Bipartisan Health Care Summit: All Eyes on the GOP

It's showtime! At 10:00AM this morning, President Obama and his administration will kick off a bipartisan health care summit to persuade Americans that Republicans have insufficient ideas on health care reform, and to convince Democrats to vote on a bill.

Marc Ambinder's analysis sounds spot on. His major points are: (1) Democrats are trying to set a trap for Republicans; (2) Republicans know they're walking into a trap; (3) So expect a lot of off-topic platitudes about the role of government generally, because let's face it, statements like "Well yeah the CBO expects premiums to rise over the baseline of health inflation projections, but the administration proposes to offset these increases with generously scaled subsidies for low-income Americans" is not destined to be the leading sound bite on O'Reilly tonight.

Here's one thing I wanted to respond to. Marc writes:

It is hard to figure out why Republicans, whose plan largely addressed those with insurance, failed to address the need to expand coverage -- as least politically -- even though they know that it is the conflict between the policies one pursues to expand coverage that clash with the policies pursued to make sure people get to keep their insurance don't pay more.

I can think of a couple reasons why Republicans' plans don't expand insurance:

1) They're Republicans.

If Republicans wanted to expand the size of government to subsidize 50 million additional Americans' insurance by 2020, we wouldn't call them Republicans. We would call them "liberal Democrats." Since the beginning of the health care reform debate, analysts have regularly assumed that appropriately generous subsidies to help all low-income individuals have health insurance would come to about $1 trillion. That $1 trillion has to come from somewhere. Democrats have suggested surtaxes, excise taxes, payroll taxes, and Medicare cuts. Republicans have countered with no cuts ... except to taxes! It's impossible to pay for extending government subsidies by cutting revenue.

How would you expand coverage to the poor without significant government subsidies? I don't know that it's possible, but I suppose you'd propose significantly reform the system along the lines of the old McCain plan: begin to end the employer tax subsidy, give families tax credits, "restructure" the insurance market somehow and slip in a federal mandate to guarantee more people are insured. The problem with this plan is that...

2) Reforming the Health Care Industry is a Nightmare
The Mickey Kaus Theory of Health Care Debacle-ism is that the White House blindly followed its OMB director's advice to make health care reform about fiscal reform. The problem is -- as Marc alludes to above, and Mickey has pointed out relentlessly -- fiscal reform is tough and mostly unpopular. The administration says, "Let's bend the curve," and Americans respond, "Sounds like a plan!" Then the administration finishes its sentence "...with an excise tax and Medicare panels" and Americans finish their sentence with "...that we hate!"

Close to ninety percent of voters in 2008 had health insurance, and they like their health insurance, making them jittery about change. So it's not politically crazy for Republicans to counter-propose with minor reforms that "largely addressed those with insurance."

This health care debate has revealed a fascinating schism in the electorate. Americans want to extend coverage to the uninsured, hypothetically. But they don't want to pay for it. Not with higher taxes, not with Medicare cuts, not with disruptive changes to the health care system. That's what Republicans understand, and fortunately for them, it fits snuggly into their party narrative of opposing everything Obama does. The tragedy is that many honest analysts -- on both sides of the spectrum -- would agree that removing the employer insurance tax benefits, and beginning to fit a belt around Medicare, and beginning to disrupt our byzantine and bloated health care system with various fiscal and delivery system reforms are utterly necessary. So we're stuck with a plan that does the hypothetically popular thing well, and the utterly necessary thing not so well. There's as word for that, I suppose, and it sounds a lot like politics.