President Obama visited the White House briefing room today, where he made a statement about bipartisanship and then took several questions from reporters. He had a lot to say about health care, starting with this:

There are some core goals that have to be met.  We've got to control costs, both for families and businesses, but also for our government.  Everybody out there who talks about deficits has to acknowledge that the single biggest driver of our deficits is health care spending.  We cannot deal with our deficits and debt long term unless we get a handle on that.  So that has to be part of a package.

Number two, we've got to deal with insurance abuses that affect millions of Americans who've got health insurance.  And number three, we've got to make health insurance more available to folks in the individual market, as I just mentioned, in California, who are suddenly seeing their premiums go up 39 percent. That applies to the majority of small businesses, as well as sole proprietors. They are struggling.

So I've got these goals.  Now, we have a package, as we work through the differences between the House and the Senate, and we'll put it up on a Web site for all to see over a long period of time, that meets those criteria, meets those goals.  But when I was in Baltimore talking to the House Republicans, they indicated, we can accomplish some of these goals at no cost.  And I said, great, let me see it.  And I have no interest in doing something that's more expensive and harder to accomplish if somebody else has an easier way to do it.

So I'm going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals.  What I will not do, what I don't think makes sense and I don't think the American people want to see, would be another year of partisan wrangling around these issues; another six months or eight months or nine months worth of hearings in every single committee in the House and the Senate in which there's a lot of posturing.  Let's get the relevant parties together; let's put the best ideas on the table.  My hope is that we can find enough overlap that we can say this is the right way to move forward, even if I don't get every single thing that I want.

But here's the point that I made to John Boehner and Mitch McConnell:  Bipartisanship can't be that I agree to all the things that they believe in or want, and they agree to none of the things I believe in and want, and that's the price of bipartisanship, right?  But that's sometimes the way it gets presented.  Mitch McConnell said something very nice in the meeting about how he supports our goals on nuclear energy and clean coal technology and more drilling to increase oil production.  Well, of course he likes that; that's part of the Republican agenda for energy, which I accept.  And I'm willing to move off some of the preferences of my party in order to meet them halfway.  But there's got to be some give from their side as well.  That's true on health care; that's true on energy; that's true on financial reform.  That's what I'm hoping gets accomplished at the summit.

Press Secretary Robert Gibbs later made clear that Obama would not rule out the use of reconciliation, should compromise between the parties become impossible.

Full transcript of Obama's briefing is at whitehouse.gov. 

CNN's Sanjay Gupta is staring a series called "Health Care Simplified" and invited me to be a guest on the first installment, which ran over the weekend. The other participant was Darshak Sanghavi, who is a frequent writer on medical issues and chief of pediatric cardiology at the University of Massachusetts.

Like me, Sanghavi supports the bills moving through Congress, albeit with reservations. For next week's segment, Gupta has said, he'll interview two relative skeptics.

About eight minutes of the discussion ran on air, which is a veritable eternity for cable news. You can watch the first part above, the second part below. 

So how would Republicans respond to President Obama's invitation to a bipartisan meeting on health care? Consider the first paragraph of this new letter from House Republican leaders John Boehner and Eric Cantor:

We welcome President Obama's announcement of forthcoming bipartisan health care talks. In fact, you may remember that last May, Republicans asked President Obama to hold bipartisan discussions on health care in an attempt to find common ground, but he declined and instead chose to work with only Democrats.

Yes, I do remember Republicans asking for bipartisan talks. I also remember Obama and the Democrats holding them, over and over again, in what became an excruciating summer of futility.

Here, for example, is the Washington Post's account of a meeting Obama held with the Gang of Six on August 6:

President Obama urged six senators to keep up their bipartisan health-care talks, despite scant evidence that their reform legislation is gaining traction among Republicans.

Three Republicans and three Democrats spent an hour with Obama this afternoon, half of it with no staff in attendance. Sen. Kent Conrad (D-N.D.) called the meeting "very constructive and very honest."

The historical record on this is unambiguous. Obama and the Democrats made enormous--and, for liberals like me, gut-wrenching--concessions to win over conservatives. They vastly reduced the size and cost of the bill, which mean far less generous subsidies and less protection against out-of-pocket costs. They dumped the public option. They ditched a millionaire surcharge and replaced it with a tax on benefits that will hit at least some middle class people. They weakened the requirement on employers.

As Ezra Klein has noted, the bills now before Congress are full of ideas that conservatives have, at various times, called their own. In fact, the bills are even more conservative than the plan that two former Republican Senate leaders, Howard Baker and Bob Dole, helped draft through the Bipartisan Policy Center. But Republicans weren't interested in these concessions--apparently because, except for Olympia Snowe, they weren't genuinely interested in bipartisan agreement.

And that's their prerogative, by the way. But if that is their attitude, then they have no business complaining about the Democrats' willingness to pass a health care reform bill without Republican support.

President Obama is making good on his pledge, first put forth in the State of the Union, to reach out to Republicans on health care reform.

In a CBS News interview with Katie Couric that just aired, Obama announced that he's inviting Republican leaders to the White House this week to put their ideas on the table--and then holding a public forum to discuss them.

White House officials say the forum will be February 25. The meeting will be open press, with C-Span (and, I presume, other networks) televising the whole thing. The likely setting will be Blair House, across the street from the White House.

A White House official, speaking on background, stressed that the meeting in no way signals a retreat from Obama's commitment to push ahead with comprehensive health care reform. He's interested in hearing out Republican ideas, the official said, but when the discussion is done he wants to see a bill move forward--and pass.

And Obama's rhetoric in the Couric interview was consistent with that. Citing recent premium hikes in California, he stated that the need for reform was only becoming more urgent with time. Later in the interview, when Couric asked him about deficits, he brought the discussion back to health care--reminding viewers that controlling health care costs was the surest way to reduce deficits in the long run.

The move makes sense, given the political moment. As my colleague Jonathan Chait noted the other day, Republicans have been complaining that Democrats locked them out of the process. And large swaths of the public seem to agree, even though the argument seems plainly untrue, given the exhaustive efforts Obama and Senate Finance Chairman Max Baucus made to accommodate Republicans. The public forum will give the GOP one more, high-profile opportunity to air their views--and, no less important, it will give the public a chance to see which approach to health care they really prefer.

My only complaint about it: Democratic leaders will apparently be joining Obama and the Republicans at the public forum. To be perfectly honest, I think Obama can make the case for Democratic reforms on his own. Then again, if there's going to be a truly open discussion, I suppose both parties have to be present.

Update: I still worry, as I wrote last week, that Obama isn't pushing hard enough on the inside. But I don't think public outreach to the Republicans interferes with that.

Jonathan Chait parses Obama's statements last night and sees an emerging game plan. A key element is Obama's determination to reach out to the Republicans one last time before pushing ahead.

I don't have a huge problem with that. The Democrats have repeatedly reached out to the Republicans and the Republicans have repeatedly rebuffed those efforts. The bill before Congress is a true compromise between left and right, one that strongly resembles the bipartisan blueprint two former Republican Senate Majority Leaders--Howard Baker and Bob Dole--helped draft and then endorsed last year.

But the American people don't seem to grasp that it's the Republicans who refuse to be part of the conversation. If holding another meeting with them, on C-Span, would help change that perception--while emboldening nervous Democrats in Congress--I'm all for it.

And I wouldn't stop there. I'm no communications specialist. But if Obama is serious about gearing up for one more big push on health care, it seems to me, he should directly address the people who distrust him most: Conservatives and independents.

Why not do a full-court press of interviews with local television in the red states? Better still, how about a prime-time town hall in one of them? The White House could ask an independent polling firm invite the guests, much like in the presidential debates, and instruct the firm to get an over-representation of conservatives.

Obama can more than hold his own in that format, as he's shown repeatedly. And while I doubt one town hall will convince hardened right-wing skeptics, it could sway some independents, in part by undermining the charge that Obama is secretly foisting a government takeover on the American people.

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As my colleague Jonathan Chait notes on his blog, Senator Richard Shelby's decision to put a hold on all Obama nominees, until his state gets several billion dollars in pork barrel spending, really does seem to be a seminal moment in the evolution of Republican obstructionism.

Many of the changes in American politics over the past three decades have involved the two parties slowly doing away with social norms that preventing them from using every tool at their disposal. The Senate minority could filibuster every single bill the majority proposed, but you just didn’t do that, until you did. You could use a House-Senate conference to introduce completely new provisions into a bill, but you just didn’t do that, until you did. (The topic became common in the Bush administration.) ...

The “hold” is a now similar tool to what the filibuster was forty years ago. It’s a sparingly-used weapon meant to signal an unusually intense preference. A Congressional scholar reports that putting a blanket hold on all the president’s nominees has never been done before. But there’s no rule that says you can’t. It’s just not done, until it is.

It occurred to me there must be some rhetorical clever way to capture what's going on--something that might finally break through all the noise and get the public's attention. The phrase "held hostage" came to mind and I was going to blog it. But then I saw that my friend Josh Marshall beat me to it, with a new item called "Senate Held Hostage, Day One."

I like it. But I wonder if it actually understates what's going on here. It's not just the hold on nominations. It's the filibustering of health care reform, as well as the planned filibustering of financial reform and the jobs bill. And it's not really the Senate being held hostage or even the government. It's the country, which desperately needs all of these reforms.

In other words, it's not "Senate Held Hostage." It's "America Held Hostage."

Day one and counting.

In the last week and a half, Obama has rediscovered his voice on health care--telling audiences he is determined to achieve comprehensive reform, not some piecemeal version, and that he is willing to fight for it. And, administration officials say, the sentiments are genuine. Obama has instructed his staff not to abandon the pursuit of a full reform package, even though, it seems, that's what some advisers would prefer--and even though the Democrats no longer have the sixty votes necessary to break Republican filibusters in the Senate.

But rhetoric alone won't get the job done. House Speaker Nancy Pelosi has said her chamber won't vote for the Senate bill, as written, until the Senate passes modifications to that bill--something the Senate would have to do through the budget reconciliation process, in which Republicans couldn't block a vote from taking place. The modifications the House has in mind include more money for affordability protections and the elimination of a tax on expensive health benefits.

Senate Majority Leader Harry Reid, naturally, wants the House to vote for the full Senate bill first. And while he's said he thinks amending the bill in reconciliation makes sense, he wants the bill to be as small--and easy to pass--as possible. He also wants to keep the benefits tax, or some version of it.

In both cases, the leaders are basing their positions in part on what their caucus members are saying to them. Most progressives don't like the benefits tax. Most moderates don't like the alternatives--some combination of taxes on the rich and cuts to industry--and don't like the high price tag in general. Members of all ideologies are worried that passing a bill in reconciliation would drag out this politically debilitating debate longer--while giving critics more reason to think the bill is full of unsavory backroom deals.

The position of the two leadership groups isn't surprising. It's exactly the sort of posturing you’d expect in a House-Senate negotiation--and, if it were happening four or five months ago, the Democrats could afford to let it play out on its own. But there’s no time for that now. While giving health reform a small break from the spotlight is probably healthy, just letting the negotiations drag out will only disappoint supporters while antagonizing the opposition--all while the attention of members begins to wander.

Nor is it clear the two houses are even capable of reaching an agreement on their own. If members of the House were rational, they would pass the Senate bill, as written, simply because it'd be such a huge achievement--one that would make life better for literally tens of millions of Americans. And, if members of the Senate were rational, they would sign off on at least some of the House’s requested fixes without a fuss, because they were about to agree on them anyway--after the last round of negotiations, before Massachusetts--and because most of the changes make the bill better.

Indeed, there's a pretty obvious deal that ought to work for both sides, even now:

1. Further reducing the benefits tax, either by further delaying its implementation or raising the threshold at which it begins
2. Replacing that money by increasing the Medicare tax on unearned income and bigger reductions in subsidies to private insurers that serve Medicare patients
3. Slightly improving the affordability protections and filling in part of the Medicare drug benefit gap, by further reducing payments to the drug industry
4. Eliminating special deals like the government's agreement to cover Nebraska's expansion.

All of this is doable in a reconciliation bill. But, as far as I know, neither House nor Senate leaders have said they'd support such an agreement. And that reluctance is doubtless based, at least in part, on bitterness between the two houses as much as it's based on actual policy outcomes. In other words, it's not just lack of common vision. It's lack of trust and respect, too.

That’s why congressional Democrats increasingly think the president has to broker a deal--and why some, at least, are upset the White House isn’t move involved already. Senator Sherrod Brown told Huffington Post's Sam Stein that White House engagement had actually “dried up” in the last ten days, notwithstanding the president's public rhetoric. Stein also reported that, at Wednesday's meeting of the Senate Democratic caucus, Al Franken and Bernie Sanders confronted White House senior counselor David Axelrod to complain about the lack of White House leadership. (Politico now has more details of what was said there.)

I’m hearing the same thing from many insiders. Responding to Obama's recent speeches--and, among other things, my own article praising them--one source plugged into the negotiations e-mailed

Obama's rhetoric is helpful, but he has not yet taken the lead in getting Pelosi and Reid to agree either on final substance or on strategy. This can only be resolved with Obama's strong leadership--and it hasn't occurred yet. He needs to move from cheer-leading to real leading. 

Another source, who's also involved in discussions, was even more blunt:

Democrats need a leader to bolster their courage and determination and they don’t have one at the moment.

And what exactly would this "real leading" entail? I honestly don’t know--this is new territory for me. But when I asked these same sources what, precisely, the president could be doing, here’s how one explained it:

It means hammering out an agreement with the congressional leaders--especially Pelosi and Reid--that results in a specific, final legislative package as well as working out the strategic details (the two-step process, including sequencing) so that there is a game plan for moving forward. Right now, there appears to be a difference between the House and Senate leadership about sequencing--i.e., what comes first, reconciliation or passing the Senate bill.

Leadership means getting an actual agreement on these things and not allowing the discussion to continue endlessly with a resolution. It probably means that the President has to state how he believes this must go forward and pushing his congressional colleagues to follow his suggestions.

To be clear--and to state what should be obvious--I’m not on the inside so I surely don’t know everything that’s going on. My information is only as good as my sources, which are diverse and informed but, inevitably, have limits and biases of their own.

And the White House has some reasons for wielding its influence carefully. Among other things, bullying legislators--even House members--can backfire, convincing wavering lawmakers to turn against what's a bill the public tells pollsters it opposes.

What's more, while the relatively hands-off strategy seems ill-advised now, it’s also the strategy that got the administration farther on health care reform than any before it. If not for a historically awful candidate in the Massachusetts Senate race, the Democrats would still have 60 votes, health care reform would be law, and everybody would be celebrating the administration’s strategic genius.

Still, giving Congress so much leeway now could invite a replay of the summer spectacle--when negotiators in the Senate Finance committee dithered and dithered, slowly but surely eroding reform’s support. Obama eventually ended those negotiations, saving reform in the process, by threatening to introduce his own bill. That move jolted Finance Committee Max Baucus into action, propelling the process forward.

The time may be right for yet another intervention along those lines. If not, reform could really be dead.

Update: I should probably reiterate what I've said before. Nobody--not the president and not the members of Congress--are going to move if progressives don't push for it. That's where the real shove has to start.

During the Bush years, when abstinence-only education got an unprecedented boost in federal money, many liberal critics pointed to studies showing such programs failed to delay sexual activity among teenagers and had a negative impact on condom use. But a new study released this week seemed to turn this consensus on its head, as Hanna Rosin explains on the XX Factor:    

The study reported yesterday that shows a certain abstinence curriculum to be effective was, in fact, an excellent study. Unlike previous studies, it looked at the most updated curriculum. It randomly divided students into several groups. The kids in the abstinence-focused curriculum were measurably less likely to have sex after two years….

Now for the caveats, and the contrary conclusion. First, this was an updated curriculum. It did not talk about delaying sex until marriage and it did not disparage condom use. It asked students to delay sex until they were ready, and then had them role-play strategies to resist pressure. This is different from the moralistic tone that tends to accompany some abstinence-only programs.

Second, these kids were very young—12 and 13. At this age, they tend to be less likely to have sex, anyway, and more open to such messages. “I'm not surprised that—especially among this younger group of teens—an apparently empowering message of saying no is working out OK,” says Mark Regnerus, author of Forbidden Fruit. “Not sure I'd advise a simple say-no answer when kids are 17 or 18. The developmental trajectory for sex is steep.”

Rosin goes on to argue that the findings should encourage policymakers “to be flexible and open to what the evidence says works,” perhaps considering abstinence-only curricula for younger teenagers and comprehensive sex ed for older ones who are much more likely to be sexually active. That is, we should heed what the science says rather than let disregard them out of hand, as some liberal agitators have already begun to do. But, as Rosin also notes, the danger also lies in overinterpreting the results of this carefully designed study and applying them wholesale to all teenagers in the U.S., when the abstinence-only program under review diverged significantly from many of the moralistic, wait-until-marriage programs that religious right-wingers promoted under Bush.

The Obama administration now has the opportunity to ensuring that evidence-based science will prevail over inflamed rhetoric on both sides of the political spectrum. Having originally pledged a $114 million pregnancy prevention initiative, the White House proposed expanding the effort to $183 million in its new 2011 budget. Such money will “fund only programs that have been shown scientifically to work,” according to The Washington Post. While Obama had previously eliminated $170 million in federal funds for abstinence-only education, citing the earlier studies that had discredited the approach, the White House should make good on its stated promise to heed the evidence and be willing to adjust its policies to the extent that the latest science warrants.

Follow Suzy Khimm on Twitter: @SuzyKhimm

Via the Boulder Daily Camera:  Jennifer Latham is a Colorado preschool teacher with four children, who suffered multiple, debilitating injuries when she was hit by a car in 2005. She spent two months in the hospital recovering, running up $185,000 in medical expenses. She was lucky to have health insurance.

Or so Latham thought. Shortly after coming home, the insurer, Time Insurance Co., told her that it was refusing to pay the bill and that it would be canceling her coverage outright. The reason? When applying for her insurance coverage, the insurer said, she'd failed to disclose two past medical incidents--an emergency room visit for shortness of breath and an episode of uterine prolapse. Not only did that leave her on the hook for $185,000; it also left her without insurance, since no private carrier would touch her after the injuries and cancellation.

Latham had the good sense to sue--and a Colorado jury had the good sense to side with her. Last week, it ordered Time Insurance Co., which also operates as Assurant Health, to pay her $37 million. Latham's lawyer had asked only for $7 to $8 million in damages. Apparently, the jury found the whole incident revolting.

As well they should have. Assurant isn't commenting on the case, except to say it only cancels policies in cases of fraud. And it will surely appeal. But this phenomenon--of insurers canceling policies when people file big claims--is one of the most well-documented problems of our health care system.

Although some people really do lie about their medical histories deliberately, in many cases it's because they have no other way to get coverage. And that's not to mention the many additional cases, apparently including this one, when insurers look for inconsequential omissions as an excuse to avoid paying large bills and to get rid of beneficiaries who will run up high bills.

(Want some more stories like that? Read this.)

Of course, the vast majority of people in these situations will never bring a lawsuit, let alone win a multi-million dollar verdict. But there's an easier way to help them: Prohibiting insurers from canceling policies retroactively and from discriminating against people with pre-existing medical conditions in the first place.

As it happens, a bill before Congress would do just that. It's called the "Patient Protection and Affordable Care Act."

Perhaps you're familiar with it.

Update: More from Denver Westword, which apparently first reported the story...

Jurors contacted by Westword say that Assurant failed to prove that Latham deliberately misrepresented her health on her application or that the company had conducted a reasonable investigation before revoking her coverage. Testimony indicated that the company's "rescission panel" reviewed more than a hundred cases in two hours--"68 seconds apiece," as Latham attorney Marc Levy put it in his closing argument.

"We had to determine who was lying," says juror Denise Kaatz, a production manager for a Louisville apparel company. "Most of their witnesses seemed dishonest, defensive and just showed a basic lack of humanity. It was kind of frightening." ...

Levy argued during the two-week trial that the company had declined to change its rescission process despite a fine from the Colorado Division of Insurance and other complaints. The jury was aware of a similar lawsuit in South Carolina but wasn't told that case resulted in a $10 million punitive damage award against Time.

"We realized that $37 million is a lot of money," says Kaatz. "But we felt we had to send a message. Anything less, and the message might not have been heard by Time, since they've continued with this practice for the past five years despite other lawsuits."

A spokesman for Time Insurance said that the company doesn't comment on litigation.

The Republican hypocrisy on health care reform has been mind-boggling, even by Republican standards. Once again, for example, New Hampshire Judd Gregg is on a rampage against the possible use of reconciliation to pass amendments to the Senate health care bill, suggesting it'd be an unholy perversion of the "spirit of the Senate." This despite the fact that (a) reconciliation would merely allow the Senate to hold a vote, so that a minority couldn't block the majority from passing a law (b) Gregg himself happily voted for bills in reconciliation when the Republicans were in charge. MediaMatters has the full story.

But let's put that aside and consider the statements of Gregg's newest colleague, Massachusetts Senator Scott Brown. Brown, as you know, campaigned on a promise to vote against health care reform if it came back to a final vote in the Senate. This required some rhetorical acrobatics, since Brown happened to support the health reforms Massachusetts implemented a few years ago--reforms that, at least on the coverage side, look a lot like what the Democrats want to enact nationally. Brown's answer was that the Senate bill was actually very different from what Massachusetts passed.

Or at least that's what he said during the campaign. ThinkProgress has dug up an interview Brown gave to MSNBC's Dylan Ratigan in August. In it, Brown praised the emerging Senate health care bill, because--you guessed it--it looked like the Massachusetts reforms. Here's the quote:

Well it's been interesting looking at... the US Senate is doing. They're really mirroring what we did a couple of years ago through Governor Romney's leadership. We had a bipartisan plan that was carefully crafted to make sure that everybody’s interests were taken into consideration: business, providers, individuals and obviously the Commonwealth. And as I said we have a plan that is somewhat similar to what the Federal plan...

To be sure, the Senate bill evolved after that interview. And Brown was angry over some of the deals cut to ensure passage. But it's not like the Massachusetts law was a pristine piece of legislation, either. Nor is it like Massachusetts expanded its coverage without help from the feds, more of which would come in the reform bill.

Now that's more like it.

President Obama on Wednesday addressed a meeting of Senate Democrats. It wasn't nearly as dramatic as his visit to a House Republican retreat last week. The question-and-answer period mostly featured vulnerable Democrats, like Evan Bayh and Blanche Lincoln, who used the opportunity to grandstand about the perils of liberalism and importance of fiscal discipline--or, at least, their own very curious brand of it. But Obama used the occasion to send another strong message about health care reform--and the need to push ahead with comprehensive reform, despite the loss of the Massachusetts Senate seat.

You look at an issue right now like health care.  So many of us campaigned on the idea that we were going to change this health care system.  So many of us looked people in the eye who had been denied because of a preexisting condition, or just didn't have health insurance at all, or small business owners in our communities who told us that their premiums had gone up 25 percent or 30 percent.  And we said we were going to change it.
 
Well, here we are with a chance to change it.  And all of you put extraordinary work last year into making serious changes that would not only reform the insurance industry, not only cover 30 million Americans, but would also bend the cost curve, and save a trillion dollars on our deficits, according to the Congressional Budget Office.  There's a direct link between the work that you guys did on that and the reason that you got into public office in the first place.
 
And so as we think about moving forward, I hope we don't lose sight of why we're here.  We've got to finish the job on health care.

Obama was doing more than appealing to the senators' sense of moral obligation, I think.

Matthew Yglesias expresses the political logic for passing health care reform, succinctly and, in my opinion, persuasively:

If you’ve already voted for health reform, which a majority of House members and 59 Senators have, then you’re already going to get hit with 100 percent of the hits that accrue to people who vote for Obamacare. Nobody is going to care about the fine nuances of “senate bill” versus “house bill” or whatever. It’s Obamacare and you’re going to get hit.

The question is whether you’d rather get hit for your participation in a discredited failure that’s been abandoned by its own architects, or whether you’d rather get hit for participation in a controversial but successful effort to fulfill the decades-long promise of universal health care? I don’t think it’s even close. If the bill passes, that generates a positive narrative around the bill that can compete with the negative narrative. If it fails, then you’ve got all the negative narratives but you also add on a new bonus negative narrative of gridlock and failure. If it passes, all the groups out there that like the bill can come out and explain to people about the good things in it. If it fails, then they all go running for the hills but your enemies still get to emphasize the unpopular parts. In other words, voting “yes” on Obamacare is politically problematic but it’s already happened now the question is whether your “yes” vote buys you an actual bill to stand and fight on.