washingtonpost.com
Health Crossroads

By Howard Kurtz
Washington Post Staff Writer
Tuesday, July 21, 2009 9:44 AM

When President Obama was having all those health-care interest groups to the White House to promise cost-cutting, join hands and sing kumbaya, I was, to put it mildly, skeptical.

Having lived through the Hillarycare battle more than a decade ago, I knew that general principles sound great until you get down to crunching the numbers on who has to give up what.

And even though the administration has done a good job in, at the very least, neutralizing opposition from doctors and hospitals, it's still asking members of Congress to impose substantial pain, which politicians hate to do.

The trillion or so dollars to cover a major chunk of the uninsured has to come from somewhere. Some would be squeezed through lower Medicare and Medicaid payments from docs, hospitals and drugmakers, and they have political clout. The rest would either be drained by a surtax on the wealthy or taxing the most generous employer-provided benefits -- both of which are making many Democrats nervous.

Add to that the controversy over Obama's preferred "public option," which can easily be caricatured as government-run health care, and a general unease about rising federal spending, and you've got a prescription for gridlock.

I'm not suggesting Obama will fall short. If Democrats are convinced that his presidency will be crippled by a failure on health care, which grievously wounded Bill Clinton in his first term, they may ram something through. But it's a monstrously hard problem, in part because while people believe the system is broken, they are generally satisfied with their own health care.

The president's response is to mount another media blitz, which includes Jim Lehrer yesterday, this morning's "Today" interview with Meredith Vieira, tonight's Katie Couric sitdown and tomorrow night's prime-time presser. (Vieira pushed him on the timing, cost and political import, with Obama saying, It's not about me. I already have health care.)

The president even did a call yesterday with liberal bloggers, including those from MyDD and Crooks and Liars, saying: "I know the blogs are best at debunking myths that can slip through a lot of the traditional media outlets. And that is why you are going to play such an important role in our success in the weeks to come."

Talk about pulling out the stops.

The sense that Obama is on the defensive was deepened by the WP/ABC poll finding that "since April, approval of Obama's handling of health care has dropped from 57 percent to 49 percent, with disapproval rising from 29 percent to 44 percent. Obama still maintains a large advantage over congressional Republicans in terms of public trust on the issue, even as the GOP has closed the gap." His overall approval rating, though, is still a healthy 59 percent.

But Obama had the sound bite of the day, repeating the words of Jim DeMint: "Just the other day, one Republican senator said -- and I'm quoting him now -- 'If we're able to stop Obama on this, it will be his Waterloo. It will break him.' Think about that. This isn't about me. This isn't about politics. This is about a health-care system that is breaking America's families, breaking America's businesses, and breaking America's economy." It's never particularly smart for the opposition to read the stage directions.

In the New Republic, Jonathan Cohn says the president will have to draw blood to make this work:

"Reform's momentum seems to have slowed, if not stalled. And it's not going to speed up again unless the Democrats do something they haven't done in a long time: Show some mettle and embrace some unpleasant positions. Some of them seem ready to do it. But others, particularly some of the party's more conservative members, don't . . .

"The second key issue is how to make health care less expensive over the long run. This is what the administration famously calls 'bending the curve.' Experts have come up with a wide variety of ideas for accomplishing this--everything from better information technology to rewarding hospitals that are the safest and most efficient. But the evidence that these efforts will yield savings isn't exactly ironclad. At least not yet.

"In the absence of such evidence, the CBO -- whose judgment on this matter most of Washington seems to be following, at least for the moment -- has indicated government must choose from a more limited set of alternatives: imposing some sort of automatic budget limit on health care, reducing congressional oversight over Medicare payment policies, or capping the income tax exclusion for group health benefits (so that there's less incentive to buy generous insurance). Again, these can work in isolation or together.

"None of these decisions would be particularly easy. One way or another, they involve taking money out of somebody's pockets. And while the direct impact on the finances of most middle class families would be modest, or in some cases non-existant, they'd all give political ammunition to critics--who will say that Democrats are either 'raising taxes,' 'rationing health care,' or some combination of the two.

"But if none of these moves seem particularly pleasant, they are nevertheless necessary."

Cohn may underestimate the difficulty of raising taxes on the affluent, especially since the added sting of losing their Bush tax cuts could push the top rate to an onerous 47 percent.

Hot Air's Ed Morrissey questions the president's media strategy in the wake of the Post poll:

"Obama will hold another prime-time press conference on Wednesday to try to sell ObamaCare to the nation. These numbers show why he's going back to the well, but they also show that he's rapidly losing credibility. More jawing at the cameras may not help much."

Weekly Standard Editor Bill Kristol, who as a GOP strategist helped torpedo the Clinton health plan, is reprising his Dr. No role:

"With Obamacare on the ropes, there will be a temptation for opponents to let up on their criticism, and to try to appear constructive, or at least responsible. There will be a tendency to want to let the Democrats' plans sink of their own weight, to emphasize that the critics have been pushing sound reform ideas all along and suggest it's not too late for a bipartisan compromise over the next couple of weeks or months.

"My advice, for what it's worth: Resist the temptation. This is no time to pull punches. Go for the kill."

That post really seems to tick off the Washington Monthly's Steve Benen:

"This isn't the identical message from '93. Then, in a private memo, Kristol made no effort to hide his motivations -- Republicans, for their own good, had to put the party's interests above the country's. The GOP had to stop the Democratic reform campaign because it was a Democratic reform campaign.

"Today's message, in a public post instead of a private memo, is at least framed in a less callous way. Kristol ostensibly believes the Democratic proposal(s) are wrong, and believes once the current reform efforts are destroyed, then the political world can rally behind a Republican-style reform package that protects insurance companies and protects the very wealthy from an additional tax burden.

"I can hardly wait. Kristol concluded, 'We have plenty of time to work next year on sensible and targeted health reform in a bipartisan way.'

"Spare me. Bill Kristol is suddenly concerned with 'bipartisan' solutions to health care? For crying out loud, does Kristol actually expect people to take this seriously?"

But Kristol is back with this piece, attacking Ted Kennedy's Newsweek cover:

"Sen. Kennedy has weighed in, and he may have helped doom Obamacare.

"For Kennedy and his co-author, Bob Shrum, have let the rationing cat out of the bag. And that's a problem for President Obama and the Democrats. Make no mistake: Beyond all the other crippling problems with the Democrats' health care proposal--its cost at a time of massive deficits, the tax increases it requires at a time of recession, its preference for government over the private sector and for central planning over free competition--the deepest vulnerability of Obamacare is that it (intentionally) puts us on a course towards government rationing of health care."

That's a nice debating point, but anyone who has dealt with insurance companies knows that we already have a form of rationing in this country.

Kristol's Standard colleague, Fred Barnes, takes to the WSJ to argue that Obama is floundering:

"He made a rookie mistake early on. He let congressional Democrats draft the bills. They're as partisan as any group that has ever controlled Congress, and as impatient. They have little interest in the compromises needed to attract Republican support. As a consequence, what they passed -- especially the $787 billion stimulus -- belongs to Democrats alone. They own the stimulus outright . . .

"The political fallout that mattered most, however, has been among Democrats in the House who will face tough re-election fights next year. They're in a state of near-panic over the lingering recession. Their confidence in Mr. Obama is fading, and they no longer believe in quickly passing the president's agenda. Cap and trade has been put off until the fall and health-care reform is starting to stall.

"For Mr. Obama, this is all a potentially disastrous turn of events. On Capitol Hill, delay favors the opposition and tends to lead to defeat. The longer a bill sits around, the more its contents are dissected and the less likely it is to pass. Mr. Obama realizes this fact, which is why he is pressing for a quick vote on his health-care reform."

Barnes is right on that point, but I think it's fairly clear that the Republican Party had no interest in cooperating on a stimulus measure that wasn't mainly tax cuts.

There's one phrase in the health care debate that sets liberal hearts aflutter, and the Nation's John Nichols is mildly encouraged about that:

"Those of us who know that the only real cure for what ails the U.S. health care system is a universal public plan that provides health care for all Americans while controlling costs recognize the frustrating reality that there are many economic and political barriers to the federal action that would create a single-payer system. This makes clearing the way experimentation at the state level all the more important.

"And, remarkably, the forces of real reform have won a congressional victory on that front, a victory that ought not be underestimated. By a 25-19 vote, the House Committee on Education and Labor on Friday approved an amendment to the House's health-care reform bill allowing states to create single-payer health care systems if they so choose."

In arguing that the country's health care system has become "wildly unfair and expensive," Slate Editor Jake Weisberg cites research by a former Washington Post reporter:

"In his new book 'The Healing of America,' the journalist T.R. Reid employs a clever device for surveying the world's health systems: He takes an old shoulder injury to doctors in various countries. In the United States, a top orthopedist recommends a major joint-replacement operation, costing tens of thousands of dollars. In France and Germany, general practitioners offer him the same surgical option, at little or no cost, but steer him instead toward a regimen of physical therapy. In Britain, the doctor is unimpressed with his injury and tells him to go home. In Canada, he is offered a place in line, where he will wait a year just to consult a specialist. In India, he is sent to an ayurvedic clinic, where he is treated, quite effectively, with herbs, massage, and meditation."

At Politics Daily, Bob Franken wonders whether Washington will simply declare victory and get out:

"By the time our leaders cobble something together, the process of compromise will have created reform that really isn't. The pressure to do anything else will have run out of steam.

"Our leaders will leave us with something that is inadequate, at best, and possibly worse than before.

"Then, in their zeal to declare success and placate voters, they will trumpet a glossy success and gloss over the mind-numbing details that will really add up to failure."

By which time much of the press will have lost interest and moved on.

Entering While Black

This incident, as described by the Boston Globe , borders on the unbelievable:

"His front door refused to budge, which is why Harvard professor Henry Louis Gates Jr., just home from a trip to China filming a PBS documentary, set his luggage down and beckoned his driver for help.

"The scene -- two black men on the porch of a stately home on a tree-lined Cambridge street in the middle of the day -- triggered events that were at turns dramatic and bizarre, a confrontation between one of the nation's foremost African-American scholars and a police sergeant responding to a call that someone was breaking into the house.

"It ended when Gates, 58, was arrested on charges of disorderly conduct in allegedly shouting at the officer; he was eventually taken away in handcuffs.

"But the encounter is anything but over. Some of Gates's outraged colleagues said the run-in proves that even in a liberal enclave like Harvard Square, even with someone of Gates's accomplishments, a black man is a suspect before he is a resident."

The confrontation persisted even after Gates showed an ID proving that he was at his own home.

Conservatism for Sale?

Last week's revelation about the American Conservative Union was a real eye-opener, but New Majority's David Frum says the situation is nothing new:

"When David Keene and the American Conservative Union attempted to extract $2 million or more from FedEx to run an activist campaign on FedEx's behalf -- and then punitively switched sides after FedEx refused to pay -- the package carrier did a remarkable thing: It went public.

"FedEx or somebody acting on its behalf handed over ACU's funding request letter to Mike Allen at Politico, and the subsequent story has triggered a blogospheric frenzy: Almost 300 posts as of 11 am.

"Every post that I have read - at least those written by conservative bloggers - has reacted with shock, shock, shock. Who had ever heard before that the ACU's support might be available for purchase or lease?

"Maybe I am getting cynical here, but I recommend the following exercise: Google 'American Conservative Union' + Microsoft and see what happens. Or 'American Conservative Union' and AT&T . . .

"The point is this: The, shall we say, 'accessibility' of ACU's policy positions has been a notorious fact of Washington life for many years."

I wonder how many other advocacy groups are carrying water for their financial backers.

That's A Lot of Pork

Drudge: "Recovery.gov//Awarded: $1,191,200 for '2 Pound Frozen Ham Sliced.' "

USDA: "The references to '2 pound frozen ham sliced' are to the sizes of the packaging. Press reports suggesting that the Recovery Act spent $1.191 million to buy '2 pounds of ham' are wrong. In fact, the contract in question purchased 760,000 pounds of ham for $1.191m, at a cost of approximately $1.50 per pound."

Untold Moon Story

NBC's Jay Barbree reveals why NASA put a four-hour rest period on the schedule after the Eagle landed in 1969. Neil Armstrong admitted it was a media maneuver in case there were delays: "For several hours you reporters would have been speculating, guessing about possible problems, and we didn't want one of you inventing stories. That's why we put in a four-hour sleep and rest period we hoped we would never use."

View all comments that have been posted about this article.

© 2009 The Washington Post Company