Health Care Summit Produces Fireworks but Lacks Bipartisan Breakthrough

Republicans and Democrats were able Thursday at the White House's health care summit to come together on a number of issues, starting with the belief that the system needs fixing, but their disagreements also fueled plenty of fireworks.

The devil was in the details, and by the end of the full-day session, a significant breakthrough still seemed beyond reach.

Republicans appeared just as steadfastly opposed to the Democrats' sweeping vision of remaking the nation's health care system as they were at the beginning.

And Democrats refused to cede any ground to the Republican argument that they should start from scratch and take an incremental approach to health care reform.

Here are the specific issues still dividing the parties.


The nation's fragmented and inefficient health system found no defenders among the three dozen Republican and Democratic lawmakers at the summit. Lawmakers from both parties said spiraling costs threatened to bankrupt families and the country.

"We all know this is urgent," Obama said.

"We all agree on the problem here and the problem is that health inflation is driving us off a fiscal cliff," said Rep. Paul Ryan, R-Wis.

So what to do? Democrats are supporting massive legislation enacting a top-to-bottom overhaul of the system and requiring nearly everyone to be insured. Republicans say that approach needs to be scrapped, and they want a step-by-step approach. If there's somewhere to meet in the middle lawmakers haven't found it yet.


The Democratic bills establish state or national purchasing exchanges where individuals and small businesses in need of insurance could pool together and compare federally regulated plans. Sen. Mike Enzi, R-Wyo., said he liked the idea of the purchasing exchanges. But Enzi said any and all private insurance plans should be offered -- not just those meeting federally established standards. Democrats say consumers need the protection of government-set standards.

Similarly, Democrats say they could accept Republican ideas for associations or small businesses to pool together and shop for health plans if the federal government could set minimum standards, but Republicans don't want the federal government that involved.


All involved agreed that people with pre-existing health conditions should be able to get health care and that people who fall ill shouldn't have their coverage revoked.

Democrats say the only way to accomplish those reforms is through a mandate for nearly everyone to carry insurance, which would create a large risk pool including many healthy people, enabling insurers to take all comers. Republicans oppose the mandate, and instead would set up "high-risk pools" where people with high-cost conditions could buy care. Democrats contend that as proposed by the GOP the pools would be so underfunded they'd be ineffective.


This is a long-running dispute between Democrats and Republicans that Obama has cited as an area of potential compromise. The Republicans' preferred solution is capping non-economic jury awards and Sen. John McCain, R-Ariz., argued in favor of that approach. But Democrats and their trial lawyer allies have rejected that notion repeatedly. Obama has announced the establishment of state-level pilot programs that Republicans say don't go far enough. "I don't think we have to experiment around," McCain said.

Sen. Dick Durbin, D-Ill., countered that there should be no limits on payments to people injured in medical errors.


Who could disagree with that? But Democrats and Republicans are far apart on how to do it. The Democrats' legislation cuts hundreds of billions of dollars from Medicare, mostly from private plans within the system. Democrats would use some of the savings to close a coverage gap in Medicare's prescription drug program and say their cuts would strengthen Medicare by extending the program's solvency and eliminating inefficiencies and overpayments to private insurers. Republicans rail against the cuts.

Ryan has a different approach: He would give future Medicare beneficiaries vouchers to shop in the private market, something Democrats say would leave seniors out in the cold.

The Associated Press contributed to this report.