Health Care: Just One Issue On Obama's Plate

The White House on Thursday hosts a summit designed to begin overhauling the nation's health care system. It's just one of the major issues President Obama is trying to tackle. Is it a good idea to have so many major issues in play at once?

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LINDA WERTHEIMER, host:

President Obama holds a health care summit at the White House today. Doctors and other health care professionals will be part of it, as will Cabinet officials, members of Congress, the White House team, conferring on how to overhaul health care. NPR News analyst Juan Williams joins us to talk about the summit.

Juan, welcome.

JUAN WILLIAMS: Good to be with you, Linda.

WERTHEIMER: So what is the point of a health care summit? What is the president hoping will happen?

WILLIAMS: Well, you know, last week he named Kathleen Sebelius, the governor of Kansas, to be the secretary of Health and Human Services. He's also named Nancy DeParle as the head of the White House Office of Health Reform. And so he's got now people at the top of the health care structure, and he's looking for ideas. He's also set aside money as part of the stimulus package that could be used in some way to revive the way Americans handle health care.

But he doesn't want to put forward an idea and have the Congress and all the lobbyists reject it. He'd rather have the lawmakers themselves - some congressional people, the lobbyists and industry leaders - come together for the summit, sort of suss out their own ideas and then say it wasn't my idea. This is the idea of the very smartest, best people in the industry.

(Soundbite of laughter)

WILLIAMS: And here, why don't you look at it, Congress?

WERTHEIMER: Health care is very difficult to get through Congress, as experience has shown. Do you think that in taking that issue on so soon the president is - is this too much?

WILLIAMS: Well, it's a big ticket. And you know what, Linda? It's just one of the many tickets. He's having a health care summit today, but he's already had summits on so many issues - transparency and accountability, a White House task force on middle class families.

WERTHEIMER: There's one working now in Afghanistan.

WILLIAMS: Economic advisory board. And, of course, he's got the stimulus package and he's got the budget and everything that's in the budget. So it could be that you could say that his plate is more than full. It's overflowing, if not cratering. But the thinking at the White House is you've got to take advantage of the early momentum.

His popularity still is a power, and they want to ride that popularity as much as possible. And they think if they can get it done now, it's better than waiting until you get close to the - what will be the 2010 midterm cycle.

WERTHEIMER: So do you think in taking on so many things, is it possible he's setting himself up to fail here?

WILLIAMS: Well, he is in a sense, Linda, in that he's got so much on his plate, you can imagine that Republicans running against Obama in the White House in 2010 are going to say look at all these things he set out to do. What did he accomplish? And so the idea for the Democrats is to simply say we're making an effort. We're trying to take advantage of this moment to create change in America.

WERTHEIMER: On the question of failure, the conservative radio talk show host Rush Limbaugh appears to be cheering for the president to fail. The Republican chairman called him on it, then he had to apologize to him. What's all this about?

WILLIAMS: Well, Michael Steele, the new chair of the RNC said that what Limbaugh was saying was ugly, incendiary, then had to apologize. But the fact is, Linda, look, Rush Limbaugh stirs the base. He's got a huge listenership.

But the base in the Republican Party is so limited. It's now about 28 percent of those who self-identify in the electorate. That's 10 percent smaller than the Democrats. It's even smaller than the independents, who are about 30 percent.

And the Democrats are happy to jump on him and say, yes, he's the face of the Republican Party, and he's very unpopular. And he's the energy, and the Republicans are afraid of him. The Republicans, for their part, are trying to somehow find a way to get beyond Rush Limbaugh. They want the base, but they have to expand the party if they have any hope of winning elections, especially going into 2010.

WERTHEIMER: NPR News analyst Juan Williams. Thanks.

WILLIAMS: Have a good morning, Linda.

(Soundbite of music)

WERTHEIMER: This is NPR News.

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Some Common Ground Ahead Of Health Care Forum

President Obama is hosting what he calls a health care forum at the White House on Thursday. It's part of his ambitious goal of getting Congress to overhaul the nation's health care system this year. How that will happen remains politically complicated — but there's at least one area of bipartisan agreement.

The current White House has a fair share of veterans of the last, unsuccessful fight to remake the health care system, including Chief of Staff Rahm Emanuel. But they're already doing things differently this time around. They're not writing their own legislation, and they're not doing things behind closed doors, White House spokesman Robert Gibbs notes.

"The event will be streamed on the Web and broadcast on C-SPAN, as the president promised many times during the campaign," Gibbs said at a briefing Wednesday.

Additionally, the White House has invited 120 people to the forum — lawmakers, patients and representatives of medical, business, insurance and other groups. The list also includes many who don't agree with Obama's approach to the issue. Gibbs says that's no accident.

"The hope is to get all of those people in the room and talk best about how to get to the ultimate outcome of reforming our health care system," he said.

The Cost Of The Payment System

But the administration does get to start with one area of agreement: fixing the way medical care is organized and provided at the patient level.

"How we deliver the health care is the real problem in the U.S.," says Douglas Holtz-Eakin, the former head of the Congressional Budget Office and adviser to Republican Sen. John McCain of Arizona. "We need to change how much we spend and how we spend it so people get better health care."

Holtz-Eakin says that when it comes to health care, fixing the way care is delivered is something Republicans and Democrats can agree on.

"I'd love to start with the delivery system," he says. "It is the problem, there is bipartisan agreement it is the problem, and there's agreement on some of the solutions."

A major cause of that problem is the payment system for health care, says Elliott Fisher, a physician and researcher at the Dartmouth Institute for Health Policy.

"The payment system treats each physician and each physician's service as a separate service that requires a separate bill," Fisher says. "So the payment system does really two things: It rewards unnecessary care, and it reinforces the fragmentation that causes so much difficulty for patients and physicians."

That fragmentation is what requires patients to physically carry medical records or X-rays from one doctor to another, for example, or results in tests having to be repeated because results can't be found.

Spending May Not Be The Solution

As for rewarding unnecessary care, Fisher and his colleagues at Dartmouth have long studied how health care spending varies widely in different parts of the country. Their research suggests that more spending is definitely not better.

"The highest spending regions of the country and the highest spending health systems in the country have much bigger problems with care coordination and no better outcomes, and lower quality of care," Fisher says.

Many experts have said that primary care doctors — most patients' point of entry to the health care system — are underpaid. But Fisher says the real solution is not just to pay them more, but to pay them differently.

"Currently, physicians are paid only for each visit that they make," he explains. "But they're not paid at all for calling you up that evening to see if you've gotten better on the medications and could have avoided the hospital stay."

And there are other, relatively easy fixes, says Holtz-Eakin.

"Reward prevention," he offers. "There's a lot of evidence that if we do the preventive care, you don't end up with costly things down the road."

Of course, when you're talking about moving around hundreds of billions of dollars, even areas where there is broad agreement can get bogged down on the details. But there seems to be a growing consensus that fixing the health care delivery system would be a good place to start.

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