WASHINGTON (AP) - Democrats and Republicans found plenty areas
of agreement at President Barack Obama's health care summit
Thursday, starting with a shared belief that the system needs
fixing. When they delved into the details, though, consensus
evaporated in many cases.
The dynamic illustrated the partisan divide that's riven the
health care debate and underscored the difficulty of coming
together even on modest measures.
Among the areas where Democrats and Republicans groped for
-OVERHAULING THE SYSTEM
The nation's fragmented and inefficient health system found no
defenders among the three dozen Republican and Democratic lawmakers at the daylong summit. Lawmakers from both parties said spiraling costs threatened to bankrupt families and the country.
"We all know this is urgent," Obama said.
"We all agree on the problem here and the problem is that
health inflation is driving us off a fiscal cliff," said Rep. Paul
So what to do? Democrats are supporting massive legislation
enacting a top-to-bottom overhaul of the system and requiring
nearly everyone to be insured. Republicans say that approach needs
to be scrapped and they want a step-by-step approach. If there's
somewhere to meet in the middle lawmakers haven't found it yet.
The Democratic bills establish state or national purchasing
exchanges where individuals and small businesses in need of
insurance could pool together and compare federally regulated
plans. Sen. Mike Enzi, R-Wyo., said he liked the idea of the
purchasing exchanges. But Enzi said any and all private insurance
plans should be offered - not just those meeting federally
established standards. Democrats say consumers need the protection
of government-set standards.
Similarly, Democrats say they could accept Republican ideas for
associations or small businesses to pool together and shop for
health plans if the federal government could set minimum standards,
but Republicans don't want the federal government that involved.
-COVERAGE FOR PEOPLE WITH HEALTH CONDITIONS
All involved agreed that people with pre-existing health
conditions should be able to get health care and that people who
fall ill shouldn't have their coverage revoked.
Democrats say the only way to accomplish those reforms is
through a mandate for nearly everyone to carry insurance, which
would create a large risk pool including many healthy people,
enabling insurers to take all comers. Republicans oppose the
mandate, and instead would set up "high-risk pools" where people
with high-cost conditions could buy care. Democrats contend that as
proposed by the GOP the pools would be so underfunded they'd be
This is a long-running dispute between Democrats and Republicans
that Obama has cited as an area of potential compromise. The
Republicans' preferred solution is capping non-economic jury awards
and Sen. John McCain, R-Ariz., argued in favor of that approach.
But Democrats and their trial lawyer allies have rejected that
notion repeatedly. Obama has announced the establishment of
state-level pilot programs that Republicans say don't go far
enough. "I don't think we have to experiment around," McCain
Sen. Dick Durbin, D-Ill., countered that there should be no
limits on payments to people injured in medical errors.
Who could disagree with that? But Democrats and Republicans are
far apart on how to do it. The Democrats' legislation cuts hundreds
of billions of dollars from Medicare, mostly from private plans
within the system. Democrats would use some of the savings to close
a coverage gap in Medicare's prescription drug program and say
their cuts would strengthen Medicare by extending the program's
solvency and eliminating inefficiencies and overpayments to private
insurers. Republicans rail against the cuts.
Ryan has a different approach: He would give future Medicare
beneficiaries vouchers to shop in the private market, something
Democrats say would leave seniors out in the cold.
-KEEPING CHILDREN ON THEIR PARENTS' HEALTH PLANS LONGER
This might be one of the few areas where Democrats and
Republicans truly do agree - getting health insurers to offer
family plans where children can stay covered by their parents until
age 25 or 26. Laws vary by state, but typically children can stay
on their parents' plan through college. Allowing them to stay on
some years longer wouldn't cost the government. Insurers don't
object because people in that age range have low medical costs, and
for that same reason costs to consumers wouldn't go up too much.