The Note, 6/15/2009: Medical Attention — Obama woos doctors as health care takes over agenda

By Caitlin Taylor

Jun 15, 2009 8:09am

By RICK KLEIN Monday brings President Obama a semi-home game — a speech in Chicago to the American Medical Association.  But, with this group of doctors opposing a public option, it’s semi-hostile territory. (Just like almost every other setting he’ll find in this debate from here on out.)  All President Obama has to do now is find a way to pay for a health-care overhaul — and devise a public option that’s maybe not really public — while keeping the stakeholders in those seats at the table — but not letting them get so comfortable that the left will get up — and give it all the shine of bipartisanship.  (And next week will bring a different kind of home game: a nationally televised “discussion” on health care, to be carried on ABC in primetime from the White House.)    The easy part of health-care reform is done. This is the time for real actual legislation, and genuine votes.  Obama is up against powerful interests — with diverse standpoints, and strong messaging and money behind them. (Quick — list three things the opponents of health-care reform will say about the Obama plan? Now tell us what the Obama plan is.)   He could use the AMA doctors to get it all done. With a 12:15 pm ET address, the president brings a sense of urgency with him to Chicago. “The president will use this address to the American Medical Association to outline why health care reform that brings down costs can’t wait another year or another administration,” a senior administration official tells ABC’s Jake Tapper. “The president will address the heart of problem of rising costs: that we’re spending too much money on treatments that don’t make Americans any healthier, and that our system equates more expensive core with better care. He’ll lay out his vision for a system that replicates best practices, incentivizes excellence, and closes cost disparities — and he’ll ask for our medical professionals’ help in getting the job done.”  He’ll reiterate that his plans “include a health insurance exchange where private plans compete with a public option that drives down costs and expands choice. The president will be clear about what a public option does and doesn’t mean for patients, physicians, and our broader health care system.” Kind of an important crowd: “Obama’s turn before the 250,000-physician group in his latest effort to persuade skeptics that his goal to provide health care to all Americans is worth the $1 trillion price tag it is expected to run during its first decade,” the AP’s Charles Babington writes.    Sweet words for the AMA: “In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials,” Sheryl Gay Stolberg and Robert Pear write in The New York Times.    “The speech comes as the president’s ideas on health reform are facing mounting criticism — not only from the A.M.A. and Republicans, who also vehemently oppose a new public plan, but also from the hospital industry, which is up in arms over a proposal Mr. Obama announced on Saturday to pay for his health care overhaul in part by cutting certain hospital reimbursements.”   “Given its historic resistance to major reform efforts, the AMA would be a tough crowd under normal circumstances,” Politico’s Carrie Budoff Brown writes. “But in pushing the public plan, Obama is looking to persuade a constituency already distrustful of the government’s role in health care that a government insurance program won’t be as objectionable as they imagine.”     “In speaking to the AMA, Obama is making his pitch directly to a constituency whose support he will need to get his proposal passed. One of the points he plans to make is that revamping the system won’t upend existing coverage if patients are happy with it,” Bloomberg’s Nicholas Johnston writes.    The doctors want details — and they don’t want it to hurt: “They promise you Utopia, but frequently they give you [Dystopia],” former AMA president Dr. Donald Palmisano tells The Hill’s Sam Youngman.    The path from here to there: “A health care overhaul demands much harder choices,” Lynn Sweet writes in the Chicago Sun-Times. “Even within Obama’s Democratic ranks, there are divisions: The left is pushing Obama for universal coverage, preferably through a government-run program along the lines of Medicare, while an important band of conservative Democrats is concerned over how a new guarantee of health insurance for all will be paid for.”    “The White House is caught in a battle within its own party over how to finance a comprehensive overhaul of America’s health-care system as key Democrats advocate a tax plan that could require Obama to break his campaign pledge not to raise taxes on the middle class,” Lori Montgomery and Ceci Connolly write in The Washington Post. “Much of the money is likely to come from reining in spending on federal health programs for the elderly and the poor. . . . The rest of the cash is likely to come from new taxes. But Democrats are deeply divided over which taxes to raise, and the issue has become a central stumbling block in the push to enact legislation by fall.”  Working out the financing: “He’s very serious about having health reform this year and having it paid for,” HHS Secretary Kathleen Sebelius told ABC’s George Stephanopoulos, on “This Week.”    But asked about veto threats, no straight answers: “Absolutely he wants a bill that’s paid for, not to increase the deficit at a time when we’re looking at looming deficits,” Sebelius said.  “We think there should be a public plan,” Vice President Joe Biden said on NBC’s “Meet the Press.” “You’ve got to have some competition.” (But lots of room for what it looks like.)    The opposition: “Republicans are lining up behind a pointed political attack line: President Barack Obama is nationalizing American industry and socializing medicine,”the AP’s Tom Braun writes. “The GOP is portraying the health care effort — which Obama has made a top priority — and government bailouts as two faces of what they portray as a dangerous burst of governmental activism by Obama and a supportive Democratic Congress. No matter that the bailouts and nationalizations were begun under the Republican administration of George W. Bush. Or that the word ‘socialism’ may not evoke the same degree of alarm among the public it once did, especially among younger voters.”    As they find the cash: “The sharp response from the hospital industry, which under the proposal faces reductions in subsidies exceeding $100 billion over 10 years, illustrates the administration’s challenge in winning the deep concessions from industry needed to pay for the overhaul,” The Wall Street Journal’s Janet Adamy and Jonathan D. Rockoff report. “After agreeing in May to contribute to a $2 trillion reduction in health spending over 10 years, the hospital industry is now bristling at the prospect of more givebacks — this time, cuts that would be set in law.”    A chance for a breakthrough? “On Wednesday, a bipartisan study group headed by former Senate leaders Tom Daschle, a Democrat, and Republicans Bob Dole and Howard Baker will release recommendations. These will displease interest groups on all sides, and may also form a realistic basis for any final compromise,” Bloomberg’s Al Hunt reports. “Barring snags, the committee will call for universal coverage and a radical change in the system of reimbursements, while offering only a minimal, perhaps fallback, plan for a public insurance entity, and spelling out ways to pay for it.”    The most important Emanuel: “[Zeke] Emanuel is officially ‘Special Advisor for Health Policy,’ and his ambiguous place in (or, rather, outside) the OMB bureaucracy can create minor strains. His memos don’t always swim through the normal channels, but they have a knack for finding Orszag’s desk,” Noam Scheiber writes in a New Republic profile.   Coming to a cable channel near you: “As President Barack Obama flies Monday to Chicago for a midday speech on health-care reform, the round trip on Air Force One will run about $236,000, according to government estimates of the operating costs for one of the top symbols, and perks, of the presidency. But that does not include such expenses as Secret Service protection, motorcades and helicopter transports,” the Chicago Tribune’s John McCormick writes.    The political argument looms: “With each dollar spent, Americans sense the need for a greater check on the unlimited power that the Democrats now hold, setting the stage for the 2010 congressional elections,” House Minority Whip Eric Cantor, R-Va., writes in a New York Daily News op-ed. “The administration pitches its unprecedented spending as an effort to douse the fire in our economy. All they have done is ensure it will last longer.”    Then there’s Iran: It’s one thing for the administration to claim ownership for the energy, and quite another thing to want to be anywhere near the messy results.  “The confused aftermath of Iran’s presidential election is complicating the Obama administration’s planned outreach to the Islamic republic and underscoring the challenges facing the president’s new approach to the Middle East based on shared values and common interests,” Scott Wilson writes in The Washington Post. “The cautious response illustrates the balance that the Obama administration is seeking between condemning what increasingly appears to be a fraudulent election and the likelihood that it will be dealing with Ahmadinejad after the dust settles.”    It’s “a stinging setback to the Obama administration’s hopes of cultivating a better relationship with the Islamic Republic,”Paul Richter writes in the Los Angeles Times.    “The contested election results put the Obama administration in a deepening bind on an issue that is one of the most important foreign policy matters facing the White House,” Michael Kranish writes in The Boston Globe. “President Obama had called for an effort to renew ties between the countries, and his administration had hopes that Ahmadinejad’s main rival, Mir Hossein Mousavi, would triumph. But with Ahmadinejad claiming victory and Mousavi yesterday calling for the result to be annulled, the Obama administration tried to avoid taking sides.” The view from the White House, per ABC’s Jake Tapper: “The White House has not issued a statement expressing support for the protestors declaring the election illegitimate. But neither has anyone in the Obama administration said a public word accepting the legitimacy of President Mahmoud Ahmadinejad’s reelection.”    The bright side? “Ahmadinejad’s win may increase Washington’s chances of getting tougher sanctions on Iran if they refuse to negotiate,” per Time’s Massimo Calabresi. “Ahmadinejad personifies Iran’s unpredictable, dangerous side. He made even more hostile and threatening statements toward Israel and the U.S. during the campaign. And though they dare not say it publicly, Administration officials privately say that the messier and more contentious the postelection period, the more it sends the message to the outside world that even if some Iranians want moderation the hard-liners will not allow it.”    The next moves will be cautious ones: “I’ve argued for engagement with Iran and I still believe in it, although, in the name of the millions defrauded, President Obama’s outreach must now await a decent interval,” Roger Cohen writes in his column. “I’ve also argued that, although repressive, the Islamic Republic offers significant margins of freedom by regional standards. I erred in underestimating the brutality and cynicism of a regime that understands the uses of ruthlessness.”    Progress for Obama, from Israel: “Insisting ‘We want peace,’ Israeli Prime Minister Benjamin Netanyahu for the first time endorsed the creation of a Palestinian state — and demanded it disarm and respect the Jewish state,” Bill Hutchinson writes in the New York Daily News. “In a historic speech, the usually bellicose Israeli leader showed a softer side, but Palestinians insisted his olive branch included too many thorns.”    ABC’s Simon McGregor-Wood: “But on some of the key issues that divide Israelis and Palestinians there were some uncompromising declarations. He demanded that the problem of Palestinian refugees created when the state of Israel was born would have to be dealt with inside the future Palestine — none would be allowed back into Israel.”    Also big this week: financial regulatory reform, with the administration proposal coming on Wednesday.  A preview, from Tim Geithner and Larry Summers, writing in The Washington Post: “Our framework for financial regulation is riddled with gaps, weaknesses and jurisdictional overlaps, and suffers from an outdated conception of financial risk. . . . The administration’s proposal will address that problem by raising capital and liquidity requirements for all institutions, with more stringent requirements for the largest and most interconnected firms. In addition, all large, interconnected firms whose failure could threaten the stability of the system will be subject to consolidated supervision by the Federal Reserve, and we will establish a council of regulators with broader coordinating responsibility across the financial system.”    CIA Director Leon Panetta takes on former Vice President Dick Cheney: “I think he smells some blood in the water on the national-security issue,” Panetta tells The New Yorker’s Jane Mayer. “It’s almost, a little bit, gallows politics. When you read behind it, it’s almost as if he’s wishing that this country would be attacked again, in order to make his point. I think that’s dangerous politics.”    A new TV ad is out Monday from the Alliance for Climate Protection: “Forty years we’ve been talking about how we’ve got to stop being held hostage by foreign oil,” says a familiar face from previous Repower America spots. “Well, we’re still borrowing money to buy oil from dictators who don’t like us and burning it in ways that kill God’s green earth,” he continues.  “Why don’t we use our own clean energy and create good paying jobs here instead of sending billions overseas?”    A pre-buttal memo, from the Workforce Fairness Institute, with the state Supreme Court set to rule in Minnesota any day: “While Al Franken is a well-known supporter of the Employee ‘Forced’ Choice Act and Senator Norm Coleman is opposed to the legislation, we do not expect the seating of either in the U.S. Senate to significantly alter the dynamics of the vote count in the upper chamber. The reality is that union bosses simply do not have the votes to pass the ‘Forced’ Choice bill and the impediment lies with Democrats, who would have a filibuster-proof majority, if Franken emerges as the victor. It is important to note that despite the inability of union bosses to secure enough votes on cloture to prevent a filibuster; they can be expected to make claims that Franken’s seating is a ‘new day’ for the legislation.”   Settling on a Republican candidate in Pennsylvania? “Last week, [Sen. John] Cornyn quietly sent a $5,000 contribution to the [Patrick] Toomey campaign from his own political action committee,” Donald Lambro reports in the Washington Times.    Said Cornyn: :I certainly haven’t taken an early endorsement off the table but want to talk to leaders in Pennsylvania first. It’s certainly an option, and I won’t foreclose it, that I would endorse him early.”   Variety’s Ted Johnson sees Hollywood making noise in Washington: “Such unity of Congress, cause and celebrity has long been a Washington formula for mutual assured publicity. But there has been an unmistakable escalation since Democrats expanded their majority and took back the White House,” Johnson writes. “The stream of stars to the Hill has had the ironic effect of raising the bar on what merits the attention of lawmakers and the media, putting extra pressure on Hollywood figures and their advocacy orgs to be savvier about how they approach a capital that’s been inundated by efforts to ‘raise awareness.’ “   
The Kicker:  “How could you ban Melville?” — Actor Pierce Brosnan, asked at a press conference whether “Moby Dick” should be banned, lobbying Congress on behalf of the International Fund for Animal Welfare.    “I am as sorry as I can be if I offended anyone. The comment was clearly in jest.” — GOP activist Rusty DePass, after commenting on his Facebook page that an escaped gorilla was “just one of Michelle’s ancestors — probably harmless.”      Today on “Top Line,”’s daily political Webcast: Michael O’Hanlon of The Brookings Institution, and Ezra Klein of The Washington Post. Noon ET.   Follow The Note on Twitter:   For up-to-the-minute political updates check out The Note’s blog . . . all day every day:

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