At issue: How much health care reform is enough?  

I sat down at 10 AM with a cup of coffee, snow falling outside and online video streaming inside, to watch as much of the health care debate as possible. I am surprised to say I'm still here, three hours later. The summit makes for compelling theater and I don't even have to dress up and travel. Kudos for making this public. Here now are thoughts on the first half of the show (final summary to be added later today).

Republican criticism: Yes, just as you might have expected, the GOP brought their talking points to the summit, despite President Obama’s appeal to look for consensus: Extend Medicare (never mind if it’s unrelated to need.) Engage in tort reform. Start over with another, more modest bill. Do not tinker with “the best health care system in the world.” Take a step-by-step approach. The starting over part was often repeated.

Obama as a regular guy but with a spine: The President was not about to be moved off his agenda, as he made clear from the get-go -- and his agenda was to find points of agreement. He was relentless in slapping down what he referred to as “talking points” and chided Representative Eric Cantor for using the massive-looking Senate bill as a “prop” to demonstrate how confusing the health care bill was. While he offered an olive branch to Republicans in his opening speech, referring to GOP recommendations he either would consider or had already incorporated into legislation, he made clear he would not consider starting from scratch, a position strongly urged at every turn by the Republicans. Nor did he let John McCain's speech about lobbyists and backroom deals pass without comment. "John," the president reminded the senior senator from Arizona, "we're not campaigning anymore."

We, the people: Although I wasn't polled, I felt intimately connected to the proceedings simply because "the American people" were invoked so many times I lost count. Apparently we want reform but not the bill currently under consideration;  we want Social Security and Medicare untouched but we don't want to fund it; we want the government to provide protection without mandates. 

The political reality: Using the Senate bill as the starting point is anathema to the Republicans, not only because of ideological differences (see below), but also because the legislation was instituted by a Democratic White House and passed by the Democratic-majority Congress. If Democrats are able to claim success for achieving health care reform, they will carry a decisive advantage into the 2010 mid-term elections.

A bridge too far: The White House believes that a full-fledged overhaul of the health care system is crucial to economic recovery; restructuring health care means restructuring a portion of the economy, but this view holds that nothing less will do. Republicans deplore such drastic measures, especially government mandates. They prefer a step-by-step plan that makes incremental changes and relies to a certain extent on businesses to take some responsibility for reform.

Time for lunch and attention must be paid to the dog at my feet. Back soon.

*  *  *  *

Back again for substantive discussions on deficit reduction. The American people remain the subject of intense speculation. People were coming and going. At one point, the feed was accompanied by a Sousa march (I kid you not!) Other highlights:

Do the math: In the afternoon, the talk shifted to the impact of the legislation on the deficit and I learned something interesting: Five percent of the Medicare recipients use fifty percent of Medicare money.These people are the chronically ill. Imagine each of their separate ailments is treated by a different doctor using separate applications to Medicare for reimbursement. Get the picture? Spreading panic about reforming a system that is set to go broke in a decade anyway (see above) by implying that seniors will lose their entitlements.

Everybody in the pool: This is a tricky concept to summarize but here goes: if everyone buys health care (young and old, healthy and sick, preexisting conditions or not), then the pool is larger. If the pool is larger, individual costs are lower. Everyone pays in and it's available for anyone who needs it at an affordable cost. You could live to ninety without ever needing a doctor. God bless. But you will, one way or another, pay for those people who don't get health insurance but visit the emergency room when they need help. As you have gathered, this is a bone of contention between Democrats and Republicans.

Do the Math, part two:  Instituting tort reform will save money but it represents only one-fifth of 1% of the potential savings. Making it the overriding issue, as some Republicans have done, is, according to Democrat Dick Durbin, disingenuous. Because while there are frivolous lawsuits, there is also medical malpractice. The focus should be on reducing medical errors.

What is believed and what is known? One of the Republicans – a doctor with impressive credentials – pointed out that most people he talks with absolutely believe that care will get worse, that coverage will cost more, and that coverage will be less accessible. Democrat Henry Waxman countered: “If I heard [and believed] the rhetoric over and over again, I wouldn’t want the health plan either.” Yes, but how do you disprove a negative?

The uninsured: To cover or not to cover: that really does seem to be the question.  Are we expanding entitlement? Are the uninsured even entitled to health care? Ah, there’s the rub.

Favorite lines of the day:

“An incremental approach is like a swimmer drowning fifty feet out where we throw him a ten-foot rope.” (Sen. Tom Harkin, D)

“Each of us is only one accident or one diagnosis away from being one of the unfortunate who can’t find health insurance.” (Sen. Dick Durbin, D)

“People don’t want government making those decisions; they want people making those decisions.” (Rep Paul Ryan, R)

Six hours later, where are we? The Republicans contine to believe that the free market will do what is necessary with but a few regulatory alterations (let people do comparative shopping across state lines; let people buy insurance that will only cover catastrophic illnesses). What the Republicans DON'T want is radical change to the health care delivery system. Follow our six proposals, the Republicans say, and we'll have a deal. The Democrats say: incremental change doesn't work; it costs more and does less. To change the system, change what drives the system.

Et voila la difference. It is absolutely a philosophical divide and from where I stand, it looks unbreachable. And I'm not sure we, the American people are going to help. After all, it was all of us who elected our representatives,  and then asked them to choose which of the mixed signals we've been sending being representative of our true feelings.

Sometimes I wonder whether the problem is inside the Beltway or outside.