Post by Queen of the Damned on Jun 6, 2009 19:55:01 GMT -5
Advisers say president determined to make sure final bill bears his stamp
By SHERYL GAY STOLBERG
The New York Times
updated 6:15 p.m. ET, Sat., June 6, 2009
WASHINGTON - After months of insisting he would leave the details to Congress, President Obama has concluded that he must exert greater control over the health care debate and is preparing an intense push for legislation that will include speeches, town-hall-style meetings and much deeper engagement with lawmakers, senior White House officials say.
Mindful of the failures of former President Bill Clinton, whose intricate proposal for universal care collapsed on Capitol Hill 15 years ago, Mr. Obama until now had charted a different course, setting forth broad principles and concentrating on bringing disparate factions — doctors, insurers, hospitals, pharmaceutical companies, labor unions — to the negotiating table.
But Mr. Obama has grown concerned that he is losing the debate over certain policy prescriptions he favors, like a government-run insurance plan to compete with the private sector, said one Democrat familiar with his thinking. With Congress beginning a burst of work on the measure, top advisers say, the president is determined to make certain the final bill bears his stamp.
“Ultimately, as happened with the recovery act, it will become President Obama’s plan,“ the White House budget director, Peter R. Orszag, said in an interview. “I think you will see that evolution occurring over the next few weeks. We will be weighing in more definitively, and you will see him out there.”
'Historic down payment'
On Saturday, while Mr. Obama was traveling in Europe, he used his weekly radio and Internet address to make the case that “the status quo is broken” and to set forth his ambitious goals.
Broadly speaking, he wants to extend coverage to the 45 million uninsured while lowering costs, improving quality and preserving consumer choice. His budget includes what he called a “historic down payment” of $634 billion over 10 years, accomplished mostly by slowing Medicare growth and limiting tax breaks for those with high incomes.
“We must attack the root causes of skyrocketing health costs,” Mr. Obama said, pointing to the Mayo Clinic in Minnesota and other institutions as among those that offer high-quality care at low cost. “We should learn from their successes and promote the best practices, not the most expensive ones. That’s how we’ll achieve reform that fixes what doesn’t work and builds on what does.”
The radio address was the start of a public relations campaign coinciding with a 50-state grass-roots effort that Organizing for America, the president’s political group, began Saturday to promote a health care overhaul. His hope is to provide what his chief of staff, Rahm Emanuel, called “air cover” for lawmakers to adopt his priorities. It is a gamble by the White House that Mr. Obama can translate his approval ratings into legislative action.
“Obviously,” Mr. Emanuel said, “the president’s adoption of something makes it easier to vote for, because he’s — let’s be honest — popular, and the public trusts him.”
'Stone tablets'
But as Mr. Obama wades into the details of the legislative debate — a process that began last week when he released a letter staking out certain specific policy positions for the first time — he will face increasingly difficult choices and risks.
Aides say he will not dictate the fine print. “It was never his intent to come to Congress with stone tablets,“ said his senior adviser, David Axelrod. But he will increasingly make his preferences known.
If he embraces a tax on employee benefits, an idea he attacked when he was running for president, he may infuriate labor and the middle class. If he insists on a big-government plan in the image of Medicare, he could lose any hope of Republican support and ignite an insurance industry backlash. If he does not come up with credible ways to pay for his plan, which by some estimates could cost more than $1 trillion over 10 years, moderate Democrats could balk.
Many Republicans are already angry over the emphasis Mr. Obama placed on the public plan in last week’s letter. Senator Mitch McConnell, the Republican leader, said Friday that “the key to a bipartisan bill is not to have a government plan in the bill.”
Mr. Obama is well aware of these risks, advisers say. “This is what he is now very focused on,“ Mr. Orszag said. “What are the key things that are nonnegotiable? He is asking those sorts of questions: What are the drop-dead things that we need to have in order to have some hope of addressing long-term cost growth?”
Pledge of bipartisanship
Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee, recalled how Mr. Obama made a personal pledge of bipartisanship when he and Senator Max Baucus of Montana, the committee’s Democratic chairman, joined the president for a private lunch at the White House last month.
“I said, ‘Yeah, it’s a problem,’ ” Mr. Grassley said of the public plan, “and he said something along the lines of, ‘If I get 85 percent of what I want with a bipartisan vote, or 100 percent with 51 votes, all Democrat, I’d rather have it be bipartisan.’ ”
On Friday, Mr. Grassley said he viewed the letter as “a political document, not a policy document,” intended to shore up Democratic support while letting Mr. Obama remain flexible.
Senator Ron Wyden, an Oregon Democrat who is a longtime proponent of revamping health care, said Mr. Obama seemed to be wrestling with how far he could push Congress.
“The president is very much aware that to bring about enduring change — health care reform that lasts, gets implemented, wins the support of the American people and does not get repealed in a couple of years — you need bipartisan support,” said Mr. Wyden, who was among two dozen Senate Democrats who met with Mr. Obama about health care last week. “So he’s grappling with, how do you do that?”
Mr. Obama began taking steps to make his case early in his administration. He convened a “fiscal summit” where health care was a major topic, followed by a “health summit.” Not long ago, he invited industry leaders to the White House, where they pledged to cut $2 trillion in health care costs over the next decade. But he has been restrained in his dealings with Congress.
He has, however, shown himself willing to exercise his presidential muscle when he thinks it is necessary. In April, Senator Kent Conrad of North Dakota, the Budget Committee chairman, balked at the idea of having the Senate consider health legislation under the fast-track process known as reconciliation, which could avoid a Republican filibuster. At a private meeting, Mr. Obama pressed him on it.
“ ‘I want to keep it on the table as an option,’ ” Mr. Conrad recalled the president saying. Not long after that, Mr. Emanuel, the White House chief of staff, visited Mr. Conrad on Capitol Hill. Mr. Conrad was not convinced, but decided not to stand in the way. “The Budget Committee chairman does not top the president of the United States,” he said.
Going forward, Mr. Emanuel said, lawmakers could expect “quiet one-on-one discussions” with the president.
But Republicans like Mr. Grassley say that after promising to leave the legislative process to Congress, Mr. Obama must be cautious about his words, and about the appearance of meddling.
“He’s doing good by staying out of it as much as he is,” Mr. Grassley said. “He’d better use kid gloves at the start.”
This article, Obama to Forge a Greater Role in Health Care, first appeared in The New York Times.
Copyright © 2009 The New York Times
URL: www.msnbc.msn.com/id/31143790/
