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Wooing the Blue Dogs

When it comes to getting President Obama's health care overhaul through Congress, Republicans don't really matter. Even in the Senate, they can be circumvented, if it comes to that.

Liberal Democrats certainly don't matter. They're not about to withhold their votes, no matter how far from ideal they find the final legislation.

No, the only really important swing vote in Congress right now is those technically Democratic but often conservative-leaning members who, in the House, call themselves the Blue Dogs. Their capricious political philosophy has put them in the catbird seat -- and they know it.

So how will Obama play them? Will he let them dictate the terms of his most precious and defining legislative initiative? Or will he find some other way of stroking their egos so they don't feel like the only way to make themselves feel important is to derail some significant element of his proposed solution?

I'm thinking the latter: That Obama, the great conciliator, will be spending a lot of time in the next weeks and months lavishing positive attention on the Blue Dogs where it doesn't cost him anything more than maybe a little teeth-gritting.

Ergo, today's big event at the White House, at which Obama gave a speech about the need to adhere to the basic principle that new tax or entitlement policies should be paid for – often called PAYGO.

As the White House press office has been at pains to point out this morning, "Members of Congress, including members of the Blue Dog Coalition, will attend the event in the East Room."

Here is Obama, from his remarks as prepared for delivery:

Paying for what you spend is basic common sense. Perhaps that's why, here in Washington, it has been so elusive.

Of course, there have been those in Washington leading the charge to restore "pay as you go." Many of them are here. I want to recognize Congressman George Miller, who introduced the first PAYGO bill in the House. I also want to thank the House Blue Dogs and their leaders, especially Baron Hill, who has been a driving force in favor of PAYGO.

As Lori Montgomery wrote in The Washington Post this morning:

If approved by Congress, the rules would forbid lawmakers from expanding entitlement programs such as Medicare and Social Security, creating new entitlement programs or cutting taxes unless the cost is covered by spending cuts or tax increases. If lawmakers fail to pay for their initiatives, Obama's rules would subject entitlement programs to automatic cuts, said sources who spoke on condition of anonymity because the plan has yet to be announced.

The most contentious issue in the health-care debate is likely to come over as aspect dear to Obama's heart: the so-called "public plan." (Washington Post blogger Ezra Klein has a great "public plan" primer.) And, unless he neutralizes them, the Blue Dogs will be Obama's biggest obstacle.

Alex Wayne wrote last week for CQ about how the Blue Dogs set

strict conditions Thursday for any government-run insurance plan Congress creates as part of a health care overhaul, ruling out support for a plan that resembles Medicare — the option favored by many liberals.

And Daily Kos blogger McJoan yesterday described how the centrist Democratic group Third Way is trying to kill the public plan by advocating one that won't work.

Meanwhile, over on the Senate side, John Fritze writes for USA Today:

As Congress considers an overhaul of the nation's health care system, pressure is mounting on a small circle of Senate moderates who helped advance President Obama's economic stimulus this year.

Centrists in both parties, including Sen. Susan Collins, R-Maine, and Sen. Ben Nelson, D-Neb. — both of whom played a critical role in shaping the stimulus — are being courted by interest groups and the White House as lawmakers seek a way to provide health care to 46 million uninsured people.

Finally, here come the lobbyists. David M. Drucker and Kate Ackley write for Roll Call (subscription required):

As health care reform takes shape in the House and Senate and shows signs of veering decidedly left, business lobbyists are considering joining their Republican allies and mounting a public relations offensive to put the brakes on President Barack Obama’s overhaul plans.

Advocates for health insurance companies, hospitals, provider groups and employers have so far been engaged in a marriage of convenience, hoping that by maintaining radio silence in exchange for a seat at the negotiating table they could influence the process and obtain a reform bill to their liking.

But as legislative details have emerged in recent days and suggested the business community could be stuck with costly mandates and a government-run, public plan option, lobbying groups are preparing to step up their opposition messaging.

Christopher Hayes wrote recently in the Nation:

It seems strange, almost surreal, to say this, but the Republican Party, and arguably the whole conservative movement, is not the left's biggest enemy at the moment. On keeping a public plan in healthcare reform; streamlining student lending; and passing the Employee Free Choice Act (EFCA), cap and trade, financial regulation and a host of other structural economic reforms progressives hope to enact, the GOP is more akin to the garbage men than the alderman....

While the Republican Party shrinks, corporate interests are deftly molting their old K Street Project skin and crawling en masse inside the big tent being pitched by the Democratic Party. These same corporate interests have always had a purchase on Democrats, of course. But for much of the last decade, business interests had the luxury of spending most of their resources aiding their allies in the GOP.

No more....So far in this cycle, Democrats have captured two-thirds of the donations from the healthcare industry.

If big business's old legislative strategy was centered on relentless opposition to progressive initiatives... the new strategy is to subvert legislation through co-optation... By converting themselves, ostensibly, from opponents to "partners," corporate lobbies are trying to have it both ways: to block reforms while changing overt power struggles over the future of the economy into seemingly cooperative negotiations. At these negotiations, to use the president's favorite phrase, "everyone has a seat at the table"--except, the lobbyists get by far the best seats.

In other health-care news, Robert Pear writes in the New York Times about how much Obama was influenced by an extraordinary New Yorker essay by Atul Gawande.

Ceci Connolly has the first in article in a Washington Post series on fixing the health care system: "Nowhere else in the world is so much money spent with such poor results," she writes, noting that the goal of health reform

is to finally get our money's worth, say industry leaders, policymakers, consumers and business executives.

They envision a health-care system that guarantees a basic level of care for everyone, shifts the emphasis to wellness and prevention, minimizes errors, and reduces unnecessary and unproved treatment. Such a system would coordinate care, track patients and doctor performance electronically, and reward good results.

By Dan Froomkin  |  June 9, 2009; 1:10 PM ET
Categories:  Health Care  
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Comments

As usual the fundamental problem with Congress is the lobbyists. At the very least we should be making all communications between lobbyists, industry, trade groups, unions and all organizations a matter of public interest. All communications to lawmakers and their staff by such groups should be made public and in writing and then posted on a website in 24 hours.

The Blue Dogs are the worst. They are in Congress simply to enrich themselves and their friends and family. If not they have an opportunity to prove it by telling the Health Care Industry not this time.

Posted by: troyd2009 | June 9, 2009 3:20 PM | Report abuse

This is the Big One. Getting a public plan into our health care mix is quite possibly the most important single thing the Obama administration can accomplish domestically in its first year in office.

There will be some horse trading behind the scenes with the Blue Dogs, but Obama will make this his top priority. He will get it done.

Posted by: Gallenod | June 9, 2009 4:30 PM | Report abuse

Lost in the health care debate is a discussion of a fundamental systemic malfunction:

1) There are millions of Americans who have no health care program at all and use emergency rooms as their source of medical treatment - often after medical conditions that could have been treated preventably and inexpensively, have been allowed to worsen, snowballing to the need for expensive care, which ultimately leads to increases in premiums and payments paid by those Americans who already have health care coverage.

2) Studies indicate that there are metropolitan regions of the US that spend between 1/2 to 1/3 of other such regions, yet the quality of care is equal to or better than those areas that expend more money and offer more specialized medical services.

3) As the front page article in today's WP by Ceci Connally indicate, more care is not necessarily better; in fact "less may be more". This article echoes the commentary in the June edition of The New Yorker, entitled "The Cost Conundrum".

There exists a medical culture in parts of this country that is geared toward expensive, unnecessary, and possibly harmful tests, encouraged by the growth of business oriented specialists who may not have successful medical outcomes as their primary goal (Today's WP article indicated that as many as 100,000 people per year may die as the result of hospital stays).

The Mayo clinic is an example of the opposite, where the common goal is providing the minimum of care necessary for good medical care, and where doctors of all specialties communicate in order to avoid incorrect diagnoses and unneeded medical intervention.

Any plan hammered out by Congress needs to address this health care dysfunction. "Restricting care" sounds draconian. But enacting a fair and rational process aimed at identifying and limiting unnecessary referral testing must be part of health care reform that aims to provide umbrella coverage, while meeting the goal of getting more medical "bang for the buck".

Posted by: MillPond2 | June 9, 2009 5:49 PM | Report abuse

Such a lofty goal as promised during the campaign by no means should turn on the whims of this claque of rogue elements in Congress. And indeed it won't. Most of the Democrats in Congress are foursquare against any change that would alter the current system. What the Blue Dogs want doesn't amount to a hill of beans, at the end of the day.

Posted by: nevereven | June 10, 2009 1:18 AM | Report abuse

Those of you that really think Obama can get this done are so naive. This will take a significant increase in taxes, from EVERYONE, and will result in some level of rationing. This will not happen, no matter how many rosing speeches Obama gives. Unemployment is on it's way to 10% and it looks like his stimulus package ain't what it was cracked up to be. People are starting to pay attention to what is going on behing the curtain and they don't like what they are seeing. His slip in a number of recent polls bears this out. At the end of the day Blue dogs will will end up being just what they really are, Reps who ran as Dems in a conservative dem district.

Posted by: mmourges | June 10, 2009 8:22 AM | Report abuse

The "Third Way" plan, among other monkey-wrenches, forbids the government from negotiating lower prices than the un-insured pay. Since every private insurer does this, their version of the public option would have to be more expensive than private insurance.

Posted by: F_L_Palmer | June 10, 2009 12:20 PM | Report abuse

This article presumes that the Blue Dog Democrats do not have a strong constituency or are somehow outsiders in the Democratic party. This is simply not true.

Obama won just barely over 50% of the primary popular vote, the slimmest margin in history. More importantly his opponent grew stronger even after he had wrapped up the Democratic nomination in terms of delegates. This leads to one obvious conclusion, i.e. that about 50% of Democrats are just so so on Obama. These are represented by the Blue Dog Democrats. Thats a pretty strong constituency.

The problem Obama has is that about 1/2 of the Democratic party is socially liberal and fiscally conservative (i.e. Blue Dog). This is not Obama's base. If Obama ends up looking like a standard liberal, which he is in terms of spending, he is in serious trouble for the next election. If the Republicans can put anyone with 1/2 a brain into the race, and the deficit is huge they can swing these voters pretty easily.

So Obama appeasing the Blue Dogs is not a choice, its a political necessity for his own future.

Also note, you can't dismiss these guys as crazy conservatives, they are articulate, smart, and have a charismatic leader who may very well unseat Obama in a primary some day (Evan Bayh).

Posted by: DCDave11 | June 11, 2009 12:09 PM | Report abuse

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