Dems Ponder Future Of Health Care Overhaul

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Democrats are weighing their options for passing a health care bill in the wake of Republican Scott Brown's upset win on Tuesday in the Massachusetts Senate race. Some Republicans argue that efforts to overhaul health care are dead. NPR's Ron Elving and Julie Rovner weigh in on what lies ahead for health care.

REBECCA ROBERTS, host:

Tuesday's special election in Massachusetts to fill the Senate seat of the late Ted Kennedy ended in Democrat Martha Coakley's defeat to Republican Scott Brown. Now Senate Democrats are weighing their public options with 59 votes, one shy of the filibuster-proof majority needed in order to pass the health care bill on party lines alone. There's talk about working on smaller pieces of the bill or scaling it back to attract bipartisan support, or even starting all over again.

NPR's Ron Elving is still with us. And we're also joined by Julie Rovner, NPR's health policy correspondent. And we want to hear from you: What would you like to see done on health care reform? Our number here in Washington is 800-989-8255. Our email address is talk@npr.org. And you can join the conversation at our Web site. Go to npr.org and click on TALK OF THE NATION.

NPR's Julie Rovner, our health policy correspondent, let's start with you. What has been going on on this topic in the last 48 hours since Scott Brown's election?

JULIE ROVNER: Well, I think in both the House and the Senate, lawmakers are in full hair-on-fire panic mode. They have been running around, trying to figure out what to do next, how to salvage this bill that was, you know, this close to getting to the president's desk.

I mean, as of last Friday, they were really very close. They had been negotiating at the White House, House and Senate leaders, with President Obama in the room. He was kind of shuttling back and forth between the negotiations and dealing with what was going on with Haiti. And then, obviously, as they were starting to see these polls from Massachusetts that looked increasingly like Martha Coakley was not going to make it, they were going to lose their 60th seat in the Senate. The negotiations kind of came to an abrupt halt Friday afternoon. And now, it looks like that bill is no more.

There was the possibility - first, there was a possibility of, perhaps, trying to finish the bill and getting it through both the House and the Senate before Senator-elect Brown became Senator Brown. That was immediately quashed. I think the outcry would have been way too loud.

Then there was a possibility that perhaps the House would take up and pass the Senate-passed bill. That would not require it to go back to the Senate. But, of course, the House does not like the Senate bill. There are a lot of distasteful things to the House, probably starting with this Cadillac tax, the tax on high-cost health plans, which unions in particular don't like because a lot of union members have this high-cost health plans. And, actually, this morning House Speaker Pelosi said she was convinced that there are not the votes, at least at this point, to get the Senate bill through the House.

So now we are to, you know, plan C which is, perhaps - and I think the president mentioned it in an interview yesterday although that's their - White House officials have tried to walk this back a bit, you know, taking the bill either boiling it down to something smaller, taking it apart and doing it in pieces. That would be difficult - both of those things would be difficult.

Robert Gibbs, the president's spokesman, just in the last few minutes, talked about, you know, the possibility of everybody taking a deep breath and maybe taking some time to sort these things out. Someone was asked does that means this is going on the back burner? He said no. But, certainly, it's hard to walk away with any other interpretation than this is going on the back burner for awhile.

ROBERTS: Right. Well - and there are political implications, of course, to all of those potential options, which we are going to get into a little bit more thoroughly this half hour. But Ron Elving, in general, is walking away and dealing with health care at another time a political option for the Democratic majority?

ELVING: Well, it's certainly not a desirable one. It's nothing that anyone's going to put forward with any kind of a smile on their face within the Democratic caucus. But ultimately, of course it's an option because there is nothing that says they must pass legislation just because they are trying to or have said they're going to. The president has said again and again it's his number one priority. Rahm Emmanuel has said the only thing that is not an option is failure.

Well, you can say those things endlessly. If in the end you can't put together the machinery to actually pass the legislation, then you fail. And yes, walking away rather than having some sort of climactic vote in which they fail is certainly an option.

ROBERTS: We are talking about political options for health care reform in the House and Senate, now that the Senate make-up has changed with Tuesday's special election results in Massachusetts.

You can join us at 800-989-8255 or send us email at talk@npr.org. Ron Elving and Julie Rovner will stay with us and we will take your calls and emails. I'm Rebecca Roberts. It's TALK OF THE NATION from NPR News.

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ROBERTS: After a stunning loss in Massachusetts, Democrats in Congress are scrambling to salvage a bill overhauling the nation's health care system. We're looking at options for both parties now, with NPR's senior Washington editor Ron Elving, and Julie Rovner, NPR's health policy correspondent. And we want to hear from you. What would you like to see done with health care reform? Our number here in Washington is 800-989-8255. Our email address is talk@npr.org. And you can join the conversation at the Web site. Go to npr.org and click on TALK OF THE NATION.

Let's take a call from Laura(ph) in Cape Cod, Massachusetts. Laura, welcome to TALK OF THE NATION.

LAURA (Caller): Yes. Hi. I'm still, you know, have aftershocks of what just happened in Massachusetts. And, you know, it's very disheartening to see, you know, what the corporate media has actually done with the election even in, you know, in Massachusetts. I mean, it just seems that, you know, the Democrats are getting it's getting harder and harder for them to get their message out. It's almost like this health care reform now, the Republicans have been able to turn it into a dirty word, really. And it's so frustrating because why can't the Democrats put a positive spin on this? What is their problem?

ROBERTS: Laura, thank you for your call. Ron Elving?

RON ELVING: Well, a - I presume she means a positive spin on health care reform itself, or what the Democrats are pushing with the health care reform.

ROBERTS: Why can't it be seen as a goal that voters want?

ELVING: That's right. That's right. And I do think that from the very beginning, it has suffered from several maladies, one of them is the sheer complexity of it all, the difficulty of getting across what exactly is changing and how that benefits the average person, especially the person who already has insurance, the person who is not particularly out there in the uninsured world, and also the kind of person who does not have a preexisting condition.

That - those obvious kinds of benefits in the bill, if they don't apply to you, what's in the bill that's good for you? What are these exchanges? What is going to be the difference from one state to another? What about if my state already has some kind of other legislation? There's a lot of complexity that's extremely difficult to address, let alone dispel from a podium in Washington where you just say: Well, here in 30 seconds is what you need to know. That's not going to be easily possible to do.

So as a result, an attempt is made to characterize the whole thing positively in the sense of, let's say, demonizing the insurance companies, or demonizing somebody else in the pharmaceutical companies. And that's fine, except then people find out that there's a lot of buy-in here by insurance companies, and pharmaceuticals, and doctors, and nurses and lots of other people in the system, because they've already in some sense or another cut a deal in the larger bills. So people get a little disillusioned with that kind of populist rhetoric as well.

So all the different things the Democrats have tried to put a positive spin on their legislation have been, let's say, less effective than the demonizing message which, featuring a lot of misinformation and a lot of playing to people's fears, has been highly effective, and we saw that in Massachusetts.

ROBERTS: Well, also that whole process of cutting deals and certainly the deal with Nebraska Senator Ben Nelson and the deal with unions to not to be of the tax on Cadillac plans has gotten a lot of tension nationally and in Massachusetts as the process bothering voters.

Speaking of positive spins, Julie Rovner, is there a way for the Democrats to say, hey, okay, we can't get this through strictly on party lines. We now have to have by partisan support. We're going to strive for, you know, everybody holding hands and singing "Kum Ba Yah" and passing a bill.

ROVNER: Well, the problem with that is that the Republicans, you know, now sense blood in the water. I mean, why on earth would the Republicans want to help the Democrats pass a health care bill at this point? If you were a Republican and you were sensing, you know, a great hot issue for the 2010 elections, what benefit would there be for you to now come alongside? And in addition, you know, John Boehner, this morning, the House minority leader, said, you know, we will not start with any piece of this monstrosity, is what he called it.

You know, he did say, well, if the Democrats would like to start all over again and do some of the things that we want, but of course, most of things that the Republicans want to do when it comes to health care are things that are anathema to the Democrats. There are things that the Republicans have floated over the years that didnt even really have full Republican support, things like selling insurance across state lines which are opposed by most of the state insurance commissioners and consumer groups.

ROBERTS: Are there even little things that are common ground, preexisting conditions?

ROVNER: The problem with preexisting conditions is that it only works if you have everybody the insurance company says, yes, we'll do preexisting conditions, but you've got to have everybody covered, otherwise people will wait until they get sick. So, if you've got to have an individual mandate to do that, if you have an individual mandate, you've got to have help for people who otherwise couldn't afford it.

If you're going to have - that would be in the form of subsidies. If you have subsidies, you've got to have a way to pay for them. And then you get into these taxes that are the - basically, what Scott Brown ran on and won in Massachusetts. It's all of a piece. It's very hard to take this bill apart and do it in little chunks, which is what some people are starting to talk about. The things that are very popular need the rest of the things to make them work.

ROBERTS: Let's hear from Jeff(ph) in Syracuse, New York. Jeff, welcome to TALK OF THE NATION.

JEFF (Caller): Thank you. I was wondering if along those lines, if, you know, picking out the most broadly favorable elements and blaming the Republicans and others for that would certainly be a good strategy. But I was wondering if -are there more farsighted business and industry leaders who have come to realization, or can they be brought to the realization, that health care reform is really essential for an economic recovery that will last, that the amount of money for health care is more than that for the steel in the Chevrolet. Certainly, there are industries that - it would seem - and business in the long run that would recognize that, you know, this is - would be to their benefit and competing in a world market.

ROBERTS: Jeff, thanks for your call. Julie Rovner?

ROVNER: Oh, I think business and industry leaders are among those running around with their hair on fire right now at the thought of this bill not happening. They were very much, you know, behind it. There were certainly - you know, the chamber of commerce and some business groups who didn't like the employer mandate, didn't want to be forced to cover workers, who were against it.

But a lot of big businesses who obviously already cover their workers were very much in favor of this, very much like they were - you know, this bill had always been painted as not having very much in the way of cost control, but there was definitely a start towards cost control. There were a lot of demonstration programs that people really thought were important.

There were a lot of, you know, big - yes, there was a lot of stuff in this bill that people didn't like, but there was also a lot of stuff in this bill that people did like, think was very important. And there's a lot of very anxious people who think that nothing would really be an extraordinarily bad thing.

So there's a considerable amount of worry. There were - that's - there was a reason that all of these people did these deals. It wasn't just that they wouldn't be hurt at all. They did these deals to be hurt less. Remember, the hospitals went in saying, we'll give up $150 billion. Not that we're going to get something, these were people who were going to - these were industries that were going to take cuts, not that they were going to get particular help out of it, because they know that this is something that needs to be addressed.

ROBERTS: And Ron Elving, what do you think of the political advantages and disadvantages to tying health care reform to economic recovery?

ELVING: If you could sell the idea - as the president has, at times, really tried hard to do - that economic recovery depends on health care, if you will, changes, the improving of that system, the distribution of those costs more (unintelligible), the restraint of those costs really in the long run, the restraint of those costs is absolutely essential to our long-term economic recovery. Maybe not to the next six months' jobless rate but to the next...

ROBERTS: Maybe not by, say, the November elections?

ELVING: And perhaps not by that, which is, of course, very significant to the members of Congress, especially in the House who are all on the ballot in November. But over the next five years, 10 years, 50 years, we have to get our act together with respect to this ballooning cost or else it's going to be a long-term economic drag.

And, you know, the other thing for all these corporate leaders who are thinking about exactly that is if this thing goes down, if it does not happen in this Congress, if there is no health care bill, when will the next Congress be seated and convened that will be willing to take up health care reform? I don't think we can see it in the foreseeable future. It's been a long time since 1994.

ROBERTS: Another 15 years. Let's take a call from Anastus(ph) in Gallatin, Tennessee. Welcome to TALK OF THE NATION.

ANASTUS (Caller): Hello, long-time listener, first-time caller. My comment is I don't understand why the government feels that they need to take on this burden. If we want to do reform, we have an existing system, why not regulate it in the same ways that we do corporations, banks and other entities, and fine tune it so that things like preexisting conditions, certain - you know, other ailments, we work that into the system and what we have that works, fine tune that.

There's no need for the government to take on another burden with costs that we simply can't afford right now. And I'll listen to the comments. Thank you very much.

ROBERTS: Thanks for your call. Why not fine tune the current system instead of overhauling it completely?

ROVNER: Well, that's basically what this bill would've done. In fact, one of the reasons this bill was so complicated is that it wasnt really a government takeover of the system. Believe me, there are a lot of people on the left who wanted what's known as a single-payer system, which would've been a government-run system.

In fact, in the end, there wasn't even going to be a government-run option as one possibility within these new systems. It was going to be all private insurance. There would've been government regulation of private insurance to bar the - you know, discrimination against people who had preexisting conditions. But, in fact, one of the reasons it was so convoluted was to keep the president's promise of if you like what you have, you can keep it. That was why the bill was so totally complicated.

ROBERTS: Well, that's also what in many ways sent the '94 effort, the whole Harry and Louise.

ROVNER: That's right.

ROBERTS: So that was seen as essential politically for getting it through.

ROVNER: It was. But it was also one of the main reasons why this bill was - had so many moving parts, was to allow people who had coverage to keep it and yet to have an improvement in security, if you will, to make sure that they wouldn't lose it and that they would get some new protections, but to also cover people who - to include more low-income people on Medicaid, that would have been a government take over. But that was - it would've been more people into these new health insurance exchanges, to give them choices of new private insurance coverage options and to have small businesses give them a place to have their employees buy coverage at a lower cost. But it would've all private. It would have been built on the existing system. That was exactly the point of it.

ROBERTS: We are talking about options for legislative health care reform with NPR's Julie Rovner and Ron Elving. And we are taking your calls at 800-989-8255, and your emails: talk@npr.org. You can also check out the Web site. Go to npr.org and click on TALK OF THE NATION. You're listening to TALK OF THE NATION from NPR News.

We have an email from Casey(ph) in Portland, Oregon. He says, I'd like wellness care separated from illness care. I want the government to provide free and available wellness and preventive care, leave illness care for the insurance companies. It is in the country's best interest to keep the population, as a whole, healthy, not cover all health care for everyone. We do, or should, provide access to education for all citizens. We don't pay for everyone's education regardless of where they get it. I'd like wellness care to be the same. Julie Rovner?

ROVNER: Well, indeed there are a lot of wellness provisions in the bills. There were rather controversial provisions that actually encouraged private insurance to provide incentives for people to participate in wellness programs, even promise them lower premiums for participating in wellness programs. But there would not have been a government-provided wellness program, although there would have been free preventive coverage within the existing government insurance programs, Medicare and Medicaid.

ROBERTS: And Ron Elving, if you had to handicap this politically, if - Harry Reid has said they're not going to try to smash something through before Scott Brown is seated, and Nancy Pelosi has said she doesn't think the House is going to pass the Senate version, what do you think happens next?

ELVING: In answering your question, I'd like to just reference what the last telephone caller was asking of about fine-tuning versus the government taking on this burden. I think the caller's impression is widespread. I think a great number of people in this country believe that what is being debated in Washington right now is some form of government takeover of the entire health care delivery and insurance system, not just a public option, but a takeover. And they have been told that and they believe that. It is consonant with people's fears on some of the subjects, and that people are concerned about the size of government in Washington, and the spending, the taxes and all the rest of it. So it's not hard for them to believe.

Because that impression is widespread that even though the bill has retreated from all of the ambitions, if you will, of the left, because of that widespread impression, it is extremely difficult, it seems to me at this point, for any bill to be done that does not have the explicit imprimatur of at least some Republicans. Now, I don't know that's going to happen in the House, but I can imagine it still happening in the Senate.

One reason that the Senate's minority, the 40 votes before Scott Brown, hardened and started voting no not just on health care but on everything - on the Defense appropriations bill coming to the floor - one reason they did that was because they were just in full resistance to the Democratic 60-40 hegemony, the elimination of the filibuster as an effective weapon.

Once that's taken away, once that tension is removed, it is conceivable. I'm not predicting that it's going to be easy, but it's possible for me to imagine, for example, one of the six senators who is retiring or one of the two moderate Republican senators from Maine, taking the view that the Senate does not need to be as toxic as it's been in the last several months, particularly in November and December, and that they might actually see an opportunity to be part of something that would be fine-tuning and that they could give their imprimatur to.

If there were at least a few, two or three, Republicans who are willing to do that, then this could have a chance of coming back to life in the Senate and actually passing also in the House. But I see that as pretty much the only route that would not become political poison for the Democrats to pass, facing the 2010 November elections.

ROBERTS: Julie Rovner, let me ask you the same question. What do you think happens next?

ROVNER: Well, I think that's certainly one possibility. There is still the possibility, you know, the fact Speaker Pelosi was very careful when she said there are not the votes now for the Senate bill. That bill doesn't die in the next week, it's alive until the end of the Congress. That's not to say that they couldn't come back to it in a month or two months or three months, do something. They still have budget reconciliation, that process open to them where they could do perhaps some fixes to the Senate bill if they got a negotiated compromise. That would go back to the Senate only needing 51 votes and not able to be filibustered. So that's still a possibility. So there are still ways around it none of them is easy, none of them is pretty, none of them is very palatable. But this is not necessarily dead yet.

ROBERTS: And do you think Scott Brown's victory, Ron Elving, gives some Republicans who worried going along with their party leadership and trying to obstruct the president's agenda was going to be frowned on by the voters, then now they have political cover for that.

ELVING: I believe that there will be a lot of reassured Republicans on all levels, on all 50 states because of what Scott Brown was able to accomplish. At the same time, I think that these people are pretty hard-headed and they calculate pretty well when it comes to votes. And they're going to look at the special circumstances of this special election in Massachusetts. And they're going to ask themselves: Will all of those same elements be in place for me to win a 52-47 percent victory over a Democratic candidate in November? Maybe I won't be running against Martha Coakley, maybe it won't become a national referendum on health care which could fade by this coming November. Lots of ifs, lots of ifs, including the factor of the Supreme Court decision today, opening up an access for corporate spending, free spending by corporations in favor of candidates and against candidates they don't like.

ROBERTS: Ron Elving, NPR senior Washington editor, joining us here in Studio 3A. Thanks so much.

ELVING: Thank you, Rebecca.

ROBERTS: And thanks also to NPR's Julie Rovner, our health policy correspondent, also here in Studio 3A. Thanks to you.

ROVNER: You're welcome. Tomorrow it's TALK OF THE NATION SCIENCE FRIDAY with a look at how social media is changing charitable giving. Neal Conan will be back on Monday with guest Bill Gates. This is TALK OF THE NATION from NPR News. Im Rebecca Roberts in Washington.

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