Takeaway from the Summit

For weeks leading up to the president’s health care summit yesterday, the media tossed around phrases like ‘kabuki dance,’ ‘dog-and-pony show,’ and ‘political theater.’ As February 25 approached, anticipation focused on ‘changing the game,’ ‘finding common ground,’ ‘taking a stab at bipartisanship.’ Will the summit reveal the new ideas that the president asked for? Will the GOP show up? What do the Dems have to lose? And the Republicans? Katie Couric wondered whether the “much-anticipated summit at the White House” would save health reform. Last week I appeared on a radio show where the other guests and host were consumed with the gambles the Democrats and Republicans were taking—and who would win or lose.

In the pre-summit build up, though, there was little discussion of what the public has to win or lose if reform fails. But then, there has been little of that all along. The run-up was all about the process, with some stories even reporting on the initial indecision about the shape of the conference table. (For us of a certain generation, that recalled the Viet Nam peace process: There, too, the combatants argued over the shape of the table before serious talks could begin.)

Some of the press coverage after the summit similarly stressed the process. Witness the chatter about reconciliation. The media zoomed in on the clashes at the summit without digging too deeply. The headlines, though, seemed to agree on the outcome. Politico said there was “No clear winner in seven-hour gabfest.” The New York Times headline noted: “Health Meeting Fails to Bridge Partisan Rift.” An early Washington Post story yesterday proclaimed: “Little sign of common ground at health-care summit.”

That indeed was the bottom line. But there was more to the summit if you paid close attention. While it offered ordinary folks listening at home a chance to see both sides go at each other, albeit sort of politely, the summit revealed the deep fissures in this country over social policy—fissures that have persisted for decades.

There is still no consensus on whether the 30 million or even the 45 million uninsured should receive health care or get the ticket to pay for it through the health insurance system. Or whether care should be rationed to this group as it already is. That was the point of the anecdotes the attendees used to pepper their remarks throughout the day. Tedious as they were, they illustrated the genuine hardship families suffer from not being able to get medical care. The Wall Street Journal made light of the anecdotes in a piece called “Talks Suffer An Outbreak of Anecdotes,” taking note of the juicier ones—like the constituent in the district of New York Democrat Louise Slaughter who couldn’t afford dentures and used her dead sister’s instead.

House Republican whip Eric Cantor showed the lack of consensus pretty clearly when he said that mandating that everyone has insurance—and laying benefit mandates on top—is something “this government can’t afford.” In effect, he was saying that the U.S. could not afford to provide health care for all its citizens. Iowa senator Charles Grassley underscored that argument when he pooh-poohed giving more people access to care by expanding Medicaid. Grassley said it was intellectually dishonest to expand Medicaid when there were no doctors to treat the new recipients. Was he saying they don’t deserve care because no one wants to treat them?

Illinois Republican Peter Roskam came right out and said that “the foundation for expansion is Medicaid” and that Medicaid is “flawed,” adding that “we can do much better.” He didn’t offer a substantive solution, however, other than starting over.

The president got the message when he asked the assembled whether there were any areas of agreement on coverage beyond what was in the bill sponsored by Ohio representative John Boehner—which calls for additional coverage for only three million people. Later Obama shot back that he did not get an answer. In his summation, the president admitted: “I don’t know frankly if we can close that gap.” In other words, there is still no consensus that everyone should have coverage. We still have not embraced the notion that in America health care is a right, rather than a privilege.

Same story with equity. Should everyone, young or old, be entitled to a minimum set of benefits? There was a lot of back and forth centering on a standardized set of benefits for policies offered in the Exchange, the proposed shopping service to help people select policies. Cantor couched standardized benefits in terms of fear of government. Does fear of government trump the security that minimum health benefits offer families? That, too, remains unresolved.

John McCain got at the equity issue in another way when he complained that 800,000 Medicare beneficiaries in Florida were protected against cuts in Medicare Advantage plans that could affect the benefits they receive or the amount they pay for them. McCain objected and framed the problem in terms of backroom politics: beneficiaries in Arizona, he said, couldn’t get the same deal. If he had negotiated such an arrangement for his people back home, what about equity for Florida beneficiaries? Equity in health care, it seems, depends on who is writing the rules rather than on some fundamental principle about equity in health care.

Regulation—how much and for whose benefit—was another biggie threaded throughout the summit. At this point, a goal of reform has become insurance regulation, and that came through loud and clear yesterday. It came up in the discussion of allowing carriers to sell policies across state lines—something companies would like to do. But the fear is carriers will license their policies in states with weak regulations and sell them in states with strong ones. Consumers in those states could lose those protections since the rules in weak states would prevail. Obama likened the problem to that of banks moving to states with high interest-rate limits for their credit cards, the phenomenon that has caused consumers so many headaches of late.

Regulation also came up in the context of the lengthy discussion of malpractice. Republicans generally want to limit the right of consumers harmed by medical errors to sue and cap the amount of damages they can recover. Democrats generally do not. In this case, the regulation seems to benefit doctors and hospitals.

The president indicated there might be some meeting of the minds on these two regulatory issues. But their outcome remains an unsettled matter as health reform moves to a new stage—another underreported takeaway from the summit.

Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.