Health Care Summit: Seven Hours and a Cloud of Dust
When President Obama invited Republican Congressional leaders to join him for a televised health care summit, they reasonably feared it was “a trap” in which the contrast between the contrast between a smooth talking Commander-in-Chief and Podunk legislators would make them look small. Clearly, Obama intended it as a PR gambit that would showcase him at his best and bully the Republicans into making concessions in order to appear reasonable.
It doesn’t seem to have worked out that way.
Like most Americans, I had more pressing things to do with my time than watch a seven hour gabfast. Earning a living, for example, took precedent. But the journalists whose job it is to report on these things and help establish the Conventional Wisdom seem to agree that the Republicans came out just fine.
WaPo’s Chris Cillizza pronounces an odd mix of Winners — Tom Coburn, Obama, the process, the Senate, Paul Ryan, and C-SPAN — and Losers — Harry Reid, John McCain, genuine discussion, the public option, and the cable networks.
Politico‘s Glenn Thrush saw no clear winner. And that, because we’re grading on a curve, means the GOP won.
President Barack Obama’s Blair House health care summit was billed as political theater — but it was so dull in parts, it’s hard to imagine anyone would demand a repeat performance.
And boring never looked so beautiful to House and Senate Republicans.
Seven thick hours of substantive policy discussion, preening and low-grade political clashes had Hill staffers nodding at their desks, policy mavens buzzing — and participants declaring the marathon C-SPAN-broadcast session a draw.
But in this case, the tie goes to Republicans, according to operatives on both sides of the aisle — because the stakes were so much higher for Democrats trying to build their case for ramming reform through using a 51-vote reconciliation tactic.
“I think it was a draw, which was a Republican win,” said Democratic political consultant Dan Gerstein. “The Republican tone was just right: a respectful, substantive disagreement, very disciplined and consistent in their message.”
The Atlantic‘s Marc Ambinder, who is also somehow CBS’ chief political consultant, agrees.
The political world watched the proceedings at Blair House looking for theatre: instead, a policy fight broke out. This time, both sides came armored, and there was no referee. It was a wash — and the tie goes to the Republicans.
The key question on the table was not whether Democrats and Republicans could come up with ways to compromise; it was whether the White House could move public opinion in a way that helps Nancy Pelosi get the votes she needs to pass the Senate bill in the House. That’s unlikely.
[…]
Indeed, Republicans were successful when the focus of the debate was on process — the details of the deals that Democrats and the White House struck with key states and the (seeming) lack of transparency. The Democrats have an answer to this: if you want to find a pure debate on a pure bill, you’ll have to look to…another universe entirely, because this is how legislation gets done.
But the Democratic answer is callous, and Republicans know it: this debate is not about a weapons system, it’s about a fifth of our economy, it’s about life and death — and deals that take health care goods from one state and transfer them to another just don’t play.
Slate‘s John Dickerson splits the difference. Apparently, both Obama and the Republicans won, which means the Democrats lost. Except, of course, Obama. Who won.
If the White House health care summit was political theater, here’s a 30-second review: President Obama won. So did congressional Republicans. Democrats in Congress need another act. This is not because Obama is such a better speaker and advocate for the legislation than his allies, though he is. It’s because Democrats didn’t get much political benefit from the event.
Obama ran for office promising to reach out to the other party. He said he would try to find areas of common agreement, and when his opponents had a legitimate philosophical disagreement, he would not question their motives. He did all of that in the session. Obama was not the crazy liberal caricature of GOP attacks during the seven-hour iron-bottom discussion. (Which may itself have been bad for the health of the people in the room.)
Republicans came out ahead for the same reason: They did not look like hell-bent obstructionists. This isn’t to say that they tried to meet the president halfway. They didn’t even try to meet him a quarter of the way. Repeatedly they called on him to start over. The president tried to get the room to focus on areas of agreement, and though several Republicans—notably Sen. Tom Coburn and Rep. Dave Camp—worked in that spirit, several others (hello, Reps. John Boehner and Eric Cantor) did not.
[…]
This is why it wasn’t a good day for congressional Democrats. According to strategists involved in 2010 races, fence-sitting Democrats needed to see Obama change the political dynamic. He needed to show how health care reform could be defended and how Republicans could be brought low. He did neither. White House aides and the president himself said he was going to press Republicans for how their plans would work, but he did that only twice—and mildly. There was no put-up-or-shut-up moment.
Obama debated Republicans vigorously and with precision—but it looked like a debate among people with actual philosophical differences, which in part it was. After an in-the-weeds debate about how the Congressional Budget Office accounted for premium increases, it became clear that the debate was between Democrats who want to set minimum standards for coverage and Republicans who want the market and individual choice to rule. The Democratic plan is more expensive but covers more people. The Republican plan is cheaper and doesn’t.
As it played out, the event didn’t look like one reasonable person aligned against a company of hooting morons. As Obama said during the lunch break: “The argument Republicans are making really isn’t that this is a government takeover of health care, but rather that we’re insuring the—or we’re regulating the insurance market too much. And that’s a legitimate philosophical disagreement.” Obama continued to affirm this view by saying things like this: “Neither of these proposals is radical. The question is which one works best.”
Of course, the only opinion that really matters is that of David Gergen. He’s like the provost or something:
The folks in the White House just must be kicking themselves right now. They thought that coming out of Baltimore when the President went in and was mesmerizing and commanding in front of the House Republicans that he could do that again here today. That would revive health care and would change the public opinion about their health care bill and they can go on to victory. Just the opposite has happened.
HotAir‘s AllahPundit about sums it up, though, with this:
Obama’s problem today was that he couldn’t fly solo; he tried to, speaking for more minutes at the meeting than either the Democrats or Republicans did, but surrounding him with sad sacks like Reid and Harkin was bound to dilute the effect.
All in all, I’d say that the real winner were those of us who didn’t spend seven hours watch.
A waste of time. The Dems have never had 60 votes. From the beginning, they needed to decide if they wanted to go the reconciliation route. I will be surprised if we end up with anything other than the status quo, the Republican goal all along.
Steve
Actually, assuming that the White House has any lick of sense about them, the only goal for the health care summit should have been to demonstrate that bipartisanship was impossible in order to lay a foundation for the House passing the Senate bill. I think they accomplished that goal just fine.
I feel like The Count: “One pretend dialogue; two pretend dialogues…”
Maybe no one won, but Obama lost. He was petty and condescending to John McCain with his “We’re not campaigning any more, the election’s over†comments. Looking down his nose at and cutting off the Republicans didn’t come off as being very presidential.
The president and the Democrats lost ground on this one.
I won; I didn’t watch any of it.
“Clearly, Obama intended it as a PR gambit that would showcase him at his best and bully the Republicans into making concessions in order to appear reasonable.”
How many elements of the current bills were originally proposed by Republicans?
A weak and transparently partisan post.
Actually, assuming that the White House has any lick of sense about them, the only goal for the health care summit should have been to demonstrate that bipartisanship was impossible in order to lay a foundation for the House passing the Senate bill. I think they accomplished that goal just fine.
I agree completely – this was about giving Obama justification to move ahead without the Repubs.
And most people who watched think McCain looked terriible and Obama was the clear “winner” in that exchange. If McCain received condescension it was deserved. He’s the cranky old uncle at the Christmas dinner.
Interesting that none of the GOP legislators have opted out of the socialistic federal workers health care plan.
A “trap” that he promised during the campaign and that McCain and other republicans had been demanding that he deliver on, until he announced he would, then of course it became a “trap”.
The Daily Show had a great bit on Tuesday about the moving goalposts.
Alex, is it possible that there is no bipartisan support because the bill is just too damn far from the center for the public too swallow it whole? Not to mention the bribery, lack of transparency, ad infinitum…
Charles,
Far from the center? If you break the bill down in components, you find that polls show that Americans overwhelmingly favor each reform contained within the bill. It’s only if you label the whole bill that you see opposition. The public overwhelming favors the bulk of the policies being enacted. That doesn’t make them the correct policies, of course, but it doesn’t make them “far from the center.”
Who was bribed? Are criminal charges pending?
Lack of transparency? You can read the bills, and all the versions of the bills, and all the proposed amendments, and the names of everyone who voted for or against all of the above. You can watch the legislature debate on C-Span or read the Congressional Record.
Is there stuff off the record? Of course there is. And guess what? There always will be.
And by the by, do you know what was created in toto, with no records and no transparency? The United States Constitution. That’s what. As long as the drafts, amendments, and votes are public, what difference does it make that we don’t have C-Span out at the local golf courses?
I predict that if the bill is passed, a year from then, the public will think it’s a fine piece of legislation.
This. Simply this.
There are several issues with the proposed bill that do not show up in the text or are sufficiently vague, that the Republicans pointed out in huge detail.
These were:
1) Abortion funding by the feds, which is in there, that will add untold millions of deaths to the 50+ million so far;
2) adequate tort reform, which is nowhere to be found;
3) giving the states a free ride a la Nebraska’s gift to the tune of 50 x 200 million dollars = $10 billion;
4) Reducing Medicaid by $500 billion without specifying how this will affect senior citizens; and,
5) disguising the actual cost rise the bill will confer on the public because of the addition of 31 million people, and not spelling out all of the assumptions given to the CBO, many of which are also chimeras.
There are more examples, but these were the ones I remember. We all know that the hope of reducing waste and fraud in Medicaid is a chimera that will not pay off any time soon, or near the amount desired, if ever.
It is therefore highly disingenuous to tout that all of the public agrees with the bill’s provisions, or lack of same, when clear suggestions have been continuously given all year by the Republicans in over 70 bills to reduce these very large impact costs drastically, but to no avail.
We do indeed need to begin all over.
manning,
What needs to be reformed? Doctors get sued for malpractice. A jury determines whether there was malpractice, and they set damage awards accordingly. The same way it’s done everywhere else in the justice system. Why should doctors be a special class protected from responsibility for their actions that harm others?
@manning
Are you sure that’s Medicare and not Medicaid? In any event, your concern, at least I’m taking that as a statement of concern, would be touching if I thought for a moment you supported public funding of senior health care.
I am confused why people think that just b/c you get the federal health insurance plan/insurance, this is socialism – isn’t it a job benefit? – I get TRICARE b/c I am in the Army and it is one of my benefits – giving free health care or substantially reduced rate insurance to a lot (not all) of people who pay little if any taxes that is not linked to their employment seems different.
Here is Obama’s malpractice reform idea, in print. He did put malpractice on the table, but Republicans did not respond.
http://content.nejm.org/cgi/content/full/354/21/2205
Please feel free to link any plans by Republicans that have been published in a peer reviewed journal.
Steve
“What needs to be reformed? Doctors get sued for malpractice. A jury determines whether there was malpractice, and they set damage awards accordingly. The same way it’s done everywhere else in the justice system. Why should doctors be a special class protected from responsibility for their actions that harm others?”
That’s pathetic, Alex. Clean and pure, eh? That must be why most of the suits in IL are brought near the brilliant jury pool of East St. Louis.
C’mon.
I predict that if the bill is passed, a year from then, the public will think it’s a fine piece of legislation.
Sam, the problem with that theory is that all the costs in the bill are up front, and the benefits and the . . . er . . . synergy effects take place closer to ten years out. This is the effect of trying to be deficit neutral over ten years. The first impacts are going to be taxes and fees floating down through the system. And in one year, Medicare is supposed to slash reimbursements rates to physicians by 23%. So one year out the story is going to be rising healthcare costs, decreased benefits, but hold on.
(I’m just talking the politics of it; I support taxing healthcare benefits for instance. And I also agree with a lot of what Matt Yglesias wrote today about a lot of this being a dog and poney show to avoid talking about taxes.)
Drew,
Even if I accept the premise of your argument, that does not explain why this should be considered (a) a federal matter or (b) single out doctors as a special protected class.
@PD
Point taken (kinda), but I was thinking more of the extension of insurance to the uninsured; the doing away with denial for those with preexisting conditions; deepsixing summary cancellation if you get sick; capping of out-of-pocket yearly expenses; and so forth. From my reading, these elements are very popular.
Oh c’mon, Alex, they are doctors! That makes them deserving of special consideration right there!
Next thing you know, people will expect them to show up for work sober, well slept, and versed in their patients files. We might even expect them to remember we are allergic to certain meds 5 minutes after we tell them we are and to actually know the pertinent cross reactions.
Ridiculous!
@Alex
If I may interject myself–(a) because the feds have the clout to override states on this matter, but (b), and much, much more importantly, trial lawyers are big-time contributors to Democratic politicians.
It’s very easy to understand.
Here’s another link of note…
That’s the basic problem, in a nutshell…
And then we can hear more disingenuous cries of how reconciliation is supposedly so “unfair” and “trampling the rights of the minority”…awwwww….
You are correct, tom p, they are the most incompetant peiople in the world. They really should be working at 7-11 (like you).
How is it much much more important that the evil trial lawyers give to Dems, while the good doctors and hospitals who only want what is best for you give overwhelmingly to the GOP?
(I have no idea if this is true, but I find it hard to believe that any politician will regularly line up against his contributors, and the “good/evil” storyline is well entrenched)
Drew,
Even if I accept the premise of your argument, that does not explain why this should be considered (a) a federal matter or (b) single out doctors as a special protected class.
Yeah, a protected class, yeah, uh, like the state of LA, or maybe Colorado, or what other state, or the unions………………plus our side bar
😉
So many individual aspects of the elephant can be approved by a small majority of the citizens, but when presented with the whole elephant, the citizens are overwhelmingly opposed to it. Is that hard to understand?
Senator Landrieu. Senator Nelson. Big Pharma? Others?
Sadly, no. But I think the people have expressed their displeasure with Senator’s Landrieu and Nelson. And Senator wannabe Coakley for that matter.
True, but rather belatedly and only because attempts to ram an unread version failed. But what about President Obama’s promises that the entire process would be open, transparent, and televised? Perhaps like President Clinton he will keep the promises he meant to keep.
So now your going to compare the six page US Constitution, whose authors we can identify, to the two-thousand-plus page so-called Health Care Reform Bill, whose authors we cannot identify? Really?
It sounded appallingly boring (and the fact that it was fully televised essentially guaranteed that nothing would get done), so I skipped.
Although I’m a liberal Democrat, I’m glad that this flopped. I don’t get this obsession with media coverage of process – just make the damn bill, present it in its entirety, and we’ll debate and vote on it. That’s how the Framers did it with the Constitution, and that’s how it should be done in this case.
(emphasis mine)
WTF??!??!!??
Ahhh, yes. The unsubstantiated insult. When you are unable to argue the points of an argument, revert to nonsense. The sad part is, I made no argument, I engaged in pure sarcasm. Apparently it struck a little too close to home and pointed out an all too obvious truth that even Drew could not deny.
Drew: Here is a hint: Stop digging. The hole only gets deeper.
A question: How many doctors have stopped practicing medicine because their malpractice insurance was too high?
It was Medicare.
As to tort reform, the total costs associated with the high levels of rewards for malpractice, far beyond a rational amount because juries are utterly sympathetic to the victim and have a hard time putting a realistic value on injuries and death, causes doctors to do two things of huge cost impact:
1) they pay for malpractice insurance to the tune of about $100,000 per year, which is passed on to Medicare, private insurance, and the patient by their fees; and,
2) they are forced to practice defensive medicine, which translates into a large number of useless tests, X-rays, MRIs, and patient discomfort every year at a greatly extended cost per patient. The sum of these items drives patient and insurance costs way up. So the mere awards are perhaps the least of the impacts from tort law—someone estimated awards to be about $15 billion per year.
Another factor is their by law required free treatment of non-insured, poor patients that come into the ER, using all of their facilities, which costs the medical system–hospitals and doctors–as much as half their revenue, which has to be made up by higher charges to other paying patients, thus raising the costs again–dramatically. They, too, can sue for malpractice! This is insane.
My Son-in-Law as an intern did almost half of his work on such patients, which had amounted to well over 100 deliveries of babies…free…in a year, for example.
Sam: I certainly do NOT support a ‘public option” or government run healthcare. I have experienced it in four countries–Holland, England, Canada, and Germany–and by far prefer our basic system, minus the cost distortions that I cite above.
The only fair thing to do would be to repeal this law…if people were to die as a result, who cares? After all, they are deadbeats and deserve whatever happens to them…
As I’ve said before, I’d like to see a President Obama with a Republican majority Congress (historically, this particular combination of party power results in the best fiscal discipline for unknown reasons). I think the summit today shows it can be done. Kick Reid and Pelosi to the curb (and probably Boehner, too – can’t stand that guy) and let’s get something useful done.
How many “high levels of rewards” cases are there a year? What percentage of filed suits do these cases make? What is the percentage of these awards as a total of health care costs?
They pay less than half that. Try again.
How do you know they’re useless? They are, after all, tests designed to avoid malpractice. And you do know that doctors are sued for malpractice for too many tests, unnecessary treatments, etc., right? That would tend to cut against your argument.
Based on what evidence?
I defy you to find this law. People cannot be turned away for treatment based on lack of ability to pay, but I assure you they are charged. If they can’t afford it, they go bankrupt.
Citation desperately needed. Half? I sincerely doubt it.
So you’re saying that we’re better off letting those babies be born without doctors? Good point. Why should those freeloading parasitic babies get one dime of your hard-earned tax money?
By the by, it’s worth mentioning that doctors in states with damage caps pay higher malpractice premiums than doctors in states that don’t. So it doesn’t even accomplish its stated purpose!
Give us a link for that last, Alex.
Only for immediately life threatening conditions. What would be your solution here?
AK:
“So you’re saying that we’re better off letting those babies be born without doctors? Good point.”
That is your stupid and irrational inference, not mine. The point is that the hours spent, and the medical resources used come out of operating costs, and are not paid for by these poor or illegals today. Nothing was said about whether they should be treated or not, just that the full costs have to be accounted for and they are not currently well-recognized.
Besides the point that you can’t get blood out of a turnip, the three hospitals that I am familiar with cannot spend the effort to pursue each of these numerous indigents in court, knowing in the end they cannot recover either their costs or the costs of litigation. You obviously haven’t been to an ER recently and experienced the overload of uninsured people. Gee, if you are poor to begin with, adding bankruptcy has little effect.
“Why should those freeloading parasitic babies get one dime of your hard-earned tax money?”
Why should I bother to respond to such an uncalled-for, imsulting inference?
“They pay less than half that. Try again.”
OK. I polled seven of my doctors: a surgeon, an anesthetist; my personal physician; an orthopedic surgeon; a gynecologist; and an ENT man. The average of this sample was $102,400 per year, paid for by either themselves or by their multiple-doctor group practices. The highest was $125k. You try again. Another gynecologist friend and neighbor was paying $85k/yr some 10 years ago.
Tests: How do you know they’re useless? They are, after all, tests designed to avoid malpractice. And you do know that doctors are sued for malpractice for too many tests, unnecessary treatments, etc., right? That would tend to cut against your argument.
Why, I can only repeat what many of my own doctors have told me: they know from their experience with office examinations and simple tests that the expensive tests are not needed, but they order them anyway, primarily as a defensive act against lawsuits. Plus, as long as Medicare pays for them, and private supplements help, the doctors know that the cost to the patient is minimized; but, then, the cost to the medical system is far larger.
I can only go with the facts as I know them, but you can claim what you like if it suits your taste, your biases, or your imagination, Dr. Knapp.
Geez Alex, that is a fallacy of composition. So Bob likes part A, Sally likes part B, and Joe likes part C, but none of them likes a Bill with A, B and C.
Anoother reference cites OB/GYNs paying $200k to $300k MPI/yr in major metro areas. Actual citation on request. Still other citations show the $100k+ costs, not for all types of doctors and not for all areas, especially not rural areas.
Yet another citation shows that the award costs are not all that impacting on the total health costs, and are in the vicinity of $15B to $30B per year. Just Google malpractice insurance costs.
gg
I would not be so arrogant and presumptious as to propose any solution in an area where my expertise, background, and knowledge doesn’t apply.
Many people present themselves at the ER with illnesses that cannot be determined to be life threatening or not without tests–sometimes rather extensive tests. Brain tumors are one example, where the patient has headaches and eye problems. Even unexplained fevers and pain symptoms cannot be dismissed arbitrarily, especially with swine flu running around, etc.
I meant possible or suspected brain tumors…
I don’t think this is an accurate assessment of what the polls have shown. A *majority* of people like each component. So it would be more like “Bob and Sally like part A, Sally and Joe like Part B, and Joe and Bob like Part C, but for some reason the majority of them don’t like A+B+C.”
But why don’t they like the total bill? It could be that Joe hates part A so much that it overwhelms his positive feelings for B & C. Or it could be that most experienced observers assume the bill is loaded with pork that isn’t included in those individual polls. Or something else entirely. It simply hasn’t been explained; Alex’s conclusion is just as far from being definitive as yours.
As many have pointed out, people do not like the idea of greater government intervention into their lives, and they see this bill for what it is: yet another arrogant power grab. Plus, they are convinced that the bill is being sold under very specious claims of cost reduction, when the real cost drivers are not addressed–in their opinion–and, as is usual for government solutions, the costs will inevitably explode downstream by factors of two or three at least. They liken this bill to making medicine a large set of highly regulated utility companies representing 1/6th of the economy, which is just one small step away from government ownership.
Further, many simply are not buying into the Obama agenda of ever greater government solutions, instead of market driven solutions. While some provisions are attractive, they do not account for how they are being paid for clearly, and there is suspicion that Medicare fiddles are counting savings twice, whether that is true or not, and to talk of a $500 billion reduction in Medicare scares the elderly to tears.
In short, the Democrats and Obama have lost the trust of many because of their fiddles with medical hot buttons, and see the need to begin over with clarity for all to understand.