Opposing Views On Health Care Bill

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President Obama's plan to overhaul the nation's health care system hangs in the balance. Uwe Reinhardt, professor of economics and public affairs at Princeton University, says it won't make much difference to most Americans if the legislation dies. But Gail Wilensky, a health care economist who served in the administration of President George H.W. Bush, says she believes there needs to be an overhaul of the system because the soaring costs are unsustainable.


This is ALL THINGS CONSIDERED from NPR News. I'm Madeleine Brand in California.


And I'm Robert Siegel in Washington, where tomorrow, President Obama delivers his State of the Union message.

One big question is what he will say and then do about health care. We asked two health care economists with different political backgrounds what they think is feasible in the way of health care legislation, now that there are 41 Republican votes against the Senate Democrats' bill.

In a moment we'll hear from Gail Wilensky, who has chaired Republicans on health policy. First, Professor Uwe Reinhardt of Princeton, who says the Senate bill is still worth passing.

Professor UWE REINHARDT (Economics, Princeton University): The idea of taking the Senate bill, have the House endorse it and then pass it into law is not as far-fetched as even the president seem to have make it appear, because the Senate bill does many of the things Americans want. Americans need help buying health insurance. Well, it does that. Americans don't want the premiums based on their own health status, the bill outlaws that. Americans don't want rescission, that is, having their insurance canceled after an illness strikes, this bill outlaws that.

SIEGEL: But it's not as though the administration or Democrats in the House or the Senate have not been describing these bills for the past year. We've heard a tremendous amount. President talks about them every week, it seems.

Prof. REINHARDT: Well, there's a difference between oratory and pedagogy. Oratory means to string the emotions of people. Pedagogy means you actually teach people carefully. I haven't seen either from the Senate, which is, of course, not even their job, or from this president an attempt to really explain to the people what's in the bill.

I give speeches and I have that in two slides. I can explain it really quite simply. And I'm stunned that the president has not either thought about it or taken the time to do it to tell people: These are the things that bug you and here is precisely what this bill does about it. Everything that was communicated seemed that there was chaos, that there were sleazy deals.

Of course there is log rolling. Log rolling in the Congress is an old American tradition. It wasn't invented by the Senate bill. I don't know why the president never became the teacher of the people and always resorts either to two modes. One is oratory and the other one is sort of graduate school seminars, which are fine for eggheads like me. But they're not good for people who drive in their car and need different pedagogic devices. They need anecdotes. They need metaphors. None of that the president uses.

SIEGEL: Let's say the Republicans say, you know what's always near the top of our list when it comes to health care. It's tort reform. It's reforming the system of malpractice insurance in the country, which President Obama only went so far as to say, okay, maybe some pilot projects to look at alternative ways of dispute resolution.

Are the Democrats capable, or would it be worth it, even if it's for a small share of the health care dollars, to meet the Republicans halfway on that question?

Prof. REINHARDT: I think they should have. I think at the very least it was discourteous not to have done it. But I believe the recent CBO report on malpractice shows it would actually yield savings if we had major reform. There are some great ideas out on this. They've been out, actually, for 20 or more years. It's called alternative dispute resolution that takes this roulette wheel of jury rooms out of the proceedings and separates whether a patient got hurt and needs help from whether a physician was negligent.

All of these ideas are out there. And for a comprehensive health insurance bill not to have embraced that facet of it is actually rather inexcusable.

SIEGEL: Uwe Reinhardt of Princeton, thank you very much for talking with us today.

Prof. REINHARDT: It's been my pleasure, Bob.

And now, Gail Wilensky, who is a health care economist who served as White House health policy adviser to President George H.W. Bush, ran Medicare and Medicaid and later served as an adviser on health policy to Senator John McCain during his run for the White House.

Thanks a lot for joining us. Welcome.

Dr. GAIL WILENSKY (Health Care Economist): My pleasure to be with you.

SIEGEL: Uwe Reinhardt's reading of where we stand now is the Senate health care bill is a good bill. It's been very badly sold by President Obama. But if he could get the message down pat, it would still be a good solution to our problems. What do you say?

Dr. WILENSKY: There are three significant problems in health care. The Senate bill primarily focused on one and did it reasonably well, that is, expanding coverage to a substantial number of the uninsured. Did very little for the other two, which is slowing health care spending and improving the value and the quality for what we spend.

Those are extremely important, much harder problems. Disappointing that we were making so little progress even when health care reform was looking more promising.

SIEGEL: What right now do you think - speaking of promising, what do you think the prospects are? Is it simply finished, and in another year, perhaps Washington will take another swing at it? Or is there something that can be revived from what now is on Capitol Hill?

Dr. WILENSKY: I believe there are three options and none of them are terribly appealing. Nothing is done. Unfortunately, the problems remain. The challenges are there. So that's a problem. There is a bill that is pushed through reconciliation, the budget process.

SIEGEL: You mean without needing 60 votes in the Senate.

Dr. WILENSKY: Without needing 60 votes. That would be a very big mistake. The public is already feeling that they're not getting the kind of change they were promised in terms of how Washington does its business. This would only reinforce that.

A third is to have an incremental bill. That won't be so easy to do. Medicaid expansion for some of the uninsured, insurance reforms, maybe a few other changes won't satisfy the Democratic base. It won't be easy to get, but it's probably the most possible of those three. I hope there'll be an attempt.

SIEGEL: Do you think there are Republican votes for such bills?

Dr. WILENSKY: It will be hard. It will be harder now than it would've been a year ago. There's a lot of jaundiced views. People like Orrin Hatch, who have had a history of being a part of bipartisan bills, walked away very angrily from what was going on in the Senate, one of the great losses that Senator Kennedy was not actively involved in the health care reform debate. It's possible. It will be hard. It's worth the effort.

SIEGEL: Professor Reinhardt agreed that it was a great mistake on the part of the Democrats not to have some nod toward malpractice reform in their approach to health care. Do you agree?

Dr. WILENSKY: I do agree. I think if you want to have physicians practice in a more conservative way, if you want to have hospitals be a little less aggressive, you've got to provide them with some assurance that they won't be sued if there's a bad outcome. Can use the interest in evidence-based medicine so that if physicians in hospitals introduce some patient safety measures approved by the Institute of Medicine and follow the guidelines of the various specialty societies, they should be protected unless there's some kind of criminal negligence.

SIEGEL: If the alternative to all of this - if one possible alternative is status quo, how bad is that?

Dr. WILENSKY: It's very bad. We have challenges we must take on. Fifteen percent of the population, almost 50 million, about 45 million right now without health insurance coverage is a serious problem to the individuals and the communities where they live. And it's wrong.

But we also have, for all of us that have coverage, unsustainable growth in health care spending, already at 17 percent of our GDP and growing. And we have a lot of quality problems. We don't get what we need at the right time with patient safety measures. We really have to take these issues on, and they're hard. They won't be easy to fix.

SIEGEL: Gail Wilensky, thank you very much for talking with us.

Dr. WILENSKY: My pleasure.

SIEGEL: That's health care economist Gail Wilensky. We also heard from Professor Uwe Reinhardt of Princeton University.

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