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Emanuel: Cost, Competition Central to Health Reform

October 13, 2009 at 12:00 AM EDT
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In an interview, White House Chief of Staff Rahm Emanuel discusses the Senate Finance Committee's passage of a health reform bill, the future for the public option and more.

JUDY WOODRUFF: Now joining us is Rahm Emanuel, the White House chief of staff.

Rahm Emanuel, good to have you with us.

RAHM EMANUEL, White House chief of staff: Thank you, Judy. How are you.

JUDY WOODRUFF: So, how big a deal was today?

RAHM EMANUEL: Well, it’s a significant milestone.

This is the first time, you know, all five committees in the House and the Senate have passed a bill. They’re now going to go to the floor in the coming weeks. So, in that sense, it’s a milestone. It also is a milestone in the sense that it achieves some of the objectives the president set out for health care, a way to control health care costs, to offer more choice to people and competition in the system. So, in that sense, it’s also a milestone.

But we are closer than ever in the history of this effort to getting health care reform to give people who have health care a sense of knowing that it will always be there and people who don’t, health care at an affordable price.

If you go back in history, five presidents over 60 years have tried to do this. Never in that process have we been this close, where you’re about now, within the coming weeks, Judy, the House and the United States Senate will be debating health care on the floor of the two chambers, where people actually believe the momentum is for getting something done.

As both Senator Baucus and Senator Snowe said, when history calls, that’s a time for action, because the status quo, as is, is unacceptable to both taxpayers, businesses, and families.

JUDY WOODRUFF: What about Senator Snowe’s vote? What was — what was the president’s reaction?

RAHM EMANUEL: Well, he was very pleased by — well, first of all, he was pleased by all the members. He’s called them all today on the Finance Committee, in the sense of those Democrats who voted yes, as well as Olympia Snowe, to thank them for their hard work, and urged them on to keeping that momentum, that energy to going forward and working immediately in merging the two bills out of the Senate, so that it will be ready to go to the floor.

JUDY WOODRUFF: She said that — that, yes, she has voted for it today, but she said she still has concerns. And, principally, she mentioned affordability. How important is it to keep her in the tent?

RAHM EMANUEL: Well, it’s — I mean, it’s very — I mean, first of all, it’s — everybody I think who voted for it had they by themselves would have had a different bill.

But the question — I think every senator knew, not only that the status quo was not — that the status quo was unacceptable, B, that what you have to do is not make the perfect the enemy of the good. And, C, to the core of your question, she is going to be an important player not just on the committee, but going forward, as are other people when you have to round up 60 votes.

Making health care affordable

Rahm Emanuel
White House Chief of Staff
As to the issue of affordability, that is to make sure those who don't have health care will be able to afford health care in the exchange or on the other ways of purchasing it through their employer or individually.

JUDY WOODRUFF: So, what about this affordability question? You had a number of people out there today saying, yes, we're glad you have done this, but there are still many Americans who are going to be paying higher premiums, higher taxes. How do you...

RAHM EMANUEL: Yes, but wait. The affordability issue, let's draw back a little and take a step.

If you have health care today, it's going to -- what this legislation and the other bills both in the House and Senate said -- and it's very clear -- is that insurance companies cannot discriminate based on preexisting conditions. If you lose your job, you won't lose your health care.

Those basic core reforms are essential for people that have health care. But, also, in addition to that, by the fact that you will be controlling costs, you won't see your premiums going up three times the rate of inflation.

As to the issue of affordability, that is to make sure those who don't have health care will be able to afford health care in the exchange or on the other ways of purchasing it through their employer or individually, and making sure that you're finding that right balance between making health care available to folks, as well as that they can afford it and where that break point is.

And they have a core issue. She's raised it all through the process. It's one of the core issues for the president and a core issue for a lot of Democrats.

JUDY WOODRUFF: Well, is that a sliding -- you were just saying that that's a key balance that has to be struck.

RAHM EMANUEL: Well, some people...

JUDY WOODRUFF: Is that a sliding decision?

RAHM EMANUEL: No, it's not a sliding -- you try to find where -- how much of somebody's overall income do they get in the sense where they can opt out and say, I can't afford it, or it breaks out -- a break point.

It's not a sliding -- just, there's different variations on it. But the issue of affordability is key for families who are making $60,000, $70,000, that they're able to afford health care and be able to purchase health care, and making sure that it's competitive out there.

One of the key parts of this bill is making sure there's competition in the system, because, in many parts of the country, Judy, a single insurance company controls 70 percent of the market. And when you have one company controlling 70 percent of the market, you can't find health care at an affordable price.

Controlling costs

Rahm Emanuel
White House Chief of Staff
The health care bill has to control costs for everybody. It cannot let a system continue to drive costs out of control.

JUDY WOODRUFF: So, you have got four other versions right now of health care reform, three in the House, another one in the Senate. At this point, do I hear you saying that this version coming out of the Senate Finance Committee looks like it's the one that is most likely to survive?



RAHM EMANUEL: I'm only reminded when you said that of a joke my mother used to say. When I used to say, "Do you love my older brother more than you love me?" she goes, "No, I hate you all equally."

No, this is -- as it relates to this bill, this is not the more important bill as compared to any other bill. It is a bipartisan bill, achieves the objectives. That's also true of what Senator Dodd did in his committee. The House is now going to merge those three bills.

It is also, what all five bills do, which is important to remember, is achieve the objective the president set out for them. And that is, the health care bill has to control costs for everybody. It cannot let a system continue to drive costs out of control.

Two, it has to provide individuals choice. Three, there must be competition in the system. Each of these bills do it in a different way, but they get to the same destination. What will happen in this process, you know this -- you followed it very well -- the Senate will vote. It will pass a bill. The House will. There will be differences.

But the differences are not as stark as you said. But we will merge those bills in the conference and come out with a single product.

Future of the public option

Rahm Emanuel
White House Chief of Staff
There are different ideas, but everybody is working around the same principle. How do you create competition, so insurance companies who dominate a market can't set prices and you have no other choice?

JUDY WOODRUFF: One of the differences is public option. A lot of unhappiness about that, not only among Republicans, but a number of Democrats. Is it, in essence, dead?

RAHM EMANUEL: No, I wouldn't say that at all. The president, as you know, in...

JUDY WOODRUFF: Well, it's not in this version that came out.

RAHM EMANUEL: No, it isn't in this version. The House will have their version.

The president believes that it's important to bringing the type of competition. He spoke to it in the joint session. But, as he said in that joint session, he believes strongly in it. He believes strongly because of what it achieves in the sense of keeping the competition that insurance companies need, so the prices don't continue to jump and out of control, that, if there are other ways to achieve that goal, as you know, Senator Snowe has the idea of a trigger, that, in case that price isn't achieved or that competition isn't achieved, there be a trigger that then the option, a public option, would come available.

Some -- Senator Carper has a different idea.


RAHM EMANUEL: Right. Of Delaware.

There are different ideas, but everybody is working around the same principle. How do you create competition, so insurance companies who dominate a market can't set prices and you have no other choice? And it is not allowing an insurance company to be the overpowering factor when, in fact, if you had that competition, both the consumer, i.e., the patient, and the doctor have the choice, and it's not left in the hands of the insurance companies.

JUDY WOODRUFF: So, you -- you make it sound like the president is flexible on that point, that he is prepared to accept something...

RAHM EMANUEL: Well, I thought I was doing a pretty good job reflecting what he said in the joint session, which was in front of 30 million people, which is, he believes it's the right way to go, but he's open to other ideas, as long as we don't miss -- from it.

But he's strong from the sense of what it does achieve, the type of competition that is not there in the system today, so people are basically at the beck and call of how the insurance companies want to set the price. He strongly believes in it. But if there's another way to achieve it -- Senator Snowe has the idea of a trigger -- people have to look at that.

JUDY WOODRUFF: How confident are you, as we sit here today, that you will get health care reform?

RAHM EMANUEL: Well, you live on pins and needles through the process. I think, as -- again, as I said earlier, Judy, you have to step back.

Five presidents over 50 years have tried this. Never have we been closer. Today was a big momentum push for this, a milestone on the road. We have a lot of hard work ahead of us. I'm -- there is no doubt I would rather have today happen as it happened than not. We have a lot of work. We will be up on the Hill immediately, at the request of the leadership, the House and Senate, helping them bring those bills together.

'Stealth stimulus'

Rahm Emanuel
White House Chief of Staff
We have just literally averted what is now known as the great recession, worse than what happened in 1982, the worst economic kind of contraction since the Great Depression.

JUDY WOODRUFF: We turn to another big issue on the president's plate. That's the economy. Almost 10 percent of Americans looking for a job don't have a job right now. It's been reported the administration is looking at doing a number of things, extending unemployment benefits, tax credits for businesses that add jobs, home-buyers credit, expanding that, a number of other things.

How far along is that process?

RAHM EMANUEL: Well, it's extensive. I mean, well, it's far along in the sense that, since day one, when we got -- when the president was sworn in, that laser-like focus he had was on the economy and averting what we inherited.

We inherited an economy that was -- basically, $4 trillion had been added to the books. We were losing 700,000 jobs a month. Some were talking about us as the -- this will be remembered as the great recession. We have put in place a series -- the president put in place a series of things to pull the economy back from that, what could have been a far worse economic condition.

But every day he spends looking at this and asking his economic team, what are the different ideas that we can do to further enhance and jump-start the job production of the economy? While the macro pieces may be working, there's only one measure for the American people. Do they have a job? Do they have a job that is -- gives them the income, the benefits and the health care and retirement that they seek and the ability to afford a college education for their kids? And that is the central focus of what he works on every day.

JUDY WOODRUFF: It's hard to find somebody who wants to call whatever this is that you're likely to do, may do, a stimulus, another stimulus. But, in effect, it would be kind of a stealth stimulus, wouldn't it? I mean...

RAHM EMANUEL: Well, in all the discussions the president has had with individuals -- you know, with CEOs from major corporations, as well as the letters he gets, is, what is it going to take to kind of get that job engine of the economy going?

We have just literally averted what is now known as the great recession, worse than what happened in 1982, the worst economic kind of contraction since the Great Depression. But what is it that is going to pull that job engine back?

It's, clearly, the private sector, as the president knows, is the key piece of it. But, as many in the private sector will tell you, that it is the public -- right now, the public sector is playing that role to kind of get it back on keel and start the process of creating jobs.

JUDY WOODRUFF: So, how quickly do we look for some decision?

RAHM EMANUEL: I will be back as soon as I can. No, listen, the -- the fact is, Judy, I mean, it is not -- it is -- he is looking at ideas, pressing his economic team. They have had three or four meetings on it. There are different ideas. He met -- when he met with Speaker Pelosi and Senate Majority Leader Harry Reid, the principal discussion about was about different ideas on what they can do for jobs.

The core function, remember, is going to come from the private sector. What the public sector can do is part of helping on that ignition right now, so that job growth that happens naturally in the economy takes off. That kind of demand isn't yet there. We have averted, as I said, the worst. There is going to be a period of growth right now, but the job piece is what's lagging. And that's the part that the president wants to see get another kick-start.

JUDY WOODRUFF: Rahm Emanuel, White House chief of staff, it's very good to see you.

RAHM EMANUEL: Thank you.

JUDY WOODRUFF: Thank you for stopping by.

RAHM EMANUEL: Absolutely. Thank you for having me.