The Note: Showtime -- What Is The President Selling On Health Care?

June 24, 2009 8:22 AM

By RICK KLEIN

President Obama’s health care challenge is just this: He needs to do more with less, while convincing people that less is more.

All while the public isn’t convinced that any of it is necessary -- no, probably not even 95 percent of the way there. 
 
As health care reform enters a more intense national discussion phase, with ABC’s 10 pm ET broadcast Wednesday from the White House, the president is engaged in a sales pitch of still-evolving proportions.

His challenge is to make the broad case for health reform -- a case that probably he alone can make. (Notwithstanding the insistence that the public is clamoring for reform, he’s going to have to amplify the clamor.)

But we’re getting farther along in the legislative process -- actual bills with (maybe) actual numbers attached are staggering through committees. Reporters and even members of Congress really want to know where the Obama White House stands.

There’s White House calm, animated by presidential optimism.

“We're gonna get it done. So, I won't engage in hypotheticals in which we don't,” Obama told ABC’s Diane Sawyer, on “Good Morning America” Wednesday. “The reason it's going to get done is because the American people understand it has to get done.” 

If this becomes the case, do the odds of success shoot up dramatically? “In this debate, the burden should be on those who say we should do nothing,” the president said.

On mandates, his thinking has “evolved,” and he still wants limits on tax deductions as part of the financing:

“I still think that’s the best way to go about it,” the president said. “I have identified the ways that I think we should finance this. I think Congress should adopt them. I'm going to wait and see what ideas ultimately they come up with. I suspect when they start saying what the options are, they might end up concluding that actually the options we're presenting are the best ones.”

Yet where does this admission lead to -- other than a political opening for Republicans?

“When I say if you have your plan and you like it, . . . or you have a doctor and you like your doctor, that you don't have to change plans, what I'm saying is the government is not going to make you change plans under health reform,” the president said at his news conference, in response to a question from ABC’s Jake Tapper.

The president told Diane Sawyer: “I can't pass a law that says, ‘I'm sorry, employers, you can never make changes to the health care plans that you provide your employees.’”
 
And if this is not a line in the sand, it may be a sandy line sprinkled on the pavement: On what he wouldn’t support, Obama said, “I think that if any reform that we get is not driving down costs in a serious way.”

“If people say, ‘We're just gonna add more people onto a hugely inefficient system,’ then I will say no, because we can't afford it. If there aren't some basic game changes in the system, additional incentives for prevention -- encouraging, you know, family care physicians. If we're not, you know, looking at what systems work best and trying to duplicate that. All those things that drive down costs -- if those aren't in there, then I'm not for the bill.”

(Do either of the Senate bills really do all that?)

It feels like it’s getting late pretty early. But President Obama, on whether he must have a public plan: “It’s too early to say that. Right now, I will say that our position is that a public plan makes sense.”

(ABC’s coverage of health care continues on “World News” at 6:30 pm ET, through the 10 pm ET “Primetime” special edition from the White House, and “Nightline” at 11:35 pm ET. It’s also the main topic on ABCNews.com’s “Top Line” at noon ET, and we’ll be following the latest on The Note blog and via Twitter, @thenote.)

Looking for that broad national consensus: “Americans are at once supportive of health care reform yet broadly suspicious of its impact -- keeping the issue as much a political challenge as it was in the last attempt at wholesale change 16 years ago,” ABC’s Gary Langer writes in summarizing the new ABC News/Washington Post poll.

“The chief obstacle to reform is that large majorities are satisfied with their current care and coverage; most, albeit fewer, also call their costs tolerable. Dissatisfaction with the system overall, and worry about future costs, are countered by broad concerns that change could worsen the quality, choice and coverage most Americans enjoy now,” Langer writes. “The result: pushback works.”

“More than eight in 10 said they are satisfied with the quality of care they now receive and relatively content with their own current expenses, and worry about future rising costs cuts across party lines and is amplified in the weak economy,” the Post’s Ceci Connolly and Jon Cohen write.

Working for that public plan: “Obama on Tuesday dismissed as ‘not logical’ the insurance lobby's assertion that a new government health plan he backs would dismantle the employer-sponsored coverage most Americans now have,” Ricardo Alonzo-Zaldivar and David Espo write for the AP. “Despite harsh words from the president, senators attending an evening meeting in the Capitol with White House Chief of Staff Rahm Emanuel said the administration was not ready to abandon the search for compromise.” 

“Obama framed his proposal as the only way to break the cycle of ever-higher medical costs that has sapped the financial stability of families and the government,” Noam N. Levey and Peter Nicholas write in the Los Angeles Times. “At the same time, however, he refused to rule out the possibility that he might sign a healthcare bill that did not include a public-plan option.”

“Obama refused -- first implicitly and then explicitly--to say he'd veto a bill that lacked a public insurance option,” per The New Republic’s Jonathan Cohn. “For those who hope reform will emerge without a public plan, this is good news.”

The fight is on: “Industry leaders . . . said any type of public insurance option would drive private companies out of business, raise costs for employers and workers and increase budget deficits,” USA Today’s David Jackson writes. “The back-and-forth represented a potential setback for Obama's goal of overhauling the nation's health care system -- something insurers helped to scuttle 15 years ago under President Clinton with their national "Harry and Louise" advertising campaign.”

“The ‘public option’ has emerged as the crux of the unfolding debate over health-care reform on Capitol Hill, an ideological flash point that has become perhaps the greatest challenge for the Senate negotiators attempting to reach a compromise that could actually become law,” Shailagh Murray writes in The Washington Post.

Said Sen. Chuck Schumer, D-N.Y.: “I'm losing confidence that Senate Republicans will ever agree with the types of changes to a co-op that would make it a viable substitute.”

Senate Majority Leader Harry Reid, D-Nev., sets the bar: “We need about three or four Republican senators to join with us, to have a bipartisan bill.”

Sen. Orrin Hatch, R-Utah, takes it down: “They’ll probably try and push some cockamamie bill through on reconciliation.” 

Senate Minority Leader Mitch McConnell, R-Ky., chooses his words carefully: “It remains the view of virtually all Republican senators that a government plan is the wrong way to go.”

The latest MoveOn.org e-mail takes on Sen. Dianne Feinstein, D-Calif., over her CNN appearance: “Democrats should be leading the charge to pass health care reform right now, not throwing cold water on the president's plan. Can you [call] Sen. Feinstein right away and let her know that, as a Californian, you want real health care reform this year?”

The president is more involved than he wants you to think: “As Senate Democratic leaders voiced increasing skepticism about reaching a bipartisan health care compromise, White House Chief of Staff Rahm Emanuel and a high-powered delegation of administration officials huddled with key Democratic senators on Capitol Hill Tuesday,” Politico’s Carrie Budoff Brown reports.

Not a good sign for the prospects of universal coverage: “Overseers of Massachusetts’ trailblazing healthcare program made their first cuts yesterday, trimming $115 million, or 12 percent, from Commonwealth Care, which subsidizes premiums for needy residents and is the centerpiece of the 2006 law,” The Boston Globe’s Kay Lazar reports.

Reasons for hope? “The whole effort could well fall apart once again,” Ruth Marcus writes in a Washington Post op-ed. “But my money is on the side of a significant legislative accomplishment -- something short of immediate universal coverage but more than cosmetic change. In conversations with veterans of the Clinton effort, all said the turbulence was expected, inevitable and almost certainly not the last buckle-your-seatbelt moment. But most were cautiously optimistic about the final outcome.”

Tone check from the presser: “The normally unflappable President Obama let his cool demeanor slip Tuesday, showing signs of frustration with questions on domestic and foreign policy issues as poll numbers indicate support for his policies is slipping,” The Hill’s Sam Youngman writes. “The president snapped at reporters who echoed his critics, particularly at those who questioned his response to unrest in Iran or asked about how his proposed public insurance plan might hurt the free market.”

Surely a first at a presidential news conference: “After the obligatory first question from the Associated Press, Obama treated the overflowing White House briefing room to a surprise. ‘I know Nico Pitney is here from the Huffington Post,’ he announced,” per The Washington Post’s Dana Milbank.

“Obama knew this because White House aides had called Pitney the day before to invite him, and they had escorted him into the room. They told him the president was likely to call on him, with the understanding that he would ask a question about Iran that had been submitted online by an Iranian,” Milbank writes.

“The use of planted questioners is a no-no at presidential news conferences, because it sends a message to the world -- Iran included -- that the American press isn't as free as advertised. But yesterday wasn't so much a news conference as it was a taping of a new daytime drama, ‘The Obama Show.’ ”

Arianna Huffington doesn’t want to hear about it: “Seems some of the boys can't seem to understand why the president would have the nerve to call on someone whose Iran coverage has been praised throughout the media, from Charlie Rose to Andrew Sullivan to the Economist,” she writes.

As for claims that Pitney solicited the opportunity to ask a question, Huffington writes: “Not true. Nico solicited his readers about questions they'd like to see the president asked about Iran. The White House then contacted him about asking a question at the presser.”

On Iran -- that language sure sounded different.

“President Obama hardened his tone toward Iran on Tuesday, condemning the government for its crackdown against election protesters and accusing Iran’s leaders of fabricating charges against the United States,” The New York Times’ Helene Cooper and David E. Sanger report. “In his strongest comments since the crisis erupted 10 days ago, Mr. Obama used unambiguous language to assail the Iranian government during a news conference at the White House, calling himself ‘appalled and outraged by the threats, beatings and imprisonments of the past few days.’ ”

ABC’s Jake Tapper: “President Obama amped up his rhetoric about the Iranian government crackdown on protestors Tuesday afternoon, expressing concerns about the death of a young woman who’s become an icon of the protests -- Neda Agha-Soltan -- but also not indicating any policy shift towards the Islamic Republic.”

The AP fact-check: “President Barack Obama described himself on Tuesday as being ‘entirely consistent’ in his expressions of concern about the disputed Iranian election and the government crackdown that followed street protests. But his language clearly has gotten tougher since his first statement that the suppression of dissent was ‘of concern to me.’ ”

The Chicago Sun-Times’ Lynn Sweet: “The inside story of how the White House choreographed the Huffington Post question is overwhelmed by the message Obama wanted to send out to the Iranian youths on the streets of Tehran, who are witnessing their revolution play out on the Web. Even though the Iranian government has tried to curb cell phone videos and still pictures, Twitter messages and e-mail exchanges, the social networking tools of the Internet have helped organize demonstrations and send information out to the world.” 

Slate’s John Dickerson: “He escalated his rhetoric about the violence in Iran but insisted he hadn't changed his posture. He claimed to be outside the 24-hour news cycle while simultaneously manipulating it.”

It’s not enough for Newt Gingrich. The former House speaker offers a challenge, in his newsletter to supporters: “He can use his great rhetorical skills and the resources of the American government to buttress the courage shown by the protestors in the Iranian streets, or he can use them to betray them. He can seize this moment to help bring about the end of the planet's number one state sponsor of terrorism, or he can let it pass him by. But he can't go back and negotiate with a leadership that stole an election and turned its thugs loose on the citizens who protested. He can't give legitimacy to a thoroughly illegitimate regime.”

Cap-and-trade is on the move in the House (and what are the chances this is going to be one of those votes that last just 15 minutes?).

The vote is slated for Friday: “The House Rules Committee unveiled the latest version of the bill, which weighs in at 1,201 pages,” Steven Mufson reports in The Washington Post. “It features new items such as $7.5 billion in ‘green bonds’ for a new federal financing agency called the Clean Energy Deployment Administration, extra emission allowances for politically powerful rural electric cooperatives, greater flexibility for states that want to use free allowances for mass transit, and tweaks benefiting a range of companies, including algae-based biofuel producers and major petroleum refiners.”

John Podesta finds some inspiration in offering an endorsement, at Think Progress: “Once again, Mick Jagger is right: ‘You can’t always get what you want/ But if you try, sometimes you just might find/ You get what you need.’ The House of Representatives is poised for its first ever floor debate on legislation to reduce global warming pollution. This landmark bill is revolutionary in its intent and, while imperfect in its means, deserves the support of progressives.”

Over in the financial world: “Lawmakers on a congressional oversight panel are struggling with whether to ramp up a probe into a controversial home-loan program at Countrywide Financial Corp. that involved former Chief Executive Angelo Mozilo,” John R. Emshwiller and Kara Scannell write in The Wall Street Journal. “Rep. Darrell Issa, a Southern California Republican and the ranking minority member on the House Committee on Oversight and Government Reform, wants to subpoena records of the program known as ‘Friends of Angelo.’ ”

(Don’t miss George Stephanopoulos’ --  @gstephanopoulos -- second Twitterview, this one with Rep. Issa, Wednesday at 2 pm ET.)

Welcome back (we presume): “S.C. Gov. Mark Sanford will return to work today, his staff said, cutting short a mysterious hiking trip along the Appalachian Trail,” The State’s John O’Connor and Cliff Leblanc report. “But there are still unanswered questions about Sanford’s whereabouts, from his exact location on the Appalachian Trail to why the governor, a father of four, would leave town over Father’s Day weekend.”

“Also on Tuesday: • Sawyer admitted staffers still did not know the governor’s location. . . . • A mobile phone tower picked up his last known location near Hartsfield-Jackson Atlanta International Airport on Thursday, according to a source familiar with the situation. • Greenville television station WYFF reported Tuesday night that sources had reported seeing Sanford boarding a plane at the airport.”

Politico’s Jonathan Martin: “South Carolina GOP Gov. Mark Sanford’s disappearing act is reviving an often-whispered, if rarely written, question about presidential hopefuls: Just how strange is too strange?”

Mike Huckabee takes on the NRSC, over the Florida Senate race: “I’m disgusted that they would take a position in a hotly contested race when you have a quality candidate like Marco Rubio, who was the youngest Speaker in the Florida House,” Huckabee told The Hill’s Aaron Blake. “This is not just some nameless, faceless guy that decided to throw his name in, who had no chance and no credibility.” 

The Kicker:

“There are times when an abortion is necessary. I know that. When you have a black and a white. . . . Or a rape.” -- President Richard Nixon, in 1973, after Roe v. Wade was decided, in newly released White House tapes.

“I know everybody here is on a 24-hour news cycle. I’m not. OK?” -- President Obama.

Today on “Top Line,” ABCNews.com’s daily political Webcast: Sen. Bernie Sanders, I-Vt., and Ana Marie Cox of Air America. Noon ET.

Follow The Note on Twitter: http://twitter.com/thenote

For up-to-the-minute political updates check out The Note’s blog . . . all day every day:
http://blogs.abcnews.com/thenote/