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Obama on health care: Flight or fight?

By Eugene Robinson
Friday, January 22, 2010; A21

If President Obama has decided to give up on health-care reform, he should just come out and say so. Then we could all get on with our lives -- those of us with health insurance, that is. But I don't see how his talk about some sort of slimmed-down package, reduced to its "core elements," could possibly inspire Democrats in Congress to do anything but run for the hills.

Republican Scott Brown's victory Tuesday in Massachusetts, grabbing the Senate seat that was held for decades by the late Ted Kennedy, left Democrats rattled. Actually, frantic would be a better word. Thus far, Obama has said nothing that would help calm the waters -- or help the party get out of what now can officially be called the Health Care Mess. If anything, Obama is making it messier.

In an interview Wednesday with ABC's George Stephanopoulos, Obama said this about health care: "I would advise that we try to move quickly to coalesce around those elements of the package that people agree on." He said that we have to keep insurance companies from "taking advantage of people," that we have to contain costs, and that we have to give small businesses help to provide health insurance to their employees.

That's all well and good. But there is already a measure on the table that would do these things -- the bill passed on Christmas Eve by the Senate. Now that the Democrats no longer have a filibuster-proof majority, it is all but inconceivable that the Senate could produce a new bill with all those elements. And it's not possible to do health-care reform a la carte.

One thing that "people agree on" is prohibiting the insurance companies from denying coverage on the basis of preexisting conditions. But doing that in isolation would cause insurance premiums to skyrocket. To make it work, you need a mandate that forces everyone -- including millions of young, healthy people -- to buy insurance, thus effectively subsidizing the older, sicker people whom the insurance companies would be forced to cover. But if you make low-income and moderate-income people buy health insurance, you have to give them financial assistance because otherwise they can't afford it.

Later in the interview, Obama acknowledged this chain of "interconnected" imperatives that any workable health-reform package would have to accommodate. And why shouldn't the House just pass the Senate bill?

"I think it is very important for the House to make its determinations," Obama said. "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."

Would a full-court press by the president have been able to cajole or coerce the House into passing a reform bill that many in the Democratic caucus consider insufficiently progressive? It looks as if we'll never know. On Thursday, Speaker Nancy Pelosi flatly declared that for now, at least, she cannot find the 218 votes needed to pass the Senate bill.

"I'm not going to get into the legislative strategy," Obama said in the ABC interview. That has been the White House approach all along, and it managed to bring meaningful health-care reform legislation closer to final passage than ever before. But close doesn't count: Reform didn't make it across the finish line.

Yet.

Pay no attention to the Cheshire Cat claims by Republicans that they'd love to cooperate on a bipartisan reform bill. Sen. John McCain, (R-Ariz.) has already ruled out modifying the current bill, insisting that the Senate has to start the process from scratch. There remains another way, and House Majority Whip Jim Clyburn (D-S.C.) mentioned it Thursday: Pass a reasonable reform package using the parliamentary tactic known as budget reconciliation, which would require only a simple majority of 51 to get through the Senate rather than a supermajority of 60.

The problem with budget reconciliation is that it would require considerable intestinal fortitude on the part of nervous Democratic senators following the Massachusetts result, even though it left them with an 18-vote majority. I don't know if that courage can be summoned. I'm certain that it won't be if the message from President Obama is: "Whatever."

The president can surrender and blame Republicans for killing health-care reform yet again, or he can fight tooth and nail on behalf of the 46 million Americans who remain uninsured. But he has to do one or the other. He can't do both.

eugenerobinson@washpost.com

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