Thursday, August 13, 2009

Obama takes health risks

Members of the Senate Democratic leadership and their aides leaving the White House last week after meeting with President Obama on health care legislation.

In pursuing his proposed overhaul of the health care system, President Obama has consistently presented himself as aloof from the legislative fray, merely offering broad principles. Prominent among them is the creation of a strong, government-run insurance plan to compete with private insurers and press for lower costs.

Behind the scenes, however, Mr. Obama and his advisers have been quite active, sometimes negotiating deals with a degree of cold-eyed political realism potentially at odds with the president’s rhetoric.

Cold-eyed politics? What do people think Barack Obama is? He is a politician, and how good of one is proven by his being president. He is not the evil socialist right-wingers want their zealot legions to believe he is; nor is he the soft-hearted liberal that left-wingers are fretting he is not being. He is a moderate.

Last month, for example, hospital officials were poised to appear at the White House to announce a deal limiting their industry’s share of the costs of the overhaul proposal when a wave of jitters swept through the group. Senator Max Baucus, the Finance Committee chairman and a party to the deal, had abruptly pulled out of the event. Was he backing away from his end of the deal?

Senator Baucus has emerged as a key player. Ted Kennedy's absence is part of the reason for that. Yet his position of influence in the health care debate is consistent with the President's strategy (or, perhaps better put, tactical approach): it will be Congress that will shape the legislation, not the Administration (openly, that is).

Not to worry, Jim Messina, deputy White House chief of staff, told the lobbyists, according to White House officials and lobbyists briefed on the call. The White House was standing behind the deal, Mr. Messina said, capping the industry’s costs at a maximum of $155 billion over 10 years in trade for its political support.

Trading support for money.

Some Democrats and industry lobbyists now argue that, in negotiating deals through Mr. Baucus’s panel with powerful health care interests, the White House was tacitly signaling as early as last spring that it might end up accepting something more modest than the government insurer the president has said he prefers.

He prefers; that is a key phrase. If, and I increasingly think that it will be when, the public option is negotiated away, he will say, words to the effect of, well, can't get everything we want, but we have started the process of reform.

The Finance Committee, for example, appears to be coalescing around the idea of nonprofit insurance cooperatives instead of a government-run plan. It is a proposal the health care industry prefers, but many liberal Democrats oppose, in both cases because cooperatives are likely to have less leverage over health care prices.

How much influence the White House has had in helping the process of coalescing is, and will remain, known behind closed doors. The coops will be easier to sell to moderates than a public plan, and will coopt the fire the right wing is fanning, that of creeping socialism.

Industry lobbyists and moderate Democrats in both chambers, though, argue that the White House’s actions behind the scenes show a recognition that the finance panel’s anticipated compromise is the most likely template for any final legislation.

Recognition? Methinks the WHite House has been more active than passive.

“The House has largely been a sideshow,” said Representative Jim Cooper of Tennessee, a member of the so-called Blue Dog caucus of conservative Democrats. “The Senate Finance Committee is where it really matters. That’s the bottleneck.”

Members and staff of the four other committees say the White House has largely stayed on the sidelines. “They have been — what is a good way to put it? — available for consultation,” Mr. Cooper said.

What are they going to say in public?

Mr. Obama and his top aides have immersed themselves in the Senate Finance Committee process. The president talks to Mr. Baucus several times a week, people briefed on their conversations say. Mr. Obama has also held a few calls with the panel’s ranking Republican, Senator Charles E. Grassley of Iowa.

Ah, yes, Grassley, he of the "pulling the plug on grandma" infamy. Key player, but something of a schmuck.

Lobbyists for the drug and hospital industries say that, as early as June, White House officials directed them to work out cost-saving deals with Mr. Baucus’s committee. Drug industry lobbyists said they negotiated a deal to contribute $80 billion over 10 years toward the cost of an overhaul with Mr. Baucus, under White House supervision, before taking it to the president for final approval. House lawmakers have said they were caught by surprise when it was announced.

House lawmakers? The leadership? Rank-and-file members?

Hospital industry lobbyists, speaking on the condition of anonymity for fear of alienating the White House, say they negotiated their $155 billion in concessions with Mr. Baucus and the administration in tandem. House staff members were present, including for at least one White House meeting, but their role was peripheral, the lobbyists said.

That makes $235 billion of the about $1 trillion estimated needed funds to pay for the health plan that is bandied about as the to-be-legislation.

Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying Medicare rates — generally 80 percent of private sector rates — or controlled by the secretary of health and human services.

Hospital lobby is speaking confidently. Too early? October will bring the answer.

Mr. Emanuel and liberal Democrats argued that the White House had worked more closely with the Senate Finance Committee because it was stepping in to break up legislative logjams. In the same way, they said, Mr. Obama and Mr. Emanuel had personally interceded to resolve a last-minute revolt by conservative House Democrats that threatened to derail a bill in the energy and commerce panel in July.

Representative Henry A. Waxman, the California Democrat who is chairman of the Energy and Commerce Committee, said Mr. Obama had assured House members that he did not intend to let the Senate Finance Committee determine the final bill.

It will have to be negotiated in conference. Will any one party have a weighted hand?

“This is going to be a genuine conference with give and take,” Mr. Waxman said. He added: “The president has said he wants a public option to keep everybody honest. He hasn’t said he wants a co-op as a public option.”

Negotiations will determine the final legislation. Some details that are now being argued about might well disappear. That's how laws are made.

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