Forum doesn't cure health care reform

Yesterday's health care forum was an extraordinary political and governmental event, a formal meeting of the executive and legislative branches to seek a compromise on one of the most controversial pieces of legislation of the decade. But it seems unlikely that it will result in a legislative breakthrough. Although discussions were reported to be civil, neither side had an epiphany that would bring about a deal.

The rhetoric indicates both sides are deluding themselves. Republicans postured as the defenders of the public, who, they said, doesn't want health care reform. They cited polls showing opposition to the health care bill pushed by Democrats in the Senate and the House. But the Republican leaders are ignoring polls showing widespread, nearly universal dissatisfaction with the cobbled-together, unintended system of job-based health care insurance we now have. The public decries the high costs of coverage, which most workers are sharing with their employers, the arbitrary and unexplained changes in coverage, the arcane and inexplicable rules about what is and isn't covered, and the fundamental unfairness of denials of coverage for pre-existing conditions or other reasons. The public as a whole thinks the current system leaves a lot to be desired. If Republicans expect to gain by keeping the same old system without any changes while health care costs continue to rise exponentially, they're deluding themselves and misleading the public.

Democrats, however, seem to have a tin ear when it comes to constituents' desires. Most voters want the current system fixed, meaning that their primary complaints with health insurance would be resolved. That incremental reform should not be so complicated, but Democrats in Congress have pushed complex bills that would overhaul the entire system of health insurance (while leaving health care itself largely untouched). Various aspects of these massive bills raise objections from the public, and conservative opponents of the legislation have harped on these individual provisions, sometimes in misleading and disingenuous ways.

Now Democratic leaders are threatening to push their legislation through using a simple-majority reconciliation provision, avoiding a procedural vote requiring 60 senators to end debate. Although Democrats have 59 reliable votes in the Senate, using reconciliation would be a suicidal maneuver. Yes, reconciliation has been used in the past, as Majority Leader Harry Reid has said, but the rare invoking of reconciliation has been limited to final budget votes, not to substantive new laws as complicated as this one.

Democrats should be able to push through many, if not most, of the provisions in their overall plan through a series of individual bills, each one addressing a health care concern, such as denial of coverage for pre-existing conditions. They should be able to attract a number of Republican votes on many of the provisions. If Republicans refuse to take part, they will be revealed as partisan obstructionists more interested in political points than in legislation.

President Obama has taken much of the blame for the failure of health care reform, and he is guilty of misjudging the recalcitrance of both parties. By leaving the legislation up to Congress, avoiding the 1993 mistakes of Bill Clinton, he has tied his popularity to a Congress that is seen as less trustworthy than used car dealers or pool sharks. But give Obama credit for being willing to compromise (although his left-wing supporters were aghast over his shifts).

For all its historic significance, yesterday's health care forum looks like it will not result in any breakthrough, leaving Democrats and Republicans with the task of finding common ground, if they can, on an issue that has sharply divided a public that wants reform but not that reform.