Scaling The Summit

During yesterday's seven-and-a-half hour bipartisan health care reform summit, President Obama urged Republicans to abandon their obstructionist tactics and work with Democrats to pass comprehensive reform. Obama highlighted areas of bipartisan agreement in his health care proposal and suggested that Democrats would move forward with or without Republican support. "I will tell you this, that when I talk to the parents of children who don't have health care because they've got diabetes or they've got some chronic heart disease; when I talk to small business people who are laying people off because they just got their insurance premium, they don't want us to wait. They can't afford another five decades," Obama said. And while it's unclear whether the forum moved the debate forward, it provided Obama with an opportunity to engage "in a spirited and detailed policy debate with Republicans about one of the most compelling and ideologically polarizing issues facing the nation." The New York Times observed that "Mr. Obama's mastery of the intricacies of health policy was impressive even to some Republicans." "It was sort of his classroom," Sen. Lamar Alexander (R-TN) said. "I was glad we did it, because the president's megaphone is the biggest one and when he shares it with Republicans like he did, that gives us several hours to make our case, and I thought we made it well.'"

AREAS OF AGREEMENT: Throughout the summer, Republicans claimed that they agreed with 80 percent of the Democrats' bill. In September 2009, for instance, Rep. Eric Cantor (R-VA) told a town hall meeting that "Republicans and Democrats agree on 80 percent of fixing the nation's healthcare system." Rep.Charles Boustany (R-LA), who delivered the Republican response to the President's congressional address in September, also said, "I would venture to say that we agree on about 80% of the issues right now. It's just a matter of hashing out those few areas where we disagree, but there's really not been that kind of real discussion, and it needs to happen." Yesterday, Democrats and Republicans held "a real discussion" and, at the President's urging, laid out many areas of agreement. Obama stressed that both agree on the need for more regulation of insurers, creating larger risk pools to help small businesses purchase cheaper coverage, establishing some insurance regulations and tackling malpractice reform. In fact, Obama's health care bill already includes many Republican proposals. The bill expands state-based high risk pools, creates a high deductible policy option for younger Americans, allows insurers to sell policies across state lines, gives states greater flexibility to undertake a number of reforms to improve the quality of how care is delivered, allows young adults to stay on their parents' health insurance policies for longer, eliminates a lot of the waste and abuse from current health care system and reduces medical errors. "And finally, with respect to bending the cost curve, we actually have a lot of agreement here. This is an area where if I sat down with Tom Coburn, I suspect we could agree on 95 percent of the things that have to be done," he added. Obama even suggested that he may embrace some Republican tort reform proposals. "[T]here are some examples of [malpractice reform] legislation that I actually would be interested in pursuing. Tom Coburn, [John McCain] and Richard Burr have talked about incentivizing and allowing states to experiment much more vigorously with ways to reduce frivolous lawsuits, to pursue settlements, to reduce defensive medicine. That's something I'd like to see if we could potentially get going."

AREAS OF DISAGREEMENT: Despite the many areas of bipartisan consensus and Republicans' past support for comprehensive Democratic policies such as the individual health insurance mandate, Republicans continued to argue that Democrats should abandon the existing health care legislation and incremental approach to reform. "We believe we have a better idea. And that's to take many of the examples that you just mentioned about health care costs, make that our goal, reducing health care costs, and start over, and let's go step by step toward that goal," said Alexander, who delivered the opening statement. "[W]e have to start by taking the current bill and putting it on the shelf and starting from a clean sheet of paper." Republicans argued that Congress should extend coverage to only three million Americans and said that re-engineering the insurance market and providing subsidies requires too much government and too much money. The best Republicans could offer was 'high-risk pools," and they portrayed minimum standards for insurance -- which they supported in 1993 -- as a government takeover. Americans should move into catastrophic health insurance policies, they claimed, with higher deductibles and smaller benefits. During one exchange, Obama asked Sen. John Barrasso (R-WY), "Would you be satisfied if every member of Congress just had catastrophic care -- you think we'd be better health care purchasers? "I mean, is that a change you think we should make?" "I think actually we would," Barrasso responded. "We'd really focus on it. We'd have more, as you say, skin in the game. And especially if they had a savings account -- a health savings account -- they could put their money into that, and they'd be spending the money out of that." Obama's response was penetrating: "Would you feel the same way if you were making $40,000? Or if that was your income. Because that's the reality for a lot of folks."

MOVING FORWARD WITH REFORM: Obama closed the summit by suggesting that, without greater Republican cooperation, Democrats would have to move reform alone. "We cannot have another year-long debate about this. So 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 asked. "[I]f we can't close that gap, then I suspect Mitch McConnell and Harry Reid, Nancy Pelosi and John Boehner are going to have a lot of arguments about procedures in Congress about moving forward." The president also dismissed the Republicans' incrimentalist approach to reform. "The reason we didn't do it is because it turns out that baby steps don't get you to the place where people need to go. They need help right now. And so a step-by-step approach sounds good in theory, but the problem is, for example, we can't solve the preexisting problem if we don't do something about coverage." Republicans continued to insist that Democrats start over on reform. "The core problem is this: we don't think a 2,700 page bill...is a good idea," Sen. Jon Kyl (R-AZ) said after the summit. "I was discouraged by the outcome," Sen. Mitch McConnell (R-KY) added. "I do not believe there will be any Republican support for this 2,700 page bill." Still, Majority Leader Harry Reid (D-NV) sounded optimistic. "I still believe that we can work together and am hopeful that we reach the bipartisan solution to health reform that we’ve always preferred.  We are serious about delivering meaningful health reform to the American people, and all options remain on the table to accomplish that," he said.