GOP Challenges Cost Of Health Care Overhaul

President Obama has been pushing his plans to overhaul the country's health care system. Opponents are skeptical about the cost of the plan.

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STEVE INSKEEP, host:

Lawmakers reworking health care know they're tiptoeing through a minefield. A few months ago on MORNING EDITION, we heard from Stan Greenberg, President Clinton's pollster during the failed health-care effort of the 1990s.

Mr. STAN GREENBERG (Pollster): The public is more skeptical about health care than any other issue I look at. They're not sure government won't muck it up. They're not sure the special interests won't come in there as well.

INSKEEP: And even though many people favor change of some kind, that public concern creates openings for the opposition today. NPR news analyst Juan Williams has been looking at the politics of health care for Republicans. Hi, Juan.

JUAN WILLIAMS: Good morning, Steve.

INSKEEP: Now, Juan, in the '90s, Republicans famously took the argument that health care is basically fine. It's good care. Most people had it. Some people didn't have insurance, but we didn't need big, risky change. Are they trying that same line of argument again?

WILLIAMS: Well, basically that's right. And with the support, if you'll recall, in the '90s of the insurance companies, doctors and the like, they were able to hold the line and say, we can just do small things, sort of incremental change around the edges. But this time, they're having a little more trouble. But basically, the same argument: Why risk whole-scale change?

INSKEEP: Why are they having a little more trouble this time?

WILLIAMS: Well, I think, clearly, what you've just heard from Stan Greenberg is that despite their concerns, there is broad popular support for the idea of health-care change because if you look at what's going on in emergency rooms, if you look at the possibility of high costs for catastrophic care or someone who has to deal with long-term care, people fear that it's going to bankrupt them and potentially, if you look at the economy, bankrupt many American companies.

INSKEEP: Of course, then, Republicans are warning that change - the wrong kind of change could make things worse. And let's listen a little bit to an argument by Senate Minority Leader Mitch McConnell.

Senator MITCH MCCONNELL (Republican, Kentucky; Senate Minority Leader): What they don't want is a Washington takeover of health care along the lines of what we've already seen with banks, insurance companies and the auto industry.

INSKEEP: Sounds like the same thing Stan Greenberg was mentioning there, that he's trying to play on the fears of the public, that the government is going to muck this up. How far can Republicans get with that argument?

WILLIAMS: Well, you know, it's interesting that the way that it is posited, Steve - for example, you heard McConnell use the phrase takeover. The Republican argument basically is to touch on a lot of specific nerves on the body politic: rationing care - you're going to have long waits for care. You might lose your doctor or your current insurance plans. Specifically, it might kill private insurance because the president is thinking about a public insurance option.

And then most of all, this comes back to what we were just talking about, Steve. It's the idea that in fact, what the government's doing may drive up the cost of health care. So that plays into raising taxes, higher deficits, big government. And you know, a lot of that issue, especially the deficit issue, is clearly now, in political polling, becoming a problem for the Obama administration.

And just recently this week, there was a big boost for the Republican argument when the Congressional Budget Office did a scorecard on one draft of a proposal and said it's going to, in fact, cause some people to lose their insurance coverage, and it won't cover everybody in the country. So immediately, that allowed the Republicans to say, this is problematic. It's not what the president is saying.

INSKEEP: Now just about everything that you have quoted Republicans as saying there, of course, is being disputed by Democrats as being distorted or overblown or just plain wrong. But of course, we're talking about the politics here and how things work.

WILLIAMS: Right.

INSKEEP: And yesterday here on MORNING EDITION, we talked about that public plan you mentioned. Republicans have said it will grow into nationalized health insurance. And Health and Human Services Secretary Kathleen Sebelius told it -that that has been the hardest thing for the administration to explain.

Secretary KATHLEEN SEBELIUS (Department of Health and Human Services): I think that the whole idea of the public option has been difficult in part because I think some of the opposition has described it as a potential for a draconian scenario that was never part of the discussion in the first place.

INSKEEP: That's Kathleen Sebelius yesterday. Juan, has the White House found any effective way to prove a negative here, to say this is not going to become creeping socialism?

WILLIAMS: Well, what you're hearing from President Obama himself is the status quo is not acceptable. Let's not forget what's going on with the high number of uninsured in the country. Let's not forget what's going on in the emergency rooms. President Obama mentions his own mother's other struggles with dying and having to argue with insurance companies. And he's on a PR offensive, Steve. He'll be all over ABC next week, prime time, making the case for changing the health-care system.

INSKEEP: Juan, thanks very much.

WILLIAMS: You're welcome, Steve.

INSKEEP: That's NPR's senior news analyst Juan Williams.

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Orszag Defends Health Care Plans Amid Criticism

President Obama is pushing to overhaul the nation's health care system, but doctors, hospital officials and others are raising sharp concerns over his call for a government-run insurance plan to compete with private plans.

Peter Orszag, director of the White House's Office of Management and Budget, defends the plan, telling NPR's Michele Norris that it will put the U.S. "on a path to eliminating the number of uninsured people in the United States."

Orszag says evidence suggests that many insurance markets lack adequate competition, and the goal of the public plan is to expand choice, introduce more competition and drive down premium costs.

"Our goal here is not to force doctors and hospitals to do things that they don't want to do, but rather to create a plan that we think that they'll want to participate in, and that beneficiaries will find helpful also in terms of having more choices available," he says.

One challenge the administration faces, however, is that in areas such as Howard County, Md., which offers relatively low-cost health coverage to its residents, many don't enroll. Orszag says no one would be required to participate in a public plan, but "there are proposals that the president is open to — to have some sort of personal responsibility where you have to carry insurance just like you do when you drive a car. But you could purchase that insurance through a health exchange where the public plan would be one of many options."

Concerns From Hospitals

One aspect of the proposal that has come under fire is a proposed $200 billion cut in federal payments to hospitals. Hospital officials say that will result in cuts in services to the people who need it most.

But Orszag says that, for example, under the reimbursement system known as disproportionate share payments, government funding is provided to hospitals in large part to help meet the cost of caring for the uninsured.

"Our argument is that as the number of uninsured goes down ... the hospitals would in a sense be double-paid if the number of uninsured people declines significantly and they were still receiving payments to meet the cost of the uninsured," he says. "So we scale those back, and we would also target those payments more efficiently toward the hospitals that are disproportionately serving the remaining uninsured."

Rich Umbdenstock, president and CEO of the American Hospital Association, tells NPR's Robert Siegel that the hospitals have accepted "in principle" that reimbursements from Washington will decline as the number of insured patients rise at those institutions. But, he says, too many questions remain.

"How soon will that coverage kick in? At what payment levels? Across what proportion of the uninsured population?" he asks. "Even by the best estimates, right now, people are saying that it looks like some of the plans that are out there can cover maybe a third, maybe, at the high end, two-thirds of the population. That still leaves a lot of people uncovered. It still leaves a lot of people on the Medicaid program, and it still leaves a lot of people who are undocumented immigrants and so on. That need's not going to go away overnight."

Orszag says opposition to the health care overhaul is inevitable. "We're not going to transform a $2 trillion sector of the economy without some jostling occurring and without some objections being raised or some concerns being raised," he says. "That's natural."

And Umbdenstock says all the stakeholders in the health care system have to examine what they can do now to cut costs.

"You have to look at cuts in the context of a complete plan for reform. And our elements in reform include the important element of affordability," Umbdenstock says. "But also we have to think about coverage. We have to think about quality."

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