The Summit Breakouts: Health Care, and Everything on the Table
The pool report by Carrie Budoff Brown of POLITICO on the Fiscal Responsibility Summit's breakout session on health care follows:
The health care breakout session convened on the fourth floor of the Eisenhower office building immediately after the president's remarks to the full summit. They convened at 2 p.m. and wrapped up at 3:30 p.m.
About 25 people sat at tables configured in a large rectangle. Melody Barnes and Peter Orszag sat in the front.
A full list of attendees is forthcoming, but the group included Republican and Democratic senators and representatives, labor leaders, McCain economic Douglas Holtz-Eakin, Heritage Foundation vice president Stewart Butler, and stakeholders from key health care groups.
Barnes led the session. The pool was brought in during his opening remarks. Barnes asked each attendee to give their thoughts the issue. She started with members of Congress and worked through the list. She would occasionally summarize some of the key points emerging from the discussion.
There was very little to no debate in the group. It was respectful and subdued. Each person would speak one-by-one and for only a few minutes, highlighting several points before the next person would talk.
Several in the group, particularly Republicans or individuals whose positions did not line up with the administration, thanked Barnes and Orszag for inviting them into the conversation and encouraged them to continue the open lines of communication - or else, they said, the promise of reform that exists today will quickly diminish.
Baucus said he wanted to get at least 60 votes in the Senate, but maybe as many as 70 votes on a health care reform bill.
Dodd said he wants a bill through the Senate by Memorial Day.
Two members - Sen. Alexander and Rep. Castle - urged the group to take a close look at the Wyden-Bennett health care bill.
The following is an account of the session. I have a tape of the session, but the acoustics in the room were not good, so I was forced to paraphrase what I could not hear. **Only direct quotes are in quotations.**
This is only half the session. More comments to come.
Sen. Lamar Alexander: He agrees that health care should be tackled first, but also encouraged the administration to deal with Social Security as well.
He would like to see the elimination of the Medicaid program. Medicaid is "strangling the states." It forcing cuts in other areas that needed to be funded, including education.
"I would urge you to take a look at (the) Wyden-Bennett plan. It incorporates coverage for everyone while still involves the public sector." It has Republican and Democratic support.
Rep. Henry Waxman: "The deficit cannot be controlled until we deal with Medicare and Medicaid."
He disagrees with Alexander about cutting Medicaid.
"It is important for seniors."
"I wouldn't want to see it eliminated."
There needs to be preventative care and investments in high quality care.
Barnes: It is important to have a system that includes preventative care, while expanding coverage and containing costs.
Sen. Chris Dodd: He spent time with Sen. Kennedy last week.
"He is doing well. He is anxious to be back here," and become engaged in the debate. "It is something he cares passionately about."
On health care, it is "just not a question of Medicare and Medicaid. We need to deal with it in totality and we need to take time to do it."
The reform effort must not just be about cutting costs, but developing "a longer plan that puts the country on solid footing."
"It is a broken system."
"We have to make investments in the system." Prevention. Technology.
"I am a little worried to just focus on the cost savings in the medium term ... and not get involved in the longer term issues on how to reform the system... the fiscal curve, that trajectory brings us down far less percentage of our GDP."
When GM is spending $1,500 per automobile, and competitors are not, "this is the economic issue in a sense."
He would like to see Congress and the White House move quickly, with a bill through the Senate by Memorial Day.
Rep. Joe Barton: "I want to commend the Obama administration for starting this process."
It is easy in the House to ignore Republicans. He went through the math in the House.
"It is important to do these programs. It is easy to ignore us. It is easy to go past us and then deal with Senate. If you are looking for an open and fair process in both bodies the Republicans in the House will participate if we are included form the beginning."
He was not, however, encouraged by the SCHIP bill negotiations, and the outcome of that bill.
"That is not a good model to improve health care reform."
But, he added, "now is the time." He said he agrees with Dodd about the need to move quickly.
If the proposal is "market-based and not government dominated, you will get a lot of Republican support."
Barnes: "One of the reasons we wanted to have Republicans come to the White House around this topic was to start with that kind of conversation."
She asked him if he wanted to go into more detail on his policy suggestions.
Barton: Maintain the health savings accounts and flexible spending health accounts. "Individuals have control over dollars." Supplements for private health insurance, a deal on long-term health care to take pressure off Medicaid.
Don't attack doctor owned specialty hospitals. He agrees with Rep. Clyburn that community health centers are important.
Sen. Mike Enzi: A task force is already at work in the Senate, "people across the aisle wiling to work on it." Sharing ideas about what needs to be done.
"Around here we try to do comprehensive things in a very bold and dramatic way that is good but a lot of times, we get weighted down by different parts."
He said he has a good relationship with Kennedy.
"We have to keep in mind that 70 percent of people have health insurance and they like what they got and will be upset if we change what they are doing."
Rep. George Miller: "Thank you for starting this conversation as opposed to a demand or a debate."
He said he favors the single payer system.
There needs to be a strong focus on prevention, and improving the health status of Americans. Child obesity will soon become a problem for the adult population.
"We have turned every dial ... over the last 30 years, and it is only gotten more expensive and more difficult, and the health status of Americans has gotten worst. It is startling what children are bringing to school because of the lack of health education and access to care."
Sen. Ben Nelson: The focus should be first on controlling the costs.
"I want to focus on costs and what do you do to control those and then you figure out how to pay."
He doesn't want to see private pay disappear.
"It is about the cost. If we don't focus on what we do to control costs, wont' be able to focus on universal" coverage.
Sen. Arlen Specter: He would like to see a greater focus on fraud and abuse in the health care, and it has annoyed him to see white collar criminals get away with a fine.
He talked of the importance of preventative care and the power of lifestyle changes. He plays squash and contemplated giving up Barton is.
"I was elated when I found it didn't make any difference."
He said the process must include the Senate and the House, with hearings and floor debates and amendments. He did not like the way this process was short-circuited during the stimulus debate.
Rep. Ron Kind: He said the stakeholders need to develop trust among one another.
On health care, "For too long we have had a health care system that rewarded utilization and consumption. We need to reward outcomes and performance," coordinated team approaches, greater transparency, information technology, and creativity on the state level.
"We have got to get to a system that starts rewarding what works."
Rep. Barbara Lee: "Health care reform is key in solving our fiscal problems and key in terms of our deficit. I believe whatever we do has to be accessible, affordable and universal."
As chair of the Congressional Black Caucus, Lee said she has worked with Hispanic and Asian American members to address health care disparities. She said the country needs a national strategy on HIV/AIDS - the lack of which disproportionately effects certain communities.
"An ounce of prevention is worth a pound of cure."
"If the focus is on prevention and public health, we will save."
Rep. Mike Castle: Community health centers deliver health care to the uninsured. Pharmaceutical companies do programs that provide low cost drugs. The administration should draw attention to resources that are out there that the uninsured isn't taking advantage of.
"More services are out there." The administration "needs to make people aware."
He spoke in favor of the Wyden-Bennett legislation.
"I think that makes sense."
He said it not be the best plan but it is a good starting point.
"It has bicameral and bipartisan support."
Agreed with comments on preventative care and lifestyle changes.
Barnes: "Lot of support" for preventative care, expansion of access of health care coverage, universal health care, maintaining competition in system, give states flexibility, health care disparities. Controlling costs while maintaining or expanding coverage "is a dominant theme."
Sen. Max Baucus: (Walked in late) "I just knew this would be a lot more interesting than tax reform so I would come over here."
"I am very pleased. I believe that we have a huge opportunity. The stars have aligned." "It has to be uniquely American solution" with a combination of public and private involvement.
"I am very excited. It has to bicameral and bipartisan. I am often asked by some, 'well Max, why don't you do reconciliation. My answer is no. My first preference is 60, maybe 70 votes, when it is all said and done."
In the early stages, it is important they focus on "not blowing it" - by getting focused on ideologies.
"Everything is on the table." It has to be "bipartisan, bicameral."
His white paper on health care is "a good starting point."
His goal is to have the public and private sectors working together.
"There is a huge opportunity here."
Posted at 6:22 PM ET on Feb 23, 2009
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