The Health Care Follies Continue

Where to start when discussing the health care summit? I'd start with Arnold Kling's pre-game conclusion...

There are two ways to approach reducing the use of high-cost, low-benefit procedures. You can have the government tell people what they can and cannot have. Or you can have individuals pay for a larger fraction of the medical procedures that they consume. It really comes down to those choices.

Advocating either one of those is political suicide, and talking about anything else is a waste of time. The Democrats will not advocate government rationing, and the Republicans will not advocate scrapping most of our current system of third-party payment in medicine. Instead, the summit, like the entire "health reform debate" this year, will be a waste of time.

As to the postgame, Slate has a decent analysis...

If the White House health care summit was political theater, here's a 30-second review: President Obama won. So did congressional Republicans. Democrats in Congress need another act. This is not because Obama is such a better speaker and advocate for the legislation than his allies, though he is. It's because Democrats didn't get much political benefit from the event.

Obama ran for office promising to reach out to the other party. He said he would try to find areas of common agreement, and when his opponents had a legitimate philosophical disagreement, he would not question their motives. He did all of that in the session. Obama was not the crazy liberal caricature of GOP attacks during the seven-hour iron-bottom discussion. (Which may itself have been bad for the health of the people in the room.)

Republicans came out ahead for the same reason: They did not look like hell-bent obstructionists. This isn't to say that they tried to meet the president halfway. They didn't even try to meet him a quarter of the way. Repeatedly they called on him to start over. The president tried to get the room to focus on areas of agreement, and though several Republicans—notably Sen. Tom Coburn and Rep. Dave Camp—worked in that spirit, several others (hello, Reps. John Boehner and Eric Cantor) did not.

If you want a good answer for why the GOP looked better than the Democrats, take a look at the opening speakers for each side. The GOP presented Lamar Alexander -- reasonable, calm, looking like everyone's favorite uncle, and laying out the principles and ideas that GOP backed for reform. The Dems, if you take out Obama since he's the President and moderator in this format, went with Nancy Pelosi. And then followed her with Harry Reid. The only way they could have made it worse was by sending in Joe Biden. Pelosi spent her time talking about the moral case for reform, invoking Ted Kennedy's dream, as if that will sway independant voters. Reid came armed with the first of many sob stories, while making the laughable claim that the Democrats haven't discussed reconciliation. Even liberals think he's full of it on that point. Yuval Levin's halftime analysis contained some important nuggets of truth...

First, the Democrats appear to have no particular purpose in mind for this event. They’re not driving anywhere, or making a clear individual case, while Republicans clearly want to get across the point that we should scrap the current bills and start over in pursuit of a few incremental steps. The Democrats may have thought that simply putting the spotlight on Republicans when the subject is health care would make the GOP look bad. But Republicans so far seem prepared enough and focused enough to avoid that, and to make the Democrats look rather aimless by comparison.

...Third, an important part of the Democrats’ problem is that Obama himself is their only star, and this format is not working for him. He certainly seems engaged and well informed (even given a few misstatements of fact, at least one of which John Kyl made very clear.) But he doesn’t seem like the President of the United States—more like a slightly cranky committee chairman or a patronizing professor who thinks that saying something is “a legitimate argument” is a way to avoid having an argument. He is diminished by the circumstances, he’s cranky and prickly when challenged, and he’s got no one to help him. The other Democrats around the table have been worse than unimpressive.

...It’s easy to dismiss all this by saying no one is watching anyway, but that’s not quite true. The purpose of this spectacle is not so much to move the public as to move Democratic members of Congress—to create some momentum that might last long enough to help wavering Democrats cast a very painful vote. That audience very likely is watching, and they are seeing their leadership fail to make a straightforward case for the Democratic approach to health care, or to respond to the most basic Republican objections about high costs, excessive spending, overregulation, and the effect of this plan on American families. They are managing to lose an argument about health care to Republican members of Congress—no mean feat.

Tunku Varadjian offers similar thoughts...

...The marathon TV teach-in—in which Obama was more schoolmarm than president—should be regarded by Democrats as a great disappointment. They made no clear gain, and won no clear argument. It became apparent from the very beginning—when a testy Obama said “Let me finish, Lamar!” to the courtly Lamar Alexander—that this was not to be an open-minded exploration of the issues in question. It was, instead, a simulacrum of a debate, a pretend-conversation, one in which Obama established, yet again, his command over fact and detail, but in which he also revealed reflexive superciliousness, intolerance of different opinions, and a shortness of patience unbecoming of a president. (He also showed that he’s a tedious clock-Nazi, cutting people off all the time, while showing no inclination to edit himself.)

What was so striking about the summit was the preparedness of the Republicans. All of them had done their homework: Lamar Alexander, Tom Coburn, Jon Kyl, John McCain, Dave Camp, John Barrasso, and Paul Ryan.

The Democrats, by contrast, suffered from an acute case of “anecdotitis” (is it a preexisting condition?): Almost all of them delivered speeches that boasted a story or two meant to tug at the heart. Obama set the tone with his account of Sasha’s asthma, Malia’s meningitis, and his mom’s ovarian cancer. Nancy and Harry—as Obama called them—told us, respectively, of having “seen grown men cry,” and of a “young man called Jesus” who was stiffed by his insurers. Steny Hoyer gave us a sob story, Louise Slaughter told us about a woman who had to wear her dead sister’s teeth, Tom Harkin told us of a letter he got “yesterday, from a farmer in Iowa…” This constant argument-by-anecdote was relentlessly populist; but it was also fatally weak, as it was the infantilizing of a national audience, an invitation to Americans to wince and say, “Gee, things are bad out there. We need this bill!”

On the anecdotes, I keep finding myself thinking of Helen Lovejoy on the Simpsons saying, "Won't somebody please think of the children?!" Or as Robert Stacey McCain noted, the Dems seem to be saying, “A killer whale with a pre-existing condition ate that poor girl’s deductible!”

There's a point here about the Democrats' performance perhaps making Obama look better (or more importantly, making the case for why the mainstream press fell in love with Obama, because they're mostly Democrats and were stunned to find a high-profile Dem who could walk and talk competently). The real problem is that he was reduced by this. As for the GOP, they have a new star in Paul Ryan. This was pretty much awesome for him.



The real question is, where do we go from here? Mickey Kaus makes the case for Dems passing the current health care bill on the grounds that if the sky doesn't fall after they do it, they will have called the GOP bluff. I'm not sure Democrats want to gamble on that chance. More importantly, they would need to use reconciliation in the Senate to pass the bill without stuff like the Cornhusker Kickback, and that might make the political process totally toxic for the rest of the year (if not the rest of Obama's first term). Bill Frist explains why...

Senate Majority Leader Harry Reid has announced that while Democrats have a number of options to complete health-care legislation, he may use the budget reconciliation process to do so. This would be an unprecedented, dangerous and historic mistake.

Budget reconciliation is an arcane Senate procedure whereby legislation can be passed using a lowered threshold of requisite votes (a simple majority) under fast-track rules that limit debate. This process was intended for incremental changes to the budget—not sweeping social legislation.

The Democrats may want to dismiss this as a simple dispute about procedural rules and rightly claim that the GOP has used reconciliation numerous times in the past. Unfortunately for them, the GOP never used it for something this big, and the last thing the public wants (after months of seemingly corrupt backroom deals on health care) is a questionable process that passes this bill without any GOP votes. It looks dirty -- and the dirt will stick to them come November and beyond.

So will they do it? Mike Allen at Politico explains that this is the gameplan, or at least was the gameplan leading into the summit. The real question, then, is whether this summit answered the worries of nervous moderate House Dems who would have to vote for the package. I can't see that it would, but I'm not a Democrat. And if I were, I'd probably be pretty frustrated right now.