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Obama steadfast on healthcare (MS)

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By Lisa Wangsness, Globe Staff / March 6, 2009 

WASHINGTON – President Obama yesterday presented his goal of fixing the healthcare system as a political imperative, as well as a moral and economic one: Americans, he said, will no longer stand for soaring costs that have bankrupted millions of families, hobbled businesses, and crowded out other public needs.

At a White House summit, Obama acknowledged that providing quality, affordable healthcare for everyone has eluded politicians for decades. But he described a kind of popular uprising, citing heart-wrenching letters he received from the public, painful stories he heard on the campaign trail, and comments, condensed into a glossy 120-page report, from more than 30,000 people who attended community meetings late last year. With such swelling demand for Washington to act, he said, "entrenched interests" can no longer stand in the way.

"This time, the call for reform is coming from the bottom up, and from all across the spectrum – from doctors, from nurses, from patients; from unions, from businesses; from hospitals, healthcare providers, community groups," the president said in opening the gathering. "This time, there is no debate about whether all Americans should have quality, affordable healthcare – the only question is, how?"

Though he repeatedly emphasized the need to compromise, Obama said he would not stand for a stalemate, which he said threatens the "very foundation of our economy."

"Those who seek to block any reform at all . . . will not prevail this time around," he said.

Signaling the enormous political task ahead, lawmakers and advocacy groups that have been preparing for this moment for months waged an early skirmish over one of the most contentious aspects of the health insurance fight: whether to create a Medicare-style public insurance plan for people under 65.

Mitch McConnell, the top Republican in the Senate, sent a letter to Obama signed by several other Republicans, including Senator Judd Gregg of New Hampshire, saying that they would not support such a plan, which private insurers see as a potentially fatal blow to their industry, because it would "create an unlevel playing field and ultimately doom true competition."

In a conference call yesterday morning, Health Care for America Now, a coalition of about 800 liberal groups, declared it would fight to include a public insurance plan to help keep costs down. Later, in a statement, the group said it was "no surprise [Republicans] don’t want choice if it threatens the profits of the private health insurance industry."

In a glimpse of how he might seek to negotiate thorny issues, Obama tried to accommodate both views.

"The thinking on the public option is that it gives the public more choices," Obama said near the end of the summit. But he also said he understood insurers’ concern about unfair competition from a government plan.

The president also spoke pointedly to groups that are focused solely on covering all 47 million Americans without insurance. "If we don’t address costs, I don’t care how heartfelt our efforts are, we will not get this done," he said. "We’ll run out of money. The federal government will be bankrupt."

In his budget last week, Obama set aside $634 billion over 10 years for healthcare, what he called a down payment on an overhaul that many analysts estimate will cost more than $1 trillion. The healthcare system now costs about $2.5 trillion a year, and is on track to consume one-fifth of the economy by 2018.

"Nothing is harder in politics than doing something now that costs money in order to gain benefits 20 years from now," Obama said.

His summit drew about 150 lawmakers and representatives of healthcare advocacy and industry groups; after the president’s opening remarks, they broke into small groups to discuss approaches to changing the expensive and extraordinarily complex system. White House press secretary Robert Gibbs called the summit a "ceremonial first pitch" – not an effort to actually solve the crisis, but rather a chance to underscore its importance to the administration.

The diversity of participants – who included groups that favor a Canadian-style Medicare-for-all system as well as insurance industry and business groups – and the open discussion were markedly different from the atmosphere in 1993-’94, the last time a serious attempt to change healthcare was made, when the Clinton White House wrote a huge bill behind closed doors and many industry groups felt shut out of the process.

"What struck me is how committed everyone is to actually working together and getting this done," Karen Ignagni, president and CEO of America’s Health Insurance Plans, the largest health insurance lobby, said after the summit. "And that is a very, very different attitude than existed 15 years ago."

Although Obama made it clear his administration will set parameters for acceptable policy, he indicated he expects Congress to handle the initial writing of the bill. That effort is well underway in hearings and private meetings among senior senators and with lobbyists. Senator Max Baucus, chairman of the Senate Finance Committee, and Representative Henry Waxman, chairman of the House Energy and Commerce Committee, have said they hope to pass a bill by the end of the summer.

But lawmakers warned that it is the specifics that will determine the fate of a healthcare overhaul.

Senator Robert Bennett, a Utah Republican, said he recalled agreeing with "absolutely everything" President Clinton said in his 1993 address to Congress on healthcare – but almost nothing in his actual plan. "Bipartisanship is not just a nice thing we say to each other before we touch gloves go to our corners and come out swinging when the bell rings," Bennett said.

When Obama returned to the East Room after the small-group meetings for closing remarks, he was accompanied by Senator Edward M. Kennedy, who has made healthcare his signature issue. Kennedy, who is suffering from brain cancer, drew a lengthy standing ovation and a chorus of cheers when he appeared.

"That’s the kind of greeting a knight deserves," President Obama said, referring to British Prime Minister Gordon Brown’s announcement Wednesday that Kennedy is receiving an honorary knighthood.

Obama also gave the first question to Kennedy, who returned to Washington for the first time since casting a key vote on the economic stimulus package last month.

Taking the microphone, Kennedy called the summit a "very special gathering," noting that all the different interests are represented.

"Now is the time for action," Kennedy said. "I’m looking forward to being a foot soldier in this undertaking, and this time we will not fail."

Obama picked up that theme.

"Let’s just be clear," he concluded. "When times were good, we didn’t get it done. When we had mild recessions, we didn’t get it done. When we were in peacetime, we did not get it done. When we were at war, we did not get it done. There is always a reason not to do it."

Lisa Wangsness can be reached at