Is Health Care Overhaul Doomed to Failure?

Experts are skeptical about consensus even as Obama calls for bipartisanship.

ByHuma Khan
February 10, 2010, 4:48 PM

Feb. 15, 2010— -- As Democrats and Republicans sharpen their knives ahead of President Obama's summit on health care, experts are questioning whether the president's health care agenda is doomed to fail just as President Clinton's did in the 1990's.

"If I had to place a bet on it, I would say two to one, it doesn't [pass]," said Dean Baker, co-director of the Center for Economic and Policy Research and a proponent of health care reform. "But it's not an absurd idea. It could happen. Given how much stake President Obama and Democrats have in it, they have to do something. ... They have every reason in the world to pull out all the stops to try and make it happen."

Obama has invited Republicans and Democrats to a televised bipartisan meeting on health care on Feb. 25, but experts are skeptical about whether the open event will be any more than political theater and actually achieve any concrete results in bringing both sides together.

"It could either be a choreographed professional wrestling match or it could be another 'Kumbaya' meeting, and I think both would be totally useless," said Uwe Reinhardt, a professor of political economy at Princeton University. "It should be a frank exchange -- thoughtful, polite, but the way adults should talk to each other."

The president is hoping to thaw the ice on a health care overhaul bill that right now faces grim prospects on Capitol Hill. By bringing both Republicans and Democrats to the table, the White House hopes to resurrect the momentum by energizing wary Democrats and staunchly opposed Republicans.

"Bipartisanship can't be that I agree to all the things that they [Republicans] believe in or want, and they agree to none of the things I believe in and want, and that's the price of bipartisanship," Obama said at an impromptu press conference Tuesday, "but that's sometimes the way it gets presented.

"I'm willing to move off some of the preferences of my party in order to meet them halfway," he said. "But there's got to be some give from their side as well. ... That's what I'm hoping gets accomplished at this summit."

Some health care experts say bringing the debate out in the open when talks haven't even really begun does not bode well for the future of health care overhaul.

"I don't think this is the right way to get that kind of dialogue taking place," said Stuart M. Butler, vice president of domestic and economic policy studies at The Heritage Foundation, a conservative think tank. "All this will do is lead to political sound bites and not much else, in my opinion."

The GOP leadership wants Obama to go back to the drawing board.

"Why are we going to talk about a bill that can't pass?" House Minority Leader John Boehner, R-Ohio, said Tuesday, after a meeting with Obama on jobs. "It really is time to scrap the bill and start over."

Democrats have been relatively quiet and awaiting direction from Obama. After a whirlwind few months of crafting legislation that would get broad support and pass both the House and Senate, Democrats faced a striking blow when Sen. Scott Brown was elected to fill late Sen. Ted Kennedy's term. Brown vowed to become the 41st GOP senator to vote against the health care bill, deflating any hopes of passing the legislation as the majority party had planned.

Experts say the president made a mistake by stepping away from the debate and leaving it up to lawmakers. He now has to take the lead and play "hardball politics," Baker said.

"I think President Obama will have to work very, very aggressively ... [and] be prepared to pull out all the stops. That's the most likely path," Baker said. "If he could basically shame some of the more moderate Republicans such as [Maine Sen.] Olympia Snowe into coming on board in a public session and try to put them on the line, I think that might be a way he gets bipartisanship."

Sen. Judd Gregg, the top Republican on the Senate Budget Committee, has also been billed as another GOP leader who has shows signs of bipartisanship on the health care front. But the senator from New Hampshire is also calling for the administration and lawmakers to start from scratch.

"I say, let's step back, let's start with a blank sheet of paper. And let's start putting on that sheet of paper things we can agree about," Gregg said in an MSNBC interview Friday.

Baker said he is "not terribly optimistic" about the summit at the end of this month. However, there are areas where Republicans and Democrats can come together and coalesce on a new bill.

The Way Forward on Health Care

Obama has said he wants to see specific proposals from Republicans on what health care reform should entail.

"I think that what I want to do," Obama told CBS News' Katie Couric in an interview on Feb. 7, "is to look at the Republican ideas that are out there and I want to be very specific: How do you guys want to lower costs? How do you guys intend to reform the insurance markets so people with pre-existing conditions, for example, can get health care? How do you want to make sure that the 30 million people who don't have health insurance can get it? What are your ideas, specifically?"

Republicans have, for the most part, opposed major Democratic proposals -- an option of a government-run health insurance plan that would compete with the private sector, taxes on high-end "Cadillac" plans, Medicare cuts and taxes on the wealthy, among a laundry list of other features.

But experts say the two parties can find common ground and work piecemeal to come up with a bipartisan solution to the health care crisis facing the country.

Both parties have said they want to get rid of pre-existing conditions clauses that prevent many Americans from obtaining health insurance.

The difference between the two schools of thought is that some, including Obama, say that doing so without making insurance mandatory would result in people exploiting the system. Those who are healthy would only get insurance when they need to, which wouldn't be cost efficient.

Others argue that the government cannot dictate whether Americans should be required to have health insurance and that a mandate isn't necessary. Those proponents say that the federal employee health care program has been successful and it does not mandate insurance.

The other area where bipartisanship can be achieved is on SCHIP -- State Children's Health Insurance Program. The program designed to cover uninsured children has received support from both sides of the political aisle. The original legislation was sponsored by Democratic Sen. Kennedy and Sen. Orrin Hatch, R-Utah, in 1997.

Outside of specific legislation, experts say leaders of the two parties need to decide how to move forward with health care.

"One of the fundamental questions is, do you try to do reform all in one bill for one seventh of the economy or do you do it in stages?" Butler said. "I think American public have said they want to see it in stages. Republicans could be drawn in on the idea of doing this in stages ... and make that commitment."

Lawmakers also need to address the question of how much flexibility to give states, many of whom are already fighting back against the Democrats' health care proposals.

Virginia this month passed a law prohibiting a requirement for residents to purchase health care insurance and other states are looking to follow suit with similar bills.

"I think that a package that would help states expand coverage in different ways, in different places, is something" that would get broad political support, Butler said.

Some Republicans, such as Rep. Paul Ryan, R-Wis., are suggesting ways to change the tax treatment of health coverage. Even though the idea hasn't gained traction among most Democrats yet, Obama has praised Ryan for putting serious ideas on the table that he is willing to consider.

Overwhelmingly, experts say Republicans need to be more specific about their ideas.

"I don't think Republicans have clear a vision as the administration and the Democratic leaders and party," Butler said. "It's because they're not in power."

Reinhardt pointed out that even among themselves, Republicans have too many different ideas and at least three different proposals on the table, some of which are right along the lines of what Democrats are already saying. Sen. Tom Coburn's, R-Okla., bill, for example, is highly regulatory, Reinhardt said.

"Eighty percent of what Coburn wants is in the [Senate] Democratic health care bill," he said. "And they seem not to have a vision."

At the same time, Reinhardt said the Democrats' bill has "a lot of garbage in it."

Still, what the White House should say, argued Reinhardt, is that the Democrats have "worked out a proposal that at least has the benefits of being washed out by some political process. Only Democrats were voting, but at least it has had some washing."

Health Care Pursuit: Genuine or Political Posturing?

Despite the administration's hopes of bipartisanship, many doubt whether the public wrangling over health care is merely for show or if there is a genuine push toward reform.

"My hope is that this doesn't end up being political theater, as I think some of you have phrased it," the president told reporters Tuesday. "I want a substantive discussion."

Nevertheless -- whether the president likes it or not -- health care has become a case of political posturing, Baker said.

"I think President Obama really lost control of the process early on when he made the decision that he would drop it in Congress's lap," he said. "[Now] he's paying a price for it."

Experts agree that the president has to take back control of the health care push, and more importantly, convey it to the public in simple terms.

Even though a majority of Americans now disapprove of the way Obama is handling four out of five major issues -- the economy, creating jobs, health care and the deficit -- an astounding 63 percent said lawmakers in Washington should keep trying to pass a comprehensive health care reform plan, rather than giving up on it, according to the latest ABC News/Washington Post poll.

What both the public and the administration would benefit greatly from is having explained to them in simpler terms what health care reform would entail.

"You've got to go down and make it very simple," Reinhardt said. "What the Obama administration needs is a good high school teacher who could explain this thing to the American people. Instead, we have a graduate school seminar professor called Obama who tries to do that."

"It should be at a level people can understand," he added.

Others say Obama should avoid following in the footsteps of former President Bill Clinton, whose own failed attempts at health care overhaul were partly attributable to not explaining the message fully to the public.

"People don't understand what they're going to get from it, same thing that happened to Clinton," Baker said.

Butler said the president should be on a "listening tour" rather than a "selling tour."

"The president is very good at laying out: here's the problem, here's the solutions on the options, what do we do?" Butler said. "I think Clinton was very good at doing that and I think President Obama can do that.

"It's very clear from the last year that you can't just devise a piece of legislation in Congress -- Clinton showed you couldn't do it in White House, this showed you can't do it in Congress -- and just push it to American people," Butler added.

Obama seems to sense the public fatigue.

"What I agree with is that the public has soured with the process that they saw over the last year," he told reporters Tuesday. "I think that actually contaminates how they view the substance on the bills."

The White House may want to start fresh on health care overhaul, but it remains to be seen whether a new push can be successful and a health care bill passes.

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