give the GOP one more, high-profile opportunity to air their views–and, no less important, it will give the public a chance to see which approach to health care they really prefer.
Memo To Leaders Boehner and McConnellThe president has called for a bipartisan health care summit. I suppose I am too suspicious, but I suspect this is part of the great pivot –from blaming George W. Bush for all of the Obama Administration failures of 2009 to blaming you for all of the Obama Administration failures of 2010. After all, David Plouffe didn’t come back in to manage Congressional relations.
President Obama could be serious. He has, after all, allocated an entire half day to the effort.
But against the possibility that he is not and that he intends this as a trampoline from which he can execute a great jump and a perfect dismount, pointing at you the entire way and leaving an adoring media to mutter about the “party of no,” I suggest you respond quickly, substantively, and in writing:
We accept your invitation. In the spirit of bipartisanship we also suggest that the agenda consist of six items, of 30 minutes each, with half of the items and presentation chosen by us, and half by you, the Speaker and The Majority Leader.
We suggest that these presentations be staggered, one from one party followed by one from the other party, and have no objection to going first or second.
Our three points will be:
1. There can be no comprehensive health care cost control and thus no real health care reform without tort reform. In addition to a national cap on pain and suffering damages similar to California’s, we will offer some other keys to controlling the cost of defensive medicine in this country. We urge you to ask your colleagues to refrain from immediately rushing to the defense of the plaintiffs’ bar. The only way to stop the rising cost of medicine is to stop the need for doctors to practice with a lawyer on both shoulders.
2. There is an enormous need for an interstate market in health care policies. We should move immediately to eliminate this artificial and extremely expensive obstacle to the lowering of the cost of health insurance.
3. There can be no long term confidence in our health care system without confidence in a growing, vibrant and robust economy, one freed from crippling entitlement debt and massive borrowing. Therefore we will use our last presentation to acquaint you and your colleagues with the details of Congressman Paul Ryan’s “Roadmap,” which we believe could be enacted in parallel with comprehensive health care reform thus setting our domestic policy house in order.
We look forward to the meeting Mr. President, and urge a similar one be scheduled on national security matters so we could persuade you to abandon the the decision to try KSM in civilian court in America and to offer Miranda rights to terrorists past and future.
John Boehner and Mitch McConnell
At this point, I don’t think it’s well understood how many of the GOP’s central health-care policy ideas have already been included as compromises in the health-care bill. But one good way is to look at the GOP’s “Solutions for America” homepage, which lays out its health-care plan in some detail. It has four planks. All of them — yes, you read that right — are in the Senate health-care bill.
(1) “Let families and businesses buy health insurance across state lines.” This is a long-running debate between liberals and conservatives. Currently, states regulate insurers. Liberals feel that’s too weak and allows for too much variation, and they want federal regulation of insurers. Conservatives feel that states over-regulate insurers, and they want insurers to be able to cluster in the state with the least regulation and offer policies nationwide, much as credit card companies do today.
To the surprise and dismay of many liberals, the Senate health-care bill included a compromise with the conservative vision for insurance regulation. The relevant policy is in Section 1333, which allows the formation of interstate compacts. Under this provision, Wyoming, Colorado, Arizona, Utah, and Idaho (for instance) could agree to allow insurers based in any of those states to sell plans in all of them. This prevents a race to the bottom, as Idaho has to be comfortable with Arizona’s regulations, and the policies have to have a minimum level of benefits (something that even Rep. Paul Ryan believes), but it’s a lot closer to the conservative ideal.
(2) “Allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do.” This is the very purpose of the exchanges, as defined in Section 1312. Insurers are required to pool the risk of all the small businesses and individuals in the new markets rather than treating them as small, single units. That gives the newly pooled consumers bargaining power akin to that of a massive corporation or labor union, just as conservatives want. It also gives insurers reason to compete aggressively for their business, which is key to the conservative vision. Finally, empowering the exchanges to use prudential purchasing maximizes the power and leverage that consumers will now enjoy.
(3) “Give states the tools to create their own innovative reforms that lower health care costs.” Section 1302 of the Senate bill does this directly. The provision is entitled “the Waiver for State Innovation,” and it gives states the power to junk the whole of the health-care plan — that means the individual mandate, the Medicaid expansion, all of it — if they can do it better and cheaper.
(4) “End junk lawsuits.” It’s not entirely clear what this means, as most malpractice lawsuits actually aren’t junk lawsuits. The evidence on this is pretty clear: The malpractice problem is on operating tables, not in court rooms. Which isn’t to deny that our current system is broken for patients and doctors alike. The Senate bill proposes to deal with this in Section 6801, which encourages states to develop new malpractice systems and suggests that Congress fund the most promising experiments. This compromise makes a lot of sense given the GOP’s already-expressed preference for letting states “create their own innovative reforms that lower health care costs,” but since what the Republicans actually want is a national system capping damages, I can see how this compromise wouldn’t be to their liking.
(5) To stop there, however, does the conservative vision a disservice. The solutions the GOP has on its Web site are not solutions at all, because Republicans don’t want to be in the position of offering an alternative bill. But when Republicans are feeling bolder — as they were in Bush’s 2007 State of the Union, or John McCain’s plan — they generally take aim at one of the worst distortions in the health-care market: The tax break for employer-sponsored insurance. Bush capped it. McCain repealed it altogether. Democrats usually reject, and attack, both approaches.
Not this year, though. Senate Democrats initially attempted to cap the exclusion, which is what Bush proposed in 2007. There was no Republican support for the move, and Democrats backed off from the proposal. They quickly replaced it, however, with the excise tax, which does virtually the same thing. The excise tax only applies to employer-sponsored insurance above a certain price point, and it essentially erases the preferential tax treatment for every dollar above its threshold.
(6) And finally, we shouldn’t forget the compromises that have been the most painful for Democrats, and the most substantive. This is a private-market plan. Not only is single-payer off the table, but at this point, so too is the public option. The thing that liberals want most in the world has been compromised away.
Reihan Salam, responding to Ezra:
By my count, (1) bears no substantive resemblance to the original idea in question, (2) and (3) and (4) do bear some resemblance to a good Republican proposal, albeit in a form that weakens their impact. On (5), the point is well taken, though it is so compromised and poorly designed already that it begs the question of whether scrapping the proposal and starting with a new one wouldn’t be preferable. And (6) strikes me as a non sequitur, insofar as private markets are not, I hope, an exclusive province of Republicans.
I have to say, this doesn’t strike me as a compelling indication that this is a “substantively bipartisan” bill, though I am impressed and pleased that Ezra didn’t include transitional measures as part of his post. The essential conservative objection to the bill is to the premise that central direction is the way to lower costs rather than more robust competition. Many conservatives also object to a federal mandate that compels individuals to purchase a product from a private entity. A bill that included elements (2), (3), (4), and (5) while also federalizing Medicaid or otherwise improving its incentive structure to finance an expansion of coverage would be great. Let’s start talking about it.
Philip Klein at American Spectator:
This is a classic Obama move. Create the appearance that he’s doing one thing when in reality he’s doing the exact opposite. Problem is, the public has already caught on to his shtick and can tell the difference between performance art and reality. I can’t see this changing the dynamics of the health care effort.
So what’s there to talk about on Feb. 25? If the summit is really about striking a new compromise, this would seemingly be pointless. But if the summit is about delving into these plans, exploring what is and isn’t in the proposal, and making it clear for all to see that Republican ideas have been considered — and in several instances, embraced — the gathering has the potential to change public attitudes and score a key public-relations victory.
Indeed, I can imagine a scenario in which the president spells all of this out explicitly — writing out which provisions are included that make Dems happy, which provisions are included (and excluded) that make Republicans happy, and declaring the whole package a triumph of bipartisan compromise. The GOP will still almost certainly balk, but the result will give Democrats cover and put Republican intransigence on full display.
UPDATE: Jonathan Chait at TNR
UPDATE #2: Steve Benen
Christina Bellantoni at TPM