The long-awaited healthcare summit is over. Republicans and Democrats aired their views, and some areas of agreement on specific issues emerged, but at the end of the day, deep philosophical differences on approach mean slim prospects for bipartisan accord.
At heart, President Obama and the Democrats are determined to proceed with comprehensive reform, and the Republicans prefer a step-by-step approach. One need look no further than the number of uninsured who would be covered by the respective plans to see the difference. The Senate Democrats’ plan, which Mr. Obama largely has endorsed, would cover an additional 30 million Americans. The House Republican plan would add 3 million people to the healthcare rolls.
The president suggested that both parties spend the next few weeks trying to work out a compromise, but hinted at an alternative: switching gears and deploying the legislative technique known as reconciliation, which requires only 51 votes for passage, as opposed to the 60 votes needed in the Senate to break a filibuster.
If the parties can’t work anything out, he said, “then I think we’ve got to go ahead and make some decisions.” Beyond that, he added, the public will get to speak in the November elections – an ominous reminder that the congressional Democrats could be headed for a drubbing amid voter anger over how Washington has handled the economy and other issues, including healthcare.
Going into the healthcare summit, many analysts assumed that the Democratic leadership on Capitol Hill was set to proceed on reform via reconciliation, perhaps as early as next week. (For more on reconciliation click here)
Whether Obama’s call for Republican “soul searching” will slow down the Democrats’ drive to move ahead on reconciliation remains unclear. What is clear is that the healthcare talks, held across the street from the White House at the Blair House guest facility, did not produce any breakthroughs.
Throughout the day, Obama focused on areas of bipartisan common ground: on the desire to help people with preexisting conditions attain health insurance; to bring overall costs down; to end waste, fraud, and abuse in Medicare.
But he also made it clear that just passing the most popular elements would not work. Requiring insurers to accept all comers, including those with chronic, expensive problems, without also requiring an individual mandate to carry insurance, would be financially disastrous to insurance companies, Obama noted. The two pieces are inextricably linked, but Republicans reject mandates; some call them unconstitutional.
The Republicans probably did themselves a favor by accepting Obama’s invitation to meet. Unlike the televised House Republican meeting with Obama in January, where the president dominated, Obama was more first among equals on Thursday.
The Republicans were less deferential, more willing to interrupt the chief executive, who sat at the table, rather than standing at a lectern. The Republicans came with props – copies of the 2,700-page Senate Democratic healthcare bill – that illustrated the complexity and magnitude of what the White House is hoping to achieve.
Obama called the Republicans on their use of props, as well as their standard talking points. But any members of the public watching the proceedings may well have come away thinking that the Republicans had more to say than just “no.”
Calling the Senate bill “full of gimmicks and smoke-and-mirrors,” Representative Ryan said it “has 10 years of tax increases, about a half a trillion dollars, with 10 years of Medicare cuts, about half a trillion dollars, to pay for six years of spending.”
“Now, what’s the true 10-year cost of this bill in 10 years?” he continued. “That’s $2.3 trillion.”
Obama sought to frame the numbers differently, but Ryan had made his point. If Obama gets credit for welcoming Republicans to the table, the Republicans get credit for coming prepared.