Health Care: Obama Engages More Deeply

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Is Barack Obama finally channeling LBJ to save his health reform initiative? As we’ve noted before, the President until now has stayed away from the nitty-gritty of the negotiations on Capitol Hill, largely because he wants to avoid the mistakes that the Clintons made in 1993, when they tried to dictate to Congress precisely how to transform the health system. His role, as he saw it, was to make the case on the outside, with the public, to convince Americans that health reform is needed–and needed now.

But that kind of hands-off approach to the legislative process hasn’t been working so well lately. The Democratic committee chairmen in Congress seem to be losing sight of one of Obama’s major goals, which is to bring long-term health care costs down. As a result, the whole effort is coming under growing criticism from such diverse and credible quarters as the Congressional Budget Office and the Mayo Clinic. As recently as last night, Obama was telling liberal bloggers that this wasn’t a real problem, and that any defects in the legislation could be fixed after it passes the House and Senate, when it reaches a conference committee.

With Congress looking less and less likely to make Obama’s deadline for House and Senate passage by the August recess, however, there are signs that he is shifting into a different gear. One close Obama ally predicted to me: “He’s going to become increasingly specific–and increasingly persistent–about the things he does and doesn’t want” in the health care bill. This afternoon found the President knee-deep in negotations with the conservative Democrats known as “Blue Dogs,” who have been slowing down Energy and Commerce Committee Chairman Henry Waxman’s efforts to get a bill through his panel. And as a result, the President and the conservative Democrats are making common cause on one cost-containment measure that both would like to see added to the House bill.

In a conference call with a group of reporters after the session, Obama Budget Director Peter Orszag said that the White House and the Blue Dogs agree that the “biggest missing piece” of the House bill is a proposal–similar to one championed in the Senate by Democrat Jay Rockefeller–to take the job of setting Medicare reimbursement rates out of the hands of Congress, and turn it over to an independent agency that presumably would have more expertise–and more insulation from political pressure. (You can read our earlier discussion of it–and Orszag’s argument for it– here.) The idea has also won words of praise from the Mayo Clinic on the very blog where it criticized the House bill yesterday. And Obama’s engagement may be bringing the Blue Dogs aboard.

As the Obama adviser told me, there is simply no one else who can close the deal the way a President can. “There is something about the President of the United States calling you as a member and asking you to do something, and not just calling once, but twice and three time,” he said. “It is awfully hard to say no to a President of your own party.”