Democrats divided on health-care details

What happened

Democratic House and Senate leaders went into closed-door negotiations with President Obama this week as policy conflicts undermined efforts to reach a final agreement on health-care legislation that would extend coverage to more than 30 million currently uninsured Americans. Pro-life Democrats objected to a Senate compromise on abortion, saying it did not fully prohibit the use of federal funds to pay for them; meanwhile, House Speaker Nancy Pelosi, backed by organized labor leaders, opposed the Senate’s “Cadillac” tax on generous health plans—those valued at $23,000 for family policies and $8,500 for individuals. Obama indicated support for the Cadillac tax as a means of raising revenue for the reform plan, but opponents appeared likely to succeed in raising the tax trigger-point to $28,000.

President Obama would like to sign a bill before his State of the Union address in early February, and both the White House and congressional Democrats are eager to turn their focus to jobs and the economy. But frustrated House Democrats say they are weary of capitulating to demands from the more conservative Senate. “We’ve got to get a bill that is more compatible to the House,” said New York Rep. Charles Rangel. Such a bill, however, might not get the filibuster-proof 60 votes in the Senate.

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What the editorials said

“To hell with democracy,” said the New York Post. Democrats are building a “Frankenstein’s monster” in secret, with Republicans and the public shut out, because the bill can’t stand the light of day. Instead of the promised “transparency,” we’re getting backroom deals with senators like Nebraska’s Ben Nelson, who was promised in return for his vote that the federal government would pick up his state’s $100 million in additional Medicaid costs. Since no other state gets that deal, it’s a “bribe.’’

Actually, Nelson’s deal should be extended to all states, said The New York Times. That would cost another $25 billion to $30 billion over 10 years, but cash-strapped states will need that money to cover millions of uninsured Americans who would now receive coverage through Medicaid. Someone has to pay for all of this, said The Washington Post, which is why a Cadillac tax is essential. Not only will it raise revenue, but by discouraging gold-plated insurance policies that promote unnecessary doctors’ visits and tests, the tax will also rein in “excess spending” over the long term.

What the columnists said

New data show costs climbed again in 2008, said Albert Hunt in The New York Times. Even in a recession, health-care spending increased 4.4 percent to about $7,700 per person. While challenges to reform remain—Republicans want to kill it, public support has eroded, and the political environment is “raw”—the status quo is unsustainable.

It’ll be a disaster if reform doesn’t pass, said Peggy Noonan in The Wall Street Journal, “but only for the administration, not the country.” This White House is strangely hellbent on defying the public will, as if it’s “vaguely dishonorable to be popular.” But given what a mess he’s made of health reform, this is one president I’d like to see “govern by the polls” from now on. Obama is flying into a storm, said Ramesh Ponnuru and Yuval Levin in National Review Online. The financial crisis didn’t increase the public’s appetite for “government activism,” and Obama’s “eloquence” has failed to rally Americans behind reform. With its combination of tax increases and $1 trillion in new federal spending, this turkey may yet sink under its own weight.

Democrats won’t let that happen, said E.J. Dionne in The Washington Post. The outlines of a deal are becoming clear: The Cadillac tax is “likely to be scaled back but not eliminated,” while “modest across-the-board Medicaid relief” will be extended to all states. Meantime, the House’s national insurance exchange, where businesses and consumers can shop for health-care policies, remains “very much alive.” In the end, the necessary compromises will be made, because Democrats are “desperate for an agreement.”