Politics & Policy

Follow-Up Appointment Needed

The health-care summit, summarized.

In the wake of the Blair House summit, we asked a few of our health-care experts: Was anything accomplished on Thursday? What is a constructive next step for Republicans?

 

JEFFREY H. ANDERSON

Several things were accomplished at the summit. The Democrats failed to make their case — which, in itself, was an accomplishment of sorts for the country. President Obama’s mystique was further reduced, as the event made him appear more like the first among equals than like the undisputed leader of a coordinate branch. And Republicans, given a much better forum than usual, gave voice to what the American people so oppose about the Democrats’ proposed health-care overhaul.

Rep. Paul Ryan (R., Wis.), who was excellent, forcefully laid out how Obamacare would raise health-care costs and budget deficits. Many other members — including Sen. Lamar Alexander (R., Tenn.) and Sen. Tom Coburn (R., Okla.) — made key points and helped set the respectful, but not overly deferential, tone of the exchange. Republicans should ride their momentum from this event, keep making a strong case against government-run health care, and keep advancing proposals for real reform.

The primary impression, however, that I take away from the summit is this: I can’t imagine that most of those who were watching on television would want the 30 or so people in that room to design a health-care system for the entire country. The 60 or so people who met in Independence Hall in 1787 didn’t think they needed to design such systems. Rather, they created a government to secure the liberty of the American people to design such systems themselves — piece by piece, person by person, company by company, through the countless free choices of a free citizenry.

The fundamental difference between the two sides is that one wants to have a small group of people in Washington design and control the society in which we will live, and the other one doesn’t. As Sen. Jon Kyl said, “We cannot paper over” that difference.

– Jeffrey H. Anderson, the director of the Benjamin Rush Society, was the senior speechwriter for Secretary Mike Leavitt at the U.S. Department of Health and Human Services in the Bush administration.

DAVID GRATZER

After a year of frenzied activity — town halls, forums, press conferences, and even a speech before a joint session of Congress — the president’s health-care reforms are unpopular. Indeed, the vast majority of the American people would like Congress to “start from scratch.”

This week, with a summit with congressional leaders scheduled at Blair House on Thursday, offered the administration an opportunity to go back to the drawing board.

Instead, on Monday, the president put on the table a plan that’s different in only three significant respects from past congressional bills: It’s bigger, it’s more expensive, and it’s more complicated than the last version.

Frustrated by the level of spending in the Senate bill? The president’s plan would cost more, pushing past a trillion dollars. Concerned about the new bureaucracies proposed by the House bill? The White House goes further, proposing a new federal agency to price-control the entire insurance industry. Annoyed by the job-killing taxes favored by Senator Reid and his colleagues? The president also wants to tax medical devices (read: medical innovation); he just wants to start a bit later, in 2013.

If the plan is stale, why would the Blair House summit be any more interesting? It wasn’t. The president stuck to his plan — and his script.

Overall, Republicans did well. They were civil but forceful. They criticized the plan, but offered alternatives. In the coming months, in Washington and on the campaign trail, that’s the right approach.

Everyone agrees that American health care needs reform and that something must be done to address the illness of health-care cost inflation. But the president’s plan is worse than the disease.

Dr. David Gratzer, a physician, is a senior fellow at the Manhattan Institute. He is the author of Why Obama’s Government Takeover of Health Care Will Be a Disaster.

ARNOLD KLING

I thought that President Obama did well to convey a willingness to negotiate. If I were the Republicans, I would move off the “scrap the bill” talking point and instead go with something like this:

We have some areas where we agree, some areas where we might negotiate, and some areas where we can never agree. That suggests a three-track approach.

1. Fast track. For issues such as ending waste, fraud, and abuse in Medicare, we should aim to pass a bill within 30 days that contains all the ideas on which we agree.

2. Negotiation track. These would be issues where compromise is possible. For insurance competition, the president expressed concern that allowing interstate sales of insurance could cause a “race to the bottom.” That may be a legitimate concern, but it is hypothetical. Instead of preemptively regulating the insurance industry, why not try the Republican approach and see what happens? Meanwhile, create a competitive-practices board for the insurance industry that would monitor the industry and issue public reports on abusive practices. Congress could later vote to convert this board into a permanent regulatory board if public pressure demands it.

I would put the Medicare-cost commission on the negotiation track. But I have long been more willing than most Republicans to endorse doing cost-benefit research on medical procedures.

In principle, the issue of expanding insurance coverage can be put on the negotiation track. But if I were a Republican legislator, I would take a hard line against funding expanded coverage with budget gimmicks, enforced cross-subsidies, or Medicare cuts (again, not that I am against Medicare cuts, but they need to be applied to improving the financial health of Medicare). I would take a relatively softer line against funding more coverage with taxes in an above-board way.

3. Gridlock track. Issues like public funding of abortion or malpractice reform probably go here. Agreement and compromise are not likely.

– Arnold Kling is a member of the Mercatus Center’s Financial Markets Working Group and co-author of From Poverty to Prosperity: Intangible Assets, Hidden Liabilities, and the Lasting Triumph over Scarcity.

NINA OWCHARENKO

In order for the summit to have been successful, Democrats should have scrapped the House and Senate bills, along with the president’s new proposal, to all of which the American people have shown clear opposition. Simply adjusting the magnitude of these proposals or adding new “conservative” provisions, as suggested in the president’s latest proposal, does not change their fundamental direction.

As Yuval Levin has explained, the crucial differences between Congress and the nation at large are not differences in degree; they are differences in policy direction. Most Americans want problems in the health-insurance markets fixed, but they do not want a federal takeover of the health-care sector of the economy. Regrettably, the cornerstone elements of these proposals would put more power in the hands of Washington bureaucrats and politicians. Instead, Congress and the administration should pursue bipartisan reforms that give Americans greater personal control of their health-care decisions. If the president and Congress were sincere about achieving bipartisanship, they should have set aside these highly unpopular proposals and shifted direction toward taking an incremental approach: one that puts health-care reform on a path toward empowering individuals and families to control more of the financing and delivery of health care.

– Nina Owcharenko is deputy director of health-policy studies at the Heritage Foundation.

REIHAN SALAM

I have no idea how the health-care summit is going to play with the public. Apart from political junkies lucky enough to have the time to watch on cable, no one will see this. For all I know, the White House will be able to convince the American people that President Obama has given congressional Republicans a fair hearing and that he has made reasonable concessions. That’s not my reading of the situation, suffice it to say, but who knows? Despite the political reversals of the last year, the president has a crack team of political communicators.

However, Rep. Paul Ryan (R., Wis.), Sen. Jon Kyl (R., Ariz.), and a handful of others have made an incredibly effective, sustained case against the wisdom of the president’s approach. Sen. Mike Enzi (R., Wyo.) and Sen. Lamar Alexander (R., Tenn.) took the different tack of projecting themselves as moderate, reasonable, conciliatory legislators who want Congress to take an incremental approach to health-care reform. When the president said Senator Enzi made reasonable points regarding allowing all plans, including plans that don’t meet minimum federal standards, on the exchanges, I was puzzled. So will President Obama abandon the actuarial minimums he backed earlier in the summit?

The president said that the fact that insurance premiums will go up is entirely acceptable because the plans in question offer richer benefits. Then he attacked Medicare Advantage “overpayments” despite the richer benefits offered by those plans, and the fact that recipients are less likely to use Medigap plans and supplemental Medicaid coverage that undermines cost controls. Again and again, the president presented himself as a wise, judicious, professorial figure who understands the real tradeoffs. But this was a disappointingly partisan performance.

So what should Republicans do? Simple. They’re winning this debate. But they don’t have an adequate plan for following through. If Republicans and Blue Dog Democrats get behind the ideas advanced by NR’s James Capretta and Yuval Levin — like generous subsidies for state-based high-risk pools — and embrace efforts to cap the tax exclusion while expanding its benefits to the small-group and individual markets, they will deliver a lasting reform that will move us in a more sustainable direction.

This might sound naïve. And frankly, it’s hard for me to see Nancy Pelosi and Harry Reid letting something like this happen. But it’s certainly worth a shot.

– Reihan Salam writes the Agenda blog for NRO and is the coauthor of Grand New Party: How Republicans Can Win the Working Class and Save the American Dream.

SABRINA L. SCHAEFFER

The president and his Democratic colleagues insist on framing the health-care debate in terms of Us vs. Them: The big bad private sector is out to hurt you, and the heroic government wants to save you. But for their continuing effort to sell Obamacare to the American people, the third time won’t be the charm.

Us vs. Them isn’t working, and what’s more, it can’t work. Because, contrary to what the Obama administration thinks, public opinion is not endlessly malleable. 

Issue-framing strategists like Frank Luntz and George Lakoff often describe a pliant public that can be manipulated by the perfectly phrased message. There is some truth to this: Research shows that citizens do seek out elite guidance in decision-making. But however many ways you frame an issue, the public still has to choose to place greater weight on one consideration or another. 

As elite opinion on health-care reform has become more defined and consistent, the public’s considerations have become more entrenched. Now, the verdict is in: Americans clearly prefer choice and freedom over government control. 

President Obama hoped his summit would be a chance to start anew and reframe the debate, but it’s too late. Citizens have been forming their views for months now. The White House might be willing to ignore public opinion, but it’s not going to be able to change it.

– Sabrina L. Schaeffer is managing partner of Evolving Strategies and a senior fellow with the Independent Women’s Forum.

TEVI TROY

We learned from the health-care summit that the Democrats are feeling defensive about their multiple, and so far unreconciled, health-care proposals, and that Republicans are anxious, even eager, to talk about the substance.

The Democrats began the day in a somewhat subdued manner, highlighting anecdotes about people harmed by the system rather than engaging in a specific defense of their approach. The Republicans seemed to come out swinging, focusing on specific objections to the Democratic bills, and rejecting the notion that the two sides were close to agreement on the substance.

The Democrats seemed a little feistier in the afternoon, almost as if they had regrouped and decided that a more aggressive approach was needed. In making this switch, the Democrats learned what the country has been seeing over the last year, that the American people want to hear serious, substantive arguments about health care, and that the Republicans are no longer health-care-policy doormats who run away at the mention of the issue.

Republicans should continue to press the argument on substance, and recognize that they now have some strong young standard-bearers — Rep. Paul Ryan (R., Wis), Rep. Marsha Blackburn (R., Tenn.) , and Rep. Eric Cantor (R., Va.), to name a few — who can help the party continue to fight for conservative ideas in the future.

– Tevi Troy, deputy secretary of health and human services from 2007 to 2009, is a visiting senior fellow at the Hudson Institute.

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