The Note, 5/12/2009: Care to Elaborate -- Healthcare push long on partnerships, short on policies


Can the game have really changed if we’re still playing the same game?

The Obama White House has again shown it knows how to make a splash -- even though we’re not sure yet exactly what’s in the pool at this watershed. (What’s better -- a budget with no numbers, or a healthcare plan with no plans?)

So far, President Obama has found perceptions to be easier to manage than realities.

You want fiscal discipline? The deficit just grew by more than those proposed budget savings. Economic recovery? Jobs are already being created by the stimulus -- still not nearly as fast as they’re being lost, mind you.

Healthcare reform? We’ll always have that photo-op . . . (And if Team Obama really had much more than that right now, might we be getting it?)

“If history is a guide, their commitments may not produce the promised savings,” Robert Pear writes in The New York Times. “Still, the event was significant. There was something in it for Mr. Obama, and something for the industry -- though not necessarily the same thing. Their interests overlap but do not coincide.” 

The overwhelming consensus is that healthcare will get done this year. But we’re a longer way away from that than these White House meetings suggest.

The healthcare plan still needs an agreement on how to pay for it -- plus consensus on a “public” option. If you know how to read Washington language, you should find about five phrases in the previous sentence that speak to the measure’s obstacles. (And six syllables wait at the end of the maze: reconciliation.)

“The industry's promises fell well short of the White House's expansive claims,” Ceci Connolly and David Hilzenrath write in The Washington Post. “Yesterday's announcement, despite the fanfare, shed little light on precisely how the industry and government might achieve $2 trillion in savings over the next decade.” 

Said Alan Sager, a professor of health policy at Boston University: “An unrivaled set of abstractions and posturing.”

Surely there will be none of that Tuesday: A second straight day of White House focus on healthcare, this time with an 11:30 am ET roundtable with business leaders on how to cut health costs.

Your optimistic tone: “People are really demanding a chance. . . . They want to be part of that change,” Health and Human Services Secretary Kathleen Sebelius told Robin Roberts on ABC’s “Good Morning America” Tuesday. “Yesterday was really a breakthrough moment.”

“[Obama] told healthcare players at the meeting, ‘You've made a commitment. We expect you to keep it,’ ” ABC’s Jake Tapper and Huma Khan report. “The president has said before that he wants to see healthcare reform enacted and signed into law by the end of 2009, but [Press Secretary Robert] Gibbs would not expand today on whether the president has told Congress when he wants a bill.” 

As for funding: “Preliminary skirmishes over clamping down on offshore corporate tax havens, taxing employee benefits and winning discounts on drug prices may dictate the fate of the president’s plan to broaden U.S. health-insurance coverage and cut costs,” Bloomberg’s Brian Faler writes. “The odds of winning so many funding fights are so daunting that an odd-couple coalition of more than two dozen interest groups, including the pro-business U.S. Chamber of Commerce, the AFL-CIO union federation and the AARP retirees’ lobby, wants lawmakers to drop Obama’s deficit-neutral goal as a potential deal-killer.” 

These are called “constituency groups” for a reason: “Each interest group has its own internal dynamics. The leadership may pull in one direction while the members pull in another. At the same time, elements within either the leadership or rank-and-file may argue among themselves,” Jonathan Cohn writes for The New Republic

He would never! “Some Republicans who resist Obama's talk of creating a public alternative to private insurance as part of a national health care overhaul suggested that the president was trying to use the new private-sector pledge to create the impression of funding in the absence of a real revenue stream,” McClatchy’s Margaret Talev and Tony Pugh report

Remember, it’s legislation: “Forty-five House Democrats in the party’s moderate-to-conservative wing have protested the secretive process by which party leaders in their chamber are developing legislation to remake the health care system,” Pear writes in the Times. “The lawmakers, members of the fiscally conservative Blue Dog Coalition, said they were ‘increasingly troubled’ by their exclusion from the bill-writing process.” 

From the annals of cooperation and comity: Health Care for America Now is up Tuesday with a new ad in support of a public option. You know the senators who matter since we know the states where the ads will run: Pennsylvania, Nebraska, Oregon, Arkansas, Indiana, and Delaware.   

The Trojan horse concern: “Not everyone considers this the ‘game-changer’ Obama has suggested. In fact, some health reform advocates fear it might have the opposite effect, allowing the companies to stay at the table long enough to kill a government-run health insurance plan,” Politico’s Carrie Budoff Brown reports

What all that fiscal discipline (millions plus billions) has meant: “The White House on Monday projected 2009 and 2010 federal budget deficits far higher than it forecast just two and a half months ago, even as it continued to defy most experts and predict that the economy is headed for a strong comeback starting late this year,” McClatchy’s David Lightman writes. “Economists scoffed at the latest administration predictions.” 

“The government will have to borrow nearly 50 cents for every dollar it spends this year, exploding the record federal deficit past $1.8 trillion under new White House estimates,” the AP’s Andrew Taylor writes

Can’t knock that search for savings -- can you? “The Obama administration said Monday that it expected even wider deficits this year and next than previously forecast, and Congress could undermine the administration's push to narrow the gap by slashing the revenue generated by the president's plan to curb greenhouse gases,” Jonathan Weisman writes in The Wall Street Journal. “White House economists didn't revise their expectation that the economy would be growing by 3.5% by the end of this year, despite the fact that some private economists have been lowering their forecasts.” 

Phrasemakers to the rescue: “If you call it 'clean energy dividend' . . . almost anything other than 'cap and trade,' you'll get people responding a lot more favorably,” said Robert Perkowitz, president of ecoAmerica, who met with the White House Council on Environmental Quality Monday, Weisman reports.

Wait -- there’s a BIGGER war with business? “Major corporations are arming for a brawl over overseas tax breaks that could be the year’s biggest clash between business and the White House,” Mike Allen and Victoria McGrane write for Politico. “The tax fight pits Big Business against a popular president -- at a time when the American public is still seething with anger over Wall Street bailouts, unemployment and the housing meltdown.” 

“The more the business community sees of the Obama administration’s tax plans, the less it likes,” CQ’s Joseph J. Schatz writes

We always have the stimulus: “The White House Council of Economic Advisers issued a report today predicting that the stimulus package will save or create 1.5 million jobs by the end of this year. That's in line with previous White House estimates,” per ABC News. “But there's a big caveat: Because there is no uniform, reliable reporting formula for states and agencies to use to calculate real jobs saved and created, there is no way to fact-check the projections.”

Don’t miss this nugget: “Actual reports of jobs created, while required by Congress for entities receiving stimulus funds, will provide ‘some independent documentation of jobs created or retained by the Act’ -- but won't be the way the White House measures progress, according to the report.” 

It’s still SAVING jobs, right? “Eleven weeks after Congress settled on a stimulus package that provided $135 billion to limit layoffs in state governments, many states are finding that the funds are not enough and are moving to lay off thousands of public employees,” Alec MacGillis writes in The Washington Post

There’s still an economy to save -- unless it’s already saved: “The insider consensus seems to be that the worst of the hard times is behind us and that the economy is back on track. Or at least on track to be back on track,” Arianna Huffington writes. “It's time to stop pretending that the Wall Street economy is the same as the real economy. The Wall Street economy may be showing signs of life -- thanks to the hundreds of billions we have poured into it -- but the real economy isn't.”

Savvy play of the day: Rush Limbaugh chose not to respond to Wanda Sykes -- at least not directly. “How can they be running a response when I didn't respond? . . . Well, there isn't going to be a response,” El Rushbo said, per The Washington Post’s Dana Milbank.

Milbank: “This means one of two highly unlikely things had to be true: Limbaugh really was the 20th hijacker, or he was taking the high road.”

Gibbs’ response, per ABC’s Jake Tapper: “A lot of topics are better left for serious reflection rather than comedy. I don't think there's any doubt that 9/11 is a part of that.”

Looking abroad: “In ousting his top commander in Afghanistan, Defense Secretary Robert M. Gates agreed Monday with growing criticism in military circles that the U.S. war effort has been suffering from stale ideas and inadequate innovation,” Julian E. Barnes writes in the Chicago Tribune. “A critical failure of Army Gen. David D. McKiernan, replaced as the commander in charge of U.S. and NATO forces, was the lack of bold, new operational plans and a reluctance to adapt successful strategies from Iraq, according to officers and Defense officials.”

Waiting for you, Madame Speaker: “For Speaker Nancy Pelosi (D-Calif.), it’s a new week of old questions: What did she know about harsh Bush administration interrogation techniques, and when did she know it?” Roll Call’s Tory Newmyer and Steven T. Dennis report. “Usually a master of message discipline, Pelosi has been thrown off balance by a mounting firestorm over whether she or her staff learned six years ago that intelligence officials were using extreme tactics such as waterboarding.”

What we’ll hear from her? “House Speaker Nancy Pelosi learned in early 2003 that the Bush administration was waterboarding terror detainees but didn’t protest directly out of respect for ‘appropriate’ legislative channels, a person familiar with the situation said Monday,” Politico’s Glenn Thrush and John Bresnahan report.

“Casting aside their president's misgivings, Democrats are racing into hearings to criticize newly released Bush administration memos justifying harsh terrorism interrogations,” the AP’s Larry Margasak reports. “So far, however, the biggest embarrassment has engulfed a Democrat, House Speaker Nancy Pelosi. As Pelosi keeps trying to clarify when she initially learned of the interrogation techniques, a Senate Judiciary subcommittee scheduled a hearing Wednesday that was billed as the ‘first public hearing on torture memos since their release.’ ”

And if former vice president Dick Cheney is so sure that memos show waterboarding worked: “The Obama administration ought to call Cheney's bluff, if it is that, and release the memos. If even a stopped clock is right twice a day, this could be Cheney's time,” Richard Cohen writes in his Washington Post column.

Senate announcement of the day: Gov. Charlie Crist, R-Fla., jumps in on Tuesday: “Crist's entry into the race is a recruiting coup for the National Republican Senatorial Committee,” ABC’s Teddy Davis reports. “Although national Republicans have been lobbying the Florida governor to get into the race, he will not have a free ride in the primary.”

Everyone’s running for something in the Sunshine State: “Crist's anticipated announcement this morning that he's running for the U.S. Senate, rather than re-election as governor, will trigger one of the most chaotic and wide open election seasons ever in Florida,” Beth Reinhard and Adam C. Smith write in the St. Petersburg Times.

That means a fan of the stimulus package is among the most prominent Republican candidates on the 2010 slate. . . .

“Crist is, without question, the star of the Republican recruiting efforts to date -- a well known and popular chief executive who also happens to be running in one of the largest and most politically competitive states in the country,”’s Chris Cillizza writes. “He is also someone with unabashed interest in playing at the national level.”

Sorry, Chuck Schumer: “Oh, I am sure she will face a Democratic primary,” Rep. Carolyn Maloney, D-N.Y., said of Sen. Kirsten Gillibrand, D-N.Y., on’s “Top Line” Monday. (Though Maloney herself hasn’t added her name to the growing list -- at least not yet.)

Checking in (or out) -- more ominous signs on card-check: “Sen. Blanche Lincoln (D-Ark.) indicated last week she does not favor the so-called ‘binding arbitration’ part of the Employee Free Choice Act (EFCA) as currently written,” The Hill’s Michael O’Brien reports. “Lincoln joins two other centrist Democrats in opposition to the second key component of EFCA favored by organized labor, making it difficult for a final compromise of the bill including the provision to overcome a Senate filibuster.”

Ready -- over on the left -- to hear about this one? “Four months in, the Obama administration does seem to have a plausible strategy for turning the ‘social issues’ to liberalism’s advantage. The outline is simple: Engage on abortion, and punt on gay rights,” Ross Douthat writes in The New York Times.

And over on the right -- Mike Huckabee really, really doesn’t like pizza parties: “It's hard to keep from laughing out loud when people living in the bubble of the Beltway suddenly wake up one day and think they ought to have a listening tour; even funnier when their first earful expedition takes them all the way to the suburbs of Washington, D.C.,” Huckabee writes at

The Kicker:

“Thanks for salvaging my bracket and vindicating me before the entire nation.” -- President Obama, meeting the UNC Tar Heels for a second time.

“On Tuesday, before Obama is inaugurated, I'm invited to the White House for a birthday lunch by the president, and I'm toasted. Twelve weeks later, I am public enemy number one.” -- Rush Limbaugh, in self-pity/self-congratulatory mode.

Today on “Top Line,”’s daily political Webcast: Former DNC Chairman Howard Dean, on healthcare reform; and GOP strategist Kevin Madden. Noon ET. 

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