What the President's Health Care Plan Means: Full Steam Ahead

The health-care-reform plan unveiled by the White House this morning sends one clear message to Republicans: this is happening with or without you. The administration has structured its plan as a series of fixes to the Senate health-care bill. On a conference call with reporters this morning, White House officials emphasized to reporters that “the president believes people deserve an up-or-down vote” on health-care reform, so they’ve structured their plan with the “flexibility” to achieve passage should Republicans take the “extraordinary step” of filibustering. When asked, officials said that meeting the procedural requirements to pass their fixes through the budget-reconciliation process, which circumvents the filibuster and only requires 51 votes, “was certainly a factor” in their thinking. Translation: if Republicans don’t play ball, Democrats will go ahead regardless.

The plan is far from a sure bet. It still requires approval of the Senate bill by the House, and we’re yet to hear from nervous House Dems about whether they’re prepared to vote for a bill that includes strict abortion language and an excise tax on "Cadillac plans," even if that proposal is a modified one. But the proposal does shed light on the strategy for Thursday’s summit: inspiring those Democrats will be just as important as reaching out to Republicans.

The president is outright rejecting the Republican calls to throw out the existing bills and start the process from scratch on Thursday─as he should. Junking a year’s worth of effort so Republicans can score some political points, and then probably end up opposing the president’s bill regardless, is a silly fantasy. And Democrats have absolutely no reason to believe that Republicans would vote for any new health-care-reform plan that helps the president progress one of his signature issues.

Instead the president is making clear that the train is leaving the station, and Republicans have one last, very public opportunity to make suggestions to improve the bill. Liberals have been longing for this sense of inevitability about health care for months. It shifts the responsibility to break the deadlock to Republicans, rather than having Democrats scramble to find a Republican vote here and there.

In posting his plan early, the White House has laid out an expectation for Republicans to reciprocate with concrete suggestions. The difference is, Obama has set the parameters. He’s decided that proposals must build on the basic structure of the Senate bill. He won't accept talking in generalities or vague attacks on a "government takeover" of health care. He's laid out his ideas and wants real, thought-out alternatives in return. If Republicans can work with that, they might well find their proposals incorporated in the final bill. If they can’t, then their window to shape the reform effort closes.

Republicans should be nervous about Thursday’s White House summit. As Obama demonstrated during his question-and-answer session with House Republicans in January, he has unparalleled skill in destroying frivolous arguments and calling out political games where he sees them, and no qualms about doing so. (And it excites his base no end.) If Republicans want medical-malpractice reform, they’d better come with a concrete plan for it. If they want to sell insurance across state lines, they’d better be prepared to do that through the insurance-exchange system. And if they want to complain about cutting funding from Medicare, they’d better be able to defend their own proposals to eliminate waste and fraud that the White House has so deftly adopted. If this was a girls' high school, it would be like daring Republicans to quit bitching behind Obama's back and say it to his face.

There’s no doubt that Thursday’s summit will be political theater. But most politics is theater in one way or another, so that charge seems inconsequential. What matters is results, and on Thursday the president will walk into the room with the upper hand on health care for the first time in months. He’s laid out his cards, and legislative momentum is slowly, ever so slowly, regrouping on his side. He's emphasizing again, as he's done for several months now, that his priority is reform (as opposed to changes in care), knowing that the public shares his concern over insurance premiums. Thursday is an opportunity to explain to Americans his plan again─a plan which, as the new NEWSWEEK poll demonstrates, gets more popular the more people understand it. And that matters not just to the president, but to those nervous Democrats in the House, who will no doubt be pumped up if the president delivers a rousing and convincing arguments for his proposals. The hope is that they'll be so psyched, they'll vote for the Senate bill. That's as much the aim on Thursday as is reaching out to GOP-ers.

Republicans will no doubt spend most of this week attacking the summit as a showy trap. But I’m not sure Americans will fall for that: being given a chance to discuss your ideas on TV hardly constitutes a trap. But the GOP will try to discredit the summit because they know it’s the outcome that matters. And the president has made clear today that the outcome will be passage of a health-care-reform bill, whether Republicans agree to it or not.

Join the Discussion