WASHINGTON – A bipartisan health summit between President Barack Obama and congressional leaders began this morning with sharp disagreements, and that's how it ended. The meeting lasted six-and-a-half hours and at the end, there was no grand compromise, and seemingly no changed minds.
Republican Senator Lamar Alexander started the session by calling on Obama and Democratic leaders to renounce the use of reconciliation – a budget procedure that would allow Democrats to pass a comprehensive health care bill with just 51 votes.
Senate Majority Leader Harry Reid quickly refused. "Reconciliation isn’t something that’s never been done before," he said, citing Republican use of reconciliation to pass Bush tax cuts. And at the end of the day, Obama, Reid and House Speaker Nancy Pelosi expressed resolve to act on a measure with or without Republican support.
Beyond the intense fight over strategy, the rare and engaging debate also highlighted the deep philosophical differences that remain -- a year after the health care debate began -- over how aggressively the federal government should intervene to expand insurance coverage and fix an insurance system that everyone at the historic meeting agreed is in need of repairs.
As expected, the summit did not live up to its billing as a forum for compromise. But it certainly proved to be riveting political theater, a radical and refreshing departure from business as usual in the capital. Instead of talking to empty legislative chambers on C-SPAN or through carefully crafted media sound bites, the nation’s elected leaders sat eyeball-to-eyeball and held a frank debate over their differences.
Meeting at Blair House, a historic building across Pennsylvania Avenue from the White House, Obama sat at the head of a square conference table, flanked by Reid and House Speaker Nancy Pelosi. Alexander, Senator John McCain and other Republican senators sat to Obama’s left.
Obama called on participants to focus on areas of overlap in their proposals. But the divide over substance and process immediately dominated.
Alexander called on Democrats to scrap their comprehensive proposals and work with Republicans to pass smaller, less ambitious changes to health insurance markets using a “clean sheet of paper.”
The GOP accused Democrats of disingenuous posturing at the summit because they continued to seek a massive overhaul that Republicans have already rejected. Alexander likened the summit to the “Detroit Auto Show” where Democrats pushed “the same model we saw last year.”
“This is a car that can’t be recalled and fixed and we would like to start over,” Alexander said.
McCain, who is facing a primary challenge from a conservative Republican in his home state of Arizona, launched into an attack on a variety of special political deals packed into in the bill the Senate passed on Christmas Eve, including the so-called “Louisiana Purchase” and Nebraska's “Cornhusker Kickback” – which were generous Medicaid benefits designed to gain support of moderate Democrats from those states.
He also cited a deal Obama’s administration negotiated with the prescription drug industry behind closed doors. Under terms of the deal, which were reported last spring, the White House got an $80 billion commitment from drug companies over 10 years to reduce drug costs for seniors on Medicare. In exchange, the White House agreed to drop efforts to bargain for lower drug prices the government pays under Medicare. It also agreed not to seek importation of lower-cost prescription drugs from Canada.
“People are angry. We promised them change in Washington,” said McCain, who was Obama’s Republican opponent in the 2008 presidential election. Democrats, he said, have treated the public instead to “unsavory dealmaking.”
“John, we’re not campaigning any more. The election is over,” Obama told McCain, urging him to focus on policy, not political talking points that are better suited for split-screen debates on Fox or MSNBC. “My hope is we can focus on the issue of how we get a bill done … We can have a debate about process, or we can have a debate over how we’re going to help the American people.”
Republicans around the table said that Democratic proposals to insure about 30 million Americans who lack coverage require expensive subsidies and too many coverage mandates that drive up premium costs. They said the taxes and Medicare cuts that would be required to pay for $1 trillion overhaul sought by Democrats would hurt many of the middle-class people the program is supposed to help.
Obama responded, however, that minimum coverage requirements are needed to sufficiently protect consumers. And, he said, the assembled politicians in the room benefit from such provisions.
“The federal health insurance program has a minimum benefit that we all take advantage of,” he said.
Senator Tom Coburn, Republican of Oklahoma and a doctor, ticked off a litany of his top priorities, including preventing and managing chronic illness.
Representative Dave Camp, Republican of Michigan, outlined a litany of disagreements Republicans have with the Democratic bills’ approach to dealing with rising health care costs. First, he said, Republicans don’t want a bill that provides large subsidies to help the uninsured afford coverage.
“A lot of Americans say to me, ‘If you are really interested in controlling costs, maybe you shouldn’t be spending $1 trillion on (expanding) health care benefits,” he said.
Camp said a key element to cost control that is missing from the House and Senate bills is medical malpractice reform -- discouraging people from filing frivolous lawsuits against doctors, which encourage physicians to practice “defensive” medicine by prescribing tests that are probably unnecessary just to protect themselves from liability.
Senator Max Baucus, Democrat of Montana, insisted the parties weren’t so far apart. He noted that setting up exchanges -- like the Massachusetts Health Insurance Connector Authority -- was a Republican idea.
But Republicans responded that the problem is with the way Democrats have constructed the exchanges -- the rules, they say, are too strict, requiring insurers to cover more than the basics, forcing premiums to go up. Representative Paul Ryan, Republican of Wisconsin, said the GOP would rather let business associations pool members independently -- with government leaving it up to them to find the best products for their members.
“We don’t think the answers lie in Washington regulating all of this,” he said.
But Obama said Democrats want to set national ground rules for what insurance policies should cover. He outlined the Democratic objection to Republicans’ call to let insurance carriers sell insurance across state lines. The fear, he said, is that insurers will go to the least restrictive, least regulated state and race to cherry-pick the healthiest people from all the states with offers of cheap coverage, leaving sick people in ever more costly plans.
“If you set a baseline, you can have interstate competition, but it’s not a race to the bottom,” the president said.
Christopher Rowland can be reached at firstname.lastname@example.org
About Political Intelligence
Glen Johnson is Politics Editor at boston.com and lead blogger for "Political Intelligence." He moved to Massachusetts in the fourth grade, and has covered local, state, and national politics for over 25 years. E-mail him at email@example.com. Follow him on Twitter @globeglen.