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Obama's Health Care Summit: Dems Find Common Ground; Republicans Not on Board

While the president made a show of listening at the White House health care summit, Republicans played their part as the party of No. Can we have reform now?
 
 
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President Obama presided over a six-hour televised summit on health care reform yesterday with Republican and Democratic members of Congress. The marathon meeting was billed as a last-ditch effort to get Republican input on the health-care reform package before Congress. But, arguably, the real purpose of the summit was to captivate the attention of the media while House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev., figured out how to push ahead with health care reform through budget reconciliation -- a parliamentary procedure that would sidestep the filibuster and the 60-vote supermajority required to overcome it, allowing Democrats to pass Senate legislation by a simple majority of 51 votes.

Republican leaders made it clear from the outset that their members had no interest in modifying the bill that has already passed the Senate, but instead wanted to scrap the bill altogether. House Minority Leader John Boehner, R-Ohio, stated repeatedly in the days before the summit that the GOP would accept nothing less than a do-over.

The president said he hoped to find common ground, but the day's proceedings only threw the divisions between the two parties into sharper relief. Obama and the Democrats appealed for insurance exchanges, regulation to curb insurance industry excesses, and eliminating wasteful subsidies to private insurers that add billions of dollars to the cost of Medicaid without adding value. At the meeting's close, House Speaker Nancy Pelosi even appeared to put the public option (a government-run health insurance program passed by the House, but not in the Senate bill) back on the table, even after the number-two ranking Democrat in the House, Majority Leader Steny Hoyer of Maryland, argued against it.

Ultra-conservative Republican Sen. Tom Coburn of Oklahoma raised eyebrows with his suggestion that the government send in "undercover patients" to root out Medicare and Medicaid fraud. "The biggest thing on fraud is to have undercover patients so that [health care providers] know we're checking on whether or not this is a legitimate bill," said Coburn, a physician.

President Obama made a big show of listening to Coburn's ideas and taking them under advisement. "We want to eliminate fraud and abuse within the government systems," the president affirmed.

Coburn also suggested that tort reform could curb rising health care costs by deterring medical malpractice lawsuits. That way, he argued, doctors wouldn't order so many expensive tests out of fear of getting sued. So far, states that have curbed medical malpractice settlements haven't observed significant decreases in health care costs.

Several Republicans insisted the health care reform would be a "government takeover" of health care. "[W]e are having a conversation about creating a new entitlement program that will bankrupt our country," Minority Leader Boehner intoned, "And it will bankrupt our country." Boehner repeated his call to scrap the bill and start over. He also suggested that instead of a comprehensive health care reform, Congress should take a more piecemeal approach.

Boehner also insisted that the bill passed by the Senate in December, on which the White House health-care reform proposal is based, allows for public funding of abortion. In fact, the Senate bill makes it more difficult for any woman to purchase health insurance that includes abortion coverage.

Republicans also accused Democrats of scheming to pay for health care reform on the backs of elderly Medicare patients. "And most worried of all are the seniors, when you go to the senior centers, because they know there's going to be $500 billion taken away from those who depend upon Medicare for their health care," said Republican Sen. John Barrasso, a former heart surgeon from Wyoming.

Actually, as many Democratic legislators pointed out, the Senate bill does not cut Medicare benefits. It provides the exact same benefits for less money by eliminating a program called Medicare Advantage, a program-within-a-program that pays insurance companies a premium to provide the same services that Medicare itself could provide for less. Eliminating Medicare Advantage would save $500 billion in worthless subsidies to insurers.

Barrasso went on to argue that high-deductible catastrophic coverage plans are good for America because they encourage patients to be "smart consumers." If their doctor suggests an MRI and their insurance won't pay for it, maybe they just don't get that MRI. This prompted one of the more interesting exchanges of the day between the president and Barrasso:

OBAMA: The -- I mean, let me just -- there's one thing I've got to -- there are a number of issues, as usual, that I've got significant difference with. I just am curious: Would you be satisfied if every member of Congress just had catastrophic care? Do you think we'd be better health care purchasers? I mean, do you think -- is that a change that we should make?

BARRASSO: Yes, I think -- I think, actually, we would. We'd really focus on it. You'd have more, as you'd say, skin in the game...

Insurance industry regulation was another hot topic. In the wake of outrage at the recent premium hikes enacted by a large California insurer as the mid-term congressional election campaigns get underway, there is now some bipartisan agreement that more needs to be done to rein in the insurance industry. In a rare display of bipartisan consensus, all House Democrats and most Republicans passed a measure on Wednesday to strip insurers of their anti-trust exemption, by a vote of 406-19.

At yesterday's summit, Republicans claimed repeatedly that if insurance companies were allowed to sell policies across state lines, competition would go up and premiums would go down. The more likely result is that insurance companies would all relocate to the states with the most lax insurance regulations. Instead of insurance companies competing with each other for consumer dollars, we'd see states competing to attract more companies by enacting more lenient insurance laws, greatly weakening consumer protections. When credit card companies were given the privilege of selling consumer debt across state lines, most of them relocated to Delaware because the state has so few consumer protections for cardholders.

The White House health care reform summit offered the president the opportunity to appear calm and reasonable in the face of Republican recalcitrance. The script played out more or less as expected. The president gave the Republicans ample time to articulate counter-proposals aimed at achieving the core goals of reform: covering the uninsured while controlling costs and curbing abusive and anti-competitive practices by the insurance industry. Instead, we heard the same old gripes about non-existent government takeovers and imaginary Medicare cuts.

The Republicans agreed that the system was broken, but explicitly disavowed any hope of a comprehensive solution. The White House has succeeded in bringing the contrast between the two parties on substantive health-care reform measures into stark relief. If the White House gives a green light, as it almost certainly will, to moving ahead with the reconciliation process in the Senate for the passage of a final health care bill, the American people will now understand why it had to go that way.

Lindsay Beyerstein is a New York writer blogging at majikthise.typepad.com, and author of The Pulse, a weekly column on health care from the Media Consortium.