The bottom line: At the end of the summit, President Obama signaled that “If it is not possible for Republicans to move in the direction of covering more than three million people, or dealing with pre-existing conditions in a realistic way . . .” Democrats will move ahead on their own.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In his closing remarks, the president took ten minutes to sum up where Democrats and Republicans agree—and where they disagree.
“We agree that we need some insurance market reforms,” Obama observed. “We don’t agree on all of them.”
“The ones we don’t agree on, the ones not included in the Republican plans are actually very popular (with the public)", he added, noting that the public thinks that out-of-pocket expenses should be capped, and that people suffering from pre-existing conditions should be able to purchase insurance without paying more than everyone else. And on these issues, the president showed no willingness to compromise: “ I strongly believe in these insurance reforms.”
He also pointed to “ A philosophical difference” between Democrats and Republicans “ as to whether there should be minimal benefits—some baseline—of adequate coverage.”
The two parties also disagree on whether “people should be able to purchase insurance across state lines. The approach some of the Republicans appear to take: let’s just open things up. Anyone can buy anything anywhere.”
He made it clear that the Democrats favor “Interstate purchase—but with baseline protections. That’s not a big government takeover—that’s something we do in almost every area of life—with respect to the food we buy, the drugs we purchase . . .”
On the subject of “medical malpractice reform,” Obama noted dryly that “Somehow when we had a Republican president, and Republicans controlled Congress, somehow it didn’t happen.” Nevertheless, President Obama indicated that he would be willing to discuss malpractice reform, but not hard caps on damages awarded to plaintiffs.
Referring to criticism that the legislation is too long and too complicated, the president said “I did not propose – and I don’t think any of the Democrats proposed something complicated just for the sake of being complicated. We’d love to have a 5-page bill. But baby-steps don’t take you where people need to go.”
And, he acknowledged, “In order to help the 30 million—that’s going to cost some money.”
In the proposal that he unveiled earlier this week, the president suggested a 2.9 percent Medicare tax on unearned income such as dividends and royalties, but, again, only if the taxpayers earn over $200,000 (or $250,000 for those filing jointly. ) Today, he explained: “people who get all their income in dividends and capital gains don’t pay any Medicare tax. But the person who cleans their building- does.”
On the question of whether reform would hurt small businesses, the president pointed out: “We exempt 95% of small businesses from any obligations whatsoever .What we do say is if you can afford to provide health insurance and have more than 50 employees — and you’re forcing others to pick up the tab [when your uninsured employees go to the ER) you’ve got to pony up some—you’ve got to pay your fair share.
“In fact, through this program most small businesses get huge subsidies by being members of the Exchange—there are tax credits for small businesses and for those who are self-employed .”
One areas where Republicans and Democrats agree, Obama declared is “With respect to bending the cost curve—we have a lot of agreement here. Reducing medical errors; incentivizing doctors to work in groups, improving prevention. We’ve included every one of these ideas in these bills. The irony is that’s part of where we get attacked for a’ government takeover.’”
The president concluded by making it clear that he does not plan to scale back his proposal.
Earlier today, blogger Bob Laslewski reported that in case the summit doesn’t generate enough support for “sweeping health care legislation,” the president has a plan B. Laslewski quoted a story published yesterday in the Wall Street Journal: .
“His leading alternate approach would provide health insurance to perhaps 15 million Americans, about half what the comprehensive bill would cover, according to two people familiar with the planning.
“It would do that by requiring insurance companies to allow people up to 26 years old to stay on their parents' health plans, and by modestly expanding two federal-state health programs, Medicaid and the Children's Health Insurance Program, one person said. The cost to the federal government would be about one-fourth the price tag for the broader effort, which the White House has said would cost about $950 billion over 10 years.
“Officials cautioned that no final decisions had been made but said the smaller plan's outlines are in place in case the larger plan fails.”
Laslewski added: “So much for all of this confidence they have the votes to pass their big health care bill.”
It seems that Laszewski, the Wall Street Journal and “two people familiar with the planning” were mistaken.
As he wrapped up his speech, Obama reiterated his commitment to helping 30 million uninsured: “ I’d like Republicans to do a little soul-searching to see if you three are things you would embrace to deal with 30 million uninsured. . . . If it is not possible for Republicans to move in the direction of covering more than 3 million people, or dealing with the pre-existing condition issue in a realistic way . . . “ well then, he seemed to suggest, there is little for the two parties to talk about.
He went on to express his concern that “starting over “ means “not doing much. “ And he was clear that we need reform now: “I will tell you this –when I talk to the parents of children who don’t have health care because they have diabetes or chronic heart disease, small businesses laying people off because they just got their insurance premium—they can’t wait.”
The president acknowledged that: “ Politically speaking, there may not be any reason for Republicans to want to do anything. I don’t need a poll to know that most Republican voters are opposed to this bill—or any compromise we might find.
“I realize that politically this is difficult for you.
But, he added, “I don’t think we are going to have another one of these [summits].
“If we saw movement—significant movement—we wouldn’t need to start over. Everyone here knows what the issues are.
"The question I am going to ask myself—is there enough serious effort that in a month’s time, six weeks’ time–that we could accomplish something” [together]?
“We cannot have another yearlong debate about this.” Here President Obama made it clear that if necessary, Democrats will move ahead to pass the bill through reconciliation. And if some voters are unhappy with that process, “that’s what elections are for.”
In other words, the voters can express their displeasure in November. But for now, the president seems committed to fight for reform.
Today, I think the president accomplished all that he could hope to do. He gave Republicans an opportunity to propose a plan to provide health care for 30 million uninsured Americans. And the Republicans made it clear that universal coverage is not their goal. Anyone who still believes that bi-partisan compromise is possible didn’t watch the summit.
Yes, The Party Of No. The Republicans don’t want to do anything, because they think that inaction’s what voters want. They are wrong, again, as usual. They are dinosaurs, who’ll soon die out & be replaced by a more enlightened and tolerant generation of us.
We cannot have another yearlong debate about this.” Here President Obama made it clear that if necessary, Democrats will move ahead to pass the bill through reconciliation. And if some voters are unhappy with that process, “that’s what elections are for.”
At the very least, I think Obama deserves credit for showing leadership. While I have some issues with the bill, on balance, I hope it passes. If it does, it should end the debate, for the most part, over universal access to health insurance. After that, it should be easier to focus on strategies to reduce the growth rate of healthcare costs. There are plenty of ideas but they would all reduce the income flowing to powerful interest groups including doctors, hospitals, trial lawyers, drug companies and device manufacturers. These five interest groups will contribute either nothing or next to nothing as a percentage of revenue that they are likely to collect over the next 10 years. We need to change that and soon.
Barry-
In the past we have disagreed on various issues–you are further to the right, I am further ot the left
But I am very glad that you and I agree that “on balance” we both hope that the healthcare bill passes.
This suggests to me that honest and intelligent people on either sidsde of the liberal/ conservative divide can agree on some central points.
Thank you.
The summit was an opportunity for the American people to see first hand that the Republican Party has NO interest in health insurance reform or any other type of reform, either now or later. Despite the recalcitrant players, the President navigated this exchange quite well. Thank you Maggie for the voracious appetite you’ve shown in tackling this complicated issue, and it’s not over yet!
And you wonder why health care reform cannot pass?
8 health care lobbyists for each member of Congress
The Center for Public Integrity has posted a searchable database of what they say are the 1,750 companies and organizations that have hired 4,525 lobbyists to influence health care reform legislation. The Center states:
“Despite the recession, 2009 was a boom year for influence peddling overall with business and advocacy groups shelling out $3.47 billion for lobbyists to represent them on all kinds of issues, according to the nonprofit group Center for Responsive Politics.
Much of that money went to fight the health reform battle, according to Center for Public Integrity data. Businesses and organizations that lobbied on health reform spent more than $1.2 billion on their overall lobby efforts. The exact amount they spent on health reform is difficult to quantify because most health care lobbyists also worked on other issues, and lobby disclosure rules do not require businesses to report how much they paid on each issue.
From an industry perspective, it was money well spent. A close look at the health reform bills that passed the House and Senate show lobbyists were apparently effective at blocking provisions like a robust government-run insurance program, and blunting the effect of cost-cutting measures on health care companies.”
Doesn’t seem like they agreed on anything at all. They got together, reiterated that they don’t agree, then went their separate ways. Not sure much was accomplished for the American people.
Hello Maggie:
I was wondering what role you think the federal government should play if, hypothetically, all the states, right now, were to commission state regulators, similar to those in Maryland (which you wrote a couple of weeks ago)?
Gene, Gregory, Robert, Keith
Gene– Thank you.
Yes, I think the President handled himself well. He showed patience and stamina.
And By giving the Republicans a chance to express their views, he demonstrated why compromise isn’t possible.
They’re willing to extend insurance to 3 million uninsured. The Democrats want to maake sure that 30 million uninsured have coverage–and they dont’ think that people who most need insurance–those suffering from “pre-conditoins” should be excluded.
That’s a huge difference.
Gregory–
Certainly, the lobbyists have had an effect on the legislation.
Though I would still say that over the next few years, I would bet that you’re going to see Medicare negotiating for discounts on drugs an devices. And, if we get reform, ultimately insurers will be regulated. If we don’t do these two things, we can’t afford refrom.
But while I blame the lobbyists, we also should acknowledge that many American voters don’t want reform. This is why legislators from some states feel they can’t vote for it: they know that voters will punish them at the polls if they help pass the legislation.
Many of these Congressmen may well share their constituents beliefs–that healthcare is a matter of personal responsibility, that they shouldn’t have to help pay for people who can’t afford insurance.
But even if they don’t agree with the majority of voters in their state, they know that they will be voted out of office of they vote for reform.
I think they should vote their conscience, but many people would say that they have a duty to reflect the views of their constituents.
Bottom line: It’s sometimes hard to realize that many Americans are against healh care reform. But they are. They are the people who elected our most conservative legislators.
Robert–
As Gene points out in his comment, the American people had a chance to see that the Republicans just aren’t intersted in universal coverage.
Not everyone understood that. Many thought that if the Democrats just compromised, the Republicans would meet them halfway.
Yesterday’s summit demonstrated “No Way.”
The philosophical differences are too large.
Either you think everyone deserves good health insurance–even if they can’t afford to pay for it. Or you don’t.
Keith–
If the states had regulators setting hospitals rates (as in Maryland) I think the Federal government should
serve as a watchdog, taking complaints about possible corruption and political influence affecting the process.
The watchdog commission would have to be protected from interference from Congress, but the good news is that only a few Congressmen (from that particular state) would have an interest in trying to block the investigation.
Penalties for anyone interfering with the process should be very stiff (prison, not just a fine.)
I’m encouraged by the fact that Maryland seems to have managed to keep the rate-setting clean. I’m sure there are some problems, but there haven’t been major scandals–not many people crying “Foul!”
Maggie
Of course the recent polls have been reflecting the point that many Americans don’t want the reform that is presently in this health care bill, that is too sided with the Senate’s version which does not have the public option in it. Most Americans (and doctors) want the public option. Take apart the individual pieces of the bill and most Americans want what is in the bill. It’s just that the public option is not there, particularly when the government is going to mandate coverage. I do not want to be forced to buy some expensive private insurance health care coverage. I want a choice to enlist in a “large pool” public option at an affordable rate.
To invite two sociopathic uncaring Republican doctor-politicians to the summit was an ethical low point for the nation and the US medical profession.
Dr. Rick Lippin
Southampton,Pa
Gregory–
Yes, some Americans don’t like the current bill because it isn’t liberal enough–they want the public option.
But a great many Americans are opposed to universal coverage– PERIOD. They don’t want to pay for other people’s health care.
They also are afraid that if we have universal coverage, more employers will feel that they can drop health benefits.
Republcian legislators represent a great many Americans who don’t believe that health care is a right. They believe that it is a matter of personal responsibility.
Too often, liberals assume that everyone thinks the way they do and shares their values. But that just isn’t true. Large parts of this country are very conservative.
Remember: the majority of white Americans voted for McCain, not Obama. And McCain was not a very strong candidate in terms of charisma, speaking ability, good looks, etc. The main thing he had going for him was his conservative views (and the fact that he was white.)
Finally, Americans say they want the public option– as long as they don’t have to pay for it.
Even middle-class Americans don’t want to see taxes raised on the rich (over $200,000 individual income) to help provide subsidies for the poor.
P.S. Gregory– see
the comment below from a college student in N.C.
Unfortunately, it sums up how many Americans feel:
The U.S. Constitution guarantees its citizens the right to life, liberty, and pursuit of happiness, yet our country’s forefathers never intended to provide our citizens with free health services. If we guarantee it for all citizens, doctors will be overstretched and our tax dollars will pay for the problems of the unhealthy, plunging our economy even further into debt. Health care is a privilege that all Americans have the chance to obtain, not a right that all Americans are guaranteed. . . .
Guaranteeing free health care to all citizens will increase the demand for medical services which will diminish the quality and accessibility of care because health care providers will be overstretched. The 60 percent of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. Doctors will consolidate into larger practices to spread overhead costs, and they will cram more patients into tight schedules to make up in volume what is lost in margin. Visits will be shortened and new appointments harder to secure, according to Dr. Scott Gottlieb, resident fellow at the American Enterprise Institute. This means that the quality of doctors will decrease, appointments will be harder to schedule, and the overall system will become less effective.
Health care is the individual’s responsibility, not the government’s. It is our own responsibility to ensure personal health. Health problems such as obesity, lung cancer, and diabetes can often be prevented by choosing to live a healthier lifestyle. According to the National Center for Health Statistics, 34 percent of Americans are obese and 32 percent are overweight. If health care is guaranteed for everyone, then our tax dollars will be paying for the health problems many citizens who chose not to live a healthy lifestyle. Also, if these citizens are guaranteed health care what incentive would they have to be healthy?”
These are the “philosophical differences” that Obama acknowledged at the summit–and this is why some moderate Democrats as well as Republicans are afraid that they will be voted out of office if they vote for health reform.