Friday, February 26, 2010

Summit Follies

QOTD, Pearlstein:
What we didn't hear from Kyl, or Camp, or Coburn or McCain, however, was an offer to vote for a health reform plan if these problems were fixed and their ideas were incorporated. Without even the hint of such offers, there was little reason for a willing president and his unwilling allies to even consider serious compromise. Now the losers will be the American people, who could have surely benefited from such productive dealmaking.
CSPAN Rocks!


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.”


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.

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.


The Republican leaders, Mitch McConnell and John Boehner, were smart enough to stand back and let Senator Lamar Alexander lead the way, which he did genially and intelligently. While Alexander was speaking, Reid and Pelosi wouldn’t even deign to look at him.

Once you got to the other members, about two-thirds of the statements were smart and well-informed. This was not a repeat of the Baltimore summit, in which Obama dominated the room. This time, Obama was very good, but so were many others, like Mike Enzi, Jim Cooper, George Miller and Tom Coburn. If you thought Republicans were a bunch of naysayers who don’t know or care about health care, then this was not the event for you. They more than held their own.

I have yet to meet an academic over 50 who doesn’t think that Bobo Brooks is a thoughtful, reasonable conservative with lots of sensible ideas. My parents both feel this way, though they will no longer admit it to me.

History will not judge this era kindly.

DougJ: Every Rose has its thorn

Apparently, Bill Frist and Mark Halperin are on Charlie Rose discussing today’s summit right now. (The good news is that Ezra Klein is on too.) I’d watch but I have no desire to take my own life this evening.

There are a lot of people out there who believe that our sorry state of affairs is caused by Glenn Beck and Rush Limbaugh and, if they’re really deluded, they’ll add “and on the left, Rachel Maddow and Keith Olbermann”. I know plenty of people who say things like this.

The truth is, it’s more the fault of Charlie Rose and Tom Friedman and David Brooks. Glenn Beck didn’t get us into Iraq.

  • from the comments:
  • Wile E. Quixote

    But the good news is that John McCain is going to get an exclusive interview on Press the Meat with David Gregory this Sunday, and I for one say that it’s about time that the liberal media gave John McCain a chance to speak his mind.

  • Gregory

    Apparently, Bill Frist and Mark Halperin are on Charlie Rose discussing today’s summit right now. (The good news is that Ezra Klein is on too.)

    On the other hand, the even-the-liberal NPR had only a Republican Congressman on to give his response to the summit.

    Not another dime from me.

This (from Drudgico) belongs in a time capsule too:

But in this case, the tie goes to Republicans, according to operatives on both sides of the aisle — because the stakes were so much higher for Democrats trying to build their case for ramming reform through using a 51-vote reconciliation tactic.

“I think it was a draw, which was a Republican win,” said Democratic political consultant Dan Gerstein. “The Republican tone was just right: a respectful, substantive disagreement, very disciplined and consistent in their message.”


Republicans drove a hard bargain with the White House over the seating arrangement — securing a massive square table that put them on a visual par with the president — to underscore their parity and seriousness.

Republicans won because they got to sit at their own table.

But that measure, my sister and I won Thanksgiving for the first 20 years of our lives.

The New York Times mentioned in passing this morning that the White House health care summit "was a kind of Hail Mary pass, a last-ditch effort to keep [President Obama's] top legislative priority from slipping out of his grasp."

That's probably not the best analogy. When a game is nearly over, a Hail Mary pass is tried in desperation. And if it fails to connect, the team that attempted it loses. But in this case, there's no reason to think health care reform is in any worse shape than it was 24 hours ago. Indeed, by some measures, it might be slightly better off.

It's probably only natural to consider a high-profile event like this by weighing whether it was a "victory" for one side or the other, looking for "winners and losers." I suppose a reasonable case could be made for just about anyone to consider this a "win" -- the president won by making a powerful case for reform, and proving he knows infinitely more about the issue than his GOP rivals. Republicans won by maintaining message discipline and refusing to back down. Congressional Democrats won by having their predictions about GOP intransigence proven right.

But if we put aside that analysis, a more important truth emerges: it became painfully, overwhelmingly clear yesterday exactly what has to happen next.

E.J. Dionne's summary struck the right note.

The Republicans simply don't want to pass comprehensive health-care reform. That is the main lesson of today's health-care summit. It started, as Steve Stromberg pointed out earlier, with the Republicans wanting to talk more about process than about the content of the various health-care bills. It approached an end with House Minority Leader John Boehner (R-Ohio) delivering the core Republican message: "Scrap this bill."

As I argued in a post I put up before the summit began, this discussion would be successful if it simply revealed the stark philosophical differences between the parties. That's exactly what it's done.

No reasonable observer, regardless of ideology, could disagree. We learned, over the course of an entire day, that Democrats and Republicans have wildly different visions on every possible aspect of the debate. As if it weren't enough that the two sides disagree about how to solve various problems, the parties also fundamentally disagree about whether the problems exist and whether there's even any point in trying to solve them.

Jonathan Cohn noted that GOP proposals are clearly, woefully inadequate for addressing key public needs, but Republicans "seem to believe these problems are fundamentally unsolvable, at least in any manner they would find acceptable."

That's not even intended as criticism; it's simply a rephrasing of what GOP leaders said repeatedly. For Republicans, there's a dangerous intersection of practical and ideological concerns -- policymakers could fix dysfunctional aspects of the status quo, but that would mean spending money and imposing new government regulations. And since spending money and imposing new government regulations are bad, the dysfunctional aspects of the status quo must remain broken. QED.

If the goal of the summit was to reach a bipartisan compromise, the event obviously wasn't successful. If the goal was to change policymakers' minds, we can characterize yesterday as something of a letdown.

But if the goal was to air out the various approaches to health care reform, in a candid and transparent way, and realize once and for all that bipartisan compromise is quite literally impossible with an intractable minority that will settle for nothing but failure, I'd call the summit an illustrative success.

Obama listened politely for six hours, with occasional flashes of temper, but in the end, the message was clear: It’s over. We’re moving forward without Republicans.

Whether Obama and Dems will succeed in passing reform on their own is anything but assured, to put it mildly. But there’s virtually no doubt anymore that they are going to try — starting as early as tomorrow.

That was the subtle but unmistakable message of Obama’s closing argument. After hours of hearing Republicans repeat again and again that only an incremental approach to reform is acceptable to them, Obama rejected that out of hand.

Here’s the key bit from Obama:

I’d like Republicans to do a little soul searching to find out if there are some things that you’d be willling to embrace that get to this core problem of 30 million people without health insurance, and dealing seriously with the pre-existing conditions issue. I don’t know frankly whether we can close that gap.

And if we can’t close that gap, then I suspect Mitch McConnell, Harry Reid, Nancy Pelosi and John Boehner are going to have a lot of arguments about procedures in Congress about moving forward.

Unless I’m misreading that, Obama is saying that unless Republicans support comprehensive reform as Obama and Dems have defined it — dealing with the problem of 30 million uninsured and, by extension, seriously tackling the preexisting condition problem — they will almost certainly move forward with reconciliation.

What’s more, Obama also essentially accused Republicans of approaching today’s summit in bad faith — after they had sat there with him for six hours. He said that even after the public option was taken off the table, Republicans continued to use the same “government takeover” slur.

“Even after the public option wasn’t available, we still hear the same rhetoric,” Obama said. “We have a concept of an exchange which previously has been an idea that was embraced by Republicans before I embraced it. Somehow, suddenly it became less of a good idea.”

This accusation, combined with his assertion that Repubicans need to do some “soul-searching” on whether they wanted to join Dems in tackling reform as they have defined it, amount to an unmistakable vow to move foward without them.

Democratic aides are already interpreting Obama’s remarks along these lines. As one senior aide emailed: “We may make one last effort to try to get a Senate Republican.”

In terms of who “won” today’s debate, I tend to think Republicans actually accomplished much of what they needed to do today. It seems likely that some Congressional Dems will be just as skittish tomorrow as they were yesterday about moving forward alone via reconciliation. That means Dems still have an enormously difficult task ahead.

But Obama’s message to Dems and Republicans alike today was that barring some kind of major change on the GOP side, this is exactly what he and Dem leaders are about to attempt.


Update: To clarify, this was a call to Dems, perhaps more than anyone else, that the time has come for them to stiffen their spines and move forward with reconciliation, which Republicans, and even some nonpartisan observers, have repeatedly characterized as akin to marching off a cliff.

Also: This summit was always about laying the groundwork for Dems to go forward alone, barring a major capitulation from Republicans. As noted here repeatedly, Dems will find themselves in exactly the same position tomorrow as they did yesterday: Confronting the enormously difficult task of passing ambitious reform on their own.

Update II: A GOP aide emails the Republican take: “They badly needed a win today and they didn’t get it. Not even close. Republicans were prepared. The President was pedantic and peeved.”

George W. Bush was known for his tendency to think in terms of black and white, good and evil, us and them. This was in opposition, supposedly, to the nuance favored by Democrats. But Barack Obama has his absolutist side, too: Some arguments are right, and some are wrong. Some are legitimate, and some are not.

And on health-care reform, Obama believes that his arguments are right. The basic structure of his plan is sound. The Republicans’ alternatives are inadequate. The problem is too serious to entertain thoughts of inaction. Comprehensive works better than incremental. Compromise only makes sense if the other side is willing to give something up in turn. Good policy will be electorally defensible even if it's not obviously popular.

The big story out of the summit is not that Republicans and Democrats extended their hands in friendship, but that the White House has dug its heels into the dirt. The Democrats are not taking reconciliation off the table, they are not paring back the bill, and they are not extricating themselves from the issue. They think they're right on this one, and they're going to try and pass this legislation.

Today was a boost for that effort. The Democrats got hours to make their case, at an event they planned, with one of their own controlling the discussion. For that reason, I imagine that this will be the last bipartisan summit we see for awhile. The format is simply too kind to the president, and he takes advantage of it ruthlessly. When the camera panned, you could almost see Republicans wondering why they'd accepted the invitation.

The people who came off best were those who knew the most about the issue. Paul Ryan and Tom Coburn on the Republican side. Dick Durbin and Chris Dodd for the Democrats. But above all of them, the president, who got to enter, adjudicate and conclude discussions at will -- not to mention say when others didn't know that much about the issue, or weren't offering comments in good faith. That willingness to put himself above Congress, combined with the structure of the event, allowed Obama to fully dominate the proceedings, and he used the opportunity to firmly assert ownership over the health-care bill. This is now his legislation.

But for all that he's made the bill his own, it still has to make a final pass through Congress. Importantly, Harry Reid and other Democrats were not only using the word reconciliation, but defending it from attack. Obama joined them in this effort. But the question is what the handful of ambivalent Democrats in the House and Senate thought. Obama spent the day trying to convince them that passing this bill was right: Not just politically, but intellectually and morally. That was his argument for why he's still here, lashing himself tighter to this legislation, and why they should stick by him.

Greg Sargent:

* Now that Dems are all but certain to move forward on health reform alone, the spin war shifts to a battle over the meaning and implications of using “reconciliation” to pass their bill. Republicans are already outworking Dems, pushing the message hard that it would constitute “ramming it through” the Senate against the wishes of the American people.

* The GOP is also casting reconciliation as an extension of the Senate backroom dealing that even Dems concede has badly tainted their reform proposals. Michael Steele, for instance, is calling it a “parliamentary trick.”

* So: Will Dems step up and get serious about redefinining it as majority rule? All we heard from Dems yesterday was the constant use of the “reconciliation” phrase, which presumably has little to no meaning for many people.

* But: Nancy Pelosi did try to make the case yesterday for majority rule, albeit obliquely:

“We can’t say to [the American people], at the end of the day, well, we had an idea, we had a vision, we had a majority, but the process did not allow us to make a change for your lives. We need to have the courage to get the job done, and I think we will. And I think today took us a step closer to passing health care.”

*Senator Ben Cardin edges towards some slightly more felicitious language, telling ABC’s Top Line that majority rule in the Senate is “pretty Democratic.” Pretty hard hitting!

Steve Pearlstein: At summit, Republicans prove they aren't putting America's health first

I'm not sure what else was accomplished at Thursday's Blair House summit, but surely one result is that we learned what Republican "leaders" really think about health care and health insurance.

The most important thing Republicans think is that if there are Americans who can't afford the insurance policies that private insurers are willing to offer, then that's their problem -- there's nothing the government or the rest of us should do about it.

"We just can't afford this," said Eric Cantor, the fresh-faced House minority whip from Virginia, while John Boehner, the House Republican leader, called it "a new entitlement program that will bankrupt our country." What they were referring to, of course, was the $125 billion a year that Obama and his Democratic allies propose to spend in subsidies so tens of millions of low-income households can afford to buy health insurance and handle the co-payments. But if paying for those subsidies means raising taxes on high-income households with lots of investment profits, or capping a tax break for people with extravagant health insurance, or charging a modest fee on medical device makers that refuse to moderate future price increases, then Republicans are agin' it.

That was their clear message Thursday. It was their message during all those years when their party controlled Congress and the White House and they did nothing and said nothing about the plight of the uninsured. And it is clear that they would continue to do nothing if, by some miracle, Democrats were to drop their plan or embark on a more modest approach. For Republicans, the uninsured remain invisible Americans, out of sight and out of mind.

Judging from Thursday's discussion, Republicans have much more sympathy for those who can afford to buy health insurance but are denied because of a preexisting medical condition. They oppose Democratic efforts to end this industry practice directly through regulation, preferring instead to refer those customers to special high-risk insurance pools where they would be guaranteed to find coverage.

In some versions of the high-risk pool, the cost of a policy would be so high that households with average incomes would have to set aside a third or even half of their income to pay for it. It takes a Republican to view this as a solution -- the equivalent of giving a starving man a coupon for $2 off his next dinner at Le Bernardin.

Or perhaps Republicans imagine high-risk pools that are subsidized sufficiently enough that the insurance policies are actually affordable. Unfortunately, the only way to finance such subsidies is through some sort of tax or fee, mostly one imposed on every insurance policy sold outside the high-risk pool. It's a fine idea but one that turns out to be the actuarial equivalent of what Democrats proposed in requiring that insurers charge pretty much the same premiums for everyone, with only modest variations based on age and health condition.

Another of the Republican "big ideas" was to make it possible for small businesses to collectively negotiate with insurance companies for better deals on health plans. But that's what Democrats have in mind with insurance exchanges that will do exactly that, not only for small businesses but also for the self-employed and workers at companies that don't offer health coverage. Although they never quite came out and said it, what apparently bothers Republicans about these insurance exchanges is that they would be overseen by governments -- the same state and federal governments that for decades have negotiated a wide selection of competitively priced plans for tens of millions of satisfied government workers, including members of Congress.

Then there's the issue of what minimal level of benefits a basic health insurance package should offer. Republicans, of course, used Thursday's forum to denounce the idea that such decisions should be made by Washington bureaucrats and politicians. But as my Washington Post colleague Ezra Klein points out, Republicans apparently would have no problem if those standards were to be set by bureaucrats and politicians in Nebraska, or North Dakota or whatever Republican state decided to offer itself up as the regulatory haven from which insurers could sell their policies nationwide.

To give them their due, Republicans did manage to raise some serious issues and make a few constructive suggestions in between their carefully choreographed talking points.

Sen. Jon Kyl of Arizona, among others, complained that the minimum standards set in the House and Senate bill weren't very minimal at all, but in fact exceeded the actuarial value of the average policy now sold in the individual and small-group markets -- and are certainly more generous than the high-deductible policies that have shown some success in restraining the annual growth in premiums. Why not, he asked, start with a more modest benefits package?

Rep. Dave Camp of Michigan raised legitimate concerns about the way malpractice suits and excessive damage awards can cause physicians to practice defensive medicine, needlessly driving up the cost of health care.

Sen. Tom Coburn of Oklahoma suggested using undercover agents to weed out the waste and fraud that he claimed were responsible for the fact that one of every three dollars in the Medicare and Medicaid programs is misspent.

And Sen. John McCain demanded that his former presidential rival renounce the special Medicaid funding formulas for Florida and Louisiana that were used to buy the support of those states' wavering senators.

What we didn't hear from Kyl, or Camp, or Coburn or McCain, however, was an offer to vote for a health reform plan if these problems were fixed and their ideas were incorporated. Without even the hint of such offers, there was little reason for a willing president and his unwilling allies to even consider serious compromise. Now the losers will be the American people, who could have surely benefited from such productive dealmaking.

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