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Obama calls the next play for health-care reform


Super Bowl Sunday isn't generally a hot day for health-care news. But if the Saints can be in the Super Bowl, then anything can happen. And so it did, with Barack Obama sitting down for an interview with Katie Couric to announce that he'll be inviting the Republican and Democratic leadership to a summit to sit down and work out the differences between their health-care plans. Oh, and C-SPAN is invited.

In conversations today, the White House was quick to emphasize a couple of points. First, they're not starting over. Legislation has already passed the House of Representatives and the United States Senate. That's not to be taken lightly, and the White House isn't taking it lightly. "The President has made it clear that he’s adamant about passing comprehensive reform similar to the bills passed by the House and the Senate," one official said.

But before that legislation gets to the president's desk, modifications are needed to bring the House and Senate bills into closer alignment, and that means there's time to hear more ideas. Or so goes the story.

I'd expect to see some concessions made to Republicans at the summit. I'd also expect the president to emphasize how many of their ideas are already incorporated into the legislation. But this isn't about the ideas. The White House isn't holding a study session because they're worried they don't have the right answers for the final test.

This is, first and foremost, about defusing the lines of attack that have scared the hell out of Democratic legislators. If you talk to people on the Hill, there's relatively little concern about the substance of the likely compromise, but there's enormous anxiety over the public's belief that the bill is thick with noxious deals, which is fed by the idea that the process has been hidden from the American people. After all, people reason, if the bill was so good, why wouldn't they let C-SPAN into the negotiations? The White House hopes this summit will be a clean break with that narrative.

Second, and more importantly, this creates a next step for health-care reform. The House and the Senate have not been able to agree on a path forward. The president, of course, cannot hold a vote for them. But by setting this summit, he's bought them a few weeks to figure out how to hold a vote themselves. That won't be easy, but it'll be easier with the White House summit giving some structure and narrative to an effort that had collapsed into murky chaos.

For weeks, congressional Democrats have been calling for more leadership from the White House. Now they've got it. The president will set the agenda, as only he can. But that doesn't take the ultimate burden off House and Senate Democrats So much as Obama can call the next play, he can't run this into the end zone for them.

Photo ctedit: AP Photo/Evan Vucci.

By Ezra Klein  |  February 7, 2010; 5:31 PM ET
Categories:  Health Reform  
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Next: Invisible Senates


gamesmanship -- not the same as leadership. Today is the perfect day for this announcement.

Posted by: truck1 | February 7, 2010 7:19 PM | Report abuse

I see this as Obama's chance to debate the Senate Republicans in public, a debate they declined just the other day. I wonder if they were even informed of this "summit" before Obama announced it this afternoon. They'd look pretty foolish if they don't show up.

It will probably end up being what the town hall meetings were supposed to be back in August - a chance to explain the basics to the public and answer legitimate questions and concerns.

Posted by: tnoord | February 7, 2010 7:30 PM | Report abuse

This is exactly why nothing has happened on health care. Everyone was afraid that Obama was going to sell out again and they would be left high and dry and look its happening.

Posted by: endaround | February 7, 2010 8:04 PM | Report abuse

Why is Ezra so condescending? The opionion article today by Mr. Alexander explains very nicely why Ezra, Obama, and other liberals dismiss so easily the conservative ideas that Republicans have to fix heath care. Unfortunatly for them, the average American is wiser than they are and will vote them out of office for their arrogance. For Ezra, we just laugh at his consistent, child like dependence on big goverment solutions for every problem.

Posted by: cummije5 | February 7, 2010 8:09 PM | Report abuse

i think this is good news!

Posted by: jkaren | February 7, 2010 8:18 PM | Report abuse

Any chance this summit is going to be held out in the country somewhere? In the middle of nowhere? Someplace where Obama can "accidentally" leave congressional leadership to try and make their own way home?

Posted by: slag | February 7, 2010 9:56 PM | Report abuse

So, they're planning to pass health care when, exactly?

The summit's Feb. 25. If it's not to look like a dog and pony show, it'll require at least another month of negotiations to consider the "new ideas" generated there. If Obama can actually generate enough pressure to cause a few Republicans to crack, I'll concede he's a genius.

I'd much rather he didn't do this, but he obviously knows something about how to play this game, so...

Posted by: Sophomore | February 7, 2010 10:29 PM | Report abuse

ok, so your post is the best defense of this move I've seen. but that doesn't mean it's a good move.

It's another gimmick. Two bills have been passed by Congress; the effort, according to the White House, is "in the Red Zone", "on the 5-yard line," on the "2-yard-line." They just gotta "punch it in."

So what play do they call?

A coin flip at midfield, to see who controls the ball.

Or, if you prefer: a coach's challenge to review the last play, which was a fumble, recovered by the offense, which set them back 12 yards. Coach Obama will lose the challenge, and thus lose the time out. Then it's fourth and 14. What, is he considering a field goal?

OK, screw football. HOW ON EARTH do you make concessions now to a Senate bill that on its face is anathema to the entire House Progressive Caucus? The ONLY changes that the House could possibly pass are ones that will make the bill BETTER with respect to affordability, accessibility, abortion language, and stripping "kickbacks." Any and all Republican ideas demonstratively make the bill WORSE.

Where is the room to maneuver?
Tort reform? Yippee.

Who is telling Obama that they can deliver the votes for something like Paul Ryan's Health Care Services Commission, instead of effectiveness research?

Who will support Ryan's non-mandatory mandate?

If Obama can get the Republicans to say they are in favor of eliminating the individual income tax exclusion for employer-sponsored health care, then maybe he's got a play. But Labor will cry bloody murder.

What possible agreement of any substance can come from this?

Since we know the answer is "none", why does the White House think this summit will then *play* as them taking the Republican ideas seriously?

Posted by: andrewlong | February 7, 2010 10:33 PM | Report abuse

Andrewlong, you are assuming that the House Progressive Caucus actually matters. If they had more votes, they would. But they don't.

This bill is not held up because of the House Progressive Caucus. If enough moderates agreed to vote for the Senate bill to get to 218 with the Progressive Caucus, Pelosi would run the vote tomorrow and it would pass. Every single progressive (except for maybe Kucinich) would first complain a lot and then vote for it.

Why? Because notwithstanding all complaints about subsidies, they are not going to vote for $0 dollars in subsidies over $900 billion in subsidies. While 31 million uninsured isn't everyone, they are not going to vote for covering 0 uninsured over 31 million uninsured. While extra money to Nebraska is unfair, they aren't going to vote for no Medicaid subsidies up to 133% of FPL over 91% subsidized Medicaid up to 133% of FPL and 100% for Nebraska.

The first thing you need to do is stop pretending that the progressive caucus has one ounce of leverage in this. They are not going to kill the biggest expansion of the social safety net since Medicare passed. The whole point of Obama's speech is to win over moderates.

Posted by: JonShields31 | February 7, 2010 10:43 PM | Report abuse

This is the bargaining phase of the grief process....

Health care reform remains dead.

Posted by: zeppelin003 | February 7, 2010 11:18 PM | Report abuse

JonShields31: I thought the whole point of this summit (not a speech) is to win over Republicans--either a few actual legislators, by offering them a concession or two. If that doesn't work, which it won't, then, the thinking apparently goes, he will have demonstrated his goodwill once more, and created enough momentum to help Congress push forward again. The second goal is attainable, but hardly requires a C-SPANned summit.

But you think the point is to offer something to moderate DEMS? Which of the 39 Dems who voted no do you mean? The Stupak Dems? One or two northern Blue Dogs? Enough of the 14 highly vulnerable freshmen to make a difference? Or just the 8 from districts Obama won?

I don't see any concession that will move moderate dems enough to make a difference, that won't lose significant progressive and old-line liberal votes.

and for the record: telling people what they need to do is pretty much a surefire way to be considered a jerk.

Posted by: andrewlong | February 7, 2010 11:33 PM | Report abuse

I think the likely result is what progressives have been advocating for all along. The House will agree to pass the Senate bill, and the Senate will agree to pass a set of modifications in a "sidecar" reconciliation package with a simple majority that will make the Senate bill tolerable to the House.

It has always seemed fairly easy to round up 50 votes in the Senate (plus Joe Biden) for that strategy, except for the concern among some Senators that the public sees the process that produces the legislation as a bunch of corrupt backroom deals. The Obama summit allows a renewed sense of transparency surrounding final negotiations, even bringing the Republicans in for the discussions, and it prsents a nice public forum in which to delete the more notorious elements, like the so-called Cornhusker Kickback.

Liberals will push to resurrect the public option, but that won't happen. Republicans will try to think of something in the way of an idea, like tort reform, and perhaps they may even be handed some last minute add-on like that, if it can work procedurally in the narrow definitions of what is allowed in a reconciliation bill, and if it will not be counter-productive to the objectives of HCR.

So I think the final product will be little changed from the compromise that House and Senate has nearly completed before the Martha Coakley debacle. The summit just removes the political argument that anything is being "jammed through" using some arcane and secretive procedural stunt.

It seems like a plausible stratgy to me and, if it succeeds, the epitaphs that have been written by so many pundits about the Democratic Party's prospects in November are likely to be revisited in a hurry.

Posted by: Patrick_M | February 7, 2010 11:59 PM | Report abuse

I think the expectation is that between now and then House and Senate Dems will settle their differences and come to the meeting with a plan for amending/reconciling with the Senate bill. The President will so note and review the Senate bill outlining how it meets the goals he has set and will note the Dem plan for changes and how they solve the problems that many see with the Senate bill, such as the Nebraska compromise. While doing so, he will note that many of the provisions now in the Senate bill have previously been suggested by Republicans. He will then turn to the Republicans and ask for what they want to change in the Senate bill. Some of them may match the expected Dem changes, such as removing the Nebraska compromise, while others will be changes that would make the bill worse by reducing the people covered, etc. and the President will so note why those that make the bill worse are not acceptable because they dont help solve the problem. There may be some GOP suggestions that would be acceptable and which the president may say can be included so long as they do not work against coverage, pre-exisiting condtion soloutions, etc. He may at some point ask if any GOPers will support the legislation with those changes. The answer is likely to be that none will. He may follow up with a question to GOP senators on whether or not they intend to allow the bill as so revised to be voted on or filibuster. I expect they will say that they intend to filibuster. At that point, the President will say that the House Dems will thus pass the Senate bill and reconciliation will be used to make the changes, after which health care reform will actually happen and public approval of it and Obama will go up.

Posted by: gregspolitics | February 8, 2010 12:01 AM | Report abuse

I think this is a smart move. I would expect Obama to go to a logical end of this process by bringing actual votes on the final bill.

The whole point of this exercise is what people say on C-SPAN, use that in advertisement in Nov 2010. It cuts both ways so GOP can have some strong opportunities too. But other than that, I do not believe it will be very easy for GOP.

Unless GOP brings 'game changers' like 'this is not Ted's seat, it is the seat of MA people'; they can be on defensive.

By taking to the logical end of 'floor vote' on the final bill; Obama can go to the hustling on this issue single handedly if he wants.

This whole process is quite pregnant with enormous political uphill and if Obama wanted, he can literally make the election of Nov 2010 on this single issue.

I believe three issues will come out prominently in this media fest:
- how the deficit is impacted
- issue of 'death panels' i.e. rationing or cut in entitlements
- individual mandate.

If Dems can further cover ground on 'cost control' and hence deficit management; the case is not as hopeless as Dems fear.

All said and done, WH can justify why it took time to unfold this strategy after a while instead of panicking. Whether WH succeeds or not, we will see; but I think there are less grounds to blame WH for not having any worked out strategy at all.

Good show by Obama, Axelrod & co.

Posted by: umesh409 | February 8, 2010 12:13 AM | Report abuse

One other benefit of this approach is that the truth about what's been proposed comes out in public. Polling shows that most of what's been proposed by the House and Senate meets with broad popular support.

Posted by: stan_1036 | February 8, 2010 12:27 AM | Report abuse

The President has come up with a brilliant way to burn some time, forcing the new health care tax to take effect AFTER the November elections.

It's a smart move politically. I'm surprised, though, that I don't hear many Democrats accusing the President (or Speaker Pelosi, who has been obstructing the House vote on the Senate bill for more than a month now) of "murder" due to the purposeful delay. Curious moral standards!

Posted by: rmgregory | February 8, 2010 1:42 AM | Report abuse


The whole issue at this point is that we don't have 218 votes for the Senate bill. Starting from a baseline of 218 (the 220 who voted for the house bill minus Cao and Wexler), it appears we are short because

a) There are many scared moderate Dems who voted for the House bill who don't want to take any more votes on healthcare at all, partly because of the seemingly shady deals in the Senate bill

b) There is some unknown number of Stupak Dems who will vote against the bill because of the Senate bill due to the abortion language

Obama needs to win over as many Congresspeople from group A as possible, plus a number of the 39 Dem no-votes to make up for the remainder of group A and all of group B.

He is attempting to win these over by changing the narrative (so instead of everyone talking about corrupt, back-room deals, they are talking about an open process where Obama schools the Republicans). At that point, it will be easier for people in group A (and some of the 39 no-votes) to vote for the Senate bill.

While there might be a reconciliation fix (and I hope there is one), it will most likely have to come after the Senate bill (since Republicans can filibuster Reconciliation bills by filing amendments until November, and Senate Democrats probably don't have the balls to kill such a tactic via a ruling from the chair).

So the key at this point is whether the Senate bill passes the House. Everything else is really besides the point.

And while I respect progressives' right to disagree, I dismiss the idea that the Senate bill is "not good enough" out of hand. If no bill passes now, we will be fighting for the SCRAPS of the Senate bill in 2025. Ted Kennedy said his biggest regret was not making a deal with Nixon (for a plan more progressive than even the current House bill). At some point we need to stop making the mistake of always demanding slightly more than what is possible to get, since the realm of the possible keeps shrinking more and more each go-around. Progressives in the House know this (much more so than unelected progressives), and they will do the right thing IF it ends up coming down to them.

Posted by: JonShields31 | February 8, 2010 3:18 AM | Report abuse

Ezra, let's face facts: per Lawrence Lessig, the Democrats' health care bill is *tainted* by "institutional corruption" and Congress should go back to the drawing board and start from scratch next session.

The message that Massachusetts sent is that the People have lost their trust & confidence in Congress. The sausage factory disgusts them, and they want business-as-usual *stopped*--and most importantly, *change.*

Forget the merits ("the ends") of a new health care bill: What counts is *process* ("the means"). In other words, contrary to Rahm Emanuel's strategy of "big wins" and "legislative momentum," the means do not justify the ends.

Moreover, if you think about it, if Obama is really serious about his summit, going forward why not cut to the chase, *bypass* "regular order" (which we now know doesn't matter) and have *EVERY* bill done by summit? This is NUTS!!!

For Obama to be a *transformational* president, he has to throw symbolic Washington insiders like Tim Geithner, Larry Summers and Rahm Emanuel--as well as the Democratic Congressional leadership like Speaker Pelosi, Leader Reid and whoever has a Leadership PAC like Schumer & Durbin (I actually like Durbin but he, like Schumer, is bribing his colleagues)--under the bus. That is Obama's only hope for fulfilling his campaign promises of "fundamentally changing the way Washington works" and bringing a "new kind of politics" [see Lessig's video on The Nation website].

Posted by: msa_intp | February 8, 2010 4:18 AM | Report abuse

Ooops, I mean to say that the ends do *not* justify the means.

Posted by: msa_intp | February 8, 2010 4:21 AM | Report abuse

Totally agree with jKaren, gregspolitics, and Patrick_M.

Other thoughts re: this post:

Ezra, you must have written this BEFORE the Saints actually WON the Super Bowl.

Jeeez, does Obama have to do EVERYTHING himself? Not only does he have to travel across country promoting his policies (because none of his myriad messengers seem able to do that very effectively ), but now he has to hand hold Congress (both parties) and literally walk them through, step-by-step, a 'negotiation' process. You'd think the "leadership" could have managed that on their own by now, wouldn't ya?

I read somewhere that some Repubs are saying they'll accept the invitation only if Obama is willing to dump the current bill and "start all over". Thankfully, he's already made it clear he is not going to "start over". It's going to be interesting to watch what the Repubs do with this ... seems to me he's backed them into a bit of a corner(and rightfully so).

Posted by: onewing1 | February 8, 2010 5:43 AM | Report abuse

It'll take at least 15 Blue Dogs to get anything done in the House, which is almost exactly what Pelosi had the last time around.

Since then, the Senate has opened up the abortion language, the bill has gotten less popular and arguably more expensive, Democrats are down in every purple voting district, and Scott Brown has been elected in Massachusetts.

Are we to believe that there is still a strategy for passing this that 15 Blue Dogs will vote for? Don't count on it.

Posted by: whoisjohngaltcom | February 8, 2010 8:08 AM | Report abuse

My question is why does it make sense for the republicans to even show up? Can they be compelled to appear? If the Republicans narrative goes like this, "We would love to participate but the president has made it clear that the essence of the current legislation is off the table. There is nothing to negotiate." Why wouldn't that resonate with voters. I would like to see the polling data that suggests Americans favor the current proposed legislation.

Posted by: FatTriplet3 | February 8, 2010 10:15 AM | Report abuse

This is a great move by the administration. As I've said before, *the* public relations issue with the bill has been the perception that it's not been bipartisan. Either the summit concludes with Republicans and Democrats reaching some sort of consensus on what kind of legislation should be passed -- at some point, the Republicans have to stand for things like eliminating pre-existing conditions -- or else it concludes with Republicans basically showing that they don't want anything to do with the process.

Either way, Obama gets credit for bipartisanship, he gets to demonstrate his superior knowledge of health care reform (does anyone here think he wouldn't be able to out-debate the Republicans?), and he gets credit for fulfilling the promise of transparency in health care negotiations. This event is a great opportunity both to improve Obama's standing, to generate more positive public perception of Washington, to force Republicans to take some ownership of governance, and, most importantly, to get a good health care reform bill through Congress.

Posted by: jeffwacker | February 8, 2010 11:12 AM | Report abuse

I'm afraid this move may be a decent political gamesmanship at best with no substantial benefits. It may (not guarranteed) improve the president's status but unlikely to amount to anything.

Can we get any committed votes from this summit? It's pretty easy for people to show up to this summit, say the right things and find some specific detail in the language of the final bill to cause them to vote no.

I believe Obama is learning the wrong lesson in this whole saga. If the dems don't pass healthcare, the majority of Americans will rightfully see it as nothing short of incompetence. The focus should be on how we get it passed.

The public's frustration is not just because the process looks ugly, it's because the whole thing either produces less desirable or no result at all. In other words, we go through all this sheenanigan and have nothing to show for it.

Results. Results. Results. People have different opinions on how the game should be played, what plays should be called. In the end, frustation always set in if you keep losing no matter how pretty you play. If you win, you'll at least earn respect and recognition and you're likely to keep your job as a coach or a player whether people like you and or wanna have a beer with you or not.

Oh, And if you're gonna lose, people wanna see a damn good and passionate fight.

Posted by: lagnappe | February 8, 2010 12:43 PM | Report abuse

Answering truck1: it seems "damned if you don't and damned it you do". Republicans call for open meetings with all involved included and now when this is about to happen per President Obama's statement ... you call it "gamesmanship"! I think the majority of our citizens are smarter than that.
Let this play out in public, each side speaking their mind, and get some real HCR passed finally.

Posted by: Beaplum | February 8, 2010 12:48 PM | Report abuse

@ FatTriplet3:

"but the president has made it clear that the essence of the current legislation is off the table. There is nothing to negotiate."


I think the Pres made it clear that each section of the bill will be open for discussion, offering multiple opportunities for Repubs to bring up (weave into the debate) their opposition to "the essence", as you put it.

Posted by: onewing1 | February 8, 2010 1:45 PM | Report abuse

The idea of having a summit to get the health care proposal unstuck is a good idea...(maybe). The problem I see is the myth that the debate is based on logic and reason. If it were, the Administration would win, hand's down. Unfortunately there are other powerful political forces at play: 1. The power of the special interests to distort and confuse the public. 2. The power of their paid-off lap dogs in Congress to use their pulpit to confuse the public. 3. The public's propensity to be easily confused, manipulated, scared to death, and demagogued. The question, What's Wrong with Kansas", I fear, needs to be expanded.

Posted by: wbza4sK6c | February 8, 2010 1:52 PM | Report abuse

Yesterday there was a New York Times editorial, The Truth About the Deficit, that made the case for passing health reform soon to slow down our "relentlessly rising health care costs." The urgency of acting now was confirmed by a new federal study released today by the White House showing that U.S. health care spending rose to an estimated $2.5 trillion in 2009, or $8,047 per person. Without Congressional action it is projected to nearly DOUBLE by 2019.

While the teabaggers are nattering about deficits, over 20,000 Americans are dying each year for lack of health coverage, according to the Institute of Medicine.

In my view, the health reform legislation on the brink of passage would make giant strides towards solving many problems: controlling the deficit, creating a healthier workforce, easing states' budget woes, creating jobs, and, oh yes, saving lots of lives, pain and suffering.

With Professor Obama at the blackboard perhaps the kids will settle into their seats and do their schoolwork. They must get health reform passed so we all can move on to an expanded jobs bill, broad tax reform and take other steps we need to take to avoid economic disaster.

Posted by: sourdough70 | February 8, 2010 2:30 PM | Report abuse

I really hope this works and the bill gets passed, but I worry that there are a number of ways that the Republicans can screw this play up. It's very unlikely that anyone in the Republican leadership will read this, but I'm not going to write how I think they can defeat this process. Anyway I'm sure they can think up all the ways themselves. In fact I'm sure someone like Frank Luntz will have the strategy sorted out for them. He'll have several weeks to come up with it, poll test it and then circulate it to the pols and the right media people.

Hm. I cross my fingers and hope Obama knows what he's doing.

Posted by: Nick_Somebody | February 8, 2010 3:28 PM | Report abuse

Now that 'Dad's' called the bickering, frozen-in-place family together for a pow-wow...I have to ask, who's the Legislative branch?? Anyway, I'm glad he's re-inserted himself, and...

Posted by: dcunning1 | February 8, 2010 4:05 PM | Report abuse

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