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Obama's Big Health Care Test

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.

By Dan Froomkin  |  June 2, 2009; 2:05 PM ET
Categories:  Health Care  
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Gotta love Froomkin. He puts the success of yet another poorly thought out plan of Obama's to whether or not Obama can "control" the media. Well, he certainly fooled/controlled them, including Froomkin, during the election, so why not again?

Posted by: mmourges | June 2, 2009 2:26 PM | Report abuse

Bill Moyers did a show on healthcare reform a couple weeks ago. His two experts opined that even if a public plan is included, if private plans (the insurance industry) is allowed to coexist alongside, the whole thing will fail, because the huge financial inefficiences that exist now will still exist, and will continue to bloat. Single-payer is the ONLY way to eliminate the inefficiencies and bloat. And many healthcare providers (as opposed to the insurance industry) support single-payer.

Dan, I'm curious if you saw that, and if you'll be writing about it.

Posted by: unojklhh1 | June 2, 2009 3:16 PM | Report abuse

A single-payer plan might be best, but it's not politically feasible at the moment.

However, the reason the health care industry doesn't want a public plan in the mix is likely because they see a successful government-run option as a gateway to a single-payer system and the end of most private health insurance.

And the government already has a fairly successful model to work from, the military retiree Tricare system. If the Feds can provide a similar option at low cost to the general public, market forces will eventually drive the system to something resembling single-payer as people flock to the lowest cost alternative.

There will still be some luxury health insurance policies out there for people who want special treatment above and beyond what the rest of us get, but Obama appears to be taking the "long view" to health care, where a good foundation and patience will achieve the goal over time with less disruption that trying to force change quickly without addressing the fundamentals.

(We had more than enough of that with the last occupant in the White House.)

Posted by: Gallenod | June 2, 2009 3:36 PM | Report abuse

Interesting to see the forward-looking numbers from CEA calculating how much the proposed 1.5% cost trend deceleration could save American families in the future (if the 1.5% reduction can be enacted, which is of course the hard part). Over the last five years, such a deceleration, if enacted, would have reduced a family's healthcare cost by $3,095 total. For more information, go to

Posted by: JEngdahlJ | June 2, 2009 4:05 PM | Report abuse

The current trajectory of health care costs is unsustainable. Employers will not be able to afford it, employees will not be able to afford it and the government will not be able to afford it. The trend to deal with this problem appears to be less services in the form of higher deductibles and co-pays.

Why is it that other advanced nations cover all of their people, spend less on health care and liver longer?

These other advanced nations all have single payer systems. If people in these countries are living longer than Americans then the argument that they provide worse care than the US system does not hold water. Clearly their plans deliver better value than the US system.

I would like to see a public plan option to keep private health care providers honest. The health care industry's wet dream is to have taxpayer funded private insurance to insure everyone so they can continue to raise their rates at 7 to 9% per year. Net result is a massive subsidy to private insurance courtesy of the taxpayer. So taxpayer would you rather have medicare for all which can provide services at about 1/2 to 2/3 of the cost of private plans or would you rather pay more to private insurers for 50% to 100% more cost all of which will come out of your pocket?

If the government can provide the service at lower cost what's wrong with that?

And last the private insurance industry cannot be trusted. During the Clinton years when they were threatened with reform the rise in the cost of health care declined dramatically and was more in line with inflation. As soon as George Bush was ensconced in office and the threat of any reform was off the table health costs began rising dramatically again. I'm sure they will pursue this course again until the pressure is off once more.

A public plan option is the only way to avoid dramatic rises in future health care costs.

Posted by: troyd2009 | June 2, 2009 4:35 PM | Report abuse

Having healthcare available is a necessity, especially for those of us who are decriminated against by private insurance because of a pre-existing condition. Private(for profit) insurance companies don't want single-payer coverage because they don't want to "have to pay" for anything. Think of any insurance that you have. It's been a "necessary evil" in the past and any solution HAS to include insurance for everyone whether or not they have a pre-existing condition or an inability to pay. Gee, that sounds like a government program. Perhaps, it is nescessary to have the government control this. At least, the people have a voice and don't they pay for everything?

But because capitalism rewards those who make a profit, there is no control in a free-market capitalist society and for-profit insurance companies. It failed with George W. and it will fail again with any for-profit insurance company set-up.

Posted by: sailorflat | June 2, 2009 4:59 PM | Report abuse

"A single-payer plan might be best, but it's not politically feasible at the moment."

Huh? And double HUH?

It's only not feasible if you are Harry Reid and allow the governing of the country to be done by 40 Republicans. Everywhere else in America Obama won the election and the Democrats control both houses and can feasibly push through anything they wish.

But with the weakest "majority leader" ever in Harry Reid, then things can be needlessly difficult and America's healthcare can just be put under the power of the minority party lead by Rush Limbaugh.

Posted by: BigTimePatriot | June 2, 2009 5:22 PM | Report abuse

I'm not posting to offer a comment on the merits of public single payer vs. private health care insurance, or the viability or non-viability of coexistence of either approach.

I urge all the posters, if they haven't done so, to read Monday's WP online chat with Alec MacGillis, which followed his WP Outlook article on Sunday.

I PARTICULARLY urge all posters to pick up a copy of the June edition of "The New Yorker" (or use the link on the online chat) and read the article entitled "The Cost Conundrum". It's an eye-opener that lifts the discussion of universal health care above the swirl of the current conventional pro and con arguments.

Posted by: MillPond2 | June 2, 2009 5:53 PM | Report abuse

Here's a quick math question.
The health insurers are going to fleece the American public of $8 trillion in the next 10 years for profits and unnecessary overhead. They're proposing to forgoe $1- maybe $2 trillion. How many trillions will Americans lose? The answer is____

Susan Page did a commendable job of condensing many of the issues.

The reality is that the vast majority of Americans don't have health coverage, we have a veneer of illness coverage. Rather than focus on the uninsured, we should acknowledge that we are ALL uninsured, or susceptible to becoming uninsurable the moment we have a chronic illness. 125 million Americans have the 4 most common chronic illnesses.

Posted by: boscobobb | June 2, 2009 7:08 PM | Report abuse

Howard Dean is correct.

"a"(Toothy, Robust)"public health insurance option is more important than bipartisanship, and Democrats should pass health-care legislation that includes the option with 51 votes if necessary."

"Democrats should have "no intention" of working with Republicans if it's not the strongest possible legislation that could be passed with a simple majority." (Howard Dean)

This is what WE THE PEOPLE gave the Democrats all that power to do for ALL of us.

You see, Dr. Dean knows that in medicine and healthcare there is only one acceptable standard. And that standard is the HIGHEST level of EXCELLENCE you can provide for everyone. Nothing less has ever been acceptable in caring for a precious human life.

And the White House is right too. "Good health care reform is essentially good economic policy." (Christina Romer)

jacksmith -- WORKING CLASS

Posted by: JackSmith1 | June 2, 2009 11:01 PM | Report abuse

If the Democrats had a monolithic, united majority, yes they could pass single-payer health care. However, they don't.

It's not because of the opposition of 40 Republicans in the Senate. It's because there are a significant fraction of Senate Democrats who are either opposed to it or are too timid to try something that different. You don't usually get ahead in politics by taking chances; you get there by cutting deals.

Evolution is a lot less stressful than revolution. Trying to impose single-payer immediately would be a revolution, which would be violent, produce many casualties, and likely woulnd't produce a successful system any faster than evolving to single-payer over 10 years or so through introduction of a public option.

Posted by: Gallenod | June 3, 2009 8:56 AM | Report abuse

Why do we still talk about the private sector as though it has some advantage or some particular efficient ways of doing things? Private medical insurance is a skim operation, with 25% of costs going to "overhead," while Medicare manages to get by on 1% overhead.

Posted by: chrisfox8 | June 3, 2009 11:37 AM | Report abuse

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