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Obama, Congress Ready For Overhaul Fight

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Obama, Congress Ready For Overhaul Fight

Obama, Congress Ready For Overhaul Fight

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This is WEEKEND EDITION from NPR News. I'm Liane Hansen.

President Obama is pushing hard for a consensus on health care legislation before Congress adjourns for the summer. He'll convene a primetime news conference this week to further press his cause, which he took directly to the American people in unscheduled remarks late Friday afternoon.

President BARACK OBAMA: We are going to get this done. We will reform health care. It will happen this year.

HANSEN: That goal, however, has already hit a snag. A report issued Thursday by the Congressional Budget Office that says none of the health reform proposals floated so far will achieve his goal of curbing the skyrocketing rate of health care costs.

NPR's national political correspondent Mara Liasson joins us now. Good morning, Mara.

MARA LIASSON: Good morning, Liane.

HANSEN: Tell us why the Congressional Budget Office report was such a big setback for the president.

LIASSON: It was a big setback because it played right into the hands of the president's critics who say that his plan is going to increase the deficit, raise taxes and not bring health care costs down, not fix the health care problem. He has been out there pushing very hard saying health care reform is not just to get everybody covered, health care reform is to lower costs.

The problem is that he has been saying that his plan would bring down costs without adding to the deficit. And the CBO, who is the official umpire, the impartial, fiscal umpire on Capitol Hill, has just said that plans out there so far - and there are more plans to come - will not do that.

HANSEN: Explain for us how paying for health care reform relates to keeping costs under control and why it's going to be so hard for the president to achieve both of those goals.

LIASSON: Well, the biggest piece of paying for health care reform is paying the subsidies for all those people who you want to bring into the health insurance system. Then you have to also try to keep costs under control, just as you're now spending tremendous amounts of more money on health care.

HANSEN: Is there any consensus at all about maybe there's a best way to bring down the cost of health care?

LIASSON: There's a lot of ideas out there. One of the ideas that most experts agree on is that we should stop subsidizing these gold-plated Cadillac insurance plans that many people get from their employers. They get them tax free. So, somebody who's making $50,000 with no health insurance right now is, in effect, subsidizing someone who makes maybe $150,000, maybe they're in a union who's managed to negotiate a really good health care plan with their employer, which they get tax free.

The president and the Congress doesn't want to get rid of that tax exclusion, even though the CBO chairman, Doug Elmendorf, said that is one of the best ways we can do it. The other way is what President Obama talked about on Friday. He calls it delivery system reform, where you would change the whole way that people get health care. Right now it's very expensive and we don't get high quality.

He wants there to be an independent group of doctors and medical experts, which would review the payment policies for Medicare programs, issue recommendations to Congress. They are the ones who would, in effect, say no to an 88-year-old woman with cancer. No, we will not pay for your hip replacement.

HANSEN: How legitimate is the concern that Republicans have that any sort of bundled payment system would lead to rationing of health care?

LIASSON: Well, there's a big debate over rationing, and of course some people say health care is rationed right now. Health insurers say no to people all the time - no, we won't pay for this. This would be maybe a more rational way to do that. But that is the specter that this raises.

One of the problems with this whole health delivery system reform is that nobody really knows how to do it yet. In the town meeting I went to with the president a couple weeks ago, he said it's going to take us four to five years to just get the structures in place so we can figure out how to do this: deliver higher quality health care at lower cost. Some communities in the country do it better than others right now.

How do you enforce or put the incentives in place to get those best practices replicated all over the country? And one of the biggest problems, political problems, for the president and Congress right now is the Congressional Budget Office can't score that as savings because nobody knows how to do it. And it probably would take more than ten years to actually get savings, and the CBO only deals in ten-year increments.

HANSEN: NPR's political correspondent Mara Liasson. Mara, thank you very much.

LIASSON: Thank you, Liane.

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