841489012_4d7efe9230_mMore Summit Surprises After surprising the political establishment by announcing a bipartisan health reform summit, the Obama administration continued to shape the debate with another surprise announcement late last week: In the summit invite, the administration announced it will  bring its own legislation to the table addressing four key topics—ending insurance company abuses, extending coverage to millions of uninsured Americans, controlling skyrocketing premiums and out-of-pocket costs and reducing the deficit.

Over the weekend many observers suggested that this indicates either that the House and Senate have reached agreement on a compromise measure, or that the administration is hoping to give them a deadline for reaching an agreement.

Other sources tell us that the administration is working on its own synthesis of the House and Senate bills that Congressional leaders have not yet seen—probably based on the negotiations that were nearly completed prior to the election of Scott Brown in Massachusetts. The administration has also challenged the Republicans to share their own proposals publicly, putting the Republicans in something of a bind.

Smoking Out the Opposition There’s an old trial lawyers’ maxim that goes, “If you have the facts on your side pound the facts, if you have the law on your side, pound the law, if you have neither on your side, pound the table.”

Republicans seem to be doing a lot of table-pounding in the run up to the summit—claiming that it is not really bipartisan, not inclusive enough, should start with a blank piece of paper, etc.  Pounding the table like this takes attention away from the uncomfortable bind in which they find themselves.

The President wants to focus the summit specifically on ideas to deal with the four problems mentioned above, but Republicans either don’t have much in the way of answers (for example, the House Republican reform package was estimated to cover only 3 million people, compared to over 30 million for the House and Senate Democratic bills) or the answers they have are ones the American people don’t like (such as reducing the deficit by turning Medicare into a voucher program as ranking budget committee member Paul Ryan has proposed ). Refusing to participate would just make them look obstructionist and give the Democrats a chance to showcase their reform plans without rebuttal (In other words, it really is a trap–just like Jon Stewart said. )

Just because you’re paranoid doesn’t mean they’re not out to get you

So to avoid having to actually reveal their position (or lack thereof)to the American people, the Rs strategy is to de-legitimize the summit as much as possible in advance. All this negativity leading up to the summit does not auger well for the chances of a bipartisan breakthrough, but in truth the political leg room has always been fairly limited. Obama is probably sincere about wanting a bipartisan deal, but the actual opportunity to get one is pretty minimal given dynamics in Congress.

On the Republican side, there is no indication of any real interest in moving away from the current strategy of blocking reform, especially since the party feels they have momentum going into the elections. If a strategy is working, why change it? Even in the Senate, where a few Republicans have expressed interest in reform in the past—e.g. Bennett, Snowe, Gregg—it’s hard to imagine anyone breaking ranks at this point. If they did, it is doubtful that anything they would agree to could clear the House, given its  antipathy to the existing Senate bill.

Although the administration has signaled a willingness to consider Republican proposals in areas such as malpractice reform, even this hint is drawing opposition for Democratic-leaning interest groups, which could make its inclusion politically problematic (Not to mention there is little reason to think it would result in substantial cost containment.)

Just because there is really very little opportunity for a new bipartisan synthesis, does not make the summit a waste of time. It gives Democrats a chance to clarify just what is really in their proposals—and why—as well as the opportunity  to disavow certain pieces that have undermined public support (e.g. the special Medicaid deal for Nebraska) and change the narrative with a public that has become increasingly conflicted about reform. The Divided Self: In which the public disagrees with itself In a way that earlier debate has not, the summit gives each party a chance to explicate its ideas about reform to the public, much like a presidential debate. And this is good, since the public seems muddled on the issue.

On the one hand, there is less than majority support for the legislation the House and Senate passed. On the other hand, the public continues to support most of the major components in those bills. Inasmuch as the public wants to see a bill, they say they want to see bipartisan legislation. But it’s hard to find major public support for the few Republican health reform idea floating out there, with the exception of malpractice reform.

Most of the public does not believe that major reform will pass, nor believes we can afford to fix the system now. Additionally, trust in government is nearing an historic low, and people are far more likely to list jobs and the economy as the top problem facing the country over health care.

BUT, a substantial majority wants Congress to keep trying. Gotta love group cognitive dissonance.

Further complicating the picture, the partisan divide on whether and how to fix health care is greater than on any other issue.

Democrats remain as committed as ever to health care reform, and are much more likely than Republicans or Independents to say that covering the uninsured is important. Most of the decline in support for reform has come from Republican and Independent voters. For Republicans, this means that the risk of alienating their base outweighs any potential benefits of compromising on health care. And for Democrats, there is no upside to not passing reform but a potentially large price to pay among core supporters for failure.

Given all this, Democrats have every reason to embrace—and Republicans to fear—a major effort to talk about the real issues in the reform debate. Insurers make the case for reform (well…not intentionally) Democrats may be looking to the summit to help reestablish a rapport with the public on health care, but meanwhile, they’ve been getting some help from an unexpected quarter. Although insurers have spent more than $20 million trying to kill reform, a spate of recent insurance industry news is helping remind the public why reform is necessary.

By far the biggest story has been a proposed 39 percent increase in non-group rates proposed by Anthem Blue Cross of California. According to the company, the reason has not been health care inflation, but an erosion of the health status of the risk pool. In a down economy, healthier people are making the choice to drop insurance, leaving a sicker pool behind.

This type of death spiral and rate shock is precisely what the health insurance reform is designed to prevent. Under immense political pressure, the company has announced a delay in the rate increase, but the damage has already been done. And while the Anthem story has grabbed the headlines, it is far from an isolated phenomenon. Many other companies are raising rates in the non-group market by double digits.

At the same time that the number of enrollees shrinks, insurers are reporting record profits (Here’s the report.) Taken together, the price shocks and enrollment declines accompanied by record profits make about as clear a case for reform as anyone could ask for.

Health reform countdown (T minus 6 weeks and counting) By now, it’s clear that the debate on health care reform seems to be following Parkinson’s Law (work expands to fill the time available to do it). Congress seems determined to run the clock down to the last possible second.

The clearest indication of a possible timeline going forward has come from Speaker Pelosi’s office. The Speaker has consistently been pushing the need to advance reform via a two-step process that includes passing the Senate bill and adding amendments via reconciliation. Pelosi’s office has also clarified that the House would initiate a reconciliation bill, though the exact order of business after that remains unclear, and that the goal would be to complete, or nearly complete the entire process by the Easter recess. Basically, this gives Congress four weeks after the summit to wrap up work on health care reform–and advocates the same period to rally the public and Congress for reform.

–Michael Miller, director of strategic policy

photo credit: quaelin at flickr