Obama health plan opens tough negotiation
February 25, 2009
By RICARDO ALONSO-ZALDIVAR
WASHINGTON, Feb. 26, 2009 (AP Online delivered by Newstex) -- President Barack Obama's budget shows how difficult overhauling the nation's health care system will be. Medicare cuts and tax hikes like the ones he proposes are usually poison pills for legislation.
Such controversial details are critical, but they are not the bottom line in the budget Obama released Thursday. Administration officials say the plan is an opening bid in a tough negotiation, not a detailed prescription for health care reform.
Obama is asking Congress: If you're going to cover 48 million uninsured people in the world's costliest health care system, how do you pay for it?
His approach is a conscious departure from the path that former President Bill Clinton took in the 1990s. Clinton's 1,300-page health care bill tried to answer every question and went nowhere. Obama is asking Congress to fill in the blanks.
"The approach he's taking is to put some tough decisions on the table, and then bring people together to have a conversation, " said Christine Ferguson, former senior Republican health policy aide at the federal and state levels.
"He's outlining these cuts as examples of places where savings can be accrued," added Ferguson, now a research professor at George Washington University. "You put those on the table, and if people want to have this discussion, they have to propose alternatives."
Whether that dialogue goes anywhere depends not just on Obama, but on Democrats and Republicans in Congress, and interest groups representing insurers and doctors, hospitals and drug companies, consumers and small business.
Clinton started out with the goal of covering everyone. Obama has framed the problem in a different way: slowing the increase in costs, so that eventually everybody can be covered.
His 10-year, $634-billion plan makes some key political and policy statements.
For starters, any expansion of health care coverage has to be paid for -- it can't just be tacked onto the deficit.
Obama is calling for a 50-50 mix of tax increases on the wealthy and cuts in government health care programs that serve seniors and the poor. The administration says the spending cuts would trim waste from the system, but medical providers and Medicare recipients are likely to disagree.
"It's when you get down to the details that you hit the trip wires," said Dan Mendelson, president of Avalere Health, an information company serving government and the health care industry. "It's not inevitable that you will trip -- it's just likely."
