This afternoon, President Obama spoke with the confidence and determination of a leader who knows that he is right—and that he has won.

He is no longer pleading for bi-partisan co-operation. His final proposal includes all Republican suggestions that reformers find useful. The president realizes that some will not agree with his plan. As he said at the end of the Summit, “That’s why we have elections.” Those who disagree can make their beliefs known at the polls.

In the meantime, President Obama is saying: “this is my proposal.”  He would not speak with such authority unless he was quite certain that the Democrats have the votes to pass this legislation.

You will find my comments, in red, interspersed throughout the speech.

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Today, President Obama sent a letter to Congressional leaders, offering to incorporate more Republican ideas in health care legislation.

Don’t panic: Of the four ideas, two are excellent, one was almost certain to happen anyway, and one simply funds pilot projects in the states to explore alternatives to resolving medical malpractice disputes.   This provision does not call for capping malpractice awards—the president has made it clear that he opposes caps. 

Moreover, President Obama makes it very clear that he is not going to “strip down” his bill. He is insisting  on comprehensive reform.

More importantly, Nancy Pelosi appears very close to having the House votes to pass reform. The New America Foundation’s Joanne Kenen reports: 

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As I noted in the post below, the media seems to be turning “reconciliation” into an ugly word.

But “filibuster” is the word with a more unsavory history. (Thanks to HeathBeat reader Barry Carroll who sent me a link to the history of the word.)

“Filibuster” finds its root in the Spanish word “filibustero,” which means “pirate.” The filibuster was originally seen as an opportunity to “pirate” or “hijack” a debate.

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Sunday, Republican Senate leader, Mitch McConnell told CNN that even if Democrats made a significant concession— such as a provision that would limit malpractice suits against health-care providers — this would not persuade Republicans to vote for health reform legislation. He added that there is probably no way that Democrats could win a single Republican vote—even if they revised their plan.

I think McConnell is right. Republican politicians know that many of the voters who elected them oppose reform.

While responding to a comment by Health Beat reader Greg P. I ran into this statement by a North Carolina college student who opposes reform. She does a good job of articulating why conservatives oppose the entire idea of universal coverage:

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I’m sorry, the day and dates in the original announcement were wrong. 

The film, Money-Driven Medicine , was produced by Alex Gibney (best-known for Enron: The Smartest Guys in the Room and Taxi to the Dark Side ) and based on the book by Maggie Mahar. For more information, see www.moneydrivenmedicine.org

These are free public showings. I’ll be doing a Q&A with the audience following each screening and look forward to meeting HeatlhBeat readers in the area.

Tuesday, March 9

Philadelphia
The Drexel School of Public Health is sponsoring a screening at  the  Drexel University School of Public Health, Mitchell Auditorium, Bossone Research Center, 32nd and Market Streets, Philadelphia, PA

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Over at the New America Foundation’s “New Health Dialogue” blog, Joanne Kenen comments on how the media is treating the term “reconciliation” when discussing health care reform. 

“Scanning the news coverage this morning of the White House health summit, I kept seeing phrases like 'a parliamentary maneuver known as reconciliation.' I couldn't help wonder — if reconciliation,  which is admittedly not a pretty way to pass health reform, is a 'parliamentary maneuver' with all the negativity that phrase connotes, what is a filibuster? Have we become so inured to the constant use of the filibuster, allowing a minority to grind the Senate to a halt, that we have forgotten that it is arguably the mother-of-all parliamentary maneuvers?”

Kenen is spot-on. After reading her post, I Googled  “reconciliation,” “maneuver” and “health care”, only to find 10 pages of news stories where “reconciliation” was referred to as a “maneuver” or what the Random House dictionary defines as “an adroit move, skillful proceeding, etc., esp. as characterized by craftiness; ploy: political maneuver.”  

The New York Times (which used the term twice in the first two paragraph of a story) , CBS News, PBS, Joe Lieberman (via Huffington) Fox News, the LA Times, mother jones,  and Newsweek, all seem to believe that there is something downright shifty about trying to pass a bill by majority vote.

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In Los Angeles, insurers view Cedars Sinai Medical Center as a “must have” hospital. If a health plan doesn’t have Cedars in its network, people won’t buy the insurance plan according to a study of  “Unchecked Provider Clout in California” published in Health Affairs online yesterday.

While other medical centers in northern California have gained market leverage by acquiring other hospitals, Cedars has felt no need to get into the merger and acquisition business.  As an executive from a nearby hospital explained to researchers from the Centers for Health System Change, “Cedars can say, ‘Screw it; we have a strong marketing arm and the [movie] actors, let’s grow on campus and they will come to us.’ As a result, according to another respondent, ‘Cedars has the highest rates in the world…. The hospitals down the street have no market power. They have to fight for every penny.’”

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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.  

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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.”

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President Obama’s latest plan for health reform brought a flurry of commentary in the last two days; including divergent views on whether his commitment to "transparency" is helping or hurting the process.

Yesterday, the Los Angeles Times blamed the current “healthcare backlash” on Obama’s insistence that the messy business of hashing out health reform be done in Congress, not behind closed doors in the Oval Office. In the L.A. Times’ view, there’s been too much transparency:

“By leaving the overhaul in the hands of Congress, [Obama] has given the public a full view of how lawmakers do business. The result is an anti-Washington mood that Republicans have tapped into.”

Meanwhile, the House GOP leader John Boehner, calls the Obama plan—introduced yesterday on the eve of the “bipartisan” health summit—a “Democrats-only backroom deal” that “doubles down on the same failed approach that will drive up premiums, destroy jobs, raise taxes, and slash Medicare benefits.” In the Republican’s view of things, there’s been too little transparency in the health reform process.

So which is it: Back-room dealing or a too-public view of the dirty business of lawmaking?

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You might be wondering why I haven’t written about the President’s HealthCare bill. The reason is that I have very little to say. 

This, I realize, is unusual.  But the truth is that the president’s proposal is very similar to the Senate bill—which is not a surprise.

Nevertheless,  I am very glad to see the proposal. I was worried that the White House had put reform on the back burner.  

Will it pass? As always, I’m trying to be optimistic. But I think that everything depends on whether the White House decides to twist arms.  The president will have to persuade House liberals that this is a good first step—and that we can worry about improving the plan over the next three years. 

I would still like to see a public option, and I hope that, in the end, the federal government will wind up overseeing the state-based exchanges.  But the legislation doesn’t goes into effect until 2014; that gives us more than enough time to improve on it.

The President also will need to keep an eye on Senate moderates.  I would favor sending Joe Lieberman on a special mission to South Korea.  A relative who is stationed there tells me that the demilitarized zone is particularly bleak this time of year.

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