There is a battle looming in Congress, a contest that will pit many of the most powerful companies in America against each other, potentially reallocate trillions of dollars in spending, and literally impact the future health and well-being of each and every American. No one knows how the conflict will end, just yet, or who the winners and losers will be. But if Thursday's Health Care Reform summit at the White House is any indication, there is no doubt who will be standing at the middle of the scrum: The nation's self-anointed Mediator-in-Chief, President Barack Obama.
"I just want to make sure that I don't get in the way of all of you moving aggressively and rapidly," he told a crowd of corporate and trade group Leaders and members of Congress in an afternoon East Room ceremony. "To the extent that this work is being done effectively in these various committees, then I assure you that we are going to do everything that we can to work with all of you." (Read "Obama Moves Health Care to the Front Burner.")
They were soothing words, but all was not as touchy-feely as it seemed. Even as he offered himself up as a head referee more than a star player, Obama left no doubt about who was in charge. Congress and the trade groups, he said, could haggle over the terms. But they could not obstruct the project, and they would walk away at their own peril. "The status quo is the one option that's not on the table, and those who seek to block any reform at all, any reform at any costs, will not prevail this time around," he told the group.
The sheer enormity of the task has been clear for months. But it was on sometimes painful display at the two breakout sessions to discuss healthcare that Obama has already organized at the White House. The first session, which occurred in late February in the Indian Treaty Room, had a somewhat comical cast to it. Dozens of powerful people sat around a square table in one of the most gaudy and expensive marble rooms ever built by the U.S. government. The task: Figure out how to save money on health spending. The solution, according to almost every person present: Spend more money. (Read "Senate Democrats Optimistic on Health Reform.")
The nurses association wanted more investment in the nursing workforce. The head of the hospitals association wanted more money for hospitals. The head of the American Medical Association wanted higher Medicare reimbursement rates for doctors. Rep. James Clyburn, D-S.C., wanted more money for community healthcare centers. Sen. Arlen Specter, R-Penn., wanted a better focus on investigations of white collar fraud in the healthcare sector. Rep. Barbara Lee, D-Calif., wanted greater investment in HIV-AIDS prevention. Rep. Mike Castle, R-Del., spoke of greater National Institutes of Health Funding. It went on. (See the most common hospital mishaps.)
If there was hope, it was to be found in the fact that all these people were, in fact, sitting at the same table. All of them, from health insurance companies and medical providers to politicians from both left and right, said they were committed to reducing healthcare costs, and growing coverage, the two guiding principles that Obama has insisted on.
Sen. Sheldon Whitehouse, D-R.I., spoke to this commitment on Thursday, during the second round of breakout sessions organized by the White House, this time in the more tastefully appointed State Dining Room. "I just want to express the intensity of my confidence that there is a path through this for us," he said, before referencing the famous television advertising that the insurance industry funded to knock down the last major attempt at health-care reform. "We are past the 'Harry and Louise' moment. We are at the Thelma and Louise moment. We are in the car. We are headed for a cliff."
Whitehouse's optimism was confirmed a few minutes later by Scott Seroto, the president of the Blue Cross Blue Shield Association and a representative of the industry that had funded the "Harry and Louise" ads in 1994. "Consider that the past," he said of the ads. "We are embracing the need for reform... It just needs to be appropriate and sustainable."
This message was long ago delivered to the White House. One senior Administration official explained the situtation, last week, during an interview in the Ward Room, a navy themed dining hall near the White House mess. "If you reflect back on what health-care reform looked like and how it played out 15 years ago, some of the stakeholders who were fighting very hard against it are people who I think will start to come around to the table for the conversation now," the official said.
At the center of this strategy, as its linchpin, is the President, who has positioned himself not as the author of the new health plan, but as its mediator, facilitator and, if needed, as the taskmaster who intends to keep everyone on track. In his recently proposed budget, and on the campaign trail, Obama proposed the vague outline of a policy solution, including nearly $630 billion in new spending on health care in the short term, which would be coupled with long term cuts in the growth of medical costs. But he told leaders Thursday afternoon that he is not wedded even to his own ideas.
"If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way," the president said. "If there was a way of doing it that involved more government regulation and involvement, I'm happy to do it that way, as well. I just want to figure out what works."
If that was the carrot for lawmakers, his command that they fix the problem was the stick. At one point, he joked about Whitehouse's allusion during the breakout session to Thelma and Louise, a movie that ends with the protagonists dying in a blaze of glory. "If you actually saw the movie, they did drive over the cliff," he said, to laughter. "So just want to be clear, that's not our intention here."