The White House blog stresses that the President is proposing to include "even more Republican ideas" (!) and the revised plan incorporates several proposals voiced by Republicans at the summit. Yet at the same time, Obama's letter insists "that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs." In other words, the damn bill -- a blend of the bills passed by House and Senate Democrats -- will pass.
Directly from Republican input at the summit, Obama plucked: expanded funding for states' experiments in malpractice reform; Tom Coburn's showy proposal using undercover agents to detect Medicaid fraud; an unambiguous green light for health savings accounts in the exchanges; boosted Medicaid payments; and elimination of a special deal for Florida senior citizens in the phase-out of Medicare Advantage subsidies (as well as of the Medicaid carve-out for Nebraska, the elimination of which was in Obama's pre-summit proposal).
The tweaks are good politics: Obama is at once showcasing a fine-tuning and simultaneous cleansing of the bill's perceived "back-room deals" -- while re-introducing its core features and making a forceful case that they are indivisible. You can't insist on community rating without an individual mandate; you can't sell across state lines without universal coverage rules. The President is in effect forcing the Republicans to shape the bill at the margins while asserting that he will not let them pull the bill apart.
The rebranding of the bill as an essentially bipartisan product with no bipartisan support -- a paradox Nancy Pelosi spelled out in a weekend interview -- highlights Republican bad faith while lauding their alleged 'good ideas.' Call it an intellectual bankruptcy sale -- to purchase cover for a few blue dog Democrats to pass the Senate bill through the House.
And at the end, Obama asserts the core difference between the parties even while asserting "common ground:
Both parties agree that the health care status quo is unsustainable. And both should agree that it’s just not an option to walk away from the millions of American families and business owners counting on reform (my emphasis).I would also reiterate, as I stressed once before, that Obama has been consistent since his Jan. 20 Stephanopoulos interview in outlining how he wants to get health care reform enacted. The apparent mixed messages in that interview were a failure of communication, not intent. The suggestions that Obama would back off comprehensive reform were actually all introduced by Stephanopoulos: Obama's mistake was not to contradict Stephanopoulos directly. But look once more at what he actually said:
...it is very important to look at the substance of this package and for the American people to understand that a lot of the fear mongering around this bill isn't true. I would advise that we try to move quickly to coalesce around those elements of the package that people agree on. We know that we need insurance reform, that the health insurance companies are taking advantage of people. We know that we have to have some form of cost containment because if we don't, then our budgets are going to blow up and we know that small businesses are going to need help so that they can provide health insurance to their families. Those are the core, some of the core elements of, to this bill. Now I think there's some things in there that people don't like and legitimately don't like. If they think for example that there's a carve out for just one or two particular groups or interests, I think some of that, clearing out some of that under brush, moving rapidly..
Stephanopoulos: So start again with a smaller core package.I think now that Stephanopoulos misunderstood Obama, and that Obama did not clarify because he did not want to foreclose the possibility of Republican buy-in -- or at least, of very publicly seeking Republican buy-in, as he's still doing. Later, again, Stephanopoulos tried to steer him:
Well, look, I'm not going to get into the legislative strategy. First of all, my job is to as president, is to send a message in terms of where we need to go. It's not to navigate how Congress...
You're not advocating that the House pick up the Senate bill.
I think it is very important for the House to make its determinations. I think, right now, they're feeling obviously unsettled and there were a bunch of provisions in the Senate bill that they didn't like, and so I can't force them to do that. Now I will tell you, and I've said this before, that the House and the Senate bill overlap about 90 percent.
And so, it does seem to me that there should be a way of, after all this work and all this pain, there should be a way of taking what's best in both bills and going ahead and getting that done.
And Obama did say that the elements of the bill could not be pulled apart:
If you ask the American people about health care, one of the things that drives them crazy is insurance companies denying people coverage because of preexisting conditions. Well, it turns out that if you don't -- if you don't make sure that everybody has health insurance, then you can't eliminate insurance companies -- you can't stop insurance companies from discriminating against people because of preexisting conditions. Well, if you're going to give everybody health insurance, you've got to make sure it's affordable. So it turns out that a lot of these things are interconnected.
Now, I could have said, well, we'll just do what's safe. We'll just take on those things that are completely noncontroversial. The problem is the things that are noncontroversial end up being the things that don't solve the problemIt is clear in retrospect that Obama was planning from the start to re-present "the core elements of the bill" -- not to pare them down, but to convince the American people that they are indivisible.