Memo To The President: Fix Health Care System

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President Obama has scheduled a town hall meeting to promote his health care overhaul plan this week. He's been on the stump, pushing his plan in different forums: in press conferences, town hall meetings and discussions with several governors. But will he be able to achieve health care for all? Robert Reich says it will be difficult, but with the right strategy, Obama can prevail. Reich, former Labor Secretary and former advisor to Obama, explains how he thinks the president can remake health care policy.


We're going to switch gears now to talk about a hot political issue: health-care reform. This week, the president plans to conduct a town hall forum on his overhaul efforts. And his audience could give him an earful. Surveys show that health care is one of the most pressing concerns for most Americans, if not the top concern. At this point, nearly everybody agrees that the system is broken. But they disagree about how to fix it. The upcoming town hall is just President Obama's latest effort to sell his prescriptions for overhauling health care.

Last week, he devoted a midday press conference, a meeting with a handful of governors and a prime-time, town hall-style White House meeting to the issue, all in the name of keeping a fire lit under the five House and Senate committees working on health-care overhaul plans, which is supposed to be geared to improving access and quality, and lowering cost. But one important player says the main person who needs a fire lit under him is the president himself. The person making that argument is Robert Reich.

He's a professor of public policy at the University of California at Berkeley. He served in three administrations, most recently as secretary of Labor under President Bill Clinton, and he advised Barack Obama during the recent presidential campaign and transition. Reich wrote a memo to the president, outlining six things he believes the president must do to save universal health care. It appeared in recently. Last week, I spoke with Reich. And I asked him why he felt it was necessary to write that memo.

Professor ROBERT REICH (Public Policy, University of California, Berkeley): Health care is stalling in the Senate. You know, somebody who has spent 12 or 14 years in Washington as I have, can kind of sniff these things. But you don't really even have to be a Washington hand to see the momentum just slowing down because of these big numbers. The Congressional Budget Office came out with very terrifying numbers about the cost of universal health care, and that has scared many blue dog Democrats, many conservative Democrats, obviously Republicans are tending against this program from the beginning. But everybody is getting very nervous.

MARTIN: One of the things you say the president must do is go to the country. So I'm going to just play a short clip from his midday press conference earlier this week. Here it is.

President BARACK OBAMA: Unless we fix what's broken in our current system, everyone's health care will be in jeopardy. Unless we act, premiums will climb higher, benefits will erode further, and the rolls of the uninsured will swell to include millions more Americans. Unless we act, one out of every $5 that we earn will be spent on health care within a decade. And the amount our government spends on Medicare and Medicaid will eventually grow larger than what our government spends on everything else today.

MARTIN: Now, people may not know the specifics. But people certainly know something is wrong. Isn't this the most effective sales pitch that the president is making, that�

Mr. REICH: It's a very effective sales pitch, Michel. And I'm a huge fan of the president. I think the question in my mind is whether it's possible to overcome the huge lobbies. I mean, we're talking about some of the most formidable lobbies in the country. To overcome them, you've got to fire people up, not just in terms of rhetoric and inspiration. But you've got to name names, you've got to be tough. You've got to - most people have no idea how much demagoguery they're being, or about to be exposed to. They don't know how much money the medical industrial lobbies are spending to defeat health care.

Every president since - well, actually since Franklin D. Roosevelt. Franklin D. Roosevelt originally, in 1944, came out strongly for universal health care. The AMA beat him back, beat back Harry Truman, beat back John F. Kennedy. The only president to have any victory at all over the medical lobbies was Lyndon Baines Johnson, and that was in getting Medicare and Medicaid. And he did that, in his own inimitable way, by drawing a line in the sand and saying, I'm not going to sign anything that doesn't have X, Y and Z in it, and daring Republicans and Democrats to vote against a bill that was very popular.

MARTIN: In fact, that's your second point: Be like LBJ. You've got to twist some arms. But is it in President Obama? Because he doesn't seem like a head-cracking kind of guy, at least not so far.

Mr. REICH: We will find out, Michel. I mean, the only way this is going to get done is if he counts noses, cajoles, twists arms, threatens - as well as going to the country and saying, look it, this is a fight. We've got to fight our way to get this. You've got to put pressure on your members of Congress; we can't let the special interests win this time. Does he have it in him? Well, you know, during the election, he could get quite tough. And I think he does have it in him.

MARTIN: And your other point is forget the Republicans, you say. Forget bipartisanship. Universal health care can pass with 51 votes, and this is very much contrary to the current narrative of what the president has said he wants, and what other members of Congress say they want. He has said in the past this is the kind of divisive politics that he's trying to change in Washington. Why do you think that this is the best way to ensure that universal health care gets passed?

Mr. REICH: I think bipartisanship is a noble aspiration. The president has aspired to it, although the Republicans, on most of the bills so far, the big ones - that is, stimulus package and everything he wanted with regard to budget and so forth - have been almost, to a Republican, against him, have not come across the aisle. Now, eight years ago, George W. Bush passed his huge tax cuts, mostly for the wealthy, by wrapping it up in an all-or-nothing reconciliation measure and daring Democrats to vote against it.

This one, health care, can pass with 51 votes. It can be under a reconciliation measure. And I think we're getting to the point now where the president has got to say, if I do not get your votes on this, Republicans, I'm going to go through reconciliation. I'm going to do it without you.

MARTIN: What about the Democrats? Do you think the Democrats will support him on this?

Mr. REICH: If he gives them enough cover. That is, the public is in favor of this. The Wall Street Journal-NBC poll last week said three-quarters of the public wants universal health care. The New York Times-CBS poll showed that 80 percent wanted health care, also a public option. Also, interestingly, a majority of the public said that they were willing to pay higher taxes for the sake of having a health-care plan that covered all people.

Now that's remarkable support. Nobody in my lifetime - we have not had, and I don't think in political history, we've never had an uprising in which people say, I want to pay more taxes. People are at wit's end.

It's not just the 44 million Americans who don't have health insurance. It's the 120 million American families who are holding onto it by their fingernails, who see their premiums, co-payments and deductibles skyrocket, and who are worried about losing their jobs and losing their health care. The system is out of control.

MARTIN: But on this question of bipartisanship, the Republicans are complaining. They're saying that the president is ignoring them. In fact, this week, they released an ad by the Republican National Committee accusing President Obama of not taking their input and fomenting another government takeover. Here it is.

(Soundbite of political advertisement)

(Soundbite of music)

Unidentified Announcer: Shouldn't this be a bipartisan discussion? Republicans want health-care reform that reduces costs across the board. Republicans believe every single American deserves quality health care. Republicans also believe another government takeover would diminish health-care choice and quality. Tell President Obama to work with Republicans, and to stop rushing into another government takeover.

MARTIN: What about that? I mean, there does seem to be some concern. We know Americans are deeply concerned about their health care, but there are some who are concerned about the government's involvement in a number of areas of the economy where we have not been in many, many years. Is it your view that Republicans - what? They're either not credible enough on these issues to pose much of a problem to Democrats? Because the margins just aren't that large, particularly in the Senate.

Mr. REICH: We're not in an era, Michel, in which Republicans are attracting a great deal of the center, of independents, of mainstream Americans. I mean, the Republican Party is in danger of shrinking out of existence, and that would be bad for our two-party system of government. We need choices.

I can tell you that there is no end of demagoguery on this issue. Yes, Republicans should be consulted, but a line has got to be drawn in the sand. If they want to be part of this, they've got to sign on to such things as a public option.

MARTIN: If you're just tuning in, you're listening to TELL ME MORE from NPR News. We're speaking with Robert Reich. He's a professor of public policy, a frequent commentator on NPR and other outlets, and a former secretary of Labor, and he recently wrote a memo to the president outlining six things the president must do to save universal health care.

The other thing you say that the president must do is insist on a real, public option. You say that's the lynchpin of universal health care. And as you see, there's already a lot of pushback on this by the big insurance companies, and some influential Democrats saying that this would undermine private competition. And two of the largest insurance companies, Blue Cross Blue Shield and America's Health Insurance Plan, sent a letter to senators saying the government's insurance plan would have devastating effects, would dismantle employer-based coverage - what do you say?

Mr. REICH: Well, this is the most contentious issue and Michel, in many ways, it's the most important because all the private plans are scared of a public option, an option that people don't have to take. I mean, they still have their choice of private plan. But an option that because of its size and scale and authority, would be able to negotiate much lower rates. And obviously, the private insurers are very scared. They say to themselves, if we have to compete with that, we may go out of business. Or, we're going to be squeezed; our profits are going to be squeezed. Well, the response to that ought to be - and the president suggested this a couple of days ago - this is exactly why we need it. The private insurers have not been squeezed; they have not negotiated low rates with drug companies. Drug companies should be squeezed, also. This is a national emergency in the sense of the amount of money that is going to private insurers who are very inefficient, for-profit insurers who are paying large amounts of money every year on advertising and marketing to try to attract young people who aren't - the lowest risk risk of health problems, and avoid older and sicker people. Well, this has got to stop, and a public plan can discipline the private insurers.

MARTIN: And what about - number five on your list is, demand that taxes be raised on the wealthy to ensure that all Americans get affordable health care. This is something that during the campaign, then-candidate Obama said he would not support taxing employer-provided health benefits. That would, in effect, be a tax increase on the middle class.

And so you're saying, you know what? You're just going to have to take the hit. You're just going to have to reverse yourself on this and take the hit. How come?

Mr. REICH: I think so, particularly for wealthy employees, for high-income employees. Probably there's got to be some cap on tax-free health care. I think both the cap on how much employee-provided health care can be provided tax-free, and also limiting tax deductions for the wealthy, both of those have got to be in the bill. That's the only way, even with a public option, it's the only way it can be paid for.

MARTIN: Just because that's where the money is.

Mr. REICH: Those are the only - that's where the money is. Those are the only big pots of money left.

MARTIN: Well, and finally, you say put everything else on hold. As important as they are, your other agenda items - financial reform, home-mortgage mitigation, cap and trade - pale in significance relative to universal health care.

I found this fascinating because I'm sure you remember earlier in the year, the people in the financial reform area were saying put everything else on hold but, you know, fixing the economy and fixing the, you know, financial services, because this is the lynchpin of everything. What does he say to those folks?

Mr. REICH: Well, I think that he has to say it's important. It's high on my agenda, but right this minute I can't do it, because health care is the most important thing right now.

Obviously, I'm not an expert in tactics, but I did live through the first years of the Clinton administration. And one of the mistakes that Bill Clinton made, particularly in his first year, was trying to do so much and talk about so many things at the same time that the public became confused about what he really wanted. What was the priority?

Obama can't afford that. He is as powerful an orator, if not more powerful, than Bill Clinton, but he's also very disciplined. Right now is the time that he's got to use that discipline and impose that discipline on the White House, on his government, on the Democrats and even on the media, because it's a president that can set the agenda for the media, can decide just through news conferences and through what he says is the priority what the media is going to cover, instead of just everything.

MARTIN: Robert Reich is the author of the book, �Supercapitalism,� and 10 others. He served as an adviser to then-candidate and President-elect Barack Obama. He's a former secretary of Labor in the Clinton administration. He was kind enough to join us from the studios of the University of California at Berkeley, where he is now a professor of public policy. Professor Reich, thank you so much for speaking with us.

Mr. REICH: Well, thank you, Michel.

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