Health Care


Health care is sure to occupy Congress and the new Obama administration this coming year. The U.S. spends more than $2 trillion a year on medical care. Yet our population is no healthier than countries that spend far less. Some 46 million Americans have no health insurance. Another 25 million have insurance, but in the case of serious illness or injury, they still would be exposed to financial catastrophe. President-elect Barack Obama has promised to make health care one of his top priorities. So, to discuss his plans and their chances for success, NPR's health care correspondent Julie Rovner is in the studio. Nice to see you.

JULIE ROVNER: Nice to see you.

HANSEN: There's a lot on Mr. Obama's plate. Why do you think he's going to keep health care a high priority?

ROVNER: Well, partly because he said he would. Partly because many voters voted for him assuming he was going to keep that promise. Also I think because he's chosen Tom Daschle, one of his closest advisers, to be not just secretary of health and human services, but to head a White House task force on health reform. And also because in Congress, even before his election, you had a number of important committee chairman, people like Ted Kennedy and Max Baucus of the Finance Committee, laying the groundwork for another major effort at some kind of a health-care overhaul. So the stars are aligning to make this a big issue next year.

HANSEN: Tell us exactly what the president-elect proposes in order to change the health-care system?

ROVNER: Well, it's a bit of a work in progress. In fact, between really the middle and the end of this month, there are health-care house parties, they're calling them, where people can get together and make suggestions to the incoming Obama administration of what they would like to see. But the proposal that the president-elect ran on involved having people who were happy with what they have, basically, keep their plan. It would build on the existing system where most people get their health insurance from their job, but it would also add a new possibility. People could get a public program, much like members of Congress and federal workers have. Employers would be required to either offer insurance or pay, basically, a fee to help allow people to buy into this public program. Insurers would no longer be allowed to discriminate based on people who are already sick. And that's basically what the types of programs that Congress is looking at, also.

HANSEN: Elaborate a little bit on that. How well do the proposals put forward by President-elect Obama mesh with what Congressional leaders like Ted Kennedy have been working on?

ROVNER: Overall, the basic structure seems to be fairly similar. There are a couple of key points of contention, though. President-elect Obama was one of the few Democrats who did not have what we call an individual mandate. He did not require that everyone have insurance. Now on Capitol Hill, that seems to be kind of a non-starter. There's a general consensus among most economists that unless everybody has insurance, it's going to be very hard to remake the insurance system. So, the Democratic Congress is going to want to have everyone in the system.

Also, towards the end of the campaign, President-elect Obama was pretty firm against Senator McCain in saying that he did not want to tax the value of health benefits that employers provide. There may be even some Democrats who worry about that. That's a very large source of revenue to pay for new coverage, and that's an awful lot of money that I think a lot of people are not going to want to leave on the table.

HANSEN: What would be some early signs of success or failure of the health-care effort?

ROVNER: Well, there's talk there's going to be an early stimulus bill, not really a health-care bill, but in that stimulus bill, there's already talk of putting money to help computerize medical records. So that's something that people should look for. Also, the State Children's Health Insurance Program, which was a subject of several vetoes in this recent Bush administration, comes back up for renewal in March. So, very early out of the box, the new Congress is going to have to deal with that.

HANSEN: NPR's health-care correspondent, Julie Rovner. Thanks, Julie.

ROVNER: You're welcome.

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