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That report reminds us of the complexities of keeping a nation healthy or making it a little healthier where possible. And were going to talk, next, about the health care changes now being considered by Congress - what those changes would do and what they would not. The health bill passed by the House and a similar measure pending in the Senate would increase the number of people covered by health insurance. But critics across the political spectrum say the bills would do little to rein in runaway costs, which was the other big goal.

NPRs David Welna reports.

DAVID WELNA: There's been a significant rhetorical shift in how Democrats refer to their health care overhaul. Back in July, when President Obama was still talking about what he then called health care reform, he spoke of bending the cost curve downward.

President BARACK OBAMA: Our proposals would change incentives so that providers will give patients the best care, not just the most expensive care, which will mean big savings over time. This is what we mean when we say that we need delivery system reform.

WELNA: Fast forward to the day after the House passed its health care bill earlier this month. Notice how President Obama, in praising that action, no longer called it either delivery system reform or health care reform.

Pres. OBAMA: It brought us closer than we have ever been to comprehensive health insurance reform in America.

WELNA: Health insurance reform is the same label other leading Democrats are now using. This coincides with the insurance industry having turned against the Democrats' health care proposals, which forced insurers to drop highly unpopular policies, such as denying coverage because of pre-existing conditions.

Paul Ginsburg heads the nonpartisan Center for Studying Health System Change. He thinks the health care makeover has ended up being largely about putting the squeeze on insurance companies.

Mr. PAUL GINSBURG (Nonpartisan Center for Studying Health System Change): Insurance reform is a much more accurate label. So we can praise that for the accuracy of labeling but lament the fact that there's a lot of health care reform that needs doing and our insurance reform will get us only so far.

WELNA: And thats because while taking on the insurance companies, lawmakers are not requiring big changes in the way health care is delivered by doctors and hospitals. Those providers, in turn, are backing the health care plans moving through Congress. But their ever-increasing fees, many experts say, are driving health care costs up for everyone. Maine Republican Senator Susan Collins says those constantly rising costs are the biggest worry for people in her state.

Senator SUSAN COLLINS (Republican, Maine): I'm very concerned that the bill passed by the House does not do enough to lower health care costs in general. In fact, it does virtually nothing to lower health care costs.

WELNA: The absence of clear measures to rein in costs is being seized on by opponents of the legislation. A TV ad sponsored by business groups calling themselves Employers for a Healthy Economy targets Maine and nine other states.

(Soundbite of TV ad)

Unidentified Male #1: nothing to control rising health care costs, health insurance costs will skyrocket. Call Congress. Tell them the new health care bill is a bill America can't afford to pay.

WELNA: Even some longtime supporters of a health care overhaul are dismayed. The National Coalition on Health Care is running newspaper ads proclaiming national health care reform without cost control is like moving furniture into a burning house.

Ralph Neas is the lobbying group's CEO.

Mr. RALPH NEAS (Employers for a Healthy Economy): Because if you have coverage, if you have other things that are very important and the bill does but you don't have cost containment, then you're not going to have a bill that's sustainable.

Ms. JEAN MITCHELL (Georgetown University): The way the system is, the more you do, the more money you make.

WELNA: Thats Georgetown University health economist Jean Mitchell. She finds little in the legislation before Congress that would compel doctors to stop charging for every procedure they perform, a practice known as fee-for-service.

Ms. MITCHELL: It's almost as though patients have become like ATM machines. You know, you put them in and you try to extract as much revenue as you can.

Dr. JAMES ROHACK (American Medical Association): We believe that fee-for-service is a good mechanism because it recognizes what a physician does.

WELNA: Thats the head of the American Medical Association, cardiologist James Rohack. Though he defends fee-for-service, he also acknowledges it gives him and his fellow doctors perverse incentives to perform more procedures than are needed.

Dr. ROHACK: As long as there's fixed costs and a physician isn't able to really get paid for the true cost of care, it's created this horrible problem where physicians are pressured to increase volume just to make ends meet.

WELNA: The AMA has endorsed the health care bill passed by the House. And the House in turn is voting this week on wiping out scheduled cuts in Medicare reimbursements cuts meant to curb the exploding volume of services doctors perform.

Congress has enforced such cuts only once in the past seven years just as it now seems unlikely to get tough on the costly practices of doctors, who are, after all, more highly regarded than the insurance companies.

David Welna, NPR News, the Capitol.

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