Obama's Big Health Care Test

By Dan Froomkin
2:05 PM ET, 06/ 2/2009

President Obama has called Senate Democrats to the White House today for a huddle on health-care strategy -- and this is the one issue to watch above all.

Obama's plan to massively overhaul the nation's health-care system, hold down costs and achieve universal health insurance coverage is only one of several enormous initiatives, rescues and takeovers our new president is currently juggling. But this one is arguably the most far-reaching, the most defining, the most complicated, and the most challenging.

This is the issue to watch to see how Obama works with Congress. How eager will its members be to follow his lead when the stakes are this high? How much clout will he have to keep them in line when they stray? How brave will they be? And how beholden to special interests? Can Obama get them to meet a deadline? Will the legislation that emerges from Congress be recognizable?

This is the issue to watch to see how Obama rallies his supporters. Can he mobilize his mailing list? Will volunteers from his presidential campaign become health care activists? Can he harness the public support he does get into productive action?

This is the issue to watch to see if Obama can reach out to not-traditionally Democratic constituencies and find common ground. Will the current support from a coalition including industry groups continue? Will insurance companies and hospitals and Big Pharma stick together -- and stick with him? Will he find any Republican ideas to adopt? Will he find any Republican allies?

This is the issue to watch to see if Obama can control the media narrative. Will the press cast his plan as a massive extravagance, or as a necessary fix for a broken system and a flailing economy? Will reporters delve deeply into the issues and fuel a national conversation -- or will they focus only on the politics, the trivia, and who's up and who's down?

So what's next? Laura Litvan writes for Bloomberg:

Two Senate committees will meet behind closed doors this week to hammer out the contours of the restructuring of a sector that accounts for 17 percent of the U.S. economy. They will be racing to meet a deadline set by President Barack Obama, who said last week he wants a measure enacted by year’s end.

The White House's Council of Economic Advisers is out today with a new report which concludes that overhauling the U.S. health care system isn't just a good thing in itself -- it's actually a necessary part of fixing the economy.

Erica Werner writes for the Associated Press that the report

says that health care costs — now about 18 percent of the gross domestic product — will rise to 34 percent in 30 years if left unchecked, wreaking havoc on the federal deficit, businesses and working Americans...
"Health care reform is incredibly important not just for the American people but for the American economy," said Christina Romer, chairwoman of the Council of Economic Advisers. "Good health care reform is essentially good economic policy."
In a Yahoo opinion piece, Romer writes:
Without health care reform, American workers and families will continue to experience eroding health care benefits and stagnating wages caused by the pressure of escalating health insurance premiums. And without reform, rising spending on Medicare and Medicaid will lead to massive and unsustainable Federal budget deficits.

Edwin Chen and Laura Litvan write for Bloomberg that the report also concludes that the number of uninsured American will almost double in three decades unless Congress acts.

The report comes in the wake, they note, of Obama's remarks to his political organization last week that "if we don’t get it done this year, we’re not going to get it done." A nationwide campaign to rally support starts on Saturday.

The broad coalition of health-industry groups that last month vowed to rein in the growth in health care came back yesterday with an actual plan:

Individually and together, our organizations have developed initiatives that will help move the nation toward achieving the Administration’s goal and we intend to keep working. Our organizations will now pursue these initiatives which, together, will help transform the U.S. health care system.
Sheryl Gay Stolberg and Robert Pear write in the New York Times that
The groups, representing doctors, hospitals, drug companies and a labor union, proposed eliminating unnecessary medical tests and procedures, slashing red tape and better managing chronic diseases.
They said the potential savings could be $1 trillion to $1.7 trillion over 10 years.
Washington Post blogger Ezra Klein looks at the no-brainer ideas the industry representatives are proposing, and concludes that
in the aggregate, the document paints the picture of an almost comically ineffective sector. This isn't just a blueprint for reform. It's an argument for reform. And above that, it's an argument for why reform should not be overly constrained by the preferences of the stakeholders. Look at the system they've built. Look at the inefficiencies they've permitted. They don't deserve a guiding role.
And with an overview of where things stand, Susan Page writes for USA Today:
This year's fast-track timetable on health care calls for leaders of key congressional committees to unveil legislation this month, debate it next month and pass it before leaving for the summer recess in August. Final passage would follow in September or October, before next year's elections start to complicate things....
There is considerable agreement that the best path to universal coverage is for the government to require Americans to buy health insurance, just as drivers have to buy car insurance. A sliding scale of subsidies would help those who would have trouble affording premiums.
The biggest ideological debate is whether the insurance options Americans could consider should include a public, government-run plan that would compete with those offered by private insurance companies.
Include a public plan or there's no deal, some liberal Democrats say. "The public option is a compromise by many Democrats who would like to have a single-payer system," says Rep. Henry Waxman, chairman of one of three House committees with jurisdiction over the health care legislation. The California Democrat says the House bill will include a public option, arguing it would create a "healthy tension" to keep costs down and protect consumers' interests.....
The quandary: Include a public plan and there's no deal, some Republicans and industry leaders say. They say a government plan's reach would enable it to crush private competitors, creating a back-door path to a government-run health care system like those in Canada and Britain.
Julie Appleby and Mary Agnes Carey write for the (all new!) Kaiser Health News:
The biggest challenge: The price tag. The Democratic proposals could cost $1 trillion to $1.5 trillion over 10 years, and lawmakers are a long way from coming up with the money.
The biggest unknown: How forcefully will Obama engage, and what's his bottom line? Will he go for broke, insisting on a big expansion of health coverage and sweeping changes to the health care system? Or will he be more pragmatic, quicker to compromise than, say, the Clintons were--so as not to lose everything?
Meanwhile, White House health care czar Nancy-Ann DeParle tells Appleby in an interview that she hasn't given "a moment's thought" to fashioning a fallback position in case Congress rejects the sweeping Obama view.
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