News & Events

Health care summit underscores divisions

Democrats lay path to pass bill in majority vote

By Lisa Wangsness and Susan Milligan, Globe Staff  |  February 26, 2010

WASHINGTON -President Obama and congressional leaders gathered for an extraordinary summit on health care yesterday that offered an extended, free-flowing debate but produced no compromise. It did, however, clarify terms for the next phase of battle on Capitol Hill.

At the end of 6 1/2 hours of spirited discussion, Obama essentially offered an ultimatum to Republicans: Work seriously with Democrats on a sweeping overhaul of the nation’s health care system, or Democrats will move forward without the GOP in a matter of weeks.

“We cannot have another yearlong debate about this,’’ Obama said.

The president and Democratic leaders appeared to be laying the groundwork for an attempt to bypass Senate Republicans using a process known as budget reconciliation, which allows pas sage of legislation with a 51-vote simple majority.

House Speaker Nancy Pelosi told reporters after yesterday’s forum that she was “not overly optimistic’’ Republicans would vote for the bill, but that she thought Democrats were now a step closer to passing one.

“We need to have the courage to get this job done,’’ she said.

Whether Democrats can muster the votes they will need to revive Obama’s centerpiece domestic issue remains uncertain. Party leaders have been reeling since Jan. 19, when Massachusetts voters filled the late Edward M. Kennedy’s Senate seat with Republican Scott Brown, leaving the party one short of the 60 votes needed to block a GOP filibuster. Yesterday’s summit may help turn the tide.

“I think this particular meeting helped embolden them,’’ Ross Baker, a political scientist at Rutgers University, said of the Democrats. “I think they’ve just decided they’re going to get it passed and convince people that they did the right thing and live with the consequences.’’

The Republican National Committee chairman, Michael Steele, issued a statement deriding the event as “political theater to provide cover for reconciliation, a parliamentary trick the American people stand firmly against.’’

And Senate Republican leader Mitch McConnell of Kentucky said he was discouraged.

“It’s pretty clear that the majority, including the president, want to continue with the same Senate bill’’ the GOP opposes, McConnell said.

The session was unlike virtually any other political event in recent history. Broadcast on national television, three dozen leading lawmakers led by the president himself offered a spirited and often thoughtful airing of the two parties’ views on the basic goals of a health overhaul. For more than six hours, they sat around an open-square table at Blair House, across the street from the White House, and took turns arguing their positions on the major goals of the bills the House and Senate passed late last year – controlling costs, reducing the deficit, regulating insurers, and expanding coverage.

The discussion clarified the deep philosophical divide between the parties over basic issues, like how aggressively the federal government should intervene to expand insurance coverage and fix a system that everyone around the table agreed is in desperate need of repair.

Fundamentally, Democrats argued for a comprehensive approach that prohibits discrimination by insurers, sets up a new marketplace to give the nation’s 50 million uninsured more purchasing power, and provides tax credits to help them defray the cost of insurance.

Republicans said Congress should instead start with a series of cost-cutting strategies, such as limiting medical malpractice awards and allowing insurers to sell coverage across state lines. The GOP strategies would insure only about one-tenth of the 30 million people the Democrats’ legislation would, but Republicans argued Democrats were trying to do too much at once.

“We don’t do comprehensive well,’’ said Senator Lamar Alexander, Republican of Tennessee. “It works in the classroom, but it doesn’t work very well in our big, complicated country.’’

Obama argued that a piecemeal approach won’t work because all the elements of the plan are interrelated. If insurers are prohibited from discriminating against people with preexisting conditions, everyone must be required to obtain insurance. Otherwise, some people would buy coverage only when they’re sick. But requiring everyone to buy insurance necessitates that the government help low-income people pay for it.

“An incremental approach is like a swimmer who’s 50 feet offshore, drowning, and you throw him a 10-foot rope,’’ said Senator Tom Harkin, Democrat of Iowa.

Republicans disputed analyses by the nonpartisan Congressional Budget Office showing that the nearly $900 billion cost of the Senate bill would be more than offset by savings and tax increases. The critics said those assessments failed to reflect the political likelihood that future lawmakers would be reluctant to allow painful reductions in Medicare spending to take effect. They said cuts to the Medicare program should not be used to pay for expanding coverage to the uninsured.

Obama repeatedly urged Republicans to stop listing their complaints about the Democratic bill and focus instead on areas of agreement, but Republicans said that was impossible because Democrats refused to start from scratch on a new bill.

“It would have been helpful if we had had this nine months or a year earlier,’’ said Senator Mike Enzi, a Republican from Wyoming.

Senator Max Baucus, Democrat of Montana, insisted the parties weren’t so far apart. He pointed out that setting up health insurance exchanges – like the Massachusetts Health Insurance Connector Authority – was a Republican idea.

But Republicans argued that the Democratic bill puts too many requirements on insurers that sell coverage in the exchanges, forcing consumers to buy coverage they may not need.

“The problem is when you start to mandate all the essential benefits, there are going to be premium increases,’’ said Representative Eric Cantor, a Republican from Virginia and the House minority whip.

Obama said that without strict rules, insurers could engage in practices that would leave sick people in ever-more-costly plans.

“We could set up a system where food was probably cheaper than it is right now if we just eliminated meat inspectors,’’ he said.

The president acted as both referee and the leading proponent of the Democratic position, occasionally causing Republicans to chafe at what they saw as unfair treatment. At one point McConnell complained that Democrats had spoken almost twice as long as Republicans, 52 minutes compared with the GOP’s 24 minutes. Obama said he hadn’t counted his own remarks on the Democratic ledger “because I’m the president.’’

One of his sharpest exchanges came with his Republican rival in the 2008 presidential election, Senator John McCain of Arizona, who is now facing a Republican primary challenge in his home state. McCain attacked the special deals that fence-sitting Democratic senators got for signing on to the bill late last year.

“People are angry,’’ he said. “We promised them change in Washington.’’

“John, we’re not campaigning anymore. The election is over,’’ Obama said.

Outside Blair House, conservative protesters called for a do-over, and counterprotesters demanded universal health care.

“Stop reconciliation now!’’ yelled a man outside Blair House today, railing against a legislative process and a concept generally not discussed – let alone protested – outside the wonky walls of the US Capitol.

“We’re not against reform. We’re protesting what is really a charade, not a summit,’’ said Nancy Pfotenhauer, 46, of Virginia, a member of the conservative Americans for Prosperity.

Estrella Chaules of Sudbury, Mass., said she was disappointed that Obama had not advocated for a Canadian-style single-payer system.

“I think we need health care for all, and I’m just sorry that President Obama has forgotten or reneged on his promise to give universal health care for all,’’ said Chaules, who is 67 and retired.

The viewing public at home may not have been quite as engaged. Drew Altman, president of the Kaiser Family Foundation, a nonpartisan health care think tank based in Palo Alto, Calif., said that for the average citizen, it was probably “very hard to sort through the contending assertions of Republicans and Democrats on arcane issues of public health policy.’’

But the lengthy session may have helped convince Democrats in Congress that they must move forward without the other party.

“It’s very clear that they’re going to go for it,’’ Altman said.