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The Health-Care Bargaining Chips

By Dan Froomkin
12:25 PM ET, 06/15/2009

As the White House and Congress get to the horse-trading part of putting together a viable health-care plan, there will inevitably be some winners and some losers.

For instance, when it comes to raising the money to pay for expanding insurance coverage, Senate Democrats apparently think that President Obama's proposal to cap tax deductions for the wealthy is too daring. So they're pushing him to tax employer-supplied health benefits instead. But unions are opposed, some middle class families would see their taxes go up, and the move could come at a political cost to Obama, who campaigned against such a move.

Obama today is speaking to the American Medical Association convention in Chicago. Liberals are adamant that without a public insurance option, costs won't go down sufficiently. But many doctors fear that a government-run insurance plan would limit their payments. Doctors do like the idea of reducing malpractice lawsuits, however -- which is in turn opposed by consumer advocates and trial lawyers.

You get the picture. At some point, the health care debate isn't a zero-sum game anymore.

Lori Montgomery and Ceci Connolly write in The Washington Post:

The White House is caught in a battle within its own party over how to finance a comprehensive overhaul of America's health-care system, as key Democrats advocate a tax plan that could require President Obama to break his campaign pledge not to raise taxes on the middle class.....

In recent days, Obama has revived a tax plan he first offered in February: limiting itemized deductions for the nation's 3 million highest earners. Polls show that the idea is popular -- it was Obama's biggest applause line last week at an event in Wisconsin -- and it would enable him to abide by a campaign pledge to pay for coverage for the uninsured with new taxes on the rich.

"He believes this is the most equitable way to do this," said senior White House strategist David Axelrod. "It places the burden on people who can most afford it."

But many Democrats, particularly in the Senate, have balked at the idea, saying they prefer a tax that has some hope of winning Republican support. In legislation that could be unveiled as early as this week, Senate Finance Committee Chairman Max Baucus (D-Mont.) is expected to propose a new tax on the health benefits that millions of Americans currently receive tax-free through employers.

Sheryl Gay Stolberg and Robert Pear write in the New York Times:

In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.

It is a position that could hurt Mr. Obama with the left wing of his party and with trial lawyers who are major donors to Democratic campaigns. But one Democrat close to the president said Mr. Obama, who wants health legislation to have broad support, views addressing medical liability issues as a "credibility builder" — in effect, a bargaining chip that might keep doctors and, more important, Republicans, at the negotiating table.

Former president George W. Bush was fixated on capping malpractice jury awards. Stolberg and Pear say that's not what Obama is talking about.

Dr. J. James Rohack, the incoming president of the medical association, said Mr. Obama told him at a meeting last month that he was open to offering some liability protection to doctors who follow standard guidelines for medical practice.

And Obama is apparently looking for payback:

[O]ne Republican who met with Mr. Obama in April recalled that the president said he was willing to go against his party to get medical malpractice reforms into a health bill — but that he would expect Republican support for the legislation if he did so.

Meanwhile, Lori Montgomery and Scott Wilson write in The Washington Post that in his weekly address on Saturday, Obama

outlined measures to trim spending on federal health programs for the elderly and the poor by an additional $313 billion over the next decade...

Obama proposed limiting the growth of Medicare fee-for-service payments, taking hospitals and other health-care providers at their word that they will reduce costs. He also proposed cutting subsidies to hospitals that treat uninsured patients on the theory that such payments will decline as more people are covered through his plan.

The president also called for reducing payments to drug companies that serve Medicare recipients. Advisers declined to release details, saying the idea is still under discussion.

Mark your calendar, because ABC News has announced that Obama will participate in a nationally-televised, prime-time event called "Questions for the President: Prescription for America" next Wednesday.

And Washington Post opinion columnist Robert J. Samuelson further ratchets up his Obama critique, writing that the president's health-care plan is "naive, hypocritical or simply dishonest" or "all three." Samuelson even goes so far as to argue against providing insurance to the 46 million uncovered Americans because it would "actually worsen the spending problem."

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