Overhauling Health Care Takes More Than Money

Overcoming the politics entwined in changing the nation's health care system will be difficult. Over the weekend, some members of the Obama administration seemed to shift positions on what the president deems absolutely essential in this bill. One of the big changes seems to be the willingness to look at taxing health benefits as a way to pay for the bill.

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RENEE MONTAGNE, host:

Joining us now, as she does most Mondays, is NPR News analyst Cokie Roberts. Good morning.

COKIE ROBERTS: Good morning Renee.

MONTAGNE: In turning to the politics of health care, Cokie, over the weekend some members of the Obama administration seemed to shift positions on what the president deems absolutely essential in this bill.

ROBERTS: Well, one of the big changes seems to be the willingness to look at taxing health benefits as a way to pay for this very expensive bill. The president's advisor David Axelrod said there were no lines in the sand on that, despite the president's campaign promise that families making less than $250,000 would not see any form of tax increase. That's what candidate Obama said repeatedly, but Axelrod said yesterday that lots of ways of paying for this are on the table.

And Senator Charles Grassley of Iowa, who really has been continuing to negotiate with the Democrats in the Senate on this bill, emphasized repeatedly the option of cooperative for health insurance companies rather than a public option, where the government would back one option.

So, there's a lot of negotiating still going on there. And while it's going on, you're seeing all kinds of campaigning around it. Particularly, new ads coming from the left - groups like MoveOn.org - going after Democrats who seem to be, in their view, wavering - Democrats like Mary Landrieu of Louisiana, Ben Nelson of Nebraska - without understanding, seemingly, that these Democrats could be in very bad shape in their states and Republicans could get elected if they get too far out there on issues like health care and energy.

MONTAGNE: And when it comes to Republicans, they seem to think their best move is simply to say no to the president's policies on health care, also energy and some other issues. Is that working for them?

ROBERTS: Well, they seem to think that in 2010 it might be just fine, that the spending in all of these bills is beginning to scare people and that some taxes, if all this legislation goes through, that some of the taxes would be real.

Over the weekend, one of the president's allies, Warren Buffett, said about the energy bill that the House passed narrowly on Friday, that that would be definitely a tax and a regressive tax at that. The president yesterday was critical, by the way, of the tariff measures in that bill but he was not critical of the 44 Democrats who voted against the energy bill in the House.

Because he says, look, they've got races coming up and he knows that some Democrats are in very vulnerable seats because they did so well in the last election. So, even though the Republicans keep having big problems personally and politically, they could pick up some seats in 2010.

But, you know, even if that happens, Renee, it doesn't mean the Republican Party is in good shape. They need to look at what happened with the Democrats in 1982 after the Reagan landslide in 1980. Democrats picked up seats in that election, but it kept them from understanding that a fundamental realignment had taken place. And young people in 1984 went Republican and stayed there for a generation. Republicans could be looking at the same shift today.

MONTAGNE: And, again, to actually repeat a little bit, even so if it picks up seats in Congress, it's got some work to do in the long run.

ROBERTS: Absolutely, yeah, and for some Republicans the most important event that took place last week was the meeting at the White House on immigration reform, because they are seeing Hispanics going overwhelmingly Democratic in the last election and young people. And that's where the demography becomes inexorable. And there's a Pew poll out today showing a bigger generation gap than we've seen in decades and young people really disagreeing with Republicans on all kinds of cultural issues.

So, they've got a huge amount of work to do, if they don't want to look at the same kind of realignment the Democrats had to look at in the '80s.

MONTAGNE: That's NPR's Cokie Roberts.

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MONTAGNE: This is MORNING EDITION from NPR News.

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