Health care summit had some redeaming qualities

Going in, I was as cynical as everybody else about the Blair House health care forum. I was planning to watch for a half-hour and then write about something else.

But the event was more meaningful than that. Most of the credit goes to President Obama. The man really knows how to lead a discussion. He stuck to specifics and tried to rein in people who were flying off into generalities. He picked out the core point in any comment. He tried to keep things going in a coherent direction.

Moreover, he seemed to be trying to get a result. Republicans had their substantive criticism of the Democratic bills, but Obama kept pressing them for areas of agreement.

The second useful thing about the meeting was that it bypassed the congressional power structure. As usual, the quality of the comments got worse the closer you got to the party leadership. The Democratic Senate leader, Harry Reid, gave remarks that veered between the misleading and the incoherent. Statements from Nancy Pelosi, the House speaker, were partisan spin. The Republican leaders, Mitch McConnell and John Boehner, were smart enough to stand back and let Sen. Lamar Alexander of Tennessee lead the way, which he did genially and intelligently. While Alexander was speaking, Reid and Pelosi wouldn't even deign to look at him.

Once you got to the other members, about two-thirds of the statements were smart and well-informed. This was not a repeat of the Baltimore summit meeting, in which Obama dominated the room. This time, Obama was very good, but so were many others, like Mike Enzi, Jim Cooper, George Miller and Tom Coburn. If you thought Republicans were a bunch of naysayers who don't know or care about health care, then this was not the event for you. They more than held their own.


The third useful thing about Thursday's forum was you got to see the Obama presidency encapsulated in one event. At the very end, the president summarized some possible points of agreement between the two parties, offered some concessions and asked Republicans to see if they could make some on their own.

As always with the Obama compromise offers, this offer seemed to be both sincere and insincere. Embodying the core contradiction of the Obama presidency, the president seemed both to want to craft a new package and also to defend the strictly Democratic approach. I think he's a bipartisan man stuck in a partisan town, but maybe he's an iron partisan fist in a velvet postpartisan glove.

Fourth, you got to see how confident Republicans are. Obama's compromise offer is one the Republicans can happily refuse. In their eyes, he is saying: If you don't make some concessions now, I'm going to punch myself in the face. If you don't embrace parts of my bill, I will waste the next three months trying to push an unpopular measure through an ugly reconciliation process that will probably lead to failure anyway.

Fifth, you got to see at least one area of bipartisan agreement. Neither side was willing to be specific about how to cut costs and raise revenue. The Republicans continued to demagogue efforts to restrain Medicare spending. The Democrats (and the Republicans) conveniently neglected to mention the fact that they had just gutted the long-term revenue source for their entire package, the excise tax on high-cost insurance plans. That tax was diluted and postponed until 2018. There is no way that members of a Congress eight years from now are going to accede to a $1 trillion tax increase to pay for a measure the 2010 Congress wasn't brave enough to pay for itself.

Sixth, the summit meeting illuminated one of the core mysteries of this whole debate: Are the two parties so fundamentally divided that there will never be any agreement, or is there at least the theoretical possibility of a compromise approach?

Both parties see the same problem. The current system is a mess, with opaque prices and perverse incentives that mostly favor the insurance companies. But, as Yuval Levin has pointed out in National Review, the Democrats believe the answer is to create a highly regulated insurance system with inefficiencies eliminated through rational rules. The Republicans believe that the answer is to create a genuine market with clear price signals, empowered consumers and an evolving process.

Philosophically, it is hard to bring these two sides together. And there were times on Thursday when compromise seemed hopeless. But there were other times, when participants started talking nuts and bolts of the exchanges, when there was overlap: How to create interstate insurance markets without a race to the bottom; how to end insurance company power over those with pre-existing conditions.

Health care reform will probably not get passed this year. But there were moments, at the most wonky and specific, when the two sides echoed each other. Glimmers of hope for the next set of reformers.

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