ALISON STEWART, host:

The week ahead in Washington will likely be dominated by the health care debate, with committees at work on overhaul bills in both the House and senate. Although details of the proposed new system are still being worked out, how to pay for broader coverage, the president promised, is at the center of much of the discussion.

Joining us is NPR's senior Washington editor Ron Elving. Welcome, Ron.

RON ELVING: Good to be with you, Alison.

STEWART: Health care is the president's big priority for this year in Congress. So, how's that working out for him on Capitol Hill?

ELVING: It's getting a bit tense up there right now, actually. The president's message of a broader, fairer system is competing with questions about who's going to pay the piper. And those questions are getting increasingly loud. I would say most Democrats and even some of the Republicans in Congress do share the president's goals.

For example, they're approaching agreement on the inclusion of a public option. In a plan that would be a government insurance plan for those who can't get private insurance. And then there's a general belief that the cost should be met with revenues, rather than borrowing. But neither the House nor the Senate is anywhere near a consensus on what those revenues ought to be.

STEWART: So where are some of the places where those revenues can be found?

ELVING: One fairly straightforward idea is a surtax on high incomes, or, let's say, a cap on itemized deductions for high incomes. So, let the rich pay for it - that's always a popular idea. Another idea would be to raise the broad-based payroll tax that workers pay now for Medicare - most everybody pays that, who's got any kind of wages at all, any kind of earnings. Or Congress could impose higher taxes on certain products that have health consequences, so, alcohol and tobacco, some foods, high-sugar drinks. And then you've got some much more ambitious ideas such as European-style value: added tax on goods and services throughout the economy. Or, and here's one to watch, a new tax on the health insurance benefits that many Americans workers still get from their employers.

STEWART: Now, that's an idea that the unions and others have objected to and candidate Obama opposed last year. So, isn't that a non-starter?

ELVING: It doesn't have much momentum in the House. But in the Senate it looks pretty likely to be part of the deal. Max Baucus, the Senate Finance Committee chairman, is talking about it a lot. And remember that Republicans are a much more significant factor in the Senate equation. So it could be in the final negotiation between the Senate and the House. A sticking point in that negotiation and the White House would have to decide which side to come down on.

STEWART: What about the elephant in the room, letting the cost become part of the national debt? That's what happened with the war in Iraq.

ELVING: Yes, but because the wars were deficit financed, along with a lot of other spending in the Bush years, and the big bailouts for banks, and then the Obama stimulus and the auto bailouts, we are looking at fantastic levels of federal deficit now. I mean, we have trillion and .8 this year - way more than a trillion again next year, even without an ambitious new spending program like health care, which conservative estimates say is going to be another trillion dollars over, say, 10 years.

So, this is already the one area where the president's approval ratings are falling - on the issue of spending and debt. So, the last thing he needs is another big change that doesn't pay for itself.

STEWART: Trillion, that's a real cheery note to end on there, Ron.

(Soundbite of laughter)

ELVING: I always like to wake you up on Sunday morning with a big number.

STEWART: NPR senior Washington editor Ron Elving. Thanks, Ron.

ELVING: Thank you, Alison.

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