Summit fails to bridge partisan gaps on health reform

Friday, February 26, 2010

THURSDAY'S HEALTH-CARE summit proceeded from a flawed premise: that both sides want many of the same changes in health reform and could find a way to bridge their differences if only they could put politics aside. Early in the conversation, though, it became clear that even if the bipartisan fairy could wave her wand and make all the posturing disappear, the gaps would not be bridged. The two sides have fundamentally different goals for health reform and therefore fundamentally different visions of what legislation should contain.

Democrats want a far-reaching measure that extends coverage to tens of millions of Americans currently without insurance and that imposes stringent new requirements on insurers. Republicans put little emphasis on expanding coverage but would like to increase competition; access will increase, they argue, as costs go down. They oppose new mandates and broad regulation.

Both sides have been expressing these views for months, so it was no surprise to hear them again Thursday. But the Blair House forum made the chasm all the more apparent. Even more apparent was that, at this point in the debate, neither side is willing to accept half a loaf -- or even three-fourths of one. The president chose before the summit not to back away from the basic framework of the bills that passed the House and Senate. Republicans are less interested in seeing Democrats add Republican ideas than they are in having Democrats subtract Democratic ideas.

There is, as Mr. Obama said Thursday, "legitimate philosophical disagreement" between the two sides, and neither has a monopoly on the truth. Democrats are right to stress the moral imperative of expanding coverage but are not being honest enough about what that will cost. Republicans such as Rep. Paul D. Ryan (R-Wis.) had a point when they questioned whether promised savings will materialize. Likewise, Democrats are right about the interconnected nature of the health-care system and the consequent difficulty in achieving piecemeal change. But they may have erred in not giving enough credence to public anxiety about embarking on such a complicated and costly enterprise. When Tennessee Republican Sen. Lamar Alexander said that "we don't do comprehensive well," he struck a nerve.

The summit featured the usual dose of grandstanding and posturing from both sides. House Minority Whip Eric Cantor (R-Va.) had a copy of the Senate bill stacked in front of him. Mr. Obama had a disturbing tendency to dismiss arguments he disagreed with as stale "talking points." An unspoken purpose for both sides was to rally the faithful and the wavering -- for Democrats, to pass a bill without Republican help; for Republicans, to block that effort. We don't know which side, if either, "won" that battle; certainly, Americans who watched the session, or even snippets, came away with a better idea of the two party's differing visions.

Unfortunately, the session was less edifying on what it will take to pay for expanded access to health care or to contain rising health-care costs. Both parties acknowledged that those costs, if unchecked, could be calamitous -- for families, businesses, and state and federal budgets. But key elements of a solution aren't popular: taxing employer-provided health plans, for example, and denying coverage for treatments that don't work. So no one talked about those.

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