It's MORNING EDITION from NPR News. I'm Steve Inskeep.


And I'm Renee Montagne.

A leading voice in President Obama's health care plan is answering charges that it's more radical than it seems. The charges have come from Republicans, like former presidential candidate Mitt Romney on ABC.

Mr. MITT ROMNEY (Former governor of Massachusetts): This is not about getting competition in health insurance, which is already there. This is instead a Trojan horse.

MONTAGNE: Romney is talking about the president's proposal for a government sponsored insurance plan. It would compete with private companies.

INSKEEP: The question is whether it grows so big that it basically becomes national health insurance. We put that question to Kathleen Sebelius, president Obama's Secretary for Health and Human Services.

INSKEEP: Now, I know there are lots of different ways to structure a plan, but I want to ask about the one that's in your head right now. When you think about this public plan what number of Americans do you anticipate would go into it because they have no insurance or because they dropped their current insurer?

Secretary KATHLEEN SEBELIUS (Health and Human Services): Well, I think what we're looking at, Steve, is a program where consumers who are looking for coverage are going to look at the benefits and the cost. And what I think is important and the president has said all along is that we have a level playing field, so you don't tilt consumer choice toward a public company but you create a set of benefits and options that looks very similar.

But knowing that in many cases private insurers can have administrative costs as high as 30 percent, so you could have some ability to have a more affordable same package of benefits but lower that overhead cost.

INSKEEP: But I want to understand this number, because, as you now, Republicans have quoted a study saying way over 100 million Americans…

Sec. SEBELIUS: Yeah.

INSKEEP: You've disputed the study.


INSKEEP: So what's your number? How many people are going to end up in this thing?

Sec. SEBELIUS: Well, first of all, we know that there are only a total of 47 million uninsured Americans. We also know that it's estimated that there are about 25 million so-called underinsured who have some kind of coverage but it really isn't robust health coverage.

I would say some fraction of those people will end up choosing a public plan, but I don't pick a number off my head. And most people that I know have really disputed the Lewin study that suggests everybody under the sun who has an option would somehow run toward the public plan.

INSKEEP: Just the numbers you mentioned, though. I mean, this option - this public option if it passes as you imagine it's going to be vast. This is going to be many, many millions of people in this plan.

Sec. SEBELIUS: Well, it again depends on what it looks like. But I think you're talking about potentially 50 million-plus new insurance customers, whether they're choosing a private plan or a public option. And I think that's again what we're saying is that without some competitive way to do that we'll have a lot more people insured and the costs will just continue to spiral and we won't be any better off in the long run than we are right now.

INSKEEP: But I want to get some clarity on this debate that's been going on for weeks. You've said we just want this public plan as an option. Republicans have said Trojan horse. Everyone's going to end up in this plan. It'll be able to offer lower prices. Everyone will end up there.

Now, people in Congress are talking about putting some kind of limit on this public plan so it doesn't get too big. What limits are you prepared to expect?

Sec. SEBELIUS: I have no idea. I mean, there are so many ideas right now in Congress, and I really can't react to a plan I haven't seen. I don't know what - if this is members of the Senate and what they're talking about. I'm sorry. I don't…

INSKEEP: In the end would you accept a limit that would say this is just not going to be national health insurance at some point in the future?

Sec. SEBELIUS: You mean not a single-payer plan?

INSKEEP: Yes. Yes.

Sec. SEBELIUS: Well, again, I think the way you actuarially design a plan will determine whether the playing field is level or whether the playing field is tilted. From the outset the president has continued to say we want a level playing field, you know. This is not a trick. This is single-payer.

As you know, there've been a lot of congressional advocates who say why not. Why can't we have a single-payer? That's not what anyone is talking about — mostly because the president feels strongly, as I do, that dismantling private health coverage for the 180 million Americans that have it, discouraging more employers from coming into the marketplace, is really the bad direction to go.

INSKEEP: When you say that some private insurers are spending I think you said 30 percent…

Sec. SEBELIUS: That's correct.

INSKEEP: …of their money on overhead. And you say that in a context of a public plan. I want to make sure I understand what you're saying. You're saying this public plan is going to be out there. It's going to be charging lower prices maybe than insurers are now. And it's going to put pressure on them to cut their costs and be more efficient. You were…

Sec. SEBELIUS: And that's a good thing. I think that's a very good thing for the American public. I mean, Medicare right now has a lower overhead cost than private insurers. Medicaid has a lower overhead cost. There are insurers who compete with one another because they found ways to cut overhead costs. They spend less on marketing. They spend more of their money delivering health benefits to their consumers. That's a very good thing.

INSKEEP: Are you concerned as you go through this process that as you negotiate one legislative solution after another, trying to get, you know, just enough votes, that you end up with a similar problem to what President Clinton had in the 1990s, you have a plan that is so complicated that you can't explain it, nobody can understand it, and people just can't get over their anxiety about it?

Sec. SEBELIUS: Well, I think in the long run, you know, the 1990s initiative is thought to have failed because part of the group who couldn't understand it were the members of Congress who were being asked to vote on it. I think you have a very different situation today, where not only are the members of both the House and the Senate involved in writing the bill - and hopefully they will understand what it is that they're drafting and voting on - but also various stakeholder groups are at the table in a very different way.

INSKEEP: What's been the hardest thing for you to explain?

Sec. SEBELIUS: I think that the whole idea of the public option has been difficult in part because I think some of the opposition has described it as a potential for a draconian scenario that was never part of the discussion in the first place. So disabusing people of what is not going to happen is often difficult because there is no tangible way to do that.

INSKEEP: Can you say flat out it's just never going to be single-payer health insurance and we're going to try to write it if we can so that it won't ever be?

Sec. SEBELIUS: Oh, I think - I think that's very much the case. And again, if you want anybody to convince people of that, talk to the single-payer proponents, who are furious that the single payer idea is not part of the discussion.

INSKEEP: Secretary Sebelius, thanks very much.

Sec. SEBELIUS: Thank you, Steve, glad to have you here.

INSKEEP: She's secretary of Health and Human Services.

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