I spent most of the day watching the health care summit President Obama held at Blair House today. I’ve drawn only a few new conclusions.

1)The process needs an independent, trained facilitator.  The President isn’t one. He’s in favor of his own proposals; his party has a dog in the hunt. That reduces his credibility. It also made him talk too much; I bet he took up almost a third of the time after dividing it pretty evenly between the Democratic and Republican members of Congress. The Republicans will use that to flog him in some way.

2)On the other hand, President Obama is very smart. He’s up on the issues, and he wasn’t reading from notes or a TeleprompTer. He’s immersed in this stuff, and he has been studying all the angles. You don’t have to agree with him, but you should admire him for the seriousness with which he approaches the job. In his dreams, he wishes we were post-partisan, although in reality we are not.

3)The Republicans have some good ideas. Most of them have already been worked into the existing bill, but it is difficult for anyone to admit that.  They would rather keep on talking about “nuclear options” and “government takeover of health care.” There are many things we can all agree on.

4)Everyone forgets that the President was elected on a platform of change. When the Republicans say “the American people don’t want this bill,” do they know whether the American people want less reform? More reform? No reform?  Are they objecting to the process or the product? There’s a possibility that most Americans want greater reforms; and at the same time there’s a possibility that they don’t want change at all (people have a tough time adjusting to change). Fact is, things will change no matter what we do in Congress. Longer life spans, an aging population, an increasing national debt, and more advanced technology will see to that.

5)It was remarkably difficult to watch the Summit on TV. MSNBC was covering the Olympics, and CNN kept breaking in and cutting away. Even C-SPAN only covered the summit live on C-SPAN 3, which not everyone gets with her cable service. At several points I had to stream it, and the streams weren’t dependable either.

6)The Republicans keep saying “let’s go back to the beginning” and “the American people don’t want this bill.” What if we DID go back to the beginning, and produce a much stronger bill with a nanny-state?  I’d bet we would be surprised how many people would want that; there is still widespread support for a single payer system that would take these decisions off our hands. People are not as prepared to embrace freedom of either markets or lifestyles as we would like to think. Eric Fromm wrote Escape from Freedom in the 1940′s about how man attempts to escape freedom: through authoritarianism, destructiveness, and conformity.

7) Nobody mentioned health IT, remote patient monitoring, patient-centered medical homes, or reimbursement changes as ways to cut costs. Why not?  Because the discussion centered so much on who has insurance rather than outcomes or patient care. Yet these innovations will probably both reduce costs AND raise quality of care. Ah, but they don’t have support from doctors, pharma, or insurance companies, because they are less about the free market than about improving quality of life.

8)From what I could tell from my social media streams, only extremists followed the debate. You would think there was no one but #tcot and #p2 who cared.

Actually, everyone cares–but if your opinion is any combination of R and D, you can’t get heard. At least Congress was on its good behavior today; Twitter was not. Normal citizens seem to have covered their ears.

That’s really about all I learned.  It’s not a lot from seven hours of listening and watching.

Earlier this month, Treasury Secretary Tim Geithner said something that should have raised the antennae of every health care reform advocate in the country, but has been drowned in the rising furor over AIG executives and other distractions.

From the Wall Street Journal:

The comment came at a committee hearing where Tim Geithner was testifying on the merits of the budget blueprint, which includes a long-term health fund drawn from projected savings in Medicare and Medicaid as well as cut in tax deductions for the wealthiest Americans.

Geithner called health reform a “moral imperative, an economic imperative and a fiscal imperative for our nation,” DJ Newswires said.

With the top money guy saying that, how can it be that some Congressional Democrats are trying to kill any effort to keep health care reform in the budget process? Yet, it appears as though that is exactly what they’re doing. I emphasize the word “appears”. Right now, the political waters are so muddy it’s difficult to tell the players from the spectators. Yet when reading between the lines, a certain strange clarity emerges. I recommend a steady diet of varied sources rather than the mainstream media’s versions, which usually center on one theme stubbornly determined to obfuscate the nuance of the political gambits in play.

This is big news: Democrats have mapped out their legislative strategy for passing health care reform this year. According to George Stephanopoulos, Democrats will work with Republicans to build consensus around a plan, and then, if that doesn’t work, they’ll write the revenue-generating-and-substracting provisions of whatever health care plan they come up with into the FY 2010 budget resolution. As important: the budget reconciliation process, which circumvents moderate Democratic and GOP discontent in the Senate, will NOT be used to set up a carbon emissions credit trading system. Cap-and-trade was always the tougher sell to Congress.

So, where are we in the process right now? It appears that conservative Democrats  are reaching across to try to start the consensus-building and rumbling about ditching cap-and-trade for this round. Since this is not a blog about green politics, I’ll leave the discussion of cap-and-trade policies for one about the health care prong of the budget.

In last night’s press conference, President Obama was asked about the budget process and how he felt about Democrats revising the budget to eliminate health care reform and the middle class tax cuts. His response was that he was confident whatever budget was ultimately submitted would have the provisions he required.

Nate Silver points out that in a down economy, health care problems worsen, largely because less Americans have health insurance, or the means to pay for health care out of their own pocket.

Health care problems, by contrast, tend to worsen in a down economy. The chart below indicates the percentage of Americans covered by private health insurance; recessions are indicated by yellow bars. There has been a secular decline in this number over time because of the graying of the population and other reasons (various government-run programs have made up some of the difference, but hardly all), but the problems have been particularly acute during and immediately after recessions.


(Note: this chart corrects in a change of accounting methods made in 1999).

For obvious reasons, moreover, a more robust alternative to employer-based health insurance is probably more appealing to Americans when more of them are concerned about losing their jobs. I don’t want to call health care an easy sell … but it’s a fight where the White House ought to be favored.

President Obama has made it clear that a budget without health care investments is not one he will approve.

At the end of the day, the best way to bring our deficit down in the long run is not with a budget that continues the very same policies that have led to a narrow prosperity and massive debt. It’s with a budget that leads to broad economic growth by moving from an era of borrow and spend to one where we save and invest.

And that’s why [sic] clean energy jobs and businesses will do all across America. That’s what a highly skilled workforce can do all across America. That’s what an efficient health care system that controls costs and entitlements like Medicare and Medicaid will do. That’s why this budget is inseparable from this recovery — because it is what lays the foundation for a secure and lasting prosperity

No matter what you hear from cable news and other mainstream sources, remember that politics is a sport of deception, negotiation, and ultimately, compromise. The best thing we can do right now is keep the pressure on our elected representatives to make health care reform happen, and happen in a way that will actually work.

…and shoots across the bow of obstructionists in Congress. Expanded SCHIP benefits were widely supported on a bipartisan basis and sailed to President Obama’s desk where he signed it into law with a flourish and a warning.

The flourish:

This is not who we are. We are not a nation that leaves struggling families to fend for themselves. No child in America should be receiving her primary care in the emergency room in the middle of the night. No child should be falling behind at school because he can’t hear the teacher or see the blackboard. I refuse to accept that millions of our kids fail to reach their full potential because we fail to meet their basic needs. In a decent society, there are certain obligations that are not subject to tradeoffs or negotiation – health care for our children is one of those obligations.

The Warning

President Obama made it clear that he views his Economic Recovery and Reinvestment Plan as a key first step toward comprehensive health care reform.

Think about this – if Congress passes this recovery plan, in just one month, we’ll have done more to modernize our health care system than we’ve done in the past decade.

We’ll be on our way to computerizing all of America’s medical records, which won’t just eliminate inefficiencies, save billions of dollars and create tens of thousands of jobs – but will save lives by reducing deadly medical errors. We’ll have made the single largest investment in prevention and wellness in history – tackling problems like smoking and obesity, and helping people live longer, healthier lives. And we’ll have extended health insurance for the unemployed, so that workers who lose their jobs don’t lose their health care too.

He also made it clear that he was committed to getting this work done, and that he was not going to tolerate politics as usual with regard to Americans’ futures:

Now, in the past few days I’ve heard criticisms of this plan that echo the very same failed theories that helped lead us into this crisis – the notion that tax cuts alone will solve all our problems; that we can address this enormous crisis with half-steps and piecemeal measures; that we can ignore fundamental challenges like the high cost of health care and still expect our economy and our country to thrive.

I reject these theories, and so did the American people when they went to the polls in November and voted resoundingly for change. So I urge members of Congress to act without delay. No plan is perfect, and we should work to make it stronger. But let’s not make the perfect the enemy of the essential. Let’s show people all over our country who are looking for leadership in this difficult time that we are equal to the task. Let’s give America’s families the support they need to weather this crisis.

Science Daily: U.S. Congressional Health-care Reform Proposals Would Offer Coverage To Many Without Insurance

With health reform high on the agenda of the incoming Congress and President, a new analysis of legislative proposals—including the plans of President-elect Barack Obama and Senate Finance Committee Chairman Max Baucus (D-MT)—shows that several proposals already put forth could substantially reduce the number of uninsured Americans, and would either reduce health care spending or add only modestly to annual health care expenditures.

The proposals demonstrate that it is possible to cover everyone with little or no additional total health spending, but to do so means requiring that everyone have coverage, and achieving administrative savings and purchasing efficiencies by building on public programs and group purchase of private insurance—either through employers or insurance exchanges.

SEIU: Six Diverse Groups Unite in Nationwide Call for Health Care Reform as Key to Economic Reform

Washington, D.C. – Six organizations representing consumers, physicians, insurers, patients and pharmaceutical research companies are banding together to launch a new multi-million dollar national television advertising buy. Their common message: In order to fix the ailing economy, the nation needs health care reform that addresses the related problems of health care costs and people losing health coverage.

HCAN (Health Care for America Now): Richard Kirsch: “We’re going to have to be in our communities talking to people whether it’s by text message or phone or on the Internet but also in people’s faces, in the street demonstrating – everything it takes to make it clear to Congress and this country that it’s about time we all had good affordable health care.”