Democrat Sen. Mary Landrieu Concerned About Health Care Overhaul

After months of back and forth the details of a health care bill that might actually be voted on are being worked out by the Democratic leadership. But one group of Senators that will need convincing are conservative Democrats...the so-called "blue Dogs." Host Michel Martin speaks to Democratic Louisiana Sen. Mary Landrieu about her concerns on health care.

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MICHEL MARTIN, host:

This is TELL ME MORE from NPR News. I'm Michel Martin.

Later in the program, Megan Williams of West Virginia attracted national attention two years ago after accusing a group of men and women of beating her, raping her and holding her captive. Now, she says it was all a lie. We'll talk more about that racially charged case in just a few minutes. And we'll bring you the latest developments as we understand them.

But first, the ongoing health care debate in Congress. After months of wrangling in committees, Democratic leaders are working out the details of a bill that can actually go to the full Senate. But sharp divisions remain among Democrats, let alone with Republicans. As we reported yesterday, a group of 30 Democratic senators has written a letter to their leader saying that a final bill must include a so-called public option. That would be a government-sponsored health insurance program that could compete with private insurers.

But other senators remained skeptical, especially Democrats who represent more conservative areas or areas where Republican candidates are more competitive. Yesterday, we heard from Illinois Senator Roland Burris. He's a Democrat who says he will not support any health care overhaul plan that does not include a public option.

So today, we wanted to hear a different perspective. We called Senator Mary Landrieu. She's also a Democrat. She's from Louisiana and she is a skeptic of the public option. She chairs the Senate Committee on Small Business and Entrepreneurship and she's with us from the Senate. Welcome, senator, or I should say welcome back.

Senator MARY LANDRIEU (Democrat, Louisiana): Thank you very much.

MARTIN: You said your major concern about health care reform, or one of your significant concerns is its effect on small business. In fact, you wrote an op-ed piece for the Wall Street Journal editorial page about this recently. What are your concerns?

Sen. LANDRIEU: Well, Michel, thank you very much and it is a good opportunity to try to clarify and I'll get your question in a minute. Because in order for this recession to end and for prosperity to embrace us again, that is going to be done basically by the millions and millions of small businesses in America that get their head above water and start hiring again and then wealth can be once again created.

And health care is a big part of that because, as you know, from the statistics that you have, the rates of health insurance for small business have gone up four times higher than the cost of their goods and services over the last four years. And for small business, they pay more than 18 percent more for the same insurance given to employees by large businesses.

And now, we're just struggling with how to move forward to provide, I think my view is more choice and competition in the market should help drive down costs and make that all more affordable.

MARTIN: Well, just let me just give a couple of the statistics that you cite in your op-ed piece. You said that in 1993, 61 percent of all small companies offered health coverage. Today, that number is less than 38 percent and you also say that insurance premiums for sole proprietors are up 74 percent since 2001.

But there are those who argue that that's exactly why a public option is necessary in the same way that many state governments offer same insurance pool for car drivers who have difficulty getting insurance on the open market. That this is the same thing. It doesn't put private insurance out of business. It offers an option. Why are you skeptical?

Sen. LANDRIEU: I'll explain. And this was said best by Joe Lieberman yesterday in a meeting we had and he has been terrific. He said, you know, if the price of roofing material was high in the United States and no one could afford a roof, it would be very unlikely that the federal government would go into the roofing business. What would be more likely is that the federal government would regulate or put new rules and regulations into the marketplace to force more competition in the roofing business so Americans could afford to put roofs on their houses.

That's the reason I don't support a government-run taxpayers-subsidized national insurance plan. The second reason I don't support it is because we already basically have two big plans that people know about, Medicare and Medicaid. Now, people like Medicare better than Medicaid. Medicare is running better. That's a program, of course, for the seniors over 65 because we reimburse the rates higher. Medicaid is not running very well in many states because the federal government has not been, in states, you know, not running it very well.

In fact, in Louisiana today, if you make more than 12 percent of the poverty level, you are ineligible for Medicaid, because the state claims it can't afford Medicaid under the current system. So I would say to my colleagues, as respectfully as I can - those that want to promote and expand public option -why don't we fix the two public options we have now before creating a third one?

My third argument is that if - and I agree that in some markets, in fact in Louisiana, we really only have two or three choices. In Alabama, I understand, one company controls 95 percent of the market. I am not unconcerned nor oblivious to that. But my answer is let's use the powers of the federal government and state governments to reform those markets so that it reflects more of what we have as members of Congress, which I've been promoting and Senator Snowe has been promoting and Senator Lincoln has been promoting. Kind of a model of what federal employees have themselves, including members of Congress, which is a national pool, we have been told one of the most successful because it has eight million approximate enrollees.

In every state, there are more than a dozen choices, no matter what state you live in. So if you're a federal worker in New York, federal employee who happen to live in New York state, you can go to the marketplace and choose between 34 plans that are relatively affordable, from less expensive to more. You pay 30 percent and your employer pays 70 percent, the federal government. It is organized by the federal government, negotiated by our negotiators but it's a privately run plan.

That's the model the president has talked about in many of his speeches. And so, I'm going to take him at his word and that's the model that we're going to try to create for the American people which is not a taxpayer-funded government-run expansion of Medicare or Medicaid or a third option.

MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. I'm speaking with Senator Mary Landrieu of Louisiana. She's Democrat and we're getting her perspective on the current health care overhaul debate. There was a recent poll published by the Washington Post and ABC News that says that a majority of Americans now favor a public option.

And even though there's still a partisan divide on this point, their data also show that Democrats heavily favor a public option. But the Republicans also favor it if it's tailored to individuals who don't have other options for getting health insurance and it's run by the state. So what about that perspective? I mean, should the public's perspective on this be part of your thinking on this?

Sen. LANDRIEU: Absolutely. And the public's perspective is - the way that I interpret those polls, and I've read many of them, is that what the public wants more than anything is health insurance that they can afford, or health coverage that doesn't bankrupt the government. I think if you asked, do you want a public option but it would force the government to go bankrupt? People would say no.

So what they want is fiscally responsible action on the part of the government. And if you ask America today, would you like to get Medicaid coverage which is a government-run, government-sponsored for low-income, we'll just expand it for everyone? They'd probably say no, not because there aren't some states that run decent Medicaid programs. But in my state, I've got many doctors telling me, senator, we can't treat Medicaid patients anymore because we don't get reimbursed in a way that we can sustain our practices.

We need to be encouraging more doctors to enter the field particularly general practitioners, not discouraging doctors. So, that is why I've told the president I want to be as flexible as possible so that we can get this done. It's very important to win and to deliver to America a better health care system where our businesses can be competitive, our people can afford really good coverage and we can start getting America well and keep America healthy.

MARTIN: Thirty of your colleagues have already written a letter to the leadership saying a public option is a must. And, on the other hand, you've got the perspective of yourself. Where's the compromise? Is there a compromise?

Sen. LANDRIEU: I think there is. We don't have to put up with excessive profits in insurance companies. We can regulate that. But we don't have to eliminate them. We don't have to have the government run everything. We most certainly can have the private sector if we put the right framework and regulations and use the power of the market.

You could create co-ops that would provide an option to for-profit health insurance companies. Now, we already have nonprofit health insurance companies, Blue Cross Blue Shield. I think they need to be looked at and regulated a little bit more tightly, but we could have co-ops or something like that that's not government-run but that gives an affordable option to people.

At the end of the day, Michel, what we want is for more Americans to have access to quality health care, where they can choose their doctors, choose their hospitals, and put the power back in the hands of the consumer.

We think if we do that, increase competition, we drive down the cost, which is the most important thing, not expanding coverage but driving down the cost, because the country can't sustain it.

MARTIN: That was United States Senator Mary Landrieu of Louisiana. She's a Democrat. She chairs the Senate Committee on Small Business and Entrepreneurship, and she was kind enough to join us from the studios at the Capitol. Senator, thank you.

Sen. LANDRIEU: Thank you so much.

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