Two Sundays ago, before the Super Bowl, President Obama showed up on TV. He announced a "healthcare summit" on February 25, a "bipartisan" affair, and said he wants it televised.
That was one of the first official things the White House had said on healthcare since mid-January, when Democrats lost their supermajority and their whole agenda for reforming healthcare in America seemed to disappear into a Capitol Hill purgatory.
The president's proposal suggests that the White House is going to keep pushing reform. But it also reveals a tension that will play out publicly if the summit does occur. Democrats know that Americans are upset about all the backroom deals that took place last year on the healthcare bills, and their hope is that a big, open event will quiet some of those gripes about "transparency." At the same time, the GOP greeted the idea skeptically, and both parties have very strong feelings about healthcare. So the notion that the summit will somehow lead to a bipartisan breakthrough, after months of jabs and blows, seems pretty wild.
But that doesn't mean it can't serve a purpose. What it could do is give Americans their clearest look so far at Republicans' ideas for changing healthcare. For all the chatter, most of what's known about Republican ideas still comes from two places: a thin proposal filed by GOP leaders last fall and Sen. John McCain's platform from the 2008 presidential campaign. The summit could clarify differences between the two parties' approaches.
One of the biggest differences is over the scope of reform. Republicans say they want a more incremental approach, one that's cheaper and less reliant on government mandates. But that has its limitations. As the Congressional Budget Office said last year, the GOP plan would insure only about 3 million additional people, compared with more than 30 million for any Democratic plan. "[Republicans] don't believe as much in government," says Gary Claxton, director of the nonpartisan Kaiser Family Foundation's healthcare market project. "To get a lot of coverage requires a lot of subsidies, which by definition means taking away from people who have it and giving it to people who don't. That's not a big part of the Republican platform."
Another concern is that the Republicans' preference for handling reform one step at a time could actually be more disruptive than a comprehensive, all-at-once plan. The Democrats' plan is big, experts say, in part because it has lots of safety bumpers like subsidies to help protect consumers from unexpected changes. "If you do a lot, if you're very comprehensive, then reform itself is going to feel incremental because things move in relatively small ways," says Deborah Chollet, a senior health policy economist for the nonpartisan Mathematica Policy Research. A piece-by-piece plan, on the other hand, has no such protections, so fixing one thing could break something else. That means that Republicans, who spent most of the past year attacking the Democrats' plan, may find themselves defending their own come late February.