As anticipated, today's health-care summit didn't end in a group hug. Consensus was not achieved. Republicans still want Obama to start over, which, of course, he won't. Obama wants Republicans to recognize their ideas are already represented in Democratic bills. (For example, a national insurance exchange helps fulfill the Republican wish for insurers to sell policies across state lines.) They won't. Republicans want Obama to take the reconciliation process off the table. He won't. Perhaps the only issue where there was some meaningful movement was tort reform: despite Dick Durbin's eloquent takedown of caps on payouts, Obama believes Republicans have some good ideas and will instruct Democrats to work on them. He's particularly interested in encouraging state-based malpractice reform.
Although I've been watching this debate unfold over the past year and have heard nearly all the arguments presented today, there was something oddly satisfying about hearing them all articulated in one venue, by the key players. Watching partisan hyperbole getting busted by each side is entertaining. And regardless of your personal views of the president, his nimbleness and precision at deconstructing arguments is impressive to witness.
If you didn't watch today, you'd be forgiven for reading that last paragraph and thinking an actual conversation took place at Blair House. But you'd be wrong, and that was the most frustrating part of the entire affair. The summit wasn't a debate or a discussion. It was a series of thought-out, prepared statements addressed primarily to the president, to which he responded with either encouragement or methodical criticism. Not everyone had notes, but all were following a script. The attendees delivered their messages with one eye on their hometown newspaper and the other on YouTube, hoping they'd make a memorable point or catch their opponents in a twist. But an actual policy conversation—you know, where people chat back and forth, offering solutions and innovations, with the intent of solving a problem—didn't happen today.
That's not to say the summit wasn't worthwhile, though. Anyone tuning in who's not familiar with each party's stance on particular aspects of reform would come away with a clearer idea of where they stood. Lawmakers got into the weeds on several important issues, like the problems with high-risk pools.
Beyond the blustering, the summit exposed fault lines that are critical to understanding where the two parties differ on health care. When Republicans accuse Democrats of a government takeover of health care, what they mean is that they think the government should take the most minimal approach possible to regulating insurers. Democrats think the best way to make insurance affordable is to get everyone in the pool so the risk is widely spread. Republicans want smaller pools and to put sicker people who have trouble getting insured into their own category.
Many of my readers' eyes probably glazed over when reading those last few lines. Yet those types of differences are just a few of the reasons why bipartisan agreement on reform is so hard. They're enormously important distinctions, but unfortunately the process of clarifying them is enormously boring to most people. And that's why the ideological wrangling we saw today was both the most fascinating and most boring political spectacle we've seen in a long time. I don't think the summit will significantly change the reform bill's slow trajectory, but it will be a moment historians return to when they try to understand what the last year of debate over health care was truly about.