Health Care Summit Analysis: Closing thoughts
5:25 p.m. | It's a wrap
And, we're done. Roughly seven hours after it began, the Great Health Care Summit of 2010 has come to a close. In the end, there's little sign that the two parties are any closer together than they were before, or that there's any more likelihood of a bipartisan deal today than there was yesterday. Did you change your mind about the issue today? Or at least learn something you didn't know? Sound off in the comments section below.
Thanks very much for reading and watching with us. For all the after-action coverage of this summit and and the reform issue going forward, be sure to bookmark the Post's dedicated health-care page.
5:24 p.m. | The extent of public health programs
Obama just made a misstatement that he has made before: that there are more people now covered by public programs like Medicare and Medicaid than by private insurance. He used the factoid to argue that government already plays a big role in health care, even before the Democratic legislation has gone into effect. It's true that public health programs have grown, but his factoid is way off. He is probably referring to a recent report that there will soon be more public spending on health care than private spending. But that is different than saying that more people are enrolled in public coverage than private -- there are still tens of millions more in private plans. Why the discrepancy? The people in public programs cost more -- they are the old and disabled. So even though there are fewer of them, they will soon be driving a majority of the spending. Factcheck.org caught this mistake by Obama the first time around.
5:24 p.m. | More from Obama's close
An invitation to act that is unlikely ever to get an RSVP:
"I'd like the Republicans to do a little soul searching." The American people "don't want us to wait. They can't afford another five decades."
"Politically speaking, there may not be any reason for Republicans to want to do something... I don't need a poll to know that most of Republican voters are opposed to this bill and might be opposed to the kind of compromise we could craft. It might be very hard politically for you to do this. But I think it was worthwhile to make this effort."
Obama then signaled his own intentions: "We cannot have another yearlong debate about this." Democrats will move forward alone, and if the public doesn't like it. Well, "that's what elections are for."
5:21 p.m. | Obama sums up
In a lengthy closing, Obama summarizes for the Republicans what he thinks has been accomplished. Here's what we've got so far:
1. We agree we need insurance market reforms.
2. We agree that small businesses and individuals "trapped" in the individual market should be offered the opportunity to purchase insurance through larger pools.
3. We disagree on whether there should be minimum standards for coverage.
4. We disagree on whether to permit insurers to sell policies across state lines.
5. We disagree on whether the Democratic plan is a "big government takeover."
6. I'm willing to talk to you about malpractice reform, but not hard caps on damages for plaintiffs.
"I'd be interesting in seeing whether we could work on something," the president said, before launching into yet another defense of the big, expensive, comprehensive plan Republicans hate.
5:17 p.m. | Checking back with Paul Ryan
In the flurry of back and forths earlier this afternoon, Paul Ryan, the policy-minded Wisconsin Republican, made a provocative remark that deserves a closer look, especially since neither Obama or congressional Democrats responded to his claim: that the deficit reduction that the Democratic legislation provides is somewhat overstated because of an accounting gimmick. The Congressional Budget Office has estimated that the Senate's and House's health care bills would reduce the deficit by about $130 billion over 10 years. But this is misleading, Ryan said, because the savings are frontloaded in the bills -- the savings will be gained in the first 10 years, but after that, the bill will start to bleed red ink.
This is off the mark. There is some tricky accounting in the bills, to the degree that they understate the 10-year price tag of the bills -- the 10-year window is defined as being from 2010 to 2020, but the bill does not really take effect until 2013 and 2014, so that window understates its true 10-year cost. In fact, the cost of the bills in 2016, when it is really up and running, will be about $150 billion per year.
But that does not mean that Ryan is correct about the timeline deficit reduction. Because if the price tag climbs more in the out years, so do the revenues that will be coming in under the bills. According to the CBO, the excise tax on high-cost insurance plans that is in the Senate bill produces more revenue as time goes on and more plans cross the threshold for being taxed, which will not be adjusted more slowly than the rise in health care costs. The income tax surcharge on the very wealthy in the House bill collects more money as more people reach the threshold for the tax.
That may be less true of the proposal the president unveiled last week, since he scaled back the excise tax. His proposal has not been scored yet by the CBO, but the White House itself admits that its plan will result in smaller deficit reduction over the first 10 years than the House and Senate bills -- about $100 billion. But the notion that those two bills have been estimated only to save money in the near term is not correct.
5:01 p.m. | Still quite far apart
Lest you mistake the last six hours for a productive discussion, as the summit comes to a close, both sides are digging in: Senate Republican Leader Mitch McConnell just repeated the top GOP talking point: The public hates it. Let's scrap this bill.
And Democrats Charlie Rangel and John Dingell are responding: That ain't going to happen. If Republicans don't leave here today "at least talking about what we agree on," as Rangel put it, Democrats will have taken a stab at engaging the GOP and, having failed, must forge on alone.
As Rangel said in response to another favorite GOP talking point: "I have no clue how big the Medicare bill was, how big the Social Security bill was. And I don't think someone sick in the emergency room really cares how big the bill is that we're trying to help them with."
4:19 p.m. | On Dingell
John Dingell is the dean of the House -- the longest-serving current member of the chamber. And he has some health-care experience no other lawmaker does; Dingell was sitting in the Speaker's chair the day the House first passed the bill creating Medicare in 1965.
The current speaker, Rep. Peter Roskam (R), served in the Illinois state Senate with Obama. They had a memorable exchange during the president's visit to the House GOP retreat in Baltimore, where Roskam essentially wondered what happened to the bipartisan Obama he knew back in Springfield.
4:04 p.m. | Barrasso endorses catastrophic coverage
The Republicans have been promoting the merits of high-deductible "catastrophic coverage" plans of the sort that they say the Democrats' legislation would not allow, since it would not provide comprehensive coverage. Sen. John Barasso just said that the patients he sees as a physician back home in Wyoming who have catastrophic coverage tend to be his most informed, discerning customers because they have some skin in the game. Obama countered by asking Barasso whether he would have all of Congress switch over to catastrophic plans, and Barasso said he would. Well, Obama said, that's only because congressmen make enough money that they can pick up the cost of whatever would not be covered.
But there's another downside to high-deductible plans: their costs are soaring just as much as other. Many residents in the D.C. area have gotten notices in recent months saying that their high-deductible plans with Carefirst are going up by 40 percent or more. We checked with the District's insurance commissioner's office, which told us that it had in fact signed off on a very large increase for Carefirst's high-deductible policy in the region.
Given the opportunity to state the Republican position on insurance coverage, John Barrasso is endorsing catastrophic coverage, which makes people much "better consumers," because they have to ask how much an MRI costs before they consent to have one. Under questioning from Obama, he insists that members of Congress should have catastrophic coverage, too.
To which Obama offered a fairly powerful zinger: Of those who currently can't afford to pay for care, "we can debate whether we can afford to help them." he said. "But we can't say they don't need help."
4:10 p.m. | Summit 'not a campaign'
Obama strikes a bipartisan pose by cutting off Henry Waxman: "We're not making campaign speeches here." Will that earn him any goodwill on the GOP side?
3:56 p.m. | On to questions of coverage
Now we're getting down to the heart of the dispute between the two parties: Should the United States aspire to provide health insurance to every American? Or not?
"If we think it's important as a society to not leave people out, then we're going to have to figure out how to pay for it," Obama said.
The final 45 minutes of the summit will be devoted to the question of universal coverage.
3:52 p.m. | McCain on malpractice
John McCain followed his Republican colleagues this morning in citing limits on malpractice suits in Texas and California as a model for national malpractice reform. He noted that the reforms have had an impact in Texas in reducing the number of suits brought and the rates for malpractice insurance. But the example does not work on another level, as an argument for malpractice reform being the biggest answer to solving the problem of high health care costs and low coverage -- because Texas still has, by many measures, one of the most flawed health care systems in the country. The state has by far the highest rates of uninsured -- 25 percent of the state, more than 6 million. Many small businesses and individuals in the state face some of the highest premiums in the country. The state is very high in rankings of Medicare spending per patient. Atul Gawande captured this in his New Yorker piece last year about the sky-high Medicare spending in McAllen, Texas. He asked doctors there about their high spending:
"It's malpractice," a family physician who had practiced here for thirty-three years said. "McAllen is legal hell," the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.
That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn't lawsuits go down?
"Practically to zero," the cardiologist admitted.
"Come on," the general surgeon finally said. "We all know these arguments are [false]. There is overutilization here, pure and simple." Doctors, he said, were racking up charges with extra tests, services, and procedures.
3:47 p.m. | Senate politics of health care
Senate Majority Whip Dick Durbin (D-Ill.), who just spoke, provided a reminder that not only is the current majority leader present at the summit, but there is a good chance the next majority leader is there too. If Republicans manage to take back the Senate, Mitch McConnell would get the job. And even if Democrats hold the Senate, there is a decent chance that Harry Reid will lose his reelection race in Nevada. If he does, the contest to succeed him in the Senate's top job would likely be between Durbin and Chuck Schumer. That race, pitting two very potent political forces in the chamber, would be fascinating to watch.
3:45 p.m. | On reconciliation
Reconciliation (n.): A special budget process created to move politically difficult legislation forward, particularly if it reduces the deficit. A reconciliation bill is a budget bill that, in this case, must reduce deficits by $2 billion over the next 10 years.
The procedural advantage is that it cannot be filibustered so, in this Senate, a bill could pass with only 50 votes -- and no Republicans.
The practical problem, however, is that the reconciliation strategy would require the House first to approve a Senate bill that is deeply unpopular in the lower chamber. And then Pelosi's team would have to initiate the reconciliation bill, which would contain the fixes that would change the Senate bill and make the final product closer to the House's liking.
Why is that a problem? Because the Senate is so dysfunctional, the House doesn't trust it to pass anything.
The real equation coming out of this summit is not whether Republicans sign on to the heath reform effort. It's whether congressional Democrats have the stomach to move forward alone.
3:38 p.m. | Jim Cooper, one-man, anti-deficit band
It's fascinating that Jim Cooper is sitting at that table. He has hardly been a reliable advocate of either the administration's or House leadership's positions. Instead, Cooper is a one-man anti-deficit band, who is also deeply invested in the idea of a commission to deal with the fact that we raise way too little in taxes to pay for Medicare, Medicaid, Social Security and everything else we want to do as a nation.
"If you don't think this bill reduces the deficit enough," he lectured the Republicans, "vote for more savings."
3:28 p.m. | Health summit a warm up for Conrad?
For Kent Conrad, the chairman of the Senate Budget Committee, this health care summit is something of a warm-up for the big event -- the president's commission on the deficit. While this summit is little more than political theater, the deficit commission has the potential to shape Obama's response to budget deficits projected to hover around $1 trillion a year for much of the next decade.
The Democratic health care bill actually has a chance of improving the long term budget outlook, according to the CBO. But not by much.
3:27 p.m. | Behind the scenes
A Republican aide emails to point out that "every time a Republican makes a point the President handles the rebuttal. Doesn't seem to allow any of his congressional D's weigh in until after he's reframed the issue." It's true, there have been almost no cases today where a Republican lawmaker has spoken and then a Democratic lawmaker has immediately gotten the chance to respond. Obama always goes first. Of course, Obama called this summit. But it does mean that Hill Democrats have been less engaged in the back-and-forth debates than Obama and the Republicans have.
3:21 p.m. | Grassley flip-flops on individual mandate?
Chuck Grassley, the Iowa Republican whom the White House and Sen. Max Baucus tried so hard to bring on board the health care legislation, just gave a very strong statement against the individual insurance mandate included in the bill: "For the first time in the 220 year history of this country, the federal government is telling you you've got to buy something," he said.
There's just one thing: less than a year ago, Grassley was one of the many Republicans and conservatives who were still speaking in favor of an insurance insurance mandate, seeing it as a matter of personal responsibility. "I've been finding among some conservative Republicans the feeling of individual responsibility. Not that they want to do that, but the fact is that it is costing everyone anyway," he said in May. "So you have a shared responsibility."
3:15 p.m. | CBO: Referee? God? Or unreliable?
Unless you dwell in the most rarefied Washington policy circles, you may not realize how sharply Xavier Becerra just stabbed Paul Ryan in the heart.
"You called into question the Congressional Budget Office!" Becerra charged. "I think we have to decide, do we believe in the Congressional Budget Office or not?"
As Sen. Chuck Grassley noted, "I consider CBO God around here."
What is the CBO? The nonpartisan agency Democrats and Republicans alike rely on to attach numbers and economic projections to their proposed policies, an agency that has persevered with intensely objective analyses despite some leaders who later proved fairly partisan on both sides of the political line (hello, White House budget director Peter Orszag and McCain economic adviser Doug Holtz-Eakin).
But is the agency God? Decide for yourself. Here's my story about how they score health care bills.
3:05 p.m. | Ryan goes after Medicare spending
A new wrinkle was added to the Republican case as Paul Ryan took the mike just now to lay out the Republican argument on cost control and deficit reduction. Ryan, a Wisconsin Republican seen as one of the party's rising stars, made a forceful warning about the country's looming debt. What he didn't say, though, is that his own plan for tackling Medicare liabilities -- which some in his party have portrayed as their general economic blueprint -- is to do away with existing Medicare for all people who are now under 55 and replace it with a voucher system. At age 65, people would get vouchers to buy private insurance. The government would save money because the value of the vouchers would increase more slowly than the cost of health care. It is a bold and radical idea. But it is also highly controversial -- seniors would have reason to worry that the vouchers would not be enough to let them buy coverage, especially given how wary insurers would be to sell health insurance to the elderly.
And Ryan's stance is starkly at odds with what other Republicans have been saying today in objecting to any cuts in Medicare. Ryan would not just trim Medicare, he would replace it with something else entirely.
Paul Ryan is one of the smartest guys in the House Republican caucus, and his numbers are fairly accurate. Even some supporters of the Democratic health care plan worry that reducing Medicare spending by hundreds of billions of dollars and then using the money to finance a new entitlement program is not a particularly effective way of dealing with the looming deficit crisis.
Obama is trying to turn the discussion back to Medicare Advantage, an extremely inefficient and expensive subset of Medicare that Democrats want to scale back dramatically. But he ducked the central issue: How do you solve your long term problems if you use Medicare cuts -- not to mention significant tax increases -- to pay for a big new program that may or may not serve to cut health care costs overall.
If it were to succeed in slowing the rate of growth of the cost of health care, that would be one thing. But economists and other experts are deeply divided over whether those provisions of reform would actually work.
3:02 p.m. | Background on Medicare Advantage
Lots of discussion here about the Medicare Advantage program and proposed cuts to it. The Washington Post's Philip Rucker traveled to McCain's home state to file this report on the subject back in October.
2:55 p.m. | Obama favors individual mandate (the same one he opposed during campaign)
Hillary Clinton, are you watching? President Obama just delivered a long overdue mea culpa for having opposed an individual mandate for health insurance in the 2008 Democratic primaries, only to have since become a staunch defender of it against Republican attacks. During the primaries, Obama tussled with Hillary Clinton (and earlier John Edwards) over their difference on this score, saying that a mandate was not absolutely necessary and, at points, even attacking Clinton for her proposed mandate in an opportunistic tone not dissimilar to what Republicans are saying against Obama now.
Today, Obama acknowledged his change of heart more explicitly than he usually tends to do. "I was dragged kicking and screaming to the conclusion I arrived at, that it made sense to have everybody purchase insurance," he said.
2:50 p.m. | Biden finds consensus?
"We're not cutting Medicare benefits in this. We're trying to eliminate the third of the problem that's waste." -- Vice President Biden
This sounds AWESOME. Nobody is in favor of waste, fraud and abuse. And there are health care economists out there who do, in fact, believe that a giant chunk of change can be cut out of Medicare -- and the health system generally -- without affecting care. However, nobody actually knows how to do it. Under guidelines adopted in the Senate bill, the Congressional Budget Office believes that the increase in spending per beneficiary would be cut dramatically. But the CBO -- and the Center for Medicare and Medicaid Services, the administration agency in charge of the programs -- has signalled doubts that the program can absorb cuts of that magnitude without either driving doctors out of the program or otherwise affecting service to seniors.
2:48 p.m. | Blackburn on buying insurance across state lines
And around the bend we go again on buying insurance across state lines. Were all of these people absent for the morning session? Marsha Blackburn (R-Tenn.) just declared that Californians wouldn't be suffering 39 percent rate increases in the individual market if they could just go and buy coverage in other states. Except that by the insurance industry's own explanation of their increases, letting people buy across state lines would only exacerbate the rate hikes in California. Anthem Blue Cross says its rates are soaring in California because healthier people are dropping their coverage as a result of the recession, leaving the individual insurance pool only with older and sicker people who really need their insurance. If people could buy insurance in other states, even more young and healthy Californians would flee the Anthem plan for whatever bare-boned policy they could find in an another state, making the plan in California even more expensive for those who stayed in it.
2:45 p.m. | Health summit time of possession
On the subject of which side has been speaking longer, the Senate Republican Communications Center sends along this breakdown, along with an interesting NFL playoff parallel.
Speaking time in first half of summit:
Total D: around 108 minutes
Total R: around 56 minutes 15 seconds
Obama Alone: around 57 minutes 45 seconds
But time of possession doesn't always matter:
Vikings(28) - time of possession 36:49
Saints(31) - time of possession 27:56
2:27 p.m. | Rockefeller on individual mandate
Sen. Jay Rockefeller, in a rant against the "rapacious insurance industry," made an especially good debating point: The individual mandate -- the unpopular requirement that everyone buy insurance -- is "not in there for some government purpose," he said. The insurance industry is demanding "a big pool" of new, young, cheap customers in exchange for complying with all the popular stuff both parties want it to do: get rid of pre-existing conditions, stop yanking coverage out from under people who get sick and ban annual and lifetime limits on benefits.
Sen. Jay Rockefeller has been one of the most aggressive advocated in the Senate for moving health-care reform to the left. He was a strong supporter of the public option -- which now appears to be dead -- and it took quite awhile before he would acquiesce to backing a measure that didn't have the government-run insurance plan. He's also been one of the harshest critics of insurance companies, as we're hearing now.
2:19 p.m. | The truth about Massachusetts
Tom Harkin, the Iowa Democrat, just touted Massachusetts' universal coverage law as an example to do comprehensive health care reform, but was a bit over-general in the figures he used to make the case. He said that premiums have dropped sharply in the state since the law passed in 2006. Just to be clear: one particular part of the population has indeed seen a drop in premiums in the Bay State, people without employer-based coverage who buy their own policies. Such people have indeed seen their premiums go down because the state's insurance mandate has brought more people into the pool, spreading costs more widely (the state also provides subsidies to help people buy their coverage.) But overall in Massachusetts, the average cost of premiums have continued to increase since the law passed, just as they have elsewhere in the country. That has brought state lawmakers around to a whole new effort to control medical costs in the state, which wasn't really the focus of the initial law.
2:12 p.m. | Enzi weighs in on insurance exchanges
Sen. Mike Enzi (R-Wyo.) was a member of the infamous Gang of Six who met all summer to try to reach a bipartisan compromise on health reform. And he just offered a fairly constructive proposal: Let's create these government-run insurance exchanges, but let insurance companies offer pretty much any plan they want. Plans that meet the federal standards for minimum coverage would be marked as such, so buyers would know what they're getting.
This is particularly important to Enzi, because research by the insurance industry found that the Democrats' minimum standards would dramatically increase coverage standards in his state, forcing the average purchaser in the individual market to pay hundreds of dollars more. Yes, for better coverage. But, still, hundreds of dollars more.
12:57 | Break for Lunch/House Vote
In case you're wondering, the House is currently voting on the rule governing debate for the Intelligence Authorization Bill. Yes -- there are issues other than health care being discussed and acted upon today.
12:55 p.m. | Obama-Cantor exchange exposes fundamental disagreement between parties
The exchange just now between the president and House Whip Eric Cantor (Virginia) -- at about 12:45 -- captured the fundamental disagreement on health care better than anything else so far today. Obama, taking full advantage of his ability to control (or abuse) the clock, delivered a lengthy explanation of why, in his view, the Republicans' more incremental, piecemeal approach to health care reform doesn't work. The Republicans say that they, too, are against letting insurers deny coverage based on pre-existing conditions, and that they are against insurers who deny paying for medical costs once people with coverage actually get sick. But it is impossible to address these problems without more overarching reform, he said. If you ban pre-existing conditions as a reason for denying coverage, then people will simply wait until they're sick to buy coverage. The way to avoid that, he said, is to require everyone to be covered -- the individual mandate that Republicans are strongly opposed to.
Cantor responded by laying bare the Republican objection to the legislation in more explicit terms than usual: covering people is a nice thing to do, he said, but the country shouldn't have to pay for it. "We just can't afford this, that's the ulatmate problem," he said. "In a perfect world, everyone would have everything they want."
-- Alec MacGillis
12:43 p.m. | Cantor offers subtle critique of Obama plan
Under a smooth exterior, Eric Cantor is slipping in several digs against Obama. First he pointed out that while the Senate bill is quite long (and is stacked up in front of him for dramatic effect), Obama's proposed compromise is only an 11-page outline at this point and thus lacking in details. And he pointed out that the CBO declared that because of that lack of detail, it couldn't put a proper price tag on Obama's plan.
12:36 p.m. | John McCain is attacking Obama and the Democrats on one of their most vulnerable points in the health care debate -- the fact that the health care negotiations have not been out in the open, as Obama promised they would be during the campaign, and the fact that special deals were cut to get some votes, such as Ben Nelson's "Cornhusker Kickback."
But here's the thing: after seeing today what six hours of on-camera bipartisan health care negotiations actually look like, how many people out there are going to be wishing that they'd months and months of this?
It makes sense that John McCain would make early reference to all of the Medicare Advantage customers in Arizona. The program is quite popular in his state and, coincidentally, McCain is up for reelection this year. He faces a primary challenge from ex-Rep. JD Hayworth, and this summit provides McCain with a useful opportunity to speak directly to voters back home, just as it does for Harry Reid.
12:29 p.m. | Market-based versus minimum levels of coverage; high risk pools
Charles Boustany, Republican of Louisiana and a cardiovascular surgeon, got to the heart (sorry) of the issue just now when he noted the clear philosophical differences between the Republican vision for a more market-based health care system and the Democratic version, where the government would require minimum levels of coverage. Yes, in theory the Democratic legislation allows people to buy policies across state lines, he said, but "this bill restricts those options too much" by requiring all plans for people buying individual coverage to offer a minimum level of benefits.
Boustany also touted another favorite Republican idea -- relying on "high risk pools" to cover people who are so high-risk that they simply cannot find coverage on the open market. But our colleague Amy Goldstein looked at this idea closely in 2008 and found that they have not worked well at all in the states that have tried to use them -- pooling very sick people together, not surprisingly, is a very expensive way to approach health insurance.
12:19 p.m. | Rep. Charles Boustany, the current speaker, is a cardiovascular surgeon, as he said. Sen. John Barasso is also a doctor. According to a New York Times story on the subject: "Of the doctors elected to Congress, 11 are Republicans and 5 are Democrats. Two serve in the Senate and 14 in the House, 7 of whom are on the three committees preparing a health care bill."
12:16 p.m. | The president just broached an issue where he and congressional Democrats have been a bit disingenuous in recent weeks. To appear bipartisan, they have argued that their legislation does include a version of the longtime Republican proposal to allow people to buy health insurance across state lines. The fact is, what the Democratic legislation provides for is quite different from this in a crucial way, which Obama finally acknowledged here. The Republican proposal is based on the fact that states have widely varying insurance regulation, which means that there are cheap, bare-boned policies that low-risk people can buy in underegulated states but that similarly young and healthy people cannot find in more regulated states. Why not, the Republicans say, let a young and healthy person in New York buy a cheap plan from Texas? The Democratic legislation would allow people to buy coverage on a broader marketplace than what exists today -- a new "exchange" where insurers could offer plans that would be available to people across state lines. But there is a key difference -- to participate in the exchange, insurers would have to conform to minimum standards. Plans would have to offer a basic level of coverage, and insurers could not reject people based on preexisting conditions, as occurs in many states today.
The reason for this approach, Obama said, is that simply allowing people to buy across state lines would result in a flood of lower-risk people buying bare-boned plans in under-regulated states, leaving higher-risk people in the more-regulated states with a smaller, higher-risk pool of insured that would drive rates there even higher. Meanwhile, higher-risk people in the lower-regulated states would still be unable to find affordable coverage. The result, he said, is a "race to the bottom," where states slash insurance requirements and consumer protections so that their insurers can attract healthy customers from other states.
Most health care experts strongly endorse the Democratic approach to broadening the market. But it's wrong for the Democrats to claim it's a close cousin to the Republican idea.
By my count, at least 20 members of Congress haven't spoken yet. Which raises three questions: 1) Will the speakers after lunch keep their remarks shorter? 2) Will Obama stop responding to each one? 3) Will this summit run way past the allotted time, or will Obama simply end it after some reasonable amount of overtime?
11:59 a.m. | We can't know for sure whether or not he realizes it, but Chuck Schumer just spoke out on behalf of a controversial provision in the Democratic health care legislation that will likely hurt doctors and hospitals in his home state of New York. Maria Cantwell, of Washington state, added an amendment that would send higher Medicare payments to hospitals and doctors that provide better value -- spending less money per patient. This provision was lobbied for by the Mayo Clinic and other hospitals in the Upper Midwest and Northwest that have spend less per Medicare patient. It remains to be seen how the new payment index would be crafted, but in all likelihood it would hurt hospitals in New York City, which have some of the highest spending per Medicare patient. Critics of the revised payment system say it overlooks the higher cost of living in some areas and demographic differences that result in higher medical needs in some places.
Separately, Schumer noted the contradiction between Dave Camp's call to protect Medicare against any cuts and Tom Coburn's declaration that one-third of Medicare spending is waste and fraud. "The Republican Party has always stood for getting rid of waste, fraud and abuse, and all of a sudden now we're hearing, 'Don't get rid of any of that,'" Schumer said.
11:48 a.m. | McConnell breaks out the numbers: Democrats have spoken for 52 minutes, Republicans for 24. Obama says "I don't think that's quite right," though it probably is. Presumably some Republican staffer is keeping track. But where did McConnell get that info? From his Blackberry? A surreptitious earpiece?
11:44 a.m. | More on Dave Camp's presentation: He is correct that the Congressional Budget Office projects that premiums would be driven up by the richer benefits that insurance companies would be required to provide under the Democrats' bill. However, the CBO also found that the increase would be more than offset by other aspects of reform, including the mandate that everybody buys insurance. In other words, if young, cheap people were to pay into the insurance pool in large numbers, everybody could have better benefits at lower costs.
Worth noting that not everyone agrees with the CBO, but that's what the economic models show.
11:43 a.m. | There's a bit of contradiction emerging in the Republican ranks -- on the one hand, there's Tom Coburn talking about the need to reduce widespread fraud and waste in Medicare. On the other hand, there are others, such as Dave Camp, arguing against the Medicare reductions in the Democratic legislation -- which are targeted in large part at reducing Medicare waste and fraud of the sort Coburn is railing against.
Camp was correct in noting that the Centers for Medicare and Medicaid Services predicted that overall health care spending would increase under the Democratic legislation -- but he did not say what was driving that predicted increase, the fact that more people would be covered and availing themselves of health care. He noted that Texas and California have passed caps on malpractice damages, but those reforms have so far not resulted in any significant reductions in health care costs and premiums in those states -- in fact, it was the 39 percent increase in individual insurance rates in California that has given new fuel to the Democratic legislation.
To his credit, Camp did manage to get to the nut of the previous dispute over the extent of premium increases for individual policy holders under the Democratic legislation -- premiums would increase for some people, he said, because they would be getting "richer benefits" as a result of new insurance mandates in the legislation.
Rep. Dave Camp -- here because he's the top Republican on the Ways and Means Committee -- brings out the GOP's big gun: the need for "responsible lawsuit reform." There has been lots of speculation that Obama would reach out to Republicans by offering to deal on this issue of medical malpractice, but some of Obama's fellow Democrats are wary of giving much away on this point. They argue that lawsuits don't really have that much effect on the cost of health care. Always worth noting here: Trial lawyers are a huge and important Democratic constituency.
11:29 a.m. | Rep. John Kline just spoke. More tidbits from his official bio: "John's son - a father of two - is a helicopter pilot in the Army and has served two tours in Afghanistan and Iraq. His daughter is a freelance author, mother of two, and creator of the popular PBandJAHM e-zone, which offers community and advice for stay at home mothers across the country."
11:23 a.m. | It seems that this summit could benefit from having an official timekeeper, or perhaps an orchestra that plays when any speaker goes on too long, like during the Oscars. So far it seems that Democrats have spoken much more than Republicans have. Will the GOP get to make up for that disparity later?
11:19 a.m. | There is some irony in Tom Coburn's emphasis on the amount of fraud in Medicare. The Democrats' legislation relies to a huge degree on savings to be obtained from reducing Medicare fraud and waste. Skeptics, including many congressional Republicans, have noted that past claims to ferret out Medicare fraud have produced little savings. But Coburn seemed to be inadvertently backing up the Democratic case that much money could be made up in this area. Steny Hoyer took note of this in his remarks following Coburn, praising him for drawing attention to Medicare fraud while noting, there is a "very substantial investment in [the Democratic legislation] in doing just what you suggest."
11:18 a.m. | A follow-up on the question of polling: It is true that polls on Democrats' broad reform plans show a majority of Americans opposed. But it's also true that surveys testing the individual pieces of reform tend to find all of them popular. This survey from last week is a good example of that.
11:10 a.m. | Fight! Fight! Well, that didn't take long, the first clash of the day just broke out, between the president and Lamar Alexander, over whether the Democratic legislation would increase premiums for people without employer-based coverage. Basically, each of the two cherry-picked the data from the Congressional Budget Office report on the issue to suit their argument. The report found that premiums would go up for some people and down for others. Obama got impatient with Alexander for challenging his claim that premiums would go down, and while Obama glossed over the data somewhat, his explanation of the discrepancy in the numbers was basically correct. Premiums will go up for some people who today are able to buy very low-cost policies because they are deemed very low-risk and because they live in states where insurers are allowed to sell very bare-boned policies that are required to cover very little in medical care. But premiums will go down for many of the people who today face very high rates in the individual market because they are deemed to be higher risk. Under the legislation, everyone will be required to buy coverage, which will expand the insurance pool, spreading risk and costs. Insurers will be required to offer a minimum level of coverage. That will mean higher premiums for some people. But they will be getting more coverage for their dollar. And most of them will qualify for subsidies to help them buy the coverage.
11:08 a.m. | Mitch McConnell just said of Democrats' reform plans: "If you average all the polls, the American people are opposed, 55 to 37." It's not clear which average he's looking at. Pollster.com's average of polls pegs it at 51 percent opposed, 42 percent in favor. And of course, that mixes together lots of different surveys with varying degrees of reliability, asking the health-care question in different ways.
10:57 a.m. | Harry Reid just mentioned that the House's bill would reduce the deficit by $132 billion over the first 10 years. But the president's proposal released this week would reduce the deficit slightly less, only about $100 billion. That's because it brings in less new tax revenue than the House bill -- instead of a 5.4 percent income tax surcharge on family income over $1million, it relies on a smaller tax increase, applying the 2.9 percent Medicare payroll tax to the interest and dividends earned by taxpayers earning more than $250,000.
"A senior citizen will tell you what the doughnut hole is," Reid declares. Or you can ask Tim Noah -- he has a handy glossary of health care terms on Slate.
10:52 a.m. | Harry Reid began: "I want to spend a few minutes talking about Nevada." Yes, he is running for reelection.
Lamar Alexander's portrayal of the Democratic legislation was on target in some areas and off in others. The legislation does rely heavily on reductions in Medicare, though his estimate of $500 billion in cuts is overstated -- a large part of those savings are actually in reductions in Medicaid payments to hospitals that see a lot of uninsured patients. He is correct that the legislation could increase premiums for some people, though again overstates the scale of the impact -- the Congressional Budget Office found that premiums could increase for some people who now have bare-boned individual policies, because the legislation would require that the plans insurers sell has a minimum level of coverage. For other people deemed higher risk by insurers, individual premiums will likely fall since they will be included in a larger pool of insured people. (For those with employer-based coverage, premiums are predicted to be little affected by the legislation, at least at the outset.) Finally, Alexander referred to the proposed expansion of Medicaid as the "mother of all unfunded mandates" for the states. But in fact, the president's proposal would have the federal government picking up virtually the entire cost of newly eligible Medicaid patients -- 100 percent of the cost for the first four years, 95 percent for the next two, and 90 percent of it after 2020. That is a far higher proportion of Medicaid costs than it picks up today.
10:38 a.m. | Since Alexander made the first of what will surely be many references to Democrats using reconciliation to "jam the bill through" via reconciliation, here's a very useful history lesson on the use of reconciliation from NPR's Julie Rovner. Her point: Many major health bills and other key social policy reforms have been enacted via reconciliation. http://bit.ly/bv955e
10 27 a.m. | Lamar Alexander has been a leading voice on the Republican side for incrementalism. His argument is that the White House erred by trying to pass such a big, sweeping reform bill, and so Democrats and Republicans should instead get together and pass popular parts of reform, one piece at a time. Analysts have pointed out that many reform ideas don't really work on their own; they have to be passed altogether in order to make the system work. For what it's worth, Alexander is also more moderate than many of his fellow GOP leaders. He was one of 13 Republicans to vote for the jobs bill that passed the Senate Wednesday.
10:25 a.m. | When Obama referred to the various GOP health proposals, he was making a point about bipartisanship but he also illustrated -- deliberately or not -- a fact that Democrats have been hammering in recent days: Republicans really don't have a consensus plan, they have lots of different plans, and plenty of disagreement within the party.
After reciting a litany of disheartening health-care stories, Obama said: "This is an issue that is affecting everybody. ... Not only those without insurance but those with insurance." From a PR perspective, this point is vital. One reason that polls have generally turned against Democrats' reform plans - experts on both sides agree - is that the vast majority of Americans have insurance, and they are wary that reform will change their current situation for the worse. If Obama does one thing at this summit to help his cause, it could be to reassure that majority that their insurance is not at risk, and reform will make them more secure.
President Obama convenes a bipartisan meeting on health care this morning, bringing together leaders from both parties and members of his administration for a discussion on the key pillars of a plan to overhaul the nation's health care industry. Washington Post reporters who cover the president, Congress, politics and policy will be your guides to the action, offering live analysis and fact-checking starting at 10 a.m. ET.
February 25, 2010; 9:45 AM ET
Categories: 44 The Obama Presidency , Health Care , Live Blog
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