SAUL LOEB/AFP / Getty Images
The White House calls it an "opening bid" and a show of good faith in President Barack Obama's attempt to negotiate a health-care compromise with Republicans that will rescue his signature initiative - and his presidency.
But the administration's new blueprint for reform, tabled three days ahead of a high-stakes televised summit, is not really aimed at Republicans at all. Rather, the White House plan is designed to win over a wavering public and nervous Democrats with a new health-care deal for the middle class.
If Mr. Obama can win this week's war of perceptions - casting himself as the champion of middle America and Republicans as unyielding saboteurs - almost everything he faces as President will become easier. If he can't, it all becomes even harder.
The $950-billion plan unveiled by the White House yesterday uses the Senate bill passed in December as a template, but is more expansive, costs more to implement and implies even more government involvement in the U.S. health-care system. If he truly wanted to rally Republican votes, Mr. Obama would have gone smaller, not bigger. The few bones thrown the GOP way - largely measures to control waste and fraud - have little meat on them.
The administration appears to have discounted the possibility of cracking the Republican wall of obstruction. It now seems set to use a rare procedural manoeuvre known as reconciliation to pass health-care reform with only a bare majority in the Senate, rather than the 60 votes needed to overcome a Republican filibuster.
"The President wants and believes the American people deserve an up-or-down vote [in the Senate]on health reform. And this package is designed to provide us the flexibility to achieve that if the Republican Party decides to filibuster health reform," White House communications director Dan Pfeiffer said on a conference call with reporters.
Resorting to reconciliation, a tool used occasionally to pass annual budget measures, would be an extraordinary and risky step. It could backfire if voters perceive Democrats to be acting in a heavy-handed fashion.
But many analysts believe it is the only option left for Mr. Obama. Health care has arguably consumed more White House and congressional energy than any other domestic initiative during his first year in office. This is his last shot at averting utter failure.
"The only thing that has a chance of working is reconciliation," insisted Henry Aaron, a health-policy analyst at the Washington-based Brookings Institution. "What could come out of the summit? The administration has indicated what it wants to do. There is no way the Republicans are going to suddenly say, 'We've seen the light and we'll accept the basic framework we've been savaging all year.'"
Indeed, Republican House Leader John Boehner lambasted the President yesterday for "crippling the credibility of this week's summit by proposing the same massive government takeover of health care based on a partisan bill the American people have already rejected."
Thursday's summit now promises to resemble a high-tension tango between Mr. Obama and Republicans (the few who show up) rather than a true bargaining session. Each side will display openness to compromise by dancing verbally with the other. But the ulterior motive of each is to get the audience to turn on the other.
"This is really all about framing and agenda setting," opined Dan Wood, a professor at Texas A&M University and an expert in presidential political messaging. "If the Republicans are able to control perceptions with the idea that the President and the Democrats are - to use the Republicans' words - ramming big government down the throats of the people, then they win."
Mr. Obama has pointedly said he doesn't "want to see this meeting turn into political theatre," but Mr. Aaron said that is exactly what it will be. "And use of the word 'theatre' is in no way a denigration. This is democracy and conveying to the voters what the President wants to do in a way that is persuasive is what small-'d' democracy is all about."
If post-summit polling designates Mr. Obama as the winner, it will make it much easier for him to rally Senate Democrats who are wary about using reconciliation. More than 20 liberal Democrats have voiced support for the procedure and Mr. Obama only needs 51 of the 59 Democrats in the upper chamber to play along. That leaves room for a handful of conservative Democrats facing tough re-election battles this fall to vote against the bill.
If Mr. Obama does go the reconciliation route in the Senate, he will face yet another hurdle in getting a majority in the House to back the new version of the bill. The first House health-care bill passed by only five votes in November, and rebuilding a coalition of left-leaning, centrist and socially conservative Democrats to win again is hardly a given.
One reason is that the White House proposal adopts the original Senate bill's language on abortion, requiring Americans who receive subsidies to buy health insurance to buy an abortion rider with their own money. The original House bill prohibited an insurance policy bought even partially with federal subsidies from covering abortion at all, a measure that reflects the legislative muscle of rural and Southern Democrats.
The proposals posted on the White House website yesterday are especially crafted to appeal to middle-class voters, who until now have been cool to health-care reform. Families earning between $55,000 and $88,000 who will receive more in subsidies under the new proposals than under the current Senate and House bills.
The administration plan also raises the threshold at which a new tax on the most generous health-care plans would kick in, and delays its implementation until 2018. That concession is aimed at assuaging unions whose members enjoy such "Cadillac" coverage.
The biggest innovation in the White House plan involves the creation of a Health Insurance Rate Authority, which would review premium increases. HIRA is a response to the eye-popping 39-per-cent increase some Californians covered by Anthem Blue Cross are facing in May, a situation Mr. Obama has seized on to argue the necessity of sweeping reform.
The rate increases are the result of cash-strapped but healthy Californians cancelling their coverage to save money, leaving a smaller but riskier pool of people behind. Mr. Obama has used Anthem as exhibit 'A' to explain why making everyone buy insurance is crucial to making it affordable.
So far, Mr. Obama has failed to get that point and many others across and he has very little time left. Thursday really is make or break.