The White House on Tuesday released a letter from President Obama to the congressional leadership of both parties. In it, Obama urges them to incorporate a handful of Republican ideas into health care reform and then get on with passing a comprehensive bill, even if the Republicans still refuse to support it.
At least, that's my reading on it. I'm still waiting to hear back from Washington sources who know how to interpret these things better than I do.
The Republican ideas Obama favors will not surprise anybody who's followed this debate:
1) Better protections against fraud
2) Higher payments to doctors who see Medicaid patients
3) A more aggressive push to change the way we adjudicate and compensate for malpractice
4) Making Health Savings Accounts more available.
The first two are ideas Democrats should have no problem embracing. (Many have already.) The second two will not go down so easily. I'll have more to say on them soon.
Obama also says he wants Congress to remove some of the deals it inserted into the proposal--not just the extra Medicaid payments for Nebraska, home of Senator Ben Nelson, but also a provision on Medicare Advantage that was of particular help to Florida, home of Senator Bill Nelson.
But the crucial section, I think, is at the end. A week ago, reports suggested the administration was still considering backing away from comprehensive reform in order to push a scaled-back, "skinny" bill. In the letter, Obama seems to reject that possibility.
He reminds Congress that the Democrats' plans--and his--already reflect the input of both parties, not to mention countless experts and advocates. If the Republicans won't sign on, he seems to imply, the Democrats should be willing to pass comprehensive reform on their own:
Admittedly, there are areas on which Republicans and Democrats don’t agree. While we all believe that reform must be built around our existing private health insurance system, I believe that we must hold the insurance industry to clear rules, so they can’t arbitrarily raise rates or reduce or eliminate coverage. That must be a part of any serious reform to make it work for the many Americans who have insurance coverage today, as well as those who don’t.
I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs.
My ideas have been informed by discussions with Republicans and Democrats, doctors and nurses, health care experts, and everyday Americans – not just last Thursday, but over the course of a yearlong dialogue. Both parties agree that the health care status quo is unsustainable. And both should agree that it’s just not an option to walk away from the millions of American families and business owners counting on reform.
After decades of trying, we’re closer than we’ve ever been to making health insurance reform a reality. I look forward to working with you to complete what would be a truly historic achievement.
The letter is not strident or stirring, but, then, these letters never are. It also leaves out a lot. Among other things, it says nothing about the process going forward, which house should vote first so on. As Huffington Post's Sam Stein notes, "There is no mentioning of reconciliation and no strong demands for the GOP to allow an up-or-down vote."
Those details may (or may not) come tomorrow, when Obama make some kind of announcement from the White House.
In the meantime, again, I'll ask around to see if more experienced hands think there's more (or less) here than meets the eye.
Update: A senior Democratic strategist, one who has been frequently critical of the administration over its handling of health care reform, e-mails approvingly:
The President’s Republican outreach letter is a substantively and strategically smart move. It shows the President’s flexibility and willingness to integrate workable ideas, regardless of the party they are most associated with. While many Republicans will predictably and cynically label this effort as a “lipstick on a pig” move, it will have appeal to Republicans serious about reform and, most importantly, to the public who will like the President extending the hand of bipartisanship. It will add momentum to the foundation the Administration started to build last week and should help with wavering Democrats, particularly those more conservative members that will be key to the final House vote.
Another strategist emailed with more qualified praise, suggesting the language could have been stronger but agreeing it keeps momentum going.