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Senate Delays Health Reform as Cost Concerns Persist

July 23, 2009 at 7:46 PM EDT
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Senate Majority Leader Harry Reid said Thursday that the Senate will not vote on a health care reform bill before its August recess. In a town hall meeting meeting, President Obama said that the delay was "OK," as long as Congress is working to pass a bill by the fall.

JIM LEHRER: Democrats in the U.S. Senate gave up today on an early vote on health care reform. That word came as President Obama took to the road, following his appeal for action at last night’s news conference.

NewsHour health correspondent Betty Ann Bowser has our lead story report.

BETTY ANN BOWSER: The announcement by Senate Democrats was not unexpected, but it was a setback for the president’s hope for quick passage of health care reform. Majority Leader Harry Reid confirmed the full Senate will not vote before the August recess.

SEN. HARRY REID, D-Nev., Senate majority leader: Working with the Republicans, one of the things that they ask is that they have more time. I’ve had a number of conversations, for example, with Olympia Snowe.

And so the decision was made to give them more time for the Finance Committee part of what we’re trying to do. And I don’t think it’s unreasonable. This is a complex, difficult issue. It’s better to have a product that is one that’s based on quality and thoughtfulness, rather than trying to jam something through.

BETTY ANN BOWSER: Reid said he still hopes for a committee vote on a bipartisan bill before the month-long break. It would have to be merged with a Democratic measure that another committee already passed.

On the House side today, Energy and Commerce Committee Chairman Henry Waxman met again with fiscally conservative Democrats. They’re pressing to rein in costs in the House Democrats’ trillion-dollar bill.

But at a briefing, Speaker Nancy Pelosi stood by her claim that she has the votes to pass health care reform soon, even though some members of her own party have said otherwise.

REP. NANCY PELOSI, D-Calif., Speaker of the house: I’m more confident than ever. And when we work out some of the differences that we have, it will be very apparent to everyone else that the momentum is there. When the bill is ready, we’ll go to the floor, and we will win.

BETTY ANN BOWSER: Pelosi again left open the possibility of staying in session for part of the recess.

REP. NANCY PELOSI: I’m not afraid of August. It’s a month. What I am interested in is the sooner the better to pass heath care for the American people.

BETTY ANN BOWSER: Even so, another top House Democrat, Jim Clyburn of South Carolina, said party leaders were divided on the question of how fast to move.

Another poll today found rising divisions in public opinion, as well. The Kaiser Foundation survey showed 56 percent of those polled still support health care overhaul, but 21 percent said they and their families would be worse off if it passes. That percentage has doubled since February.

For his part, President Obama took his health care pitch to a town hall-style meeting in a Cleveland suburb where he addressed the Senate delay.

BARACK OBAMA, U.S., President: We just heard today that, well, we may not be able to get the bill out of the Senate by the end of August, or the beginning of August. That’s OK. I just want people to keep on working. Just keep working.

I want to get it right, but I also want to get it done promptly. And so as long as I see folks working diligently and consistently, then I am comfortable with moving a process forward that builds as much consensus as possible.

What I don’t want is what I referred to in my speech: delay for the sake of delay, delay because people are worried about making tough decisions or casting tough votes.

BETTY ANN BOWSER: The president also toured the Cleveland Clinic and touted it as a model for health care reform.

BARACK OBAMA: Cleveland Clinic has one of the best health information technology systems in the country. And that means they can track patients and their progress. It means that they can see what treatments work and what treatments are unnecessary. And here’s the remarkable thing: They actually have some of the lowest costs for the best care.

That’s — that’s the interesting thing about our health care system. Often the better care produces lower, not higher, expenses.

BETTY ANN BOWSER: Mr. Obama had stressed that idea of controlling costs at his news conference last night. The president also said last night for the first time he’d be willing to consider a surtax on families earning $1 million a year to help pay for the health care overhaul.

But today, House Republicans kept pushing the idea that the Democrats’ plans will cost far too much and won’t be paid for. Congressman Eric Cantor of Virginia.

REP. ERIC CANTOR, R-Va.: The president really presented the people with a false choice because, according to what he said last night, there were only two ways: either the status quo or a government health care plan.

We’re here to say that there really is a third way, that we can work together with our Democratic colleagues to try and forge a solution that really reflects the strengths of our system today with trying to address some of the weaknesses.

BETTY ANN BOWSER: A number of Republicans want to scrap the current health care reform proposals. They’ve called for tax credits and other alternatives, but have not introduced any legislation.

Waste in federal health systems?

Chris Jennings
Former White House Health Care Advisor
If you look at study after study, we have seen that fully one-third of the costs that we spend on services today are for care that does not improve outcomes. One-third of $2.5 trillion is $800 billion a year.

JIM LEHRER: The president has spent much of his time today and last night talking to the American public about quality and costs, and that's where Judy Woodruff picks up our story.

JUDY WOODRUFF: To pay for health care reform, the president said last night that as much as two-thirds of the funding may come from reducing waste and changing incentives for doctors and nurses. Well, doing that is no simple matter, though, and there's a wide spectrum of opinions even among many in the same profession.

Tonight, we sample just a few of them with the promise of more voices to come in the weeks ahead. Our panel members have all had experience with these questions.

Stuart Altman is a health care economist, and he's a professor at Brandeis University's Heller School. He has served on several federal commissions dealing with medical care and costs.

Chris Jennings is a former senior health policy adviser to President Clinton. He's now a registered lobbyist and a consultant.

And Dr. Troy Tippett is president of the American Association of Neurological Surgeons.

Thank you all for being here. This is such a complex subject. I want to try to tackle just a couple of the points that President Obama talked about last night.

One -- I want to come to you, first, Chris Jennings -- he said that his administration's estimate is that two-thirds of the cost of health insurance reform can be paid for simply by reallocating money that he said is being wasted in federal health care programs. Is he correct about that? And if so, what does that mean?

CHRIS JENNINGS, former White House health care adviser: Well, I think he is absolutely correct on this. If you look at study after study, we have seen that fully one-third of the costs that we spend on services today are for care that does not improve outcomes. One-third of $2.5 trillion is $800 billion a year.

So, clearly, there are ways to make our system far more efficient and focus much more in terms on quality and affordability. And that's really what he's simply talking about. Let's find those services and interventions that work, working in collaborations with physicians and nurses, and then apply them with appropriate incentives in the health care delivery system.

JUDY WOODRUFF: Professor Altman, do you agree that there is that much waste in federal health systems, as the president describes?

STUART ALTMAN, Brandeis University: Well, I think the term "waste" is a misleading one. I think there's inappropriate care. I think the estimates are what Chris Jennings talked about.

But this is not easy. This requires a major education of us as patients, as well as physicians and the whole health care system. It's not a question of waste in the classic sense. It's a question of services that might give you some value, but that the value is so small compared to the costs, and they really don't add that much.

But for many of us as patients, we sort of are used to getting more and we define quality as more, and that's the wrong way to look at it. So this is going to require the president, all of us, to really engage in a national education effort to convince patients that they can get better quality care for less.

JUDY WOODRUFF: Dr. Tippett, how do you see this question of waste?

DR. TROY TIPPETT, American Association of Neurological Surgeons: We have been dealing with this issue a lot in the state of Florida. We were the first to have the so-called RAC committee that looked for so-called waste, fraud and abuse.

And I will tell you, I agree with Professor Altman. What you call waste -- for example, I saw a patient in the office this afternoon. She's 82 years old. She has a terrible back problem. And by any stretch of the imagination, she needs an operation, a big operation which will make her better.

Now, if you go to England, she won't get that operation. Is that a waste to the system? That's what we're dealing with. We as physicians are trying to do what's best for our patient and yet still provide quality of care.

I don't think we have the systems in place really to do that yet. That's what really worries us about the whole plan right now. And that is, we're going to make these giant decisions about what we're doing with your mother's health care, my child's health care, and what's going to happen to our future without really knowing -- we have not done the adequate studies to look at outcomes.

The thoracic surgeons, for example, have done a great job of looking at outcome studies in which they have really studied this throughout the country. They are the example we all need to follow.

But the information otherwise is just not out there. And just because it's an outcome study by someone doesn't mean it really tells us what we need to know. So my plea would be let's take this to appropriate levels and look at it closely.

Changing payment incentives

Stuart Altman
Brandeis University
At the heart of it, we need to change the way we pay for care. We need to move away from the fee-for-service system, and these bills don't do it.

JUDY WOODRUFF: Chris Jennings, how do you respond to that, when you can't even get agreement on whether there is waste and what it is, if it's there?

CHRIS JENNINGS: Well, I actually think there is agreement, that there are services that are unnecessary, and you want to focus and work with the physician community, the nurse community to address what those are.

And, you know, this an issue of bringing consensus amongst the communities. There really is no doubt that there is a lot of money being spent on health care that does not improve outcomes. And in the end of the day, we don't want to have people have incentives to continue to go into a surgery that isn't working and then be re-hospitalized and re-hospitalized. We want to get it done right the very first time.

JUDY WOODRUFF: I'm going to come to you, Professor Altman, on that, because another thing the president said last night, he said he wants a plan that is also going to slow health care costs in the long run by changing incentives, as Chris Jennings just said, so that doctors and nurses are free, he said, to give patients the best care and not just the most expensive care, and he had a couple of examples of that.

STUART ALTMAN: Well, yes, he did, and I really do support him. My concern is that, when you look at the bills that were passed or are being debated in the House and in the Senate so far, there really is very little to change that curve.

At the heart of it, we need to change the way we pay for care. We need to move away from the fee-for-service system, and these bills don't do it. They have some experimentation and demonstration.

I would suggest that the country look at what we're doing in Massachusetts. You know, we sort of passed a bill and a law that has now been in operation for several years, and now we're getting at costs, and what we're trying to do is change the payment system.

This is the only way we're going to get the delivery system to move towards what Cleveland Clinic is already doing. I'm a strong believer in what Cleveland Clinic's doing. But we will never see this around the country unless we change the way we pay for care.

JUDY WOODRUFF: Dr. Tippett, in fact, the Cleveland Clinic is where the president visited today. Is there any kind of an agreement in the medical community about how to change those incentives so that they're structured in the right way?

DR. TROY TIPPETT: Well, I must tell you, I, frankly, last night was appalled and, frankly, embarrassed for the president when he implied that someone who came into an ENT doctor's, otolaryngologist doctor's office three or four times with a child with a sore throat that the doctor would even consider operating on that patient. I mean, that is to me just appalling.

Yes, there are ways to do the right way, as I said. Outcome studies are good. We need to do those. We need the time to do them. The AMA has had great policy on what we ought to do to try to fix the health care system for the last several years, agreed upon by physicians and many others, yet there has been no interest in going in that direction.

All of a sudden, without any warning, we have to swallow a 1,000-page bill put out by the House side which has many, many Trojan horses, things that are just not correct, and all of a sudden we're supposed to change these incentives.

There are ways to do this. It must be done properly and carefully so we don't cut off quality health care to our most trusting patients.

Medical professionals back reform

Dr. Troy Trippett
American Assn. of Neurological Surgeons
The AMA has supported some of the aspects of a House bill 3200, but certainly [...] they reject totally this new plan to have this group that's able to make decisions about everyone's health care in a dark room.

JUDY WOODRUFF: Chris Jennings, how would you respond to that? And what about that example the president used about a tonsillectomy for a child who had a sore throat?

CHRIS JENNINGS: Well, I don't know the specific case, but I will tell you this, that the AMA, the cardiologists, the pediatricians, the College of Surgeons, the many, many other physicians groups are actually embracing the legislation that the House and the Senate is working on. So, you know, there is some dichotomy of use.

JUDY WOODRUFF: Which aspect are you talking about?

CHRIS JENNINGS: Actually to move the whole legislation forward. Now, I will say that all of them -- and I think that there are many, many members of Congress who rightly say that, if we're going to spend good money, we have to make sure we don't spend good money after bad money.

And we can do better in this legislation. As the president indicated last night, he wants to improve that legislation.

But the bottom line is, the physician community well recognizes that the current system is terrible for our patients and very frustrating for our physicians. And to suggest otherwise I think is just simply untrue.

JUDY WOODRUFF: Professor Altman, do you want to pick up on that?

STUART ALTMAN: Well, yes, I wish the truth were there. I don't see in the legislation that's been debated enough to really bend the cost curve.

I strongly support the president. I think his examples were right on. But I support what CBO said. As you look at the legislation as currently written, there's almost nothing that would bend that cost curve.

We need to do more. And while there's a lot of talk about these organizations supporting this legislation, there really is very little in there to really control costs.

JUDY WOODRUFF: To control costs, Dr. Tippett, what are the most important things to do?

DR. TROY TIPPETT: Well, there are a number of things. Look, I have to go back to the previous statement that said that we have terrible care for our patients. That is just inaccurate and totally wrong.

The AMA has supported some of the aspects of a House bill 3200, but certainly there is no support out there that I've heard in any of the organizations that I belong to, including the College of Surgeons, the American association of neurologic surgeons, they reject totally this new plan to have this group that's able to make decisions about everyone's health care in a dark room for the executive side of the -- and not have any insight, no transparency like Congress has now.

So this is something the AMA and other groups do not agree with. It's included in this omnibus bill that we're rushing to pass.

JUDY WOODRUFF: But they do advocate some type of reform. Is that correct?

DR. TROY TIPPETT: I think every physician out there wants to do something about health care reform. I think you're exactly right. We all support health care reform. We support insurance reform. We support care for patients who need to be cared for who don't have insurance available. We all support all of those things.

We have a 1,000-page bill, for example, that says nothing about reforming liability costs of liability insurance, yet that's a huge issue that even the president admits is a problem, yet there's not one word in Congress about that. Now, I have to ask you, why is it we're not talking about that, as well as a cost savings?

JUDY WOODRUFF: Chris Jennings, final comment here?

CHRIS JENNINGS: Well, I think that we need to understand, within the current system, we're not talking about undermining the best quality care that we have in this country. We definitely want to maintain that.

What we're talking about -- today we're seeing physicians forced to spend all this money on red tape, spend money on how to bill, insurers spending money on how to avoid people. We're spending money on people who are uninsured and showing up in hospitals and pushing off costs to other populations.

So in the end of the day, there's plenty of wastes that we can much more efficiently apply in this and reallocate in this system without in any way undermining the quality of care. And that must be the fundamental goal of health reform.

JUDY WOODRUFF: We're going to have to leave it there. It's a subject we're going to be coming back to, I know, again and again. Chris Jennings, thank you. Dr. Troy Tippett and Professor Stuart Altman, thank you all three.

JIM LEHRER: On our Web site,, find out about the proposal to create a watchdog group overseeing insurance companies.