WASHINGTON — President Barack Obama pumped health care allies and skeptics alike for ways to overhaul the nation's costly and frustrating system Thursday and heard only applause and agreement when he told them there's "a clear consensus that the need for health care reform is here and now."
However, he conceded at a White House summit that opinions vary widely on exactly what to do and said that winning quick approval for historic and stunningly expensive legislation won't be easy.
Still, the unanimity on the urgency to act underscored how the political environment has become more favorable to revamping the thorny system since President Bill Clinton's attempt failed in the 1990s under intense resistance from drugmakers, insurance companies and others. All those interest groups were on hand Thursday, and Obama intended his daylong Washington session and a series of meetings to follow around the country to signal that his push for universal health care coverage will be more open and inclusive than Clinton's.
Status quo 'not on the table'
"Every voice has to be heard. Every idea must be considered ... The status quo is the one option that is not on the table," Obama said during the White House forum on what he calls the greatest threat to the U.S. economy — rising health care costs. Mindful of the demise of the Clinton plan, Obama warned, "Those who seek to block any reform at all, any reform at any cost, will not prevail this time around."
The U.S. system is the world's costliest; the country spends some $2.4 trillion a year on health care. It leaves an estimated 48 million people uninsured, and many others lack adequate insurance.
Firm in his insistence on action, Obama was relaxed as he fielded questions from lawmakers and the heads of crucial interest groups. At one point he sneezed twice, and then as the audience laughed said, "This is a health care forum, so I thought I'd model what happens when you don't get enough sleep."
In an emotional moment, Sen. Edward Kennedy of Massachusetts addressed the group, his first Washington appearance in weeks as he battles brain cancer. He received a long ovation and declared, "I'm looking forward to being a foot soldier in this undertaking, and this time we will not fail."
Although Obama wants coverage for all, the president suggested a willingness to compromise. That, too, was a break from Clinton's posture in the 1990s when he promised to veto any health care measure that didn't give him what he sought.
'No proposal will be perfect'
This time, Obama said, "Each of us must accept that none of us will get everything we want, and no proposal for reform will be perfect."
Republicans as well as Democrats agreed. Speaker after speaker at the end of a day of smaller White House sessions said action was needed.
Sen. Charles Grassley of Iowa, top Republican on the Senate Finance Committee, said that panel should be working on a version by June. He said the timetable might seem "a little ambitious, but if you aren't ambitious on a major problem like this that the country decides needs to be done, it'll never get done."
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Signaling arguments to come, however, he told Obama that there is concern that giving many people the option of a government insurance plan — something Obama has proposed — would reduce competition
Republican Rep. Roy Blunt of Missouri said the same at one session: "That's clearly going to be a big area of contention."
But no one told Obama he or his group would stand in the way of significant action.
Moral and economic imperative
Making his case, the president said health care overhaul is both a moral and economic imperative because of the system's huge stress on the nation's financial books. He blamed Washington politics and industry lobbying for past failures, while pledging to put the public's interest ahead of both this time.
Obama is setting a rigorous timeline to enact "comprehensive health care reform" by year's end, though he didn't precisely define what that would entail. His advisers say while he hopes for a bipartisan measure, he won't be deterred by ideological fights or interest group opposition.
Not offering a specific plan
Unlike Clinton, Obama isn't offering a specific plan, but rather is outlining general principles to guide the Democratic-controlled Congress as it writes the measure: increased coverage, improved services and better control of costs. The House and Senate will be left to do the heavy lifting.
Although he proposed a plan during the campaign, Obama said that he's open to any solution — from an entirely private system to more government involvement — as long as it meets his general priorities. "I just want to figure out what works," he said.
On Capitol Hill, Rep. Steny Hoyer, the No. 2 House Democrat, and Senate Finance Committee Chairman Max Baucus, D-Mont., said Thursday they want their respective chambers to pass bills this summer so lawmakers can spend the rest of the year working out a compromise and get a final bill to Obama's desk by year's end.
Fault line between parties
Still, the political reality of reshaping the complex medical system is certain to intervene as the broad discussion about the need for reform gives way to the details. Those may well conflict with the priorities of a host of stakeholders, including patients, doctors, labor unions, drug companies, businesses and employers, insurers and lawmakers up for re-election next year.
There is also a fault line between Democrats and Republicans over the role of government in the health care system — and that could complicate Obama's push to ensure health care for everyone.
Signaling likely areas of contention ahead, Senate Republican leader Mitch McConnell of Kentucky told Obama in a letter that his party was ready to work with the administration on health care but he also warned that the GOP would bristle at changes that lead to a government-run system and coverage expansions that don't come with curbs on costs.
In office just six weeks, Obama already has made one big move on health care. He proposed a budget that has a $634 billion "down payment" for expanded coverage over a 10-year period. The government will spend trillions on health care over the same period.
Broadly, Obama is seeking to use his popularity as a new president and the public's high level of frustration with medical costs to generate momentum for universal coverage.
In hindsight, both supporters and opponents agree that Clinton made a series of missteps and miscalculations that doomed his plan from the outset.
Obama consulting openly with people
With first lady Hillary Rodham Clinton leading the charge, the White House wrote the measure with little input from lawmakers or interest groups. Stakeholders on all sides complained they were shut out of the process. Clinton's veto threat also limited his room to negotiate.
Now, Obama is making a point to consult openly with people.
Even before he took office, he used his campaign apparatus to encourage people to hold open meetings across the country to discuss the matter. The White House says more than 30,000 people attended more than 3,000 meetings in 50 states and Washington, D.C.
On Thursday, more than 120 people from all sectors — and with a wide range of viewpoints — were taking part in the program. They included longtime health reform heavyweights, and some people who helped kill Clinton's overhaul in the 1990s. One by one, they stood and praised Obama's willingness to cast a wide net for advice and include them in the process.
Later on, Obama is planning to hold a series of health care events around the country, including in rural areas, to solicit ideas and drum up support for his vision.
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