Health Care

ARI SHAPIRO, host:

This is MORNING EDITION from NPR News. I'm Ari Shapiro.

RENEE MONTAGNE, host:

And I'm Renee Montagne.

Democratic leaders in the Senate are heading in to what they hope will be its final days of debate on a health overhaul bill. President Obama weighed in again yesterday. He invited all 60 members of the Senate Democratic Caucus to the White House to urge them to settle their lingering differences and approve the bill before Christmas.

President BARACK OBAMA: Now, let's be clear. The final bill won't include everything that everybody wants. No bill can do that. But what I told my former colleagues today is that we simply cannot allow differences over individual elements of this plan to prevent us from meeting our responsibility to solve a long-standing and urgent problem for the American people.

MONTAGNE: In a moment, we'll hear how the president is dealing with the reality of living in a more partisan Washington than he intended. First, here's NPR's Julie Rovner with the latest in those efforts to settle outstanding problems in the Senate's health bill.

JULIE ROVNER: The Senate overcame a nearly week-long delay last night when it defeated a pair of amendments that would have allowed individuals, pharmacies and drug wholesalers to import lower cost prescription drugs from other industrialized countries. The main proposal was offered by North Dakota Democrat Byron Dorgan.

Senator BYRON DORGAN (Democrat, North Dakota): I have a beef with an industry that decides they're going to overcharge the American people, in some cases 10 times more, in some cases five, double the price that is paid in other parts of the world for the identical drug. I don't think that's fair, and I don't think we should allow it to continue.

ROVNER: The idea has long enjoyed bipartisan support in Congress and long time opposition from the prescription drug industry, which worries about lost profits. It's also been uniformly opposed by whichever party is in charge of the Food and Drug Administration, which has expressed concerns about being able to keep counterfeit drugs out of the country, so it wasn't that surprising when it failed to win the 60 votes it needed to pass under a Senate agreement. What was expected to pass, though, was the amendment offered instead by New Jersey Democrat Frank Lautenberg. It would have allowed drug imports but only if they were certified as safe by FDA officials.

Senator FRANK LAUTENBERG (Democrat, New Jersey): As much as we want to cut costs for consumers, we cannot afford to cut corners and risk exposing Americans to drugs that are ineffective or unsafe.

ROVNER: Amendments like those have passed the Senate several times over the past decade and they haven't meant much because no federal official has been willing to make such a safety certification. Dorgan called out his colleagues on just that point.

Sen. DORGAN: Do not vote for this amendment and go home and say you've done something about the price of prescription drugs, because your constituents will know better.

ROVNER: And for the first time ever, the watered-down importation amendment didn't pass either, which actually takes a hurdle out of the way. But there are still plenty left. One lingering problem is how to make liberals happy now that it appears that both a government-sponsored insurance plan and a proposal to let those not quite old enough for Medicare buy into the program will be dropped from the bill. One possibility was to require insurance companies to spend a specific amount of each premium dollar on actual medical care, as opposed to administration or marketing or profits. But there's a problem with that proposal too.

Over the weekend, the Congressional Budget Office effectively squashed the proposal. It said it would basically represent a government takeover of the private insurance industry. What is still being actively negotiated is a way to satisfy anti-abortion Democrats. Pennsylvania Democrat Bob Casey, who opposes abortion, is one of the lawmakers working to find compromise on the contentious issue. He says one possibility is to add language that would expand services to pregnant teenagers and young women to help them keep their babies.

Senator BOB CASEY (Democrat, Pennsylvania): It's one of those rare policy areas where you have people on both sides of the divide on abortion who are going to be very supportive, and have been. But we want more than support, we want to get it in the bill.

ROVNER: Assuming Democrats can get their forces together, they'll need at least six days for all the procedural votes to get the measure to a final conclusion. That means they pretty much have to tie things up today or tomorrow if they want to finish before Christmas.

Julie Rovner, NPR News, Washington.

MONTAGNE: For a look at how individual Americans are coping with serious health care issues, NPR's Robert Krulwich has made a series of short videos, and you'll find them at our Web site npr.org.

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