New York Times
If there was any question about how deeply divided Republicans and Democrats are about how to reshape the American health care system, consider that they spent the first few hours of President Obama’s much-anticipated health care forum on Thursday arguing over whether they were in fact deeply divided.
The forum played out with Mr. Obama serving as moderator, M.C. and chief defender of Democratic policy prescriptions. He and his fellow Democrats tried to make the case that the two parties were closer than they thought, with the implication that their bill was centrist and would be acceptable to mainstream voters. Republicans countered that the gap was vast, the bill out of touch with what the country wanted, and that Mr. Obama should throw it out and start over. “A dangerous experiment,” warned Representative John A. Boehner of Ohio, the House Republican leader.
By day’s end, it seemed clear that the all-day televised session might have driven the parties even farther apart. Republicans said there was no way they would vote for Mr. Obama’s bill, and Democrats were talking openly about pushing it through Congress on a simple majority vote using a controversial parliamentary maneuver known as reconciliation.
As he wrapped up the session, Mr. Obama chided Republicans for advocating “baby steps” and rejected their call to start over, declaring Americans “don’t want us to wait.” He said that if he did not see any significant movement toward bipartisan cooperation, Democrats would push ahead on their own and leave it to voters to render their judgment.
“That’s what elections are for,” the president said.
The forum, at Blair House across the street from the White House, was in many respects an extraordinary sight — the president, with Vice President Joseph R. Biden Jr. at his side, engaging in a spirited and detailed policy debate with Republicans about one of the most compelling and ideologically polarizing issues facing the nation.
Mr. Obama’s mastery of the intricacies of health policy was impressive even to some Republicans.
“It was sort of his classroom,” Senator Lamar Alexander, the Tennessee Republican who delivered his party’s opening statement, said in an interview. “I was glad we did it, because the president’s megaphone is the biggest one and when he shares it with Republicans like he did, that gives us several hours to make our case, and I thought we made it well.”
The session did produce hints of potential agreement on some issues, but in each case Democrats and Republicans differed over important details.
They agreed on the need for more regulation of insurers, for example, but clashed over the question of whether the federal government should replace states as the primary regulator. They agreed that the federal government should help individuals and small businesses pool their purchasing power to buy insurance, but disagreed over whether the government should specify minimum benefits, as Democrats proposed.
Beyond the question of government intervention in the private insurance market, their most profound disagreement was over expanding coverage to the uninsured. The Democrats want to cover more than 30 million people over 10 years; Republicans said the nation could not even afford the entitlement programs, like Medicare, that already exist, much less start new ones.
Amid the debate over insurance industry regulation, cost containment, medical malpractice lawsuits and other minutiae of health policy, there were also plenty of theatrics. At one point, Senator Mitch McConnell of Kentucky, the Republican leader, chastised Mr. Obama for allowing Democrats to run on, saying Republicans had spoken for 24 minutes while Democrats had had 52. (Republicans kept track of the dialogue; at the end of the day, they said Mr. Obama had spoken for 119 minutes, Democrats 114 and Republicans 110.)
At another point, Mr. Obama looked wryly at Representative Eric Cantor of Virginia, the Republican whip, who addressed the president with a stack of papers in front of him. “Let me just guess,” Mr. Obama said, barely containing his smirk, “that’s the 2,400-page bill.”
But the biggest clash of the day involved Mr. Obama’s 2008 Republican rival, Senator John McCain of Arizona. Reminding Mr. Obama that both of them had run for office “promising change in Washington,” Mr. McCain delivered a lengthy talk deriding the Democrats’ bill as being produced “behind closed doors” and stuffed with “unsavory deal-making.”
Mr. Obama finally tried to cut the senator off. “We’re not campaigning anymore,” the president said. “The election is over.”
Mr. McCain laughed and shot back: “I’m reminded of that every day.”
Later, though, Mr. Obama credited Mr. McCain with making a valid argument in a discussion over federal payments to private Medicare Advantage plans.
Mr. McCain criticized a provision of the Senate bill that would carve out special protections for people enrolled in the plans in Florida and a few other states, while people in his own state of Arizona would not benefit. The president called it a “legitimate point.”
Throughout the day, Mr. Obama skirmished with Republicans over the effects of the Democrats’ proposal on health insurance premiums. Republicans, citing a Congressional Budget Office analysis of the Senate bill, said the average premium for individual policies would be about 10 percent to 13 percent higher in 2016 than the average premium that year under current law.
Mr. Obama countered that under the Senate bill, the federal government would establish standards for “decent insurance,” and that the better benefits might be more costly. And in any event, most people buying individual policies would qualify for federal subsidies, which would substantially lower what they pay.
One of the sharpest areas of philosophical disagreement between Mr. Obama and the Republicans emerged when Senator John Barrasso, the Wyoming Republican who is also an orthopedic surgeon, contended that Americans would make better, less costly health care choices if they had catastrophic insurance coverage that required them to pay for most services out of pocket.
Mr. Obama asked if he would prefer that members of Congress have only catastrophic coverage; the senator said he would. “That’s right, because members of Congress make $176,000 a year,” Mr. Obama replied, adding that he wondered whether Mr. Barrasso would feel the same way if he earned only $40,000.
For the president, Thursday’s session was a kind of Hail Mary pass, a last-ditch effort to keep his top legislative priority from slipping out of his grasp.
He opened the session by calling on the two parties to search for common ground and implored them to “make sure that this discussion is actually a discussion and not just us trading talking points.”
Mr. Obama said he found considerable overlap in the two parties’ ideas, and Democrats like Senator Max Baucus of Montana, a chief author of the bill, spent much of their morning trying to back up that assertion.
Sounding optimistic, Mr. Baucus said, “We are on the verge and the cusp, with not too much effort, to try to bridge a lot of gaps here.”