Obama may need firmer hand on health care debate

WASHINGTON (AP) - President Barack Obama is seeing the downside of his light touch on revamping the nation's health care system.

Congressional Democrats are off to a halting start, blindsided by a high cost estimate and divided over how to proceed. The confusion has emboldened Republican critics of the administration's approach to its top domestic priority.

While too early to rule out eventual success, it seems Obama will have to be more forceful and hands-on.

Former Senate Majority Leader Tom Daschle, who once was Obama's choice for shepherding the plan through Congress, said the chance that the legislation will pass is no better than 50-50. Those are fairly good odds, he said, for such complicated proposals that stir deep passions.

Joel Johnson, a former Clinton White House aide who lobbies for health care companies, was more optimistic. "This is probably right where it's supposed to be," he said.

"It's still a hard slog," Johnson said. "It will have some near-death experiences" along the way, which is typical for far-reaching, complex legislation, he said.

Obama has given Congress leeway, trying to avoid the heavy-handed approach that helped doom a similar effort by President Bill Clinton in 1993. Obama recently told a Wisconsin crowd that he would not run roughshod over lawmakers with a "my way or the highway" approach.

But the lack of firm guidance from the president may have contributed to an unsteady launch by the Senate Health, Education, Labor and Pensions Committee. The committee rolled out an incomplete bill in an effort to get action started and to show Republicans that Democrats had not made up their minds on every issue.

The strategy seemed to backfire when the nonpartisan Congressional Budget Office estimated that the plan would cost $1 trillion over 10 years but cover only about one-third of those now lacking health insurance.

Democrats protested that the estimate overlooked important money-savers to be added later. But Republicans seized on the costly projection and the bill's half-finished nature, throwing Democratic leaders on the defensive.

Competing plans abound in Congress, complicating Obama's task even though his party holds solid House and Senate majorities.

House Democrats presented 850 pages of draft legislation Friday that includes many of the president's priorities. It would cover nearly all the nation's nearly 50 million uninsured. It calls for a public health insurance plan to compete with private insurers, something that most congressional Republicans and some Democrats oppose.

Officials said Saturday that the White House, lawmakers and the pharmaceutical industry had struck a deal to have drug companies pay $80 billion to help narrow a gap in coverage in the prescription drug program for Medicare. The officials said that the agreement would have drug companies pay part of the cost of brand name drugs for lower and middle-income older people in the "doughnut hole." That term refers to a feature of the current drug program that requires beneficiaries to pay the entire cost of prescriptions after initial coverage is exhausted but before catastrophic coverage begins.

Obama seized on the deal as evidence that his efforts are gaining momentum.

"Key sectors of the health care industry acknowledge what American families and businesses already know - that the status quo is no longer sustainable," the president said, and noted: "We are at a turning point in America's journey toward health care reform."

Health care changes have widespread public support, according to a CBS-New York Times poll released Saturday. Almost two-thirds say the government should guarantee health insurance for all Americans while half that many think this is not government's responsibility. People are more divided when it comes to the effect of such a step on the economy and whether they are willing to pay higher taxes so that all Americans have guaranteed health care.

House leaders offered few details on how to pay for their plan, leaving tough debates for the summer months. Obama has proposed cuts in Medicare spending on hospitals, prescription drugs and other services, but a political consensus is far from certain.

Senate Democrats are more divided. The health committee, being run by Sen. Christopher Dodd, D-Conn., is trying to regroup after the criticism prompted by the latest cost estimate.

The Senate Finance Committee, drafting a separate bill in hopes of more Republican support, is scaling back its ambitions for similar reasons. The CBO projected the cost of its original plan at about $1.6 trillion over 10 years, a politically unpalatable figure.

White House press secretary Robert Gibbs said the administration is willing to accept committee changes, such as trimming federal benefits or cutting proposed subsidies for health coverage.

"These are exactly the types of trade-offs and decisions that are going to have to be made throughout this process," Gibbs told reporters Friday.

Obama has cast the need to revamp health care in dire terms. He says the nation may go the way of General Motors Corp. if the system's soaring costs and inconsistent results are not tamed. But the developments in Congress demand discipline - and the president and party leader ultimately must be the ringmaster.

"There will come a time, particularly on health care, when the president's active member-by-member lobbying will have its place, but it's too early at this point," said John Podesta, who headed Obama's transition team and presides over the Center for American Progress.

Robert Blendon, a Harvard professor who follows public opinion trends on health care, said people "still expect something big to come out of this. But they have significant concerns about taxes and the deficit."

Presidential adviser David Axelrod defended Obama's decision to let Congress work its way through the process rather than "delivering stone tablets" with directives from the White House.

"We have been engaged in the conversation from the beginning," Axelrod said in an interview Friday. "Obviously as this process picks up momentum, that will be more true."

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Associated Press writer Ricardo Alonso-Zalvidar contributed to this report.