A viewer's guide to the health-care summit

Thursday, February 25, 2010; A21

Some of us will be watching Thursday's summit because six hours of televised health-care reform wonkery sounds like a little slice of heaven. But we're a rare breed. For everyone else, here's what to watch for.

Is the summit about the problem or the policy? Republicans have made a strategic decision to counter President Obama's ambitious health-care reform package with incremental proposals. They believe that voters are unsettled by the size of the undertaking. The vulnerability of the approach is that GOP proposals don't make much of a dent in the problem: They neither insure many people nor save much money.

Democrats are going to try to define success in terms of concrete metrics: Their proposals insure more than 30 million people and cut hundreds of billions from the deficit. Republicans are going to try to focus on the pieces of Obama's plan that make voters uncomfortable -- its page length, for one thing. Whoever sets the terms of the debate will have an advantage during the summit.

What are Democrats open to including in their bill? Many observers expect Obama to signal a willingness to include at least a couple of GOP policies in his plan. A more aggressive tort-reform proposal, a larger role for health savings accounts and an easier path to selling insurance across state lines are the most obvious candidates. That will leave Republicans in the odd position of opposing a bill that includes their core ideas.

Republicans are planning for this, of course, and may well head it off by proposing a deal that Democrats have to refuse. One possibility would be demanding that Democrats remove all Medicare reforms from the bill, which would rob the legislation of needed revenue. If your opponent is trying to offer a deal you can't publicly refuse, you need to begin by extending an offer he can't possibly accept.

Is there a reconciliation over reconciliation? The most consequential fight of the day will be over the most boring item on the agenda: the budget reconciliation process. Created in the '70s, reconciliation is immune to the filibuster, designed to reduce the deficit, and an increasingly common element of legislative life: Ronald Reagan used it for taxes, Bill Clinton used it to reform welfare, George W. Bush ran his tax cuts through it, and Democrats want to finish health care within its warm, majoritarian confines.

Republicans are trying to define this as an abuse of power. Democrats have a different term: a majority vote. Republicans will spend much of the summit demanding that Democrats forswear reconciliation as a sign of good faith. Democrats will spend much of the summit refusing to do so unless the GOP agrees to give their bill an up-or-down vote.

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