"This Time We Will Not Fail": Obama Faces Tough Road on Health Care Reform

At yesterday's White House summit, the new president got a taste of the bitter health-reform battles that lie ahead.

The White House Forum on Health Reform ended in a dialogue with President Obama that turned out to be the most revealing part of the afternoon. In that final hour, you began to hear the anger of the opposition -- and you caught a glimpse of which principles the president himself considers most important.

The day before the summit began, Ron Pollack -- director of Families USA, and one of the 150 invited to attend the forum -- told me that the goal was "to set the tone of the process -- a tone that is intended to be bipartisan, a tone that is intended to be inclusive -- and to make it clear that good ideas will be welcomed".

To a large degree, the summit achieved that goal. Following the president's welcoming remarks, the attendees broke up into five small groups. Observing their conversations online, I was quite impressed by the participants' civility.

At the same time, a few forthright speakers cut through some of the more gratuitous remarks. Senator Jay Rockefeller, for example, warned that anyone who believes healthcare reform won't cost us anything is delusional: reform will cost money. Recalling the time when the Clintons were striving for healthcare reform, Rockefeller observed: "Every single poll they took showed 72% of Americans said they would be willing to pay two dollars more for universal healthcare. They didn't mean it. … There are a lot of people who have an interest in keeping costs high, in making sure that medical companies make money."

Rockefeller then went on to talk about the power of lobbyists, pointing out that their money and muscle remain formidable. This doesn't mean that healthcare reform is not doable, but it does suggest that meaningful reform will require both time and dollars.

The summit discussions produced their fair share of good ideas. Take, for instance, this observation on mental health: "You can't ignore mental illness, or put it in a separate category", one participant noted. "A patient suffering from a chronic disease is expensive. A patient suffering from depression and a chronic disease is even more expensive", because he is less likely to participate in managing his illness. The depression needs to be treated, or the patient won't care enough to take his medication.

This is something we need to keep in mind when covering the uninsured, many of whom are poor and suffering from the depression and anxiety that often accompany extreme poverty. Universal healthcare will have to address mental as well as physical suffering.

Another keen observation came during the discussion of fraud. Former health and human services secretary Donna Shalala spoke up: "If we want credibility with the public, we need to put some people in jail."

Indeed. Over the past 20 years, the FBI has raided a number of huge hospital chains. Indictments have been handed down, charging executives and physicians with defrauding Medicare and even performing unnecessary surgeries on innocent patients. Huge fines have been paid.

But it is rare that anyone is incarcerated. In fact, executives like Richard Scott -- former CEO of Columbia/HCA -- often wind up back in the healthcare business. (These days, Scott is heading up Conservatives for Patients' Rights, a group determined to block healthcare reform. I discussed Scott's past adventures in the world of healthcare earlier this week.)

Of course, the climax of the event was the final Q&A session with President Obama -- when one finally began to grasp the size of the political divide his administration is trying to bridge.

Let me be clear: the administration is wise to seek bipartisan collaboration. I think it will succeed in establishing some common ground, and I hope the bipartisan effort will generate at least a few constructive new ideas. But the process is going to test everything President Obama believes about reasonable people's ability to come to reasonable compromises. And there will be some bitter battles along the way.