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GOP sees little outreach in health care debate

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A year ago, two Republican lawmakers - one a crusty, outspoken conservative senator who is a close personal friend of President Obama; the other, a bright-eyed, wonkish Midwestern congressman - were invigorated by the new president-elect's promise to welcome different ideas on how to fix the nation's health care system.

Now Sen. Tom Coburn, Oklahoma Republican, and Rep. Paul D. Ryan, Wisconsin Republican, are convinced that Mr. Obama's promise isn't playing out in practice.

"What we need in this country is the kind of leadership he said he was going to give," said Mr. Coburn, "which is that you bring both sides together and try to work something that is amenable to the whole country, that you can give the good solid middle to support.

"We haven't seen that yet," he said.

That, however, is as harsh a criticism as Mr. Coburn is willing to offer of Mr. Obama, who he considers a friend from their days together in the Senate. The friendship is reciprocated by the president, who invited Mr. Coburn to the White House soon after his inauguration for a one-on-one meeting.

The still-evolving Democratic reform blueprints in Congress embrace many liberal policies, notably a government-created "public" insurance option and - in the House version, at least - a tax on the rich to help pay for the push for universal coverage.

By contrast, the bills are noticeably silent on some signature Republican ideas, including medical-malpractice tort reform, individual-directed health savings accounts and letting individual states take the lead in testing out innovations in cost-cutting measures and expanding coverage.

Mr. Coburn refuses to pin the lack of bipartisanship entirely on the president, suggesting Democratic leaders in Congress share more of the blame.

"I'd be disappointed if [the president] is directing it. My assumption is to think positive things about him, instead of negative," he said.

For Mr. Ryan, who is respected by Democrats as a serious lawmaker and who co-sponsored with Mr. Coburn an alternative reform bill in May, optimism about the inclusiveness of the drafting process proved to be short-lived.

Mr. Ryan said it was during a conversation with House Ways and Means Committee Chairman Charles B. Rangel, New York Democrat, early in the summer that he realizedthe administration and the Democratic leaders in Congress had "no intention" of compromise.

"He basically told us, 'Look, we want to do it our way. We want the public plan. We want it this way. We have the votes. We're going to do it this way. We'd love to have you join us. But if you don't want to join us, you don't need to,' " Mr. Ryan said.

A spokesman for Mr. Rangel did not return phone calls or e-mails.

The White House disputes the charge that Republican ideas have not been included in the health care negotiations. It says 160 GOP amendments were included in the bill drafted by the Senate Health, Education, Labor and Pensions Committee, and that outreach fulfills Mr. Obama's promise.

"Democrats or Republicans, we welcome good ideas," Mr. Obama said shortly before taking office in January. "One of the things that I think I'm trying to communicate in this process is for everybody to get past the habit that sometimes occurs in Washington of, 'Whose idea is it? What ideological corner does it come from?'

"Just show me. If you can show me that something is going to work, I will welcome it."

But Republicans say all but one of those 160 amendments were technical in nature. The one substantive amendment that was included requires all members of Congress to enroll in a government-run "public option." It is unlikely that even this provision will make it into the final Senate bill that Senate Majority Leader Harry Reid could bring to the floor as early as this week.

Meanwhile, a number of Republican-backed health care ideas ended up on the cutting-room floor.

Conservatives want insurers to focus on catastrophic care. Reform, they say, should encourage Americans to purchase tax-preferred health savings accounts, with matching contributions from employers, where workers contribute money out of every paycheck to help build a fund to pay for their individual medical needs.

These ideas have barely entered the debate, however, and Mr. Obama has never seriously addressed them in public. The White House declined to comment on why the president has ignored these ideas, despite numerous requests by The Washington Times.

But White House communications director Anita Dunn argued in a public appearance Friday that Mr. Obama "has really gone to extraordinary lengths to reach out to people who don't agree with him and to make sure the people who don't agree with him have their voices heard."

The House GOP leadership this month introduced its official alternative bill. But by that point, lawmakers like Mr. Ryan had already made up their minds that there was no point to doing anything but try to defeat the president's plan.

"The best outcome is if we stop this - then the Democrats will have a failed presidency on their hands, and then they'll have to work with Republicans to get something done that's bipartisan," Mr. Ryan said.

The White House, prior to the passage of the House bill, had also concluded that bipartisanship on health care reform was a lost cause.

Secretary of Transportation Ray LaHood, a former Republican congressman from Illinois who was given the job of contacting key GOP lawmakers before major votes earlier in the year, was given a list by the White House made up entirely of Democrats.

"The White House realized that no Republicans were going to vote for the bill, and so they didn't expend their energy on calling them," said an administration official, who spoke on the condition of anonymity to talk more freely about White House thinking and communications strategy.

In the end, just one House Republican - freshman Rep. Anh "Joseph" Cao of Louisiana - joined 219 Democrats in pushing the bill narrowly through the House. Handicappers expect none of the 40 GOP senators to support the bill Mr. Reid produces.

Mr. Ryan now sees the passage of the Democrats' bill as a possibly irreversible change in the structure of American governance and the social contract between the government and the people.

"They won't call it this, but they believe that a social welfare state is right. They believe that is what America morally should become," Mr. Ryan said. "I believe that is completely antithetical to the American idea, the American project, and what America is about."

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