There was plenty of speechifying, talking points, and political shots. There was also a good and substantive debate. Each side has a clear strategy. The president wants to constantly hammer home that the sides agree on almost everything. Meanwhile, the Republicans want to hammer home that there's a huge philosophical difference: the president wants D.C. to decide and the Republicans want the private markets to make decisions.
This is a shrewd tactic by the President. He constantly referred to ending the tactic of refusing coverage for pre existing conditions, the health care exchange, portability, risk pooling, as points of agreement. Max Baucus and Chuck Schumer also hammered that theme home. It's shrewd because if a deal falls apart the president can claim that the sides weren't that far off and so the Republicans are obstructing out of partisan gains.
The Republicans constantly pointed out all the ways that the current health care reform gives government more control: the health care exchange will be regulated by the HHS secretary, new bureaucracies, and new mandates.
The best point made was made by Tom Coburn. He said that one in three dollars spent in health care is spent on something but health care. That sounds off but there's all sorts of things: waste, fraud, abuse, lawyers, accountants, marketing, etc. Of course, we can't cut all of it out but one in three is startling. Coburn said that going after those dollars that go to something other than health care and making them more efficient.
Ultimately, all of these things are much more complicated than either party is making it seem in the summit. For instance, it's true that both parties agree on such things as denying coverage due to pre existing conditions, portability, and risk pooling. The difference is how we get there. Even pre existing conditions is not a simple topic. Forcing insurance companies to take everyone no matter what that would cripple the insurance companies. That's why the president wants to mandate coverage. That would give insurance companies millions of healthy people to counter act taking on millions of sick people. It would also stop people from gaming the system and waiting to get sick to get insurance. Yet, the Republicans feel as though mandating health insurance would be a major D.C. power grab and an unprecedented destruction of liberty.
These are the philosophical debates. They will be hashed out today. They won't end today. What happens today is not nearly as important as what happens going forward. I think the president will win plenty of goodwill today. This has been a civil and probing back and forth. Still, if he moves forward with health care reform that isn't substantively different he'll still fail.
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