Barack Obama and Health Care Reform

Can’t blame him for being somewhat cautious after the stimulus fight and moderates essentially shooting down much of his plan.

http://www.political-buzz.com/

he would spell out more clearly what is and isn’t acceptable to him in a final product.
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Why? What he going to do? Veto it?!

PD: That’s sort of the point. A lot of Democrats believe, for instance, that it won’t work without a public plan. (See my post last week on that letter from Rockefeller and Brown.) But if that isn’t part of what comes to Obama’s desk, is he going to veto it? Hard to imagine.

With people like Max Baucus and Ben Nelson around I can understand the President’s cautious approach. He needs to flush out the opportunists, the fingers to the wind wallahs and others with their hands deep in HealthCare’s pocket before he enters the fray.

Bitter: From what I’m told by the White House, Obama (like Baucus) still hasn’t given up on the hope that it can win GOP votes, even after they decided to put health care in reconciliation. Please read my story for an interesting anecdote on that subject.

Seriously, Obama isn’t interested in investing any ‘political capital’ until he actually has product to sell. He probably figures that limiting lawmaker’s perogatives at this point would lower the odds of passage.
I doubt he’d be willing to veto any bill that results.

PD: That’s the argument that Axelrod makes. (Again, see my story.) But I can tell you that some very key Democrats are getting nervous. Most won’t say it publicly, but they are.

Here is a thought, maybe President Obama doesn’t want to give the Republicans a line of attack by coming out for how he wants the bill to be only to hear them say they weren’t consulted. Right now the more he takes a hands off approach the more it shows he is giving the Republicans every opportunity to come ot the table and for compromises to be made. Now I don’t understand the concern trolling because honestly President Obama is working with a stacked deck now that reconcilliation is on the table. What I expect you will see is that after maybe a month or so has passed and Republicans aren’t offering anything of substance President Obama will take ownership of the bill and then he will convince Dem leaders in Congress to swing his way by and in large and when the obstructionists object he will point out that when they had a chance to be constructive they chose not to be. Whether Obama is cominig out strong in the media or even to some of the rank and file I would be shocked if he hadn’t spoken with Nancy Pelosi and Harry Reid about how he wants the bill to look ultimately. For now I don’t think he loses anything by being hands of. Instead in fact I think it burnishes his bipartisan cred and it takes away a target for the right wing smear machine. With the political climate being what it is I think its the right way to go.

SG: I’m not concern trolling. I am reporting. I am talking to people who are in the room, and telling you what they are saying. This is my job as a reporter. It gives me access to sources who are working on the legislation, and the responsibility to report to my readers what I discover.
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Dodd is the only one willing to be quoted on the record, but he is Ted Kennedy’s closest friend in the Senate, and the second-ranking Democrat on the Health Committee. He brought this up at a breakfast with reporters — even though he hadn’t been asked about it. And I can tell you I heard similar sentiments from a number of other very senior Democrats on this issue, including from at least one who told me he has conveyed this opinion directly to the President.
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I have also asked these questions of the White House, and have reported to you their response. Again, this is my job. Sausage-making is never pretty, but the process does shape the final product.

K Tizzle
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I actually wasn’t talking about you, I was talking about the unnamed Dems you keep referring to.

SG: They are not trolls, either. They are people who feel very passionately about this issue, and who have devoted decades of their lives trying to see health care reform happen. I’m not sure they are right here, but I thought the intensity of this fear is newsworthy. Also, I’m told by three officials at the White House that Obama will be stepping up his game shortly, but they refused to give me any details as to how. I delayed writing this story for five days trying to get those details, but finally gave up and wrote it.

Where’s the upside for Obama getting involved early? Is he calculating that he’ll have more influence coming in late to resolve stalemates than he would have had investing in a particular approach early on?
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I’m wondering if he would have been more involved early if he didn’t have so much else on his plate. On the other hand, this has been his consistent approach, hasn’t it – including with the stimulus bill?

that last post was probably more than you wanted to know about the sausage-making on my end.

If Obama doesn’t stand up for a public plan, it will be considered a betrayal of his campaign promises.
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Lets not forget that Obama was just about the last candidate to come up with a health care proposal — and he, like all the other Democratic candidates, included a “public plan” option. Had he not done so — had he said “well, I think that we can leave it in the hands of the private insurance companies”, he would likely have lost the nomination, because health care was the domestic issue in the primary.
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Not that I’d be terribly surprised if Obama does betray the people that elected him…. but its crucial to note that if he doesn’t use his political capital to ensure that there is an effective public plan that he is betraying his promises.

One other impression I get is that Obama is significantly more pro-business than either his opponents OR his allies let on. I think that when he says, “I recognize that there’s that concern. I think it’s a serious one and a real one. And we’ll make sure that it gets addressed.” he’s just being straight up honest. The folks who are crying ‘socialist’ and such are reacting to a cartoon, not to the actual man.

Kathy: I’m not sure he should be involved. But some of the people I talked to are afraid that what is going to emerge from these committees, especially in the Senate, will not be good. Also, they are afraid that the whole thing may fall apart. I’ve even heard one scenario where Reid and Pelosi may have to come in at the last minute and write a bill. People are nervous, in part, because health care reform only comes around every 15 years or so, and they don’t want to blow it again.

K Tizzle
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Describe a situation for me where health care doesn’t happen this year with reconcilliation that doesn’t involve President Obama making a big overt mistake. Right now the biggest threat to healthcare as far as I can tell is Obama making a move that Republicans can successfully paint as an overreach and that will give conservative Democrats cover to also vote against it. Keeping in mind that hopefully if it gets to where we have to use reconcilliation to push it through Franken will be seated. Its ok to be concerned but its not ok to be freaking out over smart political moves by the President. I imagine that if President Obama was very hands on the same people would be worried that he was too hands on. Either way like I said before the deck is stacked this time in a way that it never has been in the past and while nobody should be taking victory laps, they also probably shouldn’t be expressing to a reporter (no offense) that they think the President should be doing more. That gives the impression that either it isn’t important enough to him or that he doesn’t know what he is doing. Democrats are notorious concern trolls which is always problematic but this is one time where I think if they have any concerns and they want health care to pass they should keep those concerns between themselves and the WhiteHouse. Especially when we are this early in the game.

“One other impression I get is that Obama is significantly more pro-business than either his opponents OR his allies let on.”
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Its not just Obama that is more pro-business than they would like people to believe. There are a whole host of democrats who will wail, preen and pander in front of the cameras but, in the end will find some lame excuse on why they just couldn’t vote in favor of the American people. Just like they did with the cram down. But the beauty is we rubes will reup these same clowns without batting and eye. Because maybe next time.

Was Specter’s defection being embraced warmly by the Democrats all about health care? He’s already gotten a pile of money for NIH, so I’m not sure what he still wants out of a health bill.
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KT – it sounds like you’re saying that Kennedy no longer has the primary hold on the debate. Is that because he’s lost some clout on the issue or that others have equally strong pov’s.

“But now, up against a tight deadline to get this legislation passed, some Democrats say (mostly privately) that they wish the President were more of a presence in the talks.”
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Please explain to me what “deadline”, and why there is such a rush?
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Is this going to be another example of rushing a bill to vote which was never read by any of the congressmen or women?
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Do you sense that the President’s favorability ratings are falling like a rock?
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Or, do you think the American people will see this for what it really is, more democrat bull-crap, and a way to totally destroy our health-care system?

rusty: a way to totally destroy our health-care system?
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What health care system?

KT: I read your column before posting. I am sceptical about Democrats who are beholden to healthcare money. After reading several posts mentioning Kennedy I wonder whether his own health problems means he will not be leading the push for a new plan. Overall I have less confidence in the Senate to get the people’s business done. But when it comes to monied interest groups the Senate finds it can expend the energy needed given how well they are lubricated with cash.

I guess I don’t see the Senate in stark Republican, Democratic and Independent terms.

Which may be why members want the President to provide aggressive leadership.

Either way like I said before the deck is stacked this time in a way that it never has been in the past and while nobody should be taking victory laps, they also probably shouldn’t be expressing to a reporter (no offense) that they think the President should be doing more.
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there is an excellent reason why people like Dodd are saying the President should be doing more — Obama’s absense from the debate is allowing the insurance companies and their factotums to dominate the discussion to the point where the there will be no real health care reform, just a bill that enhances health insurance company profits. Obama needs to stand up for a public plan — and make it clear that such a plan is necessary because insurance companies are in the business of denying care to maximize profits.

sgwhite: i’m not nearly as confident as you are that something comprehensive will pass. right now, i’d give it 50/50. i asked a longtime hill aide, who had worked on this before in 1994, what the definition of success is. he described a bill that would cover an additional 10 million people, which still leaves 37 million without coverage. one big reason, which i wrote about last week, is the difficulty in coming up with a bill that meets the CBO scoring requirements.
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kathy: ted kennedy’s illness has made it impossible for him to play the kind of role he would be playing if he were healthy. baucus is in the drivers seat.

Obama offered to curb malpractice awards, a subject near and dear to the republicans, and expected them to offer something in return? Political theater. He knows they’re not going to cooperate under any circumstances. He knows they have no interest in bipartisanship and are going to do anything they can to derail anything he wants to accomplish. They’ll sit on their hands during the entire process and then whine about being excluded again. When the bill is finished they’ll bring out their own comic book length alternative and act like it’s a viable alternative. The right wing knows meaningful healthcare reform is another nail in their coffin. Personally, I can’t wait for the RW to flatline so that we can pronounce them dead and bury the carcass. Maybe whatever emerges to take the place of their party can use a few of the organs, but the body has to be disposed of.

“Do you sense that the President’s favorability ratings are falling like a rock?”
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No.
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http://www.pollster.com/polls/us/fav-obama.php
http://www.pollster.com/polls/us/jobapproval-obama.php
http://www.realclearpolitics.com/epolls/other/president_obama_job_approval-1044.html

oglib:
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Just using one of your citations, shows the dear leaders favorabilities, “dropping like a rock”.
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Enjoy!
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RCP Average 04/21 – 05/03 – 62.2 30.5 +31.7
RCP Average 02/17 – 03/01 – 69.0 23.0 +46.0
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What will it be like in another year?

K Tizzle
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I am not sure about this but I think the reason why I am more confident than you are is because I am focused as much on what goes on in the House as what goes on in the Senate but it seems like you are more into just what is going on in the Senate. Like I said I don’t know that for sure but that’s what it seems to me. In years past I feel like looking to the Senate would be the right way to go because almost invariably whatever came out of there would have such a hard time getting passed that no matter what came out of the House the final bill would end up having to look like the Senate version. However with reconcilliation on the table and the chance the bill can pass by a simple majority in the Senate then it seems to me that this is one of those times when the House version will actually be of consequence. I think the House bill will definitely have a public option and will definitely come close to universal coverage so in my mind the Senate bill just needs to come close to that. And if not there will actually be room for negotiation for once.
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Now as for the CBO scoring requirements I would think that the WhiteHouse has already thought that through (especially since Ortszag is in the fold) and have a vision of how the bill will look in a form that will fit into that mold. And again I would think the WhiteHouse is in contact with Pelosi and Reid on that even if they aren’t actively guiding the crafting of the legislation that way….yet.
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Now there are other reasons for my confidence, not the least of which is the masterful job of messaging that President Obama has done on health care thus far. He has made it into a fiscally responsible issue in addition to it being a moral issue. Now even rank and file Republicans have to acknowled that in order to get our deficits under control we have to act on healthcare. And indeed polling shows the public at large firmly behind universal healthcare.
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I think the two worries are of course a watered down bill and or some misstep by President Obama that is exploited by the GOP to turn public opinion on the issue. Both of which could happen but I don’t think they are very likely. And thats why I definitely think there is more than a 50-50 chance of getting universal healthcare done this year. Its pretty clear that its one of President Obama’s highest priorities if not the biggest domestic agenda priority and so in due time I think he will put a whole lot of chips on the table when its apropriate. But this is just too early inn the game. Better to just keep using the bully pulpit to keep support for universal healthcare high than to give the Republicans a target to shoot at.

Obama (like Baucus) still hasn’t given up on the hope that it can win GOP votes, even after they decided to put health care in reconciliation.
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Getting GOP votes shouldn’t be a goal unto itself any longer. The list of those that might cross over is very small anyway. Invite them to the table for any MEANINGFUL suggestions they might have. But, also, make it very clear that you are not going to stand by and let them use temper tantrums and procedural gymnastics to kill good legislation.
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There needs to be a little more of the hardball of the type that was apparently used against the hedge funds managers, both against the GOP hardliners and the so-called “moderates” that seems to smile, get in the middle of the action, call for calm and water down the product to the point that it’s like trying to swallow a mouthful of luke-warm coke.
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It’s getting to the point that there need to be some “lines in the sand” drawn. Things are getting a little more important than just senatorial comity and massaging egos to get SOMETHING passed.

@rustyreturns
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“What will it be like in another year?”
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I know one thing for certain – it won’t be lower than the GOP’s approval/favorability rating.
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If you were honest, you’d see pretty stable ratings (excluding the first month post-inauguration “glow” that every president enjoys) and a slight uptick since early-to-mid April.
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Face it dude…most people like him, trust him, and think he’s doing a good job. That, of course, can change…but right now he’s popular and his ratings are stable. The right wing echo chamber ≠ the majority of Americans.

When he needs to, Obama will hit the road for more Town Hall style meetings to get public opinion behind him for healthcare reform. I think he’ll schedule a few of the meetings in red states where the republicans are under the gun in the 2010 elections. He’ll be promoting the plan and further damaging the republican candidtaes at the same time without even mentioning their names.

sacredh,
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Obama is playing things close to the vest, there’s no doubt about that. I am hoping that all of this is his version of FDR’s “make me do the right thing” strategy. Of letting the public “push” him in the direction he already was intending to go. It’s a lot harder for his opponents to make health reform a referendum on him personally if the public “appears” to be out in front of the actions he is taking.
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Hillary tried to work for healthcare reform under Bill’s watch – and the Repubs killed the effort by turning it into a referendum on HER involvement, saying she was overstepping her bounds and authority. The merits of the proposals got lost in all of the personal politics.
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I’m hoping that yields more results this time around. His strategy is definitely different and (I think) designed to keep this from having HIS name all over it – to keep from giving his opponents the ability to make this about him and him alone.

“One other impression I get is that Obama is significantly more pro-business than either his opponents OR his allies let on.”
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I didn’t intend that as a bad thing. As I’ve said elsewhere, there are things that market forces are very good at accomplishing and other things for which they are horrible. The key is being able to detect the difference. In any event, the first law of thermodynamics ALWAYS applies. There’s no such thing as something for nothing.

“What, (BHO) wanted to know, did the Republicans have to offer in return?

Nothing, it turned out. Republicans were unprepared to make any concessions, if they had any to make”
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How is this playing out any differently than the Stimulus Bill? Same script, different words.

afguy: Hillary is smart. There’s no question about that. Obama is smart AND shrewd. He’s played the republicans like a fiddle and let them damage themselves. Look at his mention of Limbaugh to the republicans during a private meeting and how they self-destructed over that argument. KT’s remark about Obama putting malpractice awards on the table and the republicans response (or lack of response) looks like the same thing to me. They got setup, took the bait and wound up looking ineffectual again. Barack may be a relative newcomer to the Washington political games, but so far he’s been writing the book on how to play it. Having the republican party in complete disarray is just the icing on the cake. He’s playing chess while they’re playing checkers.

Hopefully rusty uses evidence-based medicine if he’s touching patients. His approach to political matters seems to be to pull fecal matter from his anal canal and fling it against the wall to see what sticks. Let’s hope rusty’s not so rigid that he’s still using inorganic mercurial diuretics to treat the dropsy because that was the standard therapy when he trained, and he’s never opened a text since that time.
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Obama’s approval ratings are higher than GW Bush’s at a similar point in time.
Bush got a bump in approval after 9/11. But the more the country got to know GW, the lower the ratings. Obama’s approval ratings are just fine. But as ogliberal points out, rusty’s not very honest in his evaluation of the evidence.

I were writin’ me Senators (Cantwell an’ Murray) an’ Congressman already more’n once lettin’ ‘em know me strong preference fer Single Pay, an’ short o’ tha’, a public option – an’ not just fer uninsured, fer anyone who wants t’ be switchin’. When me Congressman visited port las’ weekend, I let ‘im know in person an’ in writin’ (again!) th’ same.
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Me reps might be publicly wantin’ t’ know more about where the Cap’n stands (tho I be believin’ he be communicatin’, on th’ side, so t’ speak, fer now), but they be havin’ no lack o’ understandin’ where th’ pirate wench be on th’ issue!
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I be tellin’ me mates t’ do th’ same – so when it comes time t’ sign up fer th’ crew again, our parlay representatives be not havin’ th’ excuse o’ not knowin’ what their contstituents were wantin’, an further, t’ be havin’ t’ explain mightily if they didn’t deliver th’ goods.
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They all mi’ be gettin’ lots o’ booty from th’ insurance lobby, bu’ it be time they be reminded tha’ it be th’ reg’lar crew who be gettin’ their boots down t’ th’ polls (or, in me own case, t’ th’ mailbox)an’ makin’ th’ decision t’ keep them on or no. I be doin’ me part t’ keep tha’ sword o’ mutiny a hangin’ o’er their heads, me hearties !
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Arrgh!

Og an’ rmrd, don’t be gettin’ rusty an’ ‘is little friends a-goin’ – th’ thread be mostly free – so far – from th’ effects o’ their poison gas. I be preferrin’ it tha’ way – me scrollin’ finger needs a rest!
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Arrgh!

KT watching the senate hearings cnn.com
Discussion on public plan now.
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Last month David and Mitch emailed for money to fight the lobbys so I think that Obama is prepared for a battle.
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Blond insurance lady ( sorry cannot remember her name) says government is not set up to negotiate prices. LOL
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I wonder how they negotiated government employeee insurance?

KT: Thanks for your reporting.
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Honest non-snarky question: Is the argument from the Democrats in the Senate really that the Democrats in the Senate are incapable of writing a bill all by themselves? Even with a promise that they can pass it with 51 votes, they still can’t come up with something?
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I guess I’m not sure why they are a co-eval branch if they can’t legislate without the President’s help. Do they need political cover? From whom? I thought polls showed that most Americans support health-care reform.
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Is this a tacit admission that they are controlled by the “stake holders,” i.e. insurance companies?

Is this a tacit admission that they are controlled by the “stake holders,” i.e. insurance companies?
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Art,
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This is my take (this an a couple of bucks will get you that cheap cup of coffee).
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They ARE controlled by you-know-who, but a few of them haven’t sold their consciences to the highest bidder yet. They know that what is being proposed is the right thing to do, but can’t bring themselves to do it without some “cover”. They want to be able to say that they were “forced” into voting the right way. In the past, they wouldn’t have needed this. They would have had the backbone to vote as needed, esp. with so much of the country standing behind them on the position.
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Whoever said that there wasn’t a lot of difference in the two parties was undoubtedly talking about their being in the pockets of the lobbyists and corporate interests. The official platforms are very much different. Unfortunately, by the time a proposal based on a platform gets out of a committee (with the comity and backslapping and willingness to reach out to each other to be bi-partisan), a lot of the “good” in the legislation gets poured out on the floor.
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WE are going to have to force them into passing GOOD legislation on healthcare. The lobbyists are closer to their ear and, until someone pays a price for “just passing something because, politically, it’s all we could do this year (or the next, or next)”, mediocre, toothless, uninspired lawmaking is all that will happen.

the importance of the article is that Obama put some consessions on the table and the republicans refused to do the same.
They run for the cameras and complain that they are shut out and cannot get their ideas heard and try to claim Obama is super partisan and yet, this proves they are lying.
They are given a voice and a chance and like always they refuse and will not compromise.
I think this needs to be explored more as exposing this more may shame them into working as adults in good faith and possibly make them stop playing these childish and destructive games.
They need to learn that putting the country before party is what their job is suppose to be. they are suppose to act like grown ups and statement and not like a bunch of angry Jr. High Schoolers.

At least Obama isn’t making the same mistake the Clintons did. He may be making another mistake that isn’t any better, but at least he’s trying something new. It all depends on what kind of plan emerges from this fractured process. I think the fact that Obama is removed from these initial stages makes it more likely the plan will be too flawed and unstable to stand up to GOP attacks, although obviously SG is right that if Obama attached himself to the plan at this point it would risk giving the GOP a target. It’s a tough situation.
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Where I am optimistic is that if Obama and the Democrats fail this time – and yes, “fail” is the right word if they don’t manage significant reform with all the advantages they have right now – it won’t be 15 years until the next serious attempt. Big business will ensure the issue doesn’t vanish from the agenda for long.

art and afguy: it gets a little more complicated than whether congress bends to the will of the various interests. what they are really worried about, i think, are the fears that opponents can create in the minds of the public — i.e., is this some scheme that will end up with health care being rationed? is this “socialized” medicine? don’t forget, in 93-94, hillary clinton was literally being burned in effigy.
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this is where they really need obama, who has a much bigger megaphone than they do and better communications skills. also, once the thing is passed (if it is) that is only the beginning. it will take years to implement, and if public support is not there, it will fall apart.

I’m not for Nationalized Health Care (at least the proposed methods that I’ve seen so far) but I would caution Obama about the following scenario:
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A modest health care reform package makes it to a vote. It is popular among pragmatists and the American public but fails for two reasons:
1- Solid Republican opposition and 2- Opposition from some Democrats who say it doesn’t go far enough.

KT: Thanks for the response — appreciated as always.
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But your article (unless I’m misreading it) implies the Senate can’t even get a bill out of committee unless Obama personally holds their hands and gives them backrubs.
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I understand that once there is a bill, it will be a hard sell, with corporate media parroting the GOP talking points at every turn.

this is where they really need obama, who has a much bigger megaphone than they do and better communications skills. also, once the thing is passed (if it is) that is only the beginning. it will take years to implement, and if public support is not there, it will fall apart.
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KT,
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Make that SUSTAINED public support. Without that, it will be picked apart/modified over the years, too.
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Obama has a big megaphone but also needs our support so that it isn’t labeled as HIS program. (Hillary got this treatment.) It’s a lot easier to push for something this monumental if he knows we are along with him on this.
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We KNOW that the usual suspects will (1) first try to kill it outright or, failing that (2) modify it to death, saying that the political climate isn’t right for so much and that they’ll re-visit it in the future. Then… they’ll just never get around to updating it.
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There needs to be some political reward for supporting this and, conversely, some penalty for being obstructionist/moderate and trying to kill it, outright or with a thousand tiny cuts.
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We know the system needs to be changed. Don’t let the labels like “socialized medicine” keep us from trying to find something that works better for all of us.

Here’s the funny part of that anecdote KT: Obama could give the Republicans EVERYTHING they wanted and they would still vote against it out of reflex simply to prevent him from gaining any sort of political victory. I’m very worried at this point that the political game is what will keep meaningful health care reform from getting passed.
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That being said, I’m with Sgw. I think the House takes the lead on this and it gets passed via reconciliation so the Senate bill becomes less important. I think it would be a hoot if HR676 is what comes out of the House and the Senate stubles all over themselves trying to come up with a proper counter (if you’re not familiar with HR676 Google it, John Conyers has introduced it in the House for quite a few sessions now) and then it sails through on reconciliation on the backs of Franken and the like.
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Totally off topic, but Pirate Wench be sailin’ in me waters! AAAARGH!!!!!

As bad as healthcare costs are crippling businesses, I don’t understand why business isn’t literally screaming everday demanding that the government step in. Nationalized healthcare doesn’t scare me. Surely businesses here have sent people to study healthcare in countries that have single payer systems. You would think that they’d get behind any program that would lessen their costs while providing better healthcare to their workers.

One of the biggest causes of the 1993 health care failure was the absolute lack of business support. Now they are looking at GM and Chrysler and realizing this cannot continue to be such a huge expense for them and they remain viable as a company. My own workplace had their health care costs jump 13% from last year. We got EXTREMELY lucky and they decided to absorb the blow, but I couldn’t help but think that this wasn’t even close to an issue for the Canadian and UK sides of the business.

My wife and I spent some time in Canada recently and thought about moving there when I retire. We talked to several people about how their healthcare system worked (including some transplanted Americans) and they had a very favorable opinion of their system. I hear more complaints about ours. Either we’re just a nation of complainers or else we’ve managed to convince ourselves that no other country could possibly have something that works better than ours.

I have a Canadian friend who got skin cancer from being A) of Welsh descent and B) being a sun hound in his youth. Not only was his care timely and top-notch, he had follow-up care and is still being monitored. All at no cost to him or his family. When I told him how much that care would cost him down here he about had a stroke. We are honestly sending too much money out for too few results.

There are going to be horror stories about healthcare under any system. There will never be a shortage of them. The RW is trying to paint the horror stories in single payer systems as being the rule rather than the exception. No one has ever accused them of not being able to play the media.