President Obama has expressed his willingness to include a few Republican ideas in the impending incarnation of Obamacare. The four main ideas are:
* Engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs to ferret out abuses of the system;
* Provide for $50 million in grants to states that are testing medical malpractice reforms (some such funding is already proposed, but Obama is willing to designate an additional $50 million for this purpose);
* Increase physicians’ Medicare reimbursements;
* Offer health savings accounts in the insurance exchange.
Obama would not commit to any of these ideas, but I would expect them to be included, in some form or other, in the revised legislation he’s working on.
The changes are “small ball.” Indeed, the grants to test medical malpractice reform are almost insulting. The proposal amounts to trying to stall reform that the trial lawyers don’t want by studying it to death. If we’re going to run tests before engaging in reform, why don’t we test Obama’s government takeover of one-sixth of the economy with a few “pilot” programs?
But Obama isn’t looking for Republican support, he’s looking to provide cover for Democrats before they are asked to take the great leap forward — voting for unpopular legislation and using highly controversial tactics to ram it into law. Obama isn’t even trying to make Republicans look bad (though he’d happy if this occurs) as much as he is trying to permit Democratic members of Congress to hope that Republicans are going to look bad.
As I understand the process (and I admit I’m not sure I do), the House will be asked to pass the Senate bill as is, not Obama’s revised bill. The revised bill would formally arrive on the scene during the reconciliation process, but the House would understand that this (or something close to it) is the real legislation under consideration. This “real” legislation would not only contain a few Republican ideas but would be stripped of the Cornhusker Kickback and a few other particularly unsavory provisions.
It’s not clear whether this strategy will work, but it’s clear to me that Obama’s hyper-involvement in the process is improving the Democrats’ prospects for legislative success (political success this fall is another matter). I can’t help but wonder why Obama wasn’t more of a player last year.