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Public Views on Health Reform Shape Political Landscape

June 23, 2009 at 6:30 PM EST
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As Congress works to draft health care reform legislation, the Hotline's Amy Walter and NPR's Julie Rovner assess President Obama's latest remarks on a public insurance option, concerns over the cost of an overhaul and how the public is viewing the debate.
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JIM LEHRER: Next, more from the president’s news conference, this time about health care. He took questions on the public plan idea and the potential costs of reform. Here are some excerpts.

BARACK OBAMA, President of the United States: There’s been a lot of talk about, well, a trillion-dollar price tag. What I’ve said is, if we’re going to spend that much money, then it’s going to be largely funded through reallocating dollars that are already in the health care system but aren’t being spent well.

If we’re spending $177 billion over 10 years to subsidize insurance companies under Medicare Advantage when there’s no showing that people are healthier using that program than the regular Medicare program, well, that’s not a good deal for taxpayers. And we’re going to take that money, and we’re going to use it to provide better care at a cheaper cost to the American people.

The public plan I think is an important tool to discipline insurance companies. What we’ve said is, under our proposal, let’s have a system the same way that federal employees do, the same way that members of Congress do, where — we call it an exchange, but you can call it a marketplace — where essentially you’ve got a whole bunch of different plans.

If you like your plan and you like your doctor, you won’t have to do a thing. You keep your plan; you keep your doctor. If your employer is providing you good health insurance, terrific. We’re not going to mess with it.

JOURNALIST: … private insurers out of business?

BARACK OBAMA: Well, why would it drive private insurance out of business? If private insurers say that the marketplace provides the best-quality health care, if they tell us that they’re offering a good deal, then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business? That’s not logical.

Now, if it turns out that the public plan, for example, is able to reduce administrative costs significantly, then, you know what, I’d like the insurance companies to take note and say, “Hey, if the public plan can do that, why can’t we?” And that’s good for everybody in the system, and I don’t think there should be any objection to that.

I take those advocates of the free market to heart when they say that the free market is innovative and is going to compete on service and is going to compete on their ability to deliver good care to families. And if that’s the case, then this just becomes one more option. If it’s not the case, then I think that that’s something that the American people should know.

JIM LEHRER: Gwen Ifill takes it from there.

Defining the public option

Julie Rovner
National Public Radio
If it was just competing on a level playing field, then why shouldn't it go ahead and compete? Why shouldn't people have the option of doing that? As he pointed out, the government is not going to force anybody to go into it; this will be optional.

GWEN IFILL: As always occurs at a presidential news conference, there was a little bit of politics and a little bit of policy involved in today's health care discussion.

Joining us to help sort out one from the other are Amy Walter, editor-in-chief of the Hotline, National Journal's political daily, and Julie Rovner. She covers health care for National Public Radio.

Let's start about the explanation and the move to the selling of the policy. Julie, the president talked about the public option, which I think after a while people think, "What was that again?" What was it again?

JULIE ROVNER, National Public Radio: Well, I like to call it the big ink blot. The public option is basically whatever you want it to be, and that's what Congress is struggling with now, trying to figure out how to create a public option that can get 51 or perhaps more than that votes in the Senate and 218 votes in the House.

As the president pointed out, he really did argue both sides of it. The idea is to have a public plan that would compete perhaps on a level playing field, perhaps not, with a bunch of private plans in what he called this exchange, that people will be able to go and choose from a number of plans, most of them private, perhaps with a government-sponsored plan.

Perhaps it will pay Medicare-type rates, lower rates than private insurance. Perhaps it will pay more like the private rates, so that would affect how many people would go into it.

As the president pointed out, if you had an unlimited amount of public subsidy, that might not be fair. And I think that's what the insurance companies are complaining about, and he said maybe that wouldn't happen.

But if it was just competing on a level playing field, then why shouldn't it go ahead and compete? Why shouldn't people have the option of doing that? As he pointed out, the government is not going to force anybody to go into it; this will be optional.

Public perception of the plan

Amy Walter
The Hotline
Not surprisingly, people like the idea of reform, people like the idea of covering those who are uninsured, not a big surprise. But what they don't necessarily see is how it's going to benefit them, and that really is the big selling issue here.

GWEN IFILL: OK, this is the sales part of it. No one is being forced here, and he says these things and also talks about costs, in part because he's speaking for public reaction. So how is the public reacting when he makes this pitch?

AMY WALTER, Editor-in-Chief, The Hotline: Well, it's really interesting. When you look at the idea -- now, there are a lot of polls out there right now trying to gauge the public's perceptions about health care and health care reform -- and when you look at it, just over all these numbers, a couple of things pop out at you.

The first is, not surprisingly, people like the idea of reform, people like the idea of covering those who are uninsured, not a big surprise.

But what they don't necessarily see is how it's going to benefit them, and that really is the big selling issue here. The question -- and I think the Kaiser Foundation did a very good job of asking this question, where they asked, "Do you think this is going to help you and your family or not have an effect at all or hurt you? And how do you think a health care reform would help, hurt, have no impact at all on the country?"

More people said they think it would help the country than it would help them. So, really, for Obama here, there are clearly two different messages he's sending. One, obviously, to Julie's point, the votes in Congress. The other is to Americans who want to know, what's in it for me? And that is a very tough thing to do.

Health care 'sticker shock'

Julie Rovner
National Public Radio
You have to put that into a lot of perspective. We spend $2.2 trillion on health care. I usually say every year, but it goes up really fast. We spent $2.2 trillion on health care in 2006. It's probably up more like $2.5 trillion this year.

GWEN IFILL: Now, there seemed to be some wind taken out of the president's sails last week when even people like Dianne Feinstein in the Senate took a load of a trillion-dollar price tag that came out of the Congressional Budget Office and said, "Whoa, wait a minute." Max Baucus said, "Whoa, wait a minute." So he was speaking to those folks, as well, wasn't he today?

JULIE ROVNER: Yes, he was. And I think that that trillion dollars, there was a lot of sticker shock last week; that was the phrase that everybody used, "sticker shock."

But you have to put that into a lot of perspective. We spend $2.2 trillion on health care. I usually say every year, but it goes up really fast. We spent $2.2 trillion on health care in 2006. It's probably up more like $2.5 trillion this year.

We're talking about a trillion dollars over 10 years. So we're talking about adding $200 billion a year, really, for...

GWEN IFILL: But not to cover everybody?

JULIE ROVNER: Well, maybe to cover everybody. And it's confusing. And the numbers that came out last week from CBO really were not that accurate. The number that we saw for the health committee bill didn't include a public plan. It didn't include a mandate. Oddly enough, those are two things that would probably bring that number down.

GWEN IFILL: But the president still felt he had to be in the position to say, "We can pay for this," so he said, for instance, the Medicare Advantage plan, if it's not serving the people that it's supposed to serve, that can be redirected. Is that the sort of thing he's talking about?

JULIE ROVNER: Yes. The president made two stipulations today. One of them is that any bill will have to control cost, and he's talking about in the long run that we'll have to make the kinds of changes that will bring down, what they call bending the curve, that we'll have to change the kinds of incentives in the system so that health care costs won't go up so fast, but that also this bill will have to be paid for. However much it costs, whether it's $2 dollars or $2 trillion dollars, all of that will have to have offsetting cuts.

Now, one of the things he said today that I think was the first time he'd said is that, if it's going to cost more than a trillion dollars, that most of that money will have to come not from increases in taxes, which is mostly a lot of what has been talked about, but from redistributing money already within the health care system, to cuts in Medicare and Medicaid mostly, the two huge entitlement health programs.

The president has already put on the table about $600 billion in cuts to those programs. He talked today about the Medicare Advantage program; that's the private plans that serve Medicare beneficiaries that most people think are overpaid. He's got a lot of other proposals.

Congress could come up with other proposals. Something that Amy was talking about, that would be something that would certainly rile up some of the stakeholder groups at the table, but perhaps would not rile up the public so much.

Polling problems in the details

Amy Walter
The Hotline
How you pay for it is a big issue here, because, again, the closer you get to it affecting people personally, the less likely they are to be supportive of it, especially people who are the biggest stakeholders.

GWEN IFILL: Well, let's talk about the public. He said the public is optimistic, that they are with him on this.

AMY WALTER: Well, and that's where you -- again, you see all these numbers, and you have to take them somewhat with a grain of salt, but I think it's more important actually to see them as a whole, rather than take one poll and try to divine a lot of information out of it...

(CROSSTALK)

GWEN IFILL: OK, so tell us.

AMY WALTER: So we're going to try to help to do that. The first is, yes, they like the -- as I said, you ask the question, "Do you want to see reform?" Of course. Are they optimistic that reform is going to happen? I don't know about that. But when we asked in our poll, "Do you think it's important that health care gets passed, some sort of health care reform gets passed?" 68 percent said, yes, this year, we want to see health care reform.

Now, you dig into the details; of course, that's where all the problems usually are. And how you pay for it is a big issue here, because, again, the closer you get to it affecting people personally, the less likely they are to be supportive of it, especially people who are the biggest stakeholders.

GWEN IFILL: Because they think they're going to lose something.

AMY WALTER: They think somehow they're going to lose something, right. So you say, OK, we're going to -- you like to insure people? Great. Here's how we're going to pay for it. You're going to pay more in taxes. We're going to tax your health care benefits. Oh, absolutely not. That's totally off the table.

OK, how about if you agree to some taxes? OK, maybe. We saw there was a big number that came out in the CBS-New York Times poll, there was a lot of discussion about the fact that 57 percent of voters said they would be willing to pay more in taxes to cover people. That, to me, though, in looking at all the other polling, was more of an outlier. Fewer people were saying they were willing to take taxes.

But even in that New York Times poll, take them a step further and say, OK, there's a public plan or there's a big plan that covers a lot of people, but it could impact -- how worried are you that it could impact your ability to get your health care, to get to see your doctor, to get the kind of treatments you need? And 68 percent said, "I'm concerned about this."

So this is why you see President Obama today. You're going to have your plan; we're not going to change anything. The irony is, the more change you're asking in the system, right, people want change, but they don't want that change to happen to them.

GWEN IFILL: OK, briefly, we know this is going to be a long haul, this whole health care thing. Did the president move the ball today?

JULIE ROVNER: Very little bit. He did say that not having a public plan in it would not be a vetoable offense, in his -- so he said, you know, the two things that it absolutely had to have, it had to contain costs and had to help people who didn't have insurance and who are underinsured. But he refused to say that he would veto it if it didn't have a public plan.

AMY WALTER: Yes, I agree. He's keeping himself -- now he's giving himself very wide latitude here. There are no lines in the sand. This means that when something, anything comes out as a piece of legislation, he can claim victory for it.

GWEN IFILL: Amy Walter, Julie Rovner, thanks for clearing all that up.