Throughout much of the yearlong health care reform debate, political posturing and partisan vitriol often seemed to eclipse any serious discussion of policy. Who could consider the merits or dangers of the excise tax or sweeping new insurance regulations while Republicans and Democrats were slugging one another daily on cable news, shouting about government takeovers and the Party of No? But in fact there were genuine debates about which ideas and tools are best for reining in health care costs or expanding access. Those days, however, are long gone.
That much is clear in the run-up to the bipartisan health care summit that President Obama is scheduled to host on Thursday and in the reaction to the compromise plan he put out to start the week. For better or worse, there now seems to be room only for partisan posturing, jockeying, optics and framing. If Democrats win this game, they may still be able to pass health reform. If Republicans prevail, they will hand Obama a stunning defeat that could set the tone for the 2010 midterm elections.
After months of criticism that he wasn't personally involved in shaping the health reform conversation, Obama on Monday finally released his own plan for legislation. Posted on a series of glitzy new Web pages, it was heralded by the White House as "the President's proposal." The plan, however, can more accurately be described as the Senate's reform bill with a series of adjustments meant to placate more liberal Democrats in the House. Senate minority leader Mitch McConnell said the Obama plan was "yet another partisan, backroom bill that slashes Medicare for our seniors." While the Administration has described the Thursday meeting as an "open" forum to facilitate "constructive debate," the event itself is a political maneuver. The White House called for it only after Scott Brown's surprise victory in the Massachusetts Senate race destroyed the Democratic supermajority in the Senate needed to break a filibuster. (Before Brown's victory, Democrats seemed poised to cut a final deal to pass a package through the House and Senate.)
Republicans, convinced that the Thursday meeting will be pure political theater, have been trying to frame it as that ever since the event was announced. First, House Republican leaders John Boehner and Eric Cantor sent the White House an open letter calling on the President to scrap the existing Democratic reform bills and "start over." This idea gained no traction, and Republicans realized they could not skip the meeting it's hard politically to turn down an invitation to be bipartisan. Boehner then sent a follow-up open letter deriding congressional Democrats for "plotting legislative trickery" to pass health reform.
Boehner was referring to budget reconciliation, a legislative maneuver that would allow the Senate to pass changes to its reform bill with only 50 votes. (Vice President Joe Biden could, in this case, cast a tie-breaking vote.) The White House has been very careful not to explicitly say it intends to pursue a reconciliation strategy, which Republicans insist is a radical, undemocratic move this, even though the GOP used it during the Bush presidency to pass two rounds of tax cuts. But during a briefing on Monday, White House press secretary Robert Gibbs said of the approach, "The avenue exists if one wants to pursue it." On an earlier call with reporters, White House communications director Dan Pfeiffer declared, "We have made no determination which process to move forward," but then said, "The President expects and believes the American people deserve an up or down vote on health reform," adding that the President's fixes to the Senate bill were designed "with maximum flexibility to ensure we can get an up or down vote in case the opposition decides to take the extraordinary step of filibustering health reform."
Still, in an apparent effort to showcase its efforts at bipartisanship, the White House drew reporters' attention on Monday to the GOP ideas already in the House and Senate bills and in the President's reform plan. But in doing so, the White House was also communicating that Democrats have already adopted all their favorite Republican ideas and won't be adding any major new ones to their reform legislation. (One possible exception is medical-malpractice reform. Obama has said he's open to the idea, which is often cited by Republicans as a major driver of rising health care costs.) In a sign of how little value Obama places on Republican votes at this point or how unobtainable he believes them to be the White House reform plan includes a large new tax on unearned income.
But it's still not entirely clear that congressional Democrats can pass health reform on their own. House Democrats do not seem eager to do what's required for a reconciliation strategy that is, pass the Senate bill as is, along with a package of changes as outlined by the Obama plan. Meanwhile, Senate majority leader Harry Reid has not demonstrated that he can wrangle the required 50 votes to get a reconciliation package through his chamber. Republicans have said they intend to make the process difficult by offering endless amendments, for example. (Adjustments to one controversial element of the Senate bill, an excise tax on high-cost health-insurance plans, may have helped allay some House Democratic concerns.)
While the next three days are sure to be dominated by even more posturing, the reform plan that Democrats appear to have settled on closely resembles the most bipartisan version developed throughout the past year: the Senate Finance Committee bill. It's been tweaked and stretched and has gotten somewhat more expensive but, in essence, this is the legislation that Democrats hope to pass. Though the notorious bipartisan Gang of Six disbanded before the final bill was written, the basic structure of the legislation was developed with Republican input. It even got a Republican vote when it was passed out of the committee, that of Maine Senator Olympia Snowe. But don't expect that to matter on Thursday. At the meeting, the most important topic of discussion will probably be who gets to sit next to whom.