Listeners' Health Care Questions Answered

Last week, listeners were asked to submit questions about the ongoing health care debate in Washington. Listeners wanted to know what coverage members of Congress enjoy, what the government means when it says it wants to offer an affordable health insurance plan, and why health care costs are growing so fast.

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ROBERT SIEGEL, host:

Now, some English-to-English translation, which is pretty challenging when it comes to health care. Last week, we asked you to submit questions you might have about the ongoing health care debate in Washington. And many listeners did.

So we're now going to try to answer a few of those questions with the help of Julie Rovner, NPR's health policy correspondent.

Welcome, Julie.

JULIE ROVNER: Hi, Robert.

SIEGEL: We're going to start with the most-asked question from listeners. What kind of plan do the members of Congress have? How much do they pay for it? And what does it cover?

ROVNER: Boy, I get this one all the time. Members of Congress have basically choice of the same plans that the other 9 million federal workers have. This year, they can choose from 16 different plans. The most popular by far - I assume among members of Congress, but certainly among federal workers in Washington, D.C. - is the Blue Cross Blue Shield standard-option plan. This year, the premiums are $1,120.47 a month for a family. Of that, the government pays $763.88, and the member of Congress would pay $356.59 a month.

(Soundbite of laughter)

SIEGEL: Okay. Thank you for that precision in the answer, by the way.

ROVNER: They wanted to know.

SIEGEL: They did.

ROVNER: Actually, I should add that members of Congress also have access to the attending physician of Congress; that's a doctor who is there in the Capitol. They pay a couple of hundred dollars a year and have access to some preventive care. They get their flu shots there. And if there's an emergency, they tend to go to the doctor there on the Capitol for some of their preventive stuff. But their families do have to use their regular private health insurance.

SIEGEL: Okay, here's a question from listener Don Calvert(ph) in Fort Lauderdale, Florida, who writes that he's been in the insurance business for 30 years. He wants to know what the government means when it says affordable health-insurance plan. What's the target price for a government plan for singles and families? He says he's found once you get past $150 a month, you start losing participation in the medical plan.

ROVNER: Well, this is one of those thresholds that's still evolving. But we do have a bill out of the Senate Health, Education, Labor and Pensions Committee. And they say that coverage is determined to be unaffordable if the premium paid by the individual is greater than 12.5 percent of the individual's adjusted gross income.

So I did a little example. Say you earn $40,000 a year. After your deductions, your adjusted gross income is $36,000, which conveniently for me - I'm math challenged - is $3,000 a month. And you're paying $375 in premiums; then your coverage would be unaffordable. That would be 12.5 percent of income.

Now, that's just for the purpose of existing coverage that you have now. Under the bill, you would get financial help for a family of four. All the way up, you are earning $88,000 in income, because health insurance is very expensive. So affordability is, you know, something that they're trying to figure out now. It's certainly, I think - would be more than $150 a month, though.

SIEGEL: Here's another question about cost. It's from Mary Sarrone(ph) in Pittsburgh, who writes: If one of the selling points of the proposed health care legislation is that it will reduce costs, and if the nonpartisan Congressional Budget Office, as well as other studies, show that the president's plan will not, in fact, achieve cost reductions and, in fact, will lead to cost overruns and reduced quality, why on earth are we still considering it?

ROVNER: Okay, this is the hardest thing in the entire debate, and I'm going to take a shot at trying to explain it. There are two different things that we're talking about. There are cost reductions in the short run, and there are cost reductions in the long run. And then there are costs to the federal government, and there are costs to the system as a whole. So, you've got - kind of - four moving parts here.

Now, over the short term, if you add 47 million Americans to the rolls of the insured, you're going to add costs to the system, and you're particularly going to add cost to the federal government - about $100 billion a year, says the Congressional Budget Office.

Now, the Congressional Budget Office doesn't look at cost to the system. They really look at cost to the federal government.

SIEGEL: Mm-hmm.

ROVNER: And they say that over 10 years, in order to offset those costs, you're going to have to come up with real, hard savings. You're going to have to cut other programs or you're going to have to raise taxes. So those are the short-term costs.

The hope is that over the long term, more than 10 years, which is not what the Congressional Budget Office looks at, there will be ways to change the system -to change the incentives, to change how the system is structured, how doctors provide care, how insurers do things - that will perhaps save money both for the federal government and for the system as a whole. That is the goal of this entire exercise. That is why everyone is still at the table trying to do this: to save the government money, to save the system money.

SIEGEL: This listener question, Julie, is on tape.

Mr. BEVERLY BRONLAKE(ph): My name is Beverly Bronlake. I'm calling from Tahlequah, Oklahoma. And here's my question. Extension of health coverage by whatever plan to all Americans will reduce unwarranted costs tremendously by eliminating the delays in diagnosis and the lack of preventive care that exists now, and by reducing congestion in emergency rooms.

How a great a cost offset will these savings produce?

SIEGEL: What do you think?

ROVNER: Well, that is certainly the hope. You know, a lot of this - a lot lawmakers are very frustrated with the Congressional Budget Office because they are saying that a lot of preventive care really won't have much of a payoff in terms of cost saving.

There's a lot of things that can be done in the health-care system that will certainly make people's lives better and make people's health better, but won't necessarily save money. It's not a reason not to do it, but it's a bit of a frustration to these lawmakers because it won't necessarily save money. It's not a reason not to do it, but it's a bit of a frustration to these lawmakers because it won't necessarily show up in the bottom line.

SIEGEL: Here's a question from listener Eric Fluger(ph) of Jersey City, who writes: As private carriers tend to try to cherry-pick their customers, is the public option likely to become a dumping ground for supposedly undesirable patients? If so, what are the cost implications?

ROVNER: This is an easy one. The answer is no because cherry-picking won't be allowed anymore either in the public option or in the private option. The deal that the insurers are trying to make is that they say they will no longer be selective in who they insure and don't insure as long as everybody is required to be covered.

The idea is that if everybody's in the pool, sick and healthy, then the insurers can spread the risk across the sick and healthy. They won't have to try and find healthy people because everybody will be required to be covered and therefore, everybody can have, at least, premiums spread pretty widely.

SIEGEL: Here's an interesting question from Randall Davie(ph) in Forest, Virginia. Why are health-care costs growing so fast? Does it have anything to do with the basic economics of scarce supply and high demand? If so, will any of the current reform ideas address supply and demand?

ROVNER: Well, there are lots of Ph.D.s on this subject, and I'm not one of them. But I think it's mostly because health care is what we call an inelastic commodity. We are willing to spend whatever it takes to keep us healthy, particularly if we feel like it's somebody else's money. So, many of us have insurance that we feel like someone else pays for.

We can blame malpractice premiums or fraud or waste or a lot of other things, but basically, it's a lot of new and a very expensive technology, and patients demanding the latest and the best and the most expensive. That's a whole lot of what drives health-care costs in this country and around the world.

SIEGEL: You mentioned malpractice costs. Malpractice caps is a subject that we've been hearing about. Marcella Hernandez(ph) of Galena, Ohio, wants to know if monetary limits on lawsuits would be essential to reducing health-care costs.

ROVNER: I get this question every time I take questions from an audience, and I have for the last 20 years.

(Soundbite of laughter)

A lot of people wish it was so, a lot of doctors wish it were so. Malpractice is about 1 percent of health-care spending, even if you add defensive medicine that doctors do to prevent lawsuits. It's a tiny, tiny fraction. You could solve the entire malpractice problem; you would still have a big problem with health-care costs.

It's important to some doctors in some specialties, but it's really not what's driving health-care costs. It's a lot of new technology and a lot of demanding patients.

SIEGEL: OB-GYN, for example.

ROVNER: OB-GYNs, neurosurgeons. There are pockets of problems with malpractice, but it is not what's driving health-are costs in general.

SIEGEL: Well, thank you, Julie, for answering our listeners' questions.

ROVNER: My pleasure.

SIEGEL: NPR health policy correspondent Julie Rovner.

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MADELEINE BRAND, host:

And you can follow the latest on the health-care debate in Congress at our new, redesigned Web site, npr.org.

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