This week President Obama and his Democratic allies on Capitol Hill begin to get down to the short strokes, unveiling details that will transform the concept of health care reform into a specific proposal. Simultaneously, the administration and congressional Democrats are offering incentives to very interested parties, encouraging their support wherever possible and, failing that, their silence.
They are also brandishing a cudgel, warning would-be adversaries in the medical-provider community that going too far in opposition might make for tough years ahead.
On Monday, Obama traveled home to Chicago to address the highly skeptical American Medical Association on his health care proposal. It's hard to imagine that too many of the AMA's 800,000 members would find a lot to like in a proposal designed to restrain spending on health care.
But a story that morning in the New York Times suggesting that the president would be open to making changes in the area of medical malpractice liability had to give the physicians waiting to hear the president at least some reason to hesitate before unleashing their opposition.
For Democratic leaders, the biggest challenge might well be determining just how much compromise is necessary, and worth it, to achieve the bipartisan legislation they say they want.
For years, physicians and health care executives, as well as many of their Republican allies in Congress, have pointed to the payment of medical malpractice insurance premiums and the costs of practicing defensive medicine as major drivers in the soaring costs of health care. One could have a weeklong symposium on what role medical liability has had in the rising costs of health care, but the president certainly arrived at the AMA convention with a carrot in hand.
It is hard to know just how far Obama and congressional Democrats would be willing to go in antagonizing trial lawyers, one of the party's more loyal allies. But, if this gesture is sincere, it could conceivably create an important opening in this debate. It's hard to ask, ask, ask without a bit of give, give, give.
Given Obama's sky-high job approval ratings among Democrats, particularly self-described liberals, he certainly has the capital within the party to spend on winning what has come to be his legislative centerpiece.
Meanwhile, ahead of this week's Senate Health, Education, Labor and Pensions Committee markup of a health care bill, top aides to Senate Finance Chairman Max Baucus, D-Mont., held a meeting Wednesday with key lobbyists warning of the consequences of cooperating with Republicans in opposing the pending health care plan.
It's unlikely that the Baucus aides had to remind these lobbyists which party has 59 seats in the Senate -- and is likely to get a 60th soon, once Minnesota's Al Franken is sworn in -- and for that matter, which party is more likely to pick up an additional seat or two in the 2010 midterm elections. While that meeting probably didn't involve a Godfather-like offer they couldn't refuse, there still was an implicit threat.
But Obama's speech to the AMA and the HELP committee markup are just two of the three important developments this week on the health care front.
The third is a briefing Wednesday in which former Senate Majority Leaders Howard Baker, R-Tenn., Tom Daschle, D-S.D., and Robert Dole, R-Kan., will unveil "Crossing Our Lines: Working Together to Reform the U.S. Health System," a report from their Bipartisan Policy Center, which is expected to help define a middle-ground approach to reform.
The project is co-directed by two of the foremost experts from their respective parties on health care -- Democrat Chris Jennings, former President Bill Clinton's senior health adviser, and Republican Mark McClellan, the former FDA commissioner and Centers for Medicare and Medicaid Services administrator. Backers hope that by lowering the rhetorical heat and finding reasonable compromise on the thorniest aspects of the issue, the long-delayed goal of health care reform can be achieved.
For the Obama administration and Democratic leaders, the biggest challenge might well be determining just how much compromise is necessary, and worth it, to achieve the bipartisan legislation they say they want.
Failure to compromise would result in no Republican support; perhaps a 10 percent compromise might win over a couple of GOP senators, say Maine Sens. Susan Collins and Olympia Snowe. But some Democrats think that to win over the support of a half-dozen or more Republicans would require giving away the store. So they have to decide just what value is the bipartisan label worth and whether they want to pay that price.
Baker, Daschle and Dole coming together with recommendations brings to mind the 1995 film, "The American President," when Michael Douglas' character, President Andrew Shepherd, said, "We have serious problems to solve, and we need serious people to solve them." Hopefully, serious people in Congress on both sides will listen to these three highly respected leaders, compromise and move the ball forward, rather than putting off the tough decisions once again.