President Obama's news conference on July 22 is meant to be a foot on the accelerator of health-care reform, but all signs suggest that Capitol Hill is putting on the brakes. In the House, the Energy and Commerce Committee had expected to be finishing up its bill tonight; instead, the only one of the three health-related House committees that hasn't yet produced a bill has suspended its drafting sessions, while committee chairman Henry Waxman tries to work out his differences with a rebellious group of fiscally conservative Democrats known as the Blue Dogs. And in the Senate, Finance Committee chairman Max Baucus remains sequestered behind closed doors with a small group that includes Republicans; no one expects to see a bill out of their efforts until next week at the earliest.
And so while Obama presses for House and Senate passage of health legislation by the time Congress leaves town for its August recess, congressional leaders say privately that it's going to be all but impossible to meet that deadline. That in and of itself poses a new danger, which is why the White House has been so focused on hurrying along the process: a monthlong break would give opponents ample opportunity to pounce, while lawmakers are at home in their districts. "Right now, we're losing the messaging war," says Senator Chris Dodd, who, in the absence of ailing chairman Ted Kennedy, led the Senate Health, Education, Labor and Pensions Committee's successful effort to produce a bill. "We've got to regain our footing and make the case that the status quo is unacceptable."
But reminding people that the system is broken is only part of the challenge. It would help, lawmakers are saying more frequently in private, if the President would be clearer about how he wants to fix the problem. His strategy of keeping his distance from the legislative machinery while only saying that any final product must meet certain broad principles means that Representatives and Senators have no clue as to what kind of bill he would accept in the end and what they should be trying to sell to their constituents. Who will be taxed to help pay for an initiative expected to cost $1 trillion or more over the next decade? Will it have a strong government-run "public plan" as an option? For whom? What kind of requirements will it impose on businesses to provide coverage for their workers? What will the bill do to bring down costs? Those are the kinds of questions lawmakers expect to be hearing from voters when they return home in August. And at this point, they still don't have many answers.
Meanwhile, what Congress has produced thus far is coming under increasing criticism not just from Republicans but from credible, nonpartisan sources like the Congressional Budget Office and the Mayo Clinic, which Obama often cites as a model of what an efficient, high-quality health-care system would look like. While the bills that are on the table do a good job of expanding medical coverage to the 47 million or so Americans who now lack it, outside experts say, they fall short of meeting Obama's other main goal, which is to transform the health system in ways that bring its runaway costs under control.
The press conference is only one of the signs that Obama is in fact getting more engaged. On July 21, he met for more than two hours with the Blue Dog faction. At the end of the session, the Blue Dogs agreed to press House leaders to include in the bill a provision that would take the job of setting Medicare rates out of the hands of Congress and give it to an independent agency. Presumably, that agency would have more expertise and be less susceptible to political pressure. Obama Budget Director Peter Orszag has called such a move a "game changer" that could bring down health-care costs, though no one has a precise estimate of how much could be saved.
It's a beginning, and maybe a sign of more specifics to come from the Obama White House. Predicts one presidential confidant: "He's going to become increasingly specific and increasingly persistent." Democrats in Congress say that can't come a moment too soon.