Editor's note: H&HN Managing Editor Bill Santamour is blogging this week from the American Hospital Association Annual Membership Meeting.

WASHINGTON — During a lively dialogue Monday at the AHA annual meeting, Karl Rove, White House adviser under President George W. Bush, and Robert Gibbs, former White House press secretary for President Barack Obama, offered a preview of what voters can expect as campaigns move into high gear, including very different ideas on what needs to happen in health care.

Gibbs noted that Republican leaders in Congress have taken taxes off the table as a way to cut the deficit. "I'm not a mathematician," he said, "but it doesn't add up." Without an increase in revenue, the only way to reduce the deficit is "by taking a meat ax" to Medicare and Medicaid.

"We need a much broader discussion on entitlements," Gibbs said. "Everybody's going to have to pitch in. With current revenue, we are not going to be able to take care of older Americans who need health care."

Rove acknowledged that some tax reform may be in order. "Why should I be able to write off my second home?" he asked. But most importantly, the tax code should be simplified, and the tax rate lowered "in a budget neutral way."

One way to address health care costs, Rove said, is to "empower consumers" by giving them a variety of insurance options, including alternatives to Medicare. With "skin in the game," they are apt to be more circumspect when it comes to making health care decisions, Rove said, adding that he's pleased with his own health savings account, which comes with a higher deductible but allows him to roll over whatever he doesn't spend in a given year.

"So what is your premium?" moderator Frank Sesno asked Rove, who didn't provide a figure. Sesno pointed out that under high-deductible plans patients might have to pay thousands of dollars for care before their coverage kicks in, and many could not afford to do so.

Asked how they expect the Supreme Court to rule on the Affordable Care Act in late June, both Gibbs and Rove said it was difficult to predict.

Gibbs said ACA proponents cowered under their desks when they heard Justice Antonin Scalia's aggressive responses to Solicitor General Donald Verrilli, who represented the administration. "But I don't think it's all that clear how they'll come down," he said. "I'm still optimistic."

Rove said he doubted the entire law would be declared unconstitutional, but the requirement that nearly everyone get insurance, the so-called individual mandate, is unlikely to survive. "You blow up that and you blow up the Affordable Care Act," he said. And no matter how the Supreme Court rules, if Romney wins the White House and the GOP wins control of Congress, "yes, they will take down the ACA and start over."

Sesno cited political experts who say a ruling that dismantles the law will actually work in Obama's favor, galvanizing his base against the conservative court. "Yeah, I've heard James Carville telling that story," Rove scoffed.

"So, do you think we are going to get a nuanced conversation about health care in this campaign?" Sesno asked, tongue at least partly in cheek.

"We're not going to have what the country needs — frank talk," Rove said flatly, accusing the Democrats of refusing to find any common ground with the Republicans to at least start a discussion. "They go right away to the issues they know we can't agree on."

Gibbs said the administration "has been held hostage" by Republicans, who were determined from the moment Obama took the oath of office to oppose every initiative he proposed, no matter the impact on the economy or the American people. They're goal from Day 1, he said, was to make sure Barack Obama did not win a second term.

This is the final day of the AHA Annual Membership Meeting, and as is traditional, members are on Capitol Hill to meet with their state congressional delegations. They've been coached throughout this meeting to find their voices and join the election year debate over how health care will be transformed.

But the meeting has not been exclusively about the political aspect of health care transformation. I've attended a number of sessions in which hospital executives described in detail how they are already steering their organizations into this new era. They've offered practical advice, including missteps made along the way, and I'll be reporting on their insights in upcoming blogs here in H&HN Daily.

Finally, I'd like to remind you that the Health Forum-AHA Leadership Summit will take place July 19-21 in San Franscisco. Hospitals & Health Networks and H&HN Daily staff will be there, and we hope you will, too. Click here for more information.