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This Is How the Healthcare Overhaul Ends

Tuesday, February 9, 2010

The Blair House meeting will effectively end the healthcare reform debate for this year. Here’s why.

Washington observers are atwitter with the news that President Obama is holding a healthcare overhaul meeting on February 25 at Blair House. Not only will this be televised but Republicans will, for once, be invited. No one would believe that this is the beginning of bipartisanship on this highly political issue, but it is the first sign that Obama is serious about major health legislation since Scott Brown won “Kennedy’s seat” in the Senate. Or is it?

In his State of the Union address, the president said if someone has a better idea than the health bills in Congress, he would like to hear from them. His January 29 meeting with Republicans in Baltimore opened the door a crack, but the discussion touched only briefly on healthcare reform. The Blair House meeting at the end of this month will be the first—and probably only—chance for serious dialog between Republicans and the president on healthcare.

By insisting on the Democrats’ legislative framework, the president has shown that he is not ready to consider more modest policy goals or a more incremental approach to reform.

This does not mean Obama is ready to negotiate. His starting position is not the stuff of compromise. By insisting on the Democrats’ legislative framework, the president has shown that he is not ready to consider more modest policy goals or a more incremental approach to reform.

The result is predictable. Republicans will focus on malpractice reform, competition in insurance markets, and preserving Medicare, long-time positions most recently advanced in proposals from Reps. John Boehner, David Price, and Paul Ryan. Democrats will focus on creating a new entitlement for health insurance, regulating insurer behavior, and expanding Medicaid. The two sides will, once again, talk past each other.

Some strategists think that the Blair House meeting will open the door for Democrats to use the reconciliation process to get reform passed. This is legislative brute force, and it will not work. Given the sharp policy differences between the Senate and the House, it is far from clear that House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid can pull off this legislative maneuver. Moreover, the public would see through this strategy. Health reform passed with a bare majority of the Senate is doomed, no matter how much the legislation is “explained” later on.

The two sides will, once again, talk past each other.

If Democrats truly wish to advance health legislation, they will have to try a new approach at Blair House. Democrats could gain public approval and get the attention of Republicans if they started from a less polarizing set of proposals rather than a 2,000-page bill. But that would require liberal and moderate Democrats to compromise with themselves first. They have not been able to do that for the past year, and there is no reason to think they can do it now.

The Blair House meeting will effectively end the health reform debate for this year. The president will be able to say he tried to reach out, but Republicans would not engage. Republicans will be able to say that Democrats would not budge from a position that the public has rejected. We'll see in November which argument is more persuasive to voters—but the outcome of the election will depend much more on jobs and the economy, not the failure to pass a big healthcare bill.

Joseph Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute.

FURTHER READING: Antos describes "Rethinking Health Reform" and decries "The Troublesome Direction of Health Reform." In "The Uninsured: It Will Get Worse Before It Gets Better," Antos and Stephen Parente consider whether more uninsured would gain coverage under Obamacare. The 2010 "Obama Budget Rigs Healthcare Numbers," writes AEI's Andrew Biggs. And Michael Barone explains how one state's vote changed the national healthcare debate in "Massachusetts: 'the Educated Class' versus the People."

Image by Darren Wamboldt/Bergman Group.

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