Shape Of Health Care Overhaul Unclear

Debate is intensifying in Washington over the Obama administration's health care ambitions. While President Obama has made it clear he wants to use the power of the federal government to make health care available and affordable for all Americans, what exactly such a plan would look like is less clear.

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ROBERT SIEGEL, host:

As we just heard, health care was a major topic during President Obama's news conference today. In particular, he was asked about the idea of a government-sponsored health plan as one option people could chose. Here's how he described it.

President BARACK OBAMA: For us to be able to say, here's a public option that's not profit driven, that can keep down administrative costs and that provides you good quality care for a reasonable price as one of the options free to chose, I think that makes sense.

SIEGEL: Well, Republicans are dead set against even allowing a government plan as an option. Here's House Minority Leader John Boehner.

Representative JOHN BOEHNER (Republican, Ohio; House Minority Leader): It amounts to a government take over of health care and it would force millions of American's off their own plans and into a government-sponsored plan.

SIEGEL: Well, joining us to help sort out all this is NPR health policy correspondent Julie Rovner. And Julie, whether or not to include a government-sponsored health plan as part of a health overhaul has become one of the central flashpoints in this debate. What exactly are they talking about?

JULIE ROVNER: Well, that's part of the problem. It depends. There are lots and lots of different ways you could do this. You could make everybody eligible for a public plan and you could pay at rates that are similar to the rates the government pays for the Medicare program for the elderly. That would probably save a lot of money. But then it would be very attractive and a lot of people would probably join that government-sponsored plan. And that's what makes the insurance industry claim that they would be undercut and hence go out of the business. And that leads to claims like this from former House Republican Whip Roy Blunt.

Representative ROY BLUNT (Republican, Missouri; Whip): We believe, and everybody analyzing that future marketplace seems to believe, that if there's a government competitor you will not able to keep what you have. Because if there's a government competitor, the government will never compete fairly. And before you know it, there are no competitors. So what you had is no longer available for you to have.

SIEGEL: What you have he means is your current insurance policy might disappear because the government would drive your insurer out of business. You say that is not necessarily the case.

ROVNER: No. It depends, as I said at the beginning, on how you design this public plan. You could also create a government plan that limits who could join it, perhaps you could limit it to small businesses or people who aren't eligible to get insurance at their workplace. You could pay that government plan higher insurance rates - that's what members of Congress are calling this more level playing field. So it really all depends - I call this, you know, the ultimate inkblot test.

SIEGEL: So one big question seems to be this promise of whether you'll be able to keep the insurance that you have if you like your current insurance coverage.

ROVNER: Yes and both sides are using this as an enormous hammer to hit the other side. The fact is, as the president made clear today, it's not entirely clear that you will be able to keep the insurance you have, if you like it no matter what. Prices are going up, a lot of employers are, if not dropping coverage, at least changing the coverage that they have. Now the president made clear that the government is not going to force you into - to go into a government plan. If there is a public plan it will be one of the many options that people can chose from. That's why they have been resisting the Republicans urges…

SIEGEL: Mm-hmm.

ROVNER: …to say you must put in the legislation that you promised there will never be anyone forced to take a plan.

SIEGEL: Yeah, President Obama said today that if you do nothing, a lot of employers will withdraw their support from their employees' health insurance and some people may very well lose the plan that they like without doing anything.

ROVNER: Indeed, that certainly seems to be the way things are going.

SIEGEL: He was asked today at the news conference if he would refuse to sign a bill that didn't include a public plan option - would he veto it? And he wouldn't say so, what are the politics of this for him?

ROVNER: Well, the president's walking a very narrow line here. On the left, he has people who want single-payer plan, that would be no private insurance. That would be all a government option or a no-government option, just the government. On the right, he's got moderate Democrats, in addition to these Republicans, who want no public option. And he's trying not to really alienate either side, and so I think as he, you know, fell back on that old presidential chestnut that it's too early to draw lines in the sand.

SIEGEL: Thank you Julie.

ROVNER: You're welcome Robert.

SIEGEL: That's NPR health policy correspondent Julie Rovner.

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