Health care debate shifts back to Main Street

WASHINGTON - The health care debate is heading back to Main Street, to cities and towns where people are worried about medical costs but increasingly concerned that overhauling the system may do more harm than good.

Some say that's exactly where the discussion belongs.

House members have returned to their districts for their August break, and senators are going home soon. Health care will be Topic A during town-hall meetings, visits to hospitals and small businesses and conversations with constituents.

The White House will go to great lengths to shape the discussion. The political parties and interest groups of every stripe will spend millions on advertising and grass-roots efforts.

Democrats, on the defensive, need to show how their plans would help working people who have health insurance but are paying more for it every year, and who worry about what would happen if they lose their jobs.

Republicans have succeeded in raising doubts about President Barack Obama's ambitious goal of providing coverage to nearly 50 million uninsured people while simultaneously trying to restrain runaway costs that no president, Congress or corporate CEO has figured out how to tame.

But after a GOP senator said health care could "break" Obama, Republicans risk being seen as putting political gain ahead of solutions that could work if given a chance.

August may be a defining month when public opinion solidifies. September is at stake. Obama, buoyed by a House committee's passage of a health care bill, said it's time to "build upon the historic consensus that has been forged and do the hard work necessary to seize this unprecedented opportunity."

Lawmakers could come back re-energized and ready to tackle sweeping changes. Or the scope of the overhaul could get pared back.

For example, Democrats might back off their insistence on a government-sponsored insurance plan to compete with private coverage - an idea that Republicans and many moderate Democrats say they can't accept.

Or the overhaul could get shunted aside in Congress, as has happened before, most notably in the early 1990s when Democrat Bill Clinton was president.

For now, there's a sense of urgency on all sides. Even interest groups representing doctors, hospitals, insurers, drug companies and major companies say they want to get a bill this year.

"This issue is as important as Medicare and Social Security," said Rep. Baron Hill, D-Ind., a conservative who has been at odds with the House leadership over the legislation drafted by liberals. "I believe that we're going to come together in good faith to get health care for all in a fiscally responsible manner."

House Republican leader John Boehner of Ohio says Obama and the Democrats have overreached on health care and "they're likely to have a very, very hot summer."

In a memo to his rank-and-file on Friday, Boehner urged Republicans to adopt "a culture of entrepreneurial insurgency," using new media such as Twitter to connect with voters. "A flurry of surveys over the last couple of days demonstrate that the American people now oppose the Democrats' government takeover of health care, and any time the president talks about it, they like it even less," Boehner wrote.

Republicans have hit on something. Polls indicate the public is wary that the Democratic proposals could raise their costs and restrict their benefits.

Robert Blendon, a professor at Harvard's School of Public Health, says Obama and the Democrats haven't figured out how to translate their proposals into language that average voters can understand.

"The president is fixated on national spending issues," said Blendon, who follows public opinion trends on health care. "He's talking about it as if he was a national policy expert solving the federal budget problem. He has to go through the bills that he's going to stand for, take about five or six things that would lower people's future premiums, and describe them over and over again."

Democratic leaders have realized their mistake, and they're hoping it's not too late.

House Speaker Nancy Pelosi, D-Calif., distributed talking points to lawmakers that stress the benefits of the House bill for people who already have coverage. Among Pelosi's points: no yearly or lifetime limits on what health insurance will cover; limitations on patient cost sharing, such as deductibles and co-payments; affordable coverage for people who are in between jobs; no cancellation of insurance coverage if someone gets sick.

Pelosi said Friday her office will be working full time on health care over the August break, and she plans to campaign for the House plan. Building on Obama's populist call for an overhaul, she cast the industry - the main opponents of introducing government-sponsored coverage - as the villains.

"We know what we're up against," Pelosi said. "This is going to be a carpet bombing ... slash-and-burn, shock and awe ... what the insurance companies will do to hold onto their special advantages which exploit patients, and leave the consumer at (their) mercy."

Attacking insurers may not necessarily win support for the House plan and its many complex provisions. As it stands now, it wouldn't pass the Senate despite Democrats' 60-vote majority.

The House bill aims to provide coverage to nearly all the uninsured and pay the $1.5 trillion, 10-year cost by cutting spending on government health programs and raising taxes on high-income earners. The tax cuts and spending reductions would kick in right away, but the coverage expansions would be phased in slowly.

Low-income people would get insurance through an expanded Medicaid program. Many middle-income people would be eligible for government subsidies to help pay their premiums. Individuals would be required to carry health insurance, and employers to provide it, with an exemption for small businesses.

The government would set up a new insurance marketplace called an exchange through which individuals and small businesses could pick their coverage from a range of private plans or a new government-sponsored program. All this effort would significantly increase the already powerful federal role in health care.

If the specifics of the House plan make it difficult for Democrats to successfully mute criticism that theirs is a big-government solution, Republicans face another sort of credibility test. It's not clear that most of the plans they've put forward would make significant improvements in expanding coverage or controlling costs.

Sen. Ron Wyden, D-Ore., said many of his constituents are baffled by the debate in Washington. "They're hearing all this health care lingo, and they just want to know how it's going to work," Wyden said.

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Associated Press writer Laurie Kellman contributed to this report.