Today is a pivotal moment in the debate over health care reform as President Barack Obama hosts a bipartisan, televised summit and finally pushes his own proposal. The president is right to take another shot at consensus, and he should have offered a specific plan months ago rather than let Congress bog down in a swamp of side deals and partisan potshots. But even if Republicans are determined to remain obstructionists, Obama and congressional Democrats cannot give up the fight to slow the rise in health care costs and insure millions of Americans.
The president's proposal builds on the legislation passed by the Senate in December — and remains focused on the overall goals. It would cover more than 30 million uninsured, offer ways to rein in cost increases and reduce the federal deficit. It requires most people to buy insurance, creates new insurance exchanges where the uninsured and businesses could shop for coverage and taxes the most expensive private plans. It still bans insurers from denying coverage because of pre-existing conditions and from setting limits on annual or lifetime benefits. And it gradually eliminates the so-called doughnut hole in Medicare prescription drug coverage. These are important features for all Americans, not just those who are uninsured or unemployed now.
Obama also would eliminate several of the most obnoxious provisions of the House and Senate bills. For example, he eliminates the Senate deal to cover Nebraska's entire cost for expanding Medicaid and avoids the unreasonably restrictive language on abortion coverage in the House bill. Those are the sorts of special handouts and hot buttons that angered the public in December and shifted the focus from the overall positive goals of health care reform.
Some of the president's efforts at compromise move in the wrong direction. He raises the threshold for taxing expensive insurance plans and delays imposing the tax, which is counterproductive. The lost revenue would be replaced by an increase in the Medicare payroll tax and a tax on unearned income for couples earning more than $250,000 a year. But those revenue sources will be needed to prop up Medicare and reduce the overall federal deficit. And it still does not make sense to require most individuals to buy health insurance but not require most employers to offer coverage.
A couple of new features in Obama's proposal are intriguing but sure to draw political sniping when the idea is to find consensus. Giving the federal government the authority to reject increases in health care premiums and repealing the health insurance industry's antitrust exemption are populist provisions. But they also are sure to increase Republican attacks that Obama is pursuing a government takeover of health care when that is simply not true.
While the spotlight is on Obama, the Party of No also should be held accountable. Republicans cannot continue to get away with voting against everything and proposing little themselves. Their tired, inadequate incremental approach that features insurance pools for high-risk patients and legal reforms has produced few results at the state level — including in Florida. And while they preach the virtues of private competition, that model simply has not worked in health coverage. A new American Medical Association report shows about half of the states have two insurers that control at least 70 percent of the market. No wonder insurers are making money and coverage is declining.
The success of today's meeting depends on Obama's ability to once again make the case for comprehensive health care reform and on the willingness of Republicans to be constructive. Regardless of the outcome, it is time for the final push. The current health care system is not sustainable, and the House and Senate have passed their own versions of reform. To do nothing now would chain this nation to a health care system that is unavailable or unaffordable for millions of Americans.