The health care “summit” that President Obama proposed for next week will be mainly theatrics, assuming it actually happens. But, probably unintentionally, the White House maneuvering has illuminated the issues at the heart of the dispute.
On one side, Obama and congressional Democratic leaders are doing everything in their power to extend health coverage to the roughly 15 percent of Americans who do not have it. This is going to create a lot of additional demand for health care, which is going to cost a lot of money that nobody is eager to pay. So Obama and the Democrats have tried to redefine the debate to downplay the country’s total health care spending and focus only on health reform’s impact on the federal budget.
The problem for Democrats is that more than 80 percent of Americans already have health care coverage, and most of them are pretty happy with it except for the ever-increasing cost. They want strong cost-control measures, which the Democratic plans lack. This already-covered majority is not, for the most part, clamoring to provide coverage to the uninsured, and especially not when it senses that this will only exacerbate its own cost problems. And, on some level, most people realize that society is going to have to pay for all this extra health care, even if they do not focus on details such as the Democrats pushing enormous new costs onto state-funded Medicaid programs.
None of this is news. These issues have been hashed and re-hashed for most of the past year. Even a filibuster-proof Democratic majority in 2009 could not get legislation to the president’s desk, despite his initial demand that it be completed last summer, because of the intense public backlash during last August’s recess. The unexpected loss of a crucial Senate seat in Massachusetts last month has so frightened many rank-and-file Democrats that I doubt they can find the votes, without Republican help, to pass any comprehensive health care legislation at all.
Obama and Democratic congressional leaders are desperate to salvage something from the past year’s work — or at least to have an opportunity, despite their huge congressional majority, to blame Republicans if they fail. Hence Obama’s surprise demand, made on live TV just before the Super Bowl, that Republicans show up for a televised half-day conference next Thursday to say what it would take to get them to support the Democrats’ health care legislation.
The Democrats insisted that they were not starting from scratch, as Republicans demanded. As White House spokesman Robert Gibbs said in a statement earlier this month, Obama “has been very clear about his support for the House and Senate bills because of what they achieve for the American people: putting a stop to insurance company abuses, extending coverage to millions of hardworking Americans, getting control of rising premiums and out-of-pocket costs, and reducing the deficit." Note that there is nothing in Gibbs’ list about stopping, or even slowing, the skyrocketing rise in the country’s health care spending.
Obama merely seeks to call the Republicans on the carpet for not signing on to his goals. Gibbs allowed that his boss is willing to consider any Republican “good ideas,” but there is not much overlap between the two sides on what constitutes a good idea.
For their part, Republicans may decide to skip Obama’s televised tea party. Or they might take the opportunity, assuming the president actually gives them the microphone for something longer than a sound bite, to point out that expanding health coverage to everyone without articulating a way to pay for it is ultimately going to undermine health care and other essential services for the entire country — which is exactly why the legislation Obama backs has steadily lost public support. Nobody opposes universal health care, but beyond the Democratic Party’s political base, the country is deeply skeptical about how businesses and state and local governments will pay for the president’s agenda.
As the two top-ranking House Republicans put it in a letter to the president, “Bipartisan ends require bipartisan means.” House Minority Leader John Boehner of Ohio and Minority Whip Eric Cantor of Virginia wrote: “If the starting point for this meeting is the job-killing bills the American people have already soundly rejected, Republicans would rightly be reluctant to participate."
We must wait until next week to see whether Obama’s unilaterally declared summit happens and, if it does, how it unfolds. Both sides will be posturing for the independent voters who hold the key to this year’s elections. Though the president will put on his best professorial face and pretend to ponder deeply what he hears from the Republicans, and Republicans — if they show up — will make a point of respecting the president’s office, neither will pay much attention to what the other says. They have heard it all before.
But viewers at home just might get an education anyway. Listen for what the Democrats say about bringing total health care spending under control, and listen for what the Republicans would do to cover the tens of millions of uninsured. These two issues are what the debate is really all about. Each side is paying little more than lip service to the other party’s priority.