Administration officials defended President Obama's broad health care proposals on Sunday and urged a skeptical public not to judge the Democrats' overhaul until Congress writes a final version.
Facing independent budget predictions that contradict the White House's rhetoric, officials sought to refute Republican objections to massive changes in how Americans receive health care. They emphasized that Congress has not yet settled on an outline for health care legislation and reiterated Obama's desire for a bipartisan approach.
"This is a work in progress," Health and Human Services Secretary Kathleen Sebelius said, trying to calm nervous lawmakers whose re-elections could hinge on the legislation. "More will be done. The House and the Senate are committed to working with the president to get this done."
The United States is the only developed nation that does not have a comprehensive national health care plan for all its citizens, and Obama campaigned on a promise to offer affordable health care to all Americans. However, the recession and a deepening budget deficit have made it difficult to win support for costly new programs.
"The House has one approach. We put forward a different approach. The Senate is considering yet more options," White House budget director Peter Orszag said. "The key thing is we need to get there in a way that is deficit neutral."
Paying for the health care plan remains the major challenge, underscored by a nonpartisan Congressional Budget Office report that emerging House legislation would increase deficits by $239 billion over a decade.
"I don't follow why we've got to spend another $1.5 trillion to $2 trillion, most people estimate, on top of the $2.5 trillion we're already spending in this country and yet still have, under one estimate, at least 33 million people without health insurance," said Sen. Orrin Hatch (R-UT). "I mean, these are things that are real serious problems."
Democrats insisted the budget analysis ignores savings and Obama's pledge not to add red ink to the federal ledger.
"It's clear that they're working with different assumptions than the White House and the Congress is," said Rep. Charlie Rangel (D-NY), the chairman of the House tax-writing committee.
Even so, the politics of adding to the deficit or raising taxes is tricky. Obama officials have refused to rule out a tax on the wealthiest Americans and oppose a tax on employer-provided health care benefits. They also want the Senate and the House to pass separate bills before an August recess, leaving reconciliation of their differences for September or later. White House officials grudgingly accept that such a timetable — which has shifted from being a demand to more of a goal - might force them into policy compromises.
"What we have said is this bill has to be deficit neutral," said Orszag, a former top budget chief for Congress. "We think there are better ways of obtaining additional revenue, and we have to let this legislative process play out."
But it won't come cheap. That means increased taxes and political opposition.
Republicans paint Obama's proposals as a massive tax that would leave small businesses wounded, employers shifting away from private plans toward a government-based system, and workers without coverage. Some GOP members have also cautioned that the legislation could fund abortions, a fear crucial to the social conservatives who hold sway inside the Republican Party and a proposition Orszag would not rule out.
A key Republican, however, warned his party not to scuttle health care legislation over abortion.
"No matter what your views are on abortion, you shouldn't ask people to use their tax dollars if they think that abortion is taking a life," said Sen. Judd Gregg, R-N.H. "I would hate to see the health care debate go down over that issue. ... Hopefully we won't get ourselves wrapped around the wheel of abortion in this debate."
Obama's advisers have argued that overhauling health care is vital to the nation's long-term economic recovery.
About 50 million of America's 300 million people are without health insurance. The government provides coverage for the poor and elderly, but most Americans rely on private insurance, usually received through their employers. However, not all employers provide insurance and not everyone can afford to buy it. With unemployment rising, many Americans are losing their health insurance when they lose their jobs.
The insurance industry, which fought President Bill Clinton's health care effort in 1993 and 1994, is beginning to run its first TV ads of this year's health care fight. The multimillion-dollar campaign, being aired nationally on cable stations, restates the industry's support for an overhaul that provides universal coverage and its offer to cover people who are already sick. The ad campaign, which starts Monday, does not mention the insurers' strong opposition to creating a government-run insurance option.
Seeking to prod colleagues, Sen. Edward M. Kennedy wrote an essay for Newsweek magazine about the policy that has guided his decades in the Senate.
"Unless we act now, within a few years, 55 million Americans could be left without coverage even as the economy recovers," wrote the Massachusetts Democrat, who is being treated for brain cancer. "All Americans should be required to have insurance. For those who can't afford the premiums, we can provide subsidies."
