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quinta-feira, 25 de fevereiro de 2010

Blogging the Health Care Summit


February 25, 2010, 10:15 am

By DAVID M. HERSZENHORN



http://www.nytimes.com/

11:05 a.m. Go the Willie Sutton Way

Senator Tom Coburn, Republican of Oklahamo, is the first of several doctor-legislators in the room – all on the Republican side – to speak. And he’s making the case that Congress should focus first on attacking waste, fraud and abuse in the health care system and offering rewards for effective management of chronic diseases.

“What I would hope we would do is go back and concentrate on the areas that have the biggest pot of gold for us,” Mr. Coburn said. “We don’t incentivize prevention. We don’t pay rewards for great management of chronic disease. We have a system throughout the country where we are encouraging lawsuits that are productive for the country.”

“With one out of three dollars not helping everybody, we ought to go where it is,” Mr. Coburn said.

Debating the President

Mr. Alexander is challenging Mr. Obama saying the Congressional Budget Office has predicted that premiums in the individual market would rise as a result of the Democrats’ legislation.

“No no no,” Mr. Obama cut him off.

“The cost for families for the same type of coverage that they are currently receiving would go down 14 to 20 percent,” the president said.

Mr. Alexander is trying to jump back in and Mr. Obama is using the advantage of being president to hold the floor. There is no easy way to interrupt the president of the United States.

“We have tried to take every cost-containment idea that is out there,” Mr. Obama said. “Every health care proposal that economists say will reduce health care costs we have tried to adopt in the various proposals. There are some additional ideas that Republicans have presented and we think are interesting and we have also tried to include.”

Mr. Obama is challenging Republicans to discuss those ideas, and talk about how they might be included in the legislation.
10:51 a.m. Reid Jabs a Little

The Senate majority leader, Harry Reid, sought to take on Senator Alexander in his opening remarks, repeatedly telling Mr. Alexander, “You are entitled to your own opinions, but not your own facts.”

But Mr. Reid seemed to push the bounds of credibility himself when he suggested that Democrats have not been talking about budget reconciliation – the parliamentary maneuver that Democrats are indeed contemplating as a way to move the final health care legislation through the Senate without getting blocked by a Republican filibuster.

Mr. Reid seemed to try to qualify his point, saying that Democrats have not discussed reconciliation as the “only way” — but the cameras quickly caught Mr. Alexander with a deeply skeptical look on his face.

President Obama is now addressing Mr. Alexander’s criticism, saying obviously they disagree but noting that he heard a number of areas of common ground in terms of broad goals. And he is now introducing the first of four substantive chapters in the forum, focusing on cost control.
10:40 a.m. Reconciliation Rebuff

Senator Alexander is urging Mr. Obama and Democratic Congressional leaders to renounce the parliamentary maneuver called “budget reconciliation” that Democrats are eying as a way to move the final changes to the health care legislation through the Senate without being stopped by a Republican filibuster.

Calling it “a suggestion and a request about how to make this a bipartisan and truly productive session,” Mr. Alexander challenged Mr. Obama and the Democrats “to renounce jamming it through in a partisan way.”

Otherwise, Mr. Alexander said, borrowing a favorite line of Mr. McConnell, “The only thing bipartisan will be the opposition to the bill.”
10:35 a.m. Plan B?

From the White House pool report, as President Obama and Vice President Joseph R. Biden walked from the White House to Blair House where the meeting is taking place, a reporter shouted out to Mr. Obama, does he have a Plan B if this session doesn’t produce results? Mr. Obama kept walking, but said, “I always have plans.”
10:32 a.m. The Republicans’ Turn

The Senate Republican leader, Mitch McConnell of Kentucky, has just announced that he chose Senator Lamar Alexander of Tennessee, to give the Republican opening statement. It is an interesting choice. Mr. Alexander is a former governor and one of the more studious members of the Senate, though he has sharpened his political rhetoric since joining the leadership as chairman of the Senate Republican conference.

Mr. Alexander is describing the summit as a visit to the Detroit auto show, where car manufacturers roll out a new model but customers end up unimpressed. “That’s the same model we saw last year, and we didn’t like,” Mr. Alexander said.

He urged Mr. Obama and the Democrats to scratch all of their proposals and start over. “As they say in Detroit,” Mr. Alexander added, “We think we have a better idea.”

Mr. Alexander is warning that the Democrats’ plan includes too many tax increases and spending cuts on Medicare.

He also criticized a proposed expansion of Medicaid, the federal-state insurance program for low-income Americans. “It dumps 15 million to 20 million Americans into a Medicaid program” he said, noting that many doctors refuse to take new Medicaid patients because the payment rates are too low.

“It’s like giving someone a ticket to a bus line where the buses only run half the time,” he said.

Mr. Alexander is also making clear that Republicans will not offer a comprehensive alternative to Mr. Obama’s plan and do not intend to propose legislation that would cover more than 30 million people, as the Democrats’ plan is projected to do.

“If you are waiting for Mitch McConnell to roll in a wheelbarrow here with a 2,700 page comprehensive bill, it’s not going to happen,” he said.

Mr. Alexander also continued his automobile metaphor. “This is a car that can’t be recalled and fixed and we ought to start over,” he said of the Democrats’ plan.
10:23 a.m. Common Ground

Mr. Obama, as expected, is also stressing the many areas of common ground that exist in various health care proposals that Democrats and Republicans have brought forward over the years – which is true, though the current differences between the parties’ positions are huge.

“When I look at the ideas that are out there, there is overlap,” Mr. Obama said. “It’s not perfect overlap. It’s not 100 percent overlap. But there’s overlap.”

He also talked briefly about his own plan unveiled on Monday, saying the White House posted what it thinks is the best blend of the House and the Senate legislation that has already passed. “The basic concept is that we would set up an exchange, meaning a place where individuals and small businesses could go and get choice and competition for private health care plans, the same way that members of Congress get choice and competition for their health care plans,” he said. “For people who couldn’t afford it, we would provide some subsidies. But because the pool is larger, the costs we would be smaller, because they would be in a position to negotiate.”

And as he closed his opening remarks, Mr. Obama allowed for the possibility that at the end of the day the two sides would still be far apart. “I don’t know that those gaps can be bridged, and it may be at the end of the day, we come out of here and say, ‘Well, we have some honest differences.’ ”


Obama Opens the Talks

The health care summit is under way, and President Obama is framing his remarks in the context of economic recovery and the challenges that health care costs pose for individuals, families, small businesses and the federal government.

He has also shared some personal insights, recalling times when he sat in the emergency room to get treatment for family members, including his daughter, Sasha, who had meningitis as a baby. “I remember thinking while sitting in the emergency room, what would have happened if I didn’t have reliable health care,” the president asked.

Dealing with Congress can often make people feel like they are walking in circles and that’s how Mr. Obama began the morning, walking in a big square actually around the conference table to shake hands with all the participants.

But then he told everyone to have a seat, and there was a chuckle in the room as Vice President Joseph R. Biden Jr. seemed to stumble to his chair next to the president.

Mr. Obama said it was crucial for the country to begin confronting long-term challenges.

“This is an issue that is affecting everybody,” Mr. Obama said. “It’s affecting not only those without insurance but it is effecting those with insurance

When you talk to every single expert, and when you talk to ordinary people and to businesses, everybody understands the problem is not getting better, it’s getting worse.”

Earlier this morning, we framed the debate and outlined what to expect and to watch for during today’s health care summit. We’ll be updating events in this post as the meeting gets under way, so stayed tuned.

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