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Sebelius: Health Reform Puts Focus on Lower Costs, Better Choices

June 24, 2009 at 6:20 PM EDT
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Health and Human Services Secretary Kathleen Sebelius on Wednesday urged lawmakers to approve the White House health care reform plan. She outlines the case for the overhaul with Judy Woodruff.
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JIM LEHRER: Still to come on the NewsHour tonight, Afghan children as smugglers, and the president and the media. That follows our Newsmaker interview about health reform with Health and Human Services Secretary Kathleen Sebelius. Judy Woodruff spoke with her a short time ago.

JUDY WOODRUFF: Secretary Kathleen Sebelius, thank you very much for joining us.

KATHLEEN SEBELIUS, Health and Human Services Secretary: Good to be with you, Judy.

JUDY WOODRUFF: Let’s talk first about the proposed government-run public health care plan. Now, the president said yesterday that he is not going to insist on this, and yet he was challenging private health insurers on their opposition to it. If he’s in favor of it, why doesn’t he insist on it?

KATHLEEN SEBELIUS: Well, I think the president has made it clear that he wants serious ideas to be on the table and not at this point in the discussion draw lines in the sand.

Having said that, he’s a pretty strong proponent of a new marketplace for those Americans who can’t afford the coverage they have, don’t like the coverage they have, or have no coverage at all, a marketplace that would have private plans standing side by side with a public option. Some competition and some choice for consumers he thinks is a very good thing, and so do I.

JUDY WOODRUFF: Well, as you know, one of the alternatives now being discussed to this plan is a so-called co-op arrangement which would involve, I guess, a group of states putting a national option together that would — I guess where they would pool their purchasing power.

Now the debate is over how much say the government would have in the authority of such a co-op. Are you, is the administration drawing any lines in the sand on this conversation?

KATHLEEN SEBELIUS: Well, I think the good news about Senator Conrad’s proposal on co-ops is that we really have members of the Senate — and the same thing is going on, on the House side — coming to the table and saying, “We want to make this work. We understand the status quo is unacceptable. We understand we have to do something this year. And we also understand that an insurance monopoly with only private companies doesn’t hold down costs.”

And that’s one of the president’s bottom lines is, we have to have some control over costs which are bankrupting our families, making our companies less competitive, and, frankly, are unsustainable in the current economy.

Having some alternative to a private insurance monopoly is, I think, a good idea, will offer some choice and will offer some competition.

Associated costs

Kathleen Sebelius
HHS Secretary
[President Obama] wants a plan that lowers costs, lowers costs for everyone, because doing nothing is not an option and the status quo is simply not going to be sustained.

JUDY WOODRUFF: So we know the president is for cutting costs, but there are other tough choice involved, what to do about taxing health benefits, what about the overall cost of covering as many people as you want to cover, the fact that doctors and hospitals are worried about the payments. At some point, is the president going to have to be more clear about what he wants?

KATHLEEN SEBELIUS: Well, so far, Judy, he's been pretty clear. He wants a plan that lowers costs, lowers costs for everyone, because doing nothing is not an option and the status quo is simply not going to be sustained. Medicare will go bankrupt. We have 14,000 Americans losing their insurance coverage every day with this economic downturn, and we have millions of people without coverage at all.

So even if you have coverage right now, if we don't do something about the costs, spending twice as much as any other developed nation and, frankly, having worse health results to show for it, we won't be anywhere. So cost has to be addressed.

Driving up quality, lots of Americans get good quality in some parts of the country, but, frankly, a lot of people get a lot of procedures, a lot of tests taken, a lot of medications that may or may not have a great result. And right now, we pay doctors for the contact they have with patients, not what happens to their patients in the long run. So figuring out ways to give doctors incentives to have a great result with as few interventions as possible is part of the plan.

Lowering the medical errors, we have 100,000 people every year who die in the hospital from what happened to them in the hospital, not what brought them into the hospital, but what happens to them in the hospital. That's not a very good number. It's hugely costly, but it also is killing folks. So there are a lot of challenges.

So driving quality, lowering costs, covering all Americans at the end of the day, and he said pretty clearly the plan needs to be paid for. It can't add to the deficit. And so those are the principles around which he's engaged very actively in talking to members of the House and members of the Senate.

Covering the uninsured

Kathleen Sebelius
HHS Secretary
I'm confident, having really visited places all over the country, that the kind of savings that we can make in the system will help to improve the quality for all Americans.

JUDY WOODRUFF: I asked that last question, Secretary Sebelius, because you're starting to hear people say -- Democrats included -- that they're worried the president is going to accept anything in order to say that he got a health care reform plan.

KATHLEEN SEBELIUS: Well, I just came out of a meeting today with the president and five governors who were in town talking about their experiences, hosting town hall meetings, Republicans and Democrats, who understand the urgency of this issue.

Is the president committed to getting a health reform bill this year? You bet. But I don't think that the notion is that anything works. It really has to lower costs, cover Americans, drive quality, and be paid for.

JUDY WOODRUFF: How much do you worry, though, that in order to get the overall cost down, you're not going to be able to cover as many Americans as you would like to who are uninsured?

KATHLEEN SEBELIUS: Well, I'm confident, having really visited places all over the country, that the kind of savings that we can make in the system will help to improve the quality for all Americans, and that will help to pay for the costs of bringing additional people into the insurance plan.

I think we have a system where we're spending over $2 trillion a year. So one could argue there's a lot of money in the system. What we have to do is spend it more wisely, spend it to make sure that we end up with healthier Americans, that everybody has preventive care, that we drive wellness, that we have a health home and coordinated care for those more vulnerable citizens, a lot of our seniors who have chronic conditions who, frankly, are getting erratic care based on what's going on right now.

Taxing health benefits

Kathleen Sebelius
HHS Secretary
[T]he president has his own funding proposals he's come up with, just under $1 trillion of savings and revenue proposals.

JUDY WOODRUFF: Let me come back to something that I mentioned before, and that is Senate Democrats looking at taxing the health benefits that people receive through their employers. It may be a way to get money. Right now, the polls show two-thirds of Americans are against it.

KATHLEEN SEBELIUS: Well, as you know, Judy, this was a topic that was debated during the campaign. Senator McCain proposed eliminating any kind of benefit for employer-based health plans, and the president vigorously opposed that.

I think that he still worries that there is a disincentive for employer-based coverage if benefits are taxed, and, frankly, the whole notion is you fix what's broken, not what works. And 180 million Americans have employer-based coverage.

So the president has his own funding proposals he's come up with, just under $1 trillion of savings and revenue proposals. And he much prefers the proposals that he's put on the table.

Assuring Americans

Kathleen Sebelius
HHS Secretary
I guess I would assure folks that the goal is to fix what's broken and to keep the things, the parts of the system that are working.

JUDY WOODRUFF: And just quickly, finally, what do you say to those Americans, who a majority of whom say, "Yes, we think health care is too expensive," but they're worried that health care reform could lead to fewer choices, ultimately more expenses for them, and just a vastly different health care system in this country than the one they're comfortable with?

KATHLEEN SEBELIUS: Well, I guess I would assure folks that the goal is to fix what's broken and to keep the things, the parts of the system that are working.

So if you have coverage, if you have a relationship with a doctor that you like, if your health plan provides the benefits you and your family need, that stays in place. That doesn't change.

And, overall, your costs should go down, because you're right now paying about $1,000 more than you would if we didn't have so many uninsured, if we didn't provide such expensive, erratic care in other parts of the system.

If you don't have coverage, if you don't have affordable plans, if you can't get into the market, we have, again, a solution with a new marketplace, no rules that say that insurance companies can lock people out because of pre-existing conditions. And we'll pool the risks so that small-business owners and self-employed folks will have some cost-sharing going on within a larger pool.

Moving that forward, moving health and wellness forward, it will actually, I think, lower costs for everyone and produce a lot healthier America than we have right now.

JUDY WOODRUFF: Secretary Kathleen Sebelius, thanks very much for talking with us.

KATHLEEN SEBELIUS: Thanks, Judy. Good to visit with you.