LAST WEEK’s White House summit was a unique moment in the decades-long effort to reform the nation’s broken healthcare system and in President Obama’s attempts to make this a bipartisan effort. But despite its noble goals and some surprisingly robust sparring, the day’s results were substantively inconclusive. No deals were struck and no political minds were changed.
It’s unlikely that many voters’ minds were changed either; seven hours of debate from politicians does not make for riveting entertainment for anyone other than a few policy wonks. Most people got their information about the day’s debate filtered through their usual media sources.
The Republicans came armed with piles of the 2700-page bill as props, an agreed mantra that the Democrat approach was too expansive and too expensive and should be scrapped, and absolutely no plans to commit to anything that Obama put on the table, even if it was their own idea. The Democrats came with constituent stories to support the urgent need for reform, itemised lists of the extent to which Republican proposals are reflected in their bill, and an argument that the nation can no longer afford to leave healthcare unreformed.
President Obama came with an incredible mastery of the facts and the intricacies of health policy, an intention to get a result – even if that was only to show up the obstructionist tactics of the Republicans and the need to move forward without them – and no hesitation about using his bully pulpit throughout the day.
When pushed by the president to move beyond process issues and the endless repetition of their mantra about starting over, the Republicans had little new to offer in terms of substance. They were very focused on high-risk pools as a way of offering catastrophic insurance to people who can’t get cover because of pre-existing conditions, but refused to recognise that this approach provides incomplete care with large out-of-pocket costs. They were obsessed with the idea of medical malpractice reforms as the solution to all current cost and over-servicing problems. And they consistently rejected the need for government regulation and oversight of any aspect of the health industry.
It quickly became clear as the day proceeded that the philosophical gulf between the two political parties was unbridgeable. The Republicans see no value in spending money to provide health insurance to the forty-seven million Americans currently without it. Their attitude is that any American can get the care they need when they are sick. This is in part correct – but they were talking about uncompensated care, which is almost always too little, too late, and is paid for elsewhere in the health budgets of the federal and state governments and the premiums of those with insurance.
The Democrats see a critical role for government in setting standards for health insurance and healthcare quality, and in tackling waste, fraud and abuse in the system. They use both economic and social arguments for making health insurance universal, which brings with it the need for financial assistance to small businesses and low-income individuals to help them purchase the mandated cover.
A major part of the summit was consumed by partisan debates over the findings of the independent Congressional Budget Office about the extent of the likely reduction in health insurance premium costs and the impact of reforms on total health spending and the national deficit.
An army of partisan fact-checkers bombarded the media throughout the summit with cherry-picked data, confirming the adage that there are lies, damned lies and statistics. The president was well-prepared to counter the Republican versions of the truth, but the Democrats were also guilty of exaggeration and selective use of the facts.
In his summing-up at the end of day, President Obama seemed to be saying that the Democrats’ big move toward a final healthcare push is nigh. There have since been indications from the House leadership that they could move first, ahead of the Senate, to pass a healthcare bill within the next month.
The choreography is complicated and will almost certainly involve the controversial process of “reconciliation,” which would mean the bill could pass the Senate with only a simple majority vote. This will alienate Republicans further, despite the fact that they have used this process consistently in recent times to pass major reforms, including tax cuts. In fact, this is the way virtually all major health legislation has been passed over the past thirty years. •
Update: The health bill was passed by the US House of Representatives on 21 March. Lesley Russell discussed the outcome in Croakey.