Health Care Debate Tone Sharpens Congress may be taking a break for August, but the debate over a health care overhaul isn't. It's just changing venues. For the next five weeks, arguments for and against the plans being put together by President Obama and congressional Democrats will be waged on the airwaves and in individual states and members' districts.
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Health Care Debate Tone Sharpens

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Health Care Debate Tone Sharpens

Health Care Debate Tone Sharpens

Health Care Debate Tone Sharpens

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

Congress may be taking a break for August, but the debate over a health care overhaul isn't. It's just changing venues. For the next five weeks, arguments for and against the plans being put together by President Obama and congressional Democrats will be waged on the airwaves and in individual states and members' districts.


From NPR News, this is ALL THINGS CONSIDERED. I'm Madeleine Brand in California.


And I'm Melissa Block in Washington.

As Congress heads out for its summer break, don't expect a break in the ongoing debate over a health care overhaul. Instead, expect a flood of radio and television ads, town hall meetings and various other staged events from those on all sides of the issue, even as Washington gears down the fight for public opinion wages on. And with us to discuss all this is NPR's Julie Rovner who covers health policy for us. Welcome back, Julie.

JULIE ROVNER: Nice to be here.

BLOCK: And let's start with where this legislation is as Congress heads home. President Obama wanted bills voted on by both the House and the Senate before the August break. He clearly didn't get that. What did he get?

ROVNER: Well, he got kind of a half a loaf or maybe a quarter of a loaf. We've got sort four different pieces of legislation now. In the House, we've got really two different pieces of legislation. There was one bill. There were three committees. They finished work. The Energy and Commerce Committee, the last committee, finished work just Friday night, just after the house adjourned. Now we've got two other committees that basically voted out the same bill. The Energy and Commerce Committee had to make a lot of changes to please its Blue Dog - it's conservative Democratic members - and then some more changes to bring back in some of the liberals. So we've got sort of an Energy and Commerce Committee bill, and we've got a bill from those other two committees.

Then over in the Senate we've got a bill that the Health Education Labor and Pensions Committee, the HELP committee, voted out before the July 4th break. And then we've got the Senate Finance Committee, who are three Democrats and three Republicans - have been soldiering on for now it feels like many months, but it's really been about a month. They've not finished. They don't have a bill yet. They're not going to get a bill before the Senate goes out at the end of this week. They say they'll work through the August recess, hopefully get a bill by the middle of September. So we've got basically kind of a muddle - four different products, only three of which are public.

BLOCK: So the muddle here in Washington and now the message going out in the country to the voters - during the Clinton administration. when you covered this issue there was a lot of campaigning for and against health care overhaul then too. What's different this time around?

ROVNER: I think the big difference is that last time we saw a lot of the industry groups doing the campaigning pretty much against the bill. This time the industry's really on the sidelines. They say they really want something to happen here. So they're at least holding back their fire. In fact, one of the major industry groups, the drug industry, is now sponsoring the ads with the iconic Harry and Louise, who represented the insurance industry last time and here's one of the ads that they're running.

(Soundbite of advertisement)

Mr. HARRY JOHNSON (Actor): (as himself) Well, it looks like we may finally get health care reform.

Ms. LOUISE CLAIRE CLARK (Actor): (as herself) It's about time because everyday more and more people are finding they can't afford health care.

Mr. JOHNSON: (as himself) Or they're losing coverage.

Ms. CLARK: (as herself) We need good coverage people can afford. Coverage they can get.

Mr. JOHNSON: (as himself) Even if they have a pre-existing condition.

Ms. CLARK: (as herself) And coverage they can keep if they…

BLOCK: So Harry and Louise have changed their minds - before they were against health care overhaul, now they like it.

ROVNER: Well, now they say it's really time to finish the job.

BLOCK: Julie, there is still a lot of negative advertising about this plan.

ROVNER: There is plenty of negative advertising but most of it is coming directly from either the Republicans or groups that are pretty closely affiliated with Republicans. There's an ad out just today from House minority leader John Boehner. It needs a little bit of set up because it's pretty visual, but it features the theme music and one of the actors from the soap opera "The Young and the Restless."

(Soundbite of advertisement)

Unidentified Man: I'm not a doctor but I play one on TV. If your child had a cough she'd get just what the doctor orders.

(Soundbite of coughing)

President BARACK OBAMA: You know what, I make a lot more money if I take this kid's tonsils out.

Unidentified Man: I'm not a doctor but I play one on TV.

Pres. OBAMA: If there's a blue pill and a red pill and the blue pill is half the price of the red pill and works just as well, why not pay half price.

BLOCK: Some message there: The government is going to be controlling your health care decisions.

ROVNER: Indeed, President Obama is playing doctor.

BLOCK: Democrats have ads out too and they are hitting a new theme.

ROVNER: Yes, indeed it's actually a return to the old theme from the Clinton administration, which is bash the insurance industry. You know, all those photo ops we'd earlier this year with President Obama and insurance executives making nice, well, you can forget about them. Now instead of talking about health reform, the president is talking about health insurance reform. Here's another ad out just today from a Democrat-affiliated group called Americans United for Change.

(Soundbite of advertisement)

Unidentified Woman: Why do the health insurance companies and Republicans want to kill President Obama's health insurance reform? Because they like things the way they are now. Ed Hanway, CEO of insurance giant CIGNA, makes $12.2 million a year - that's $5,883 an hour.

BLOCK: Julie, do you think this tactic of bashing the insurance companies, could that backfire against Democrats.

ROVNER: Well, it could. So far, the insurance industry has been pretty supportive of this process. And if the Democrats really get, you know, too viciously against them, they could come out against it. You really don't want the insurance industry's pocketbook out advertising against this bill too. That could be something they could live to regret.

BLOCK: NPR's health policy correspondent Julie Rovner. Thanks so much.

ROVNER: You're welcome.

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Public Baffled By Health Care Arguments

President Obama talks with a group of small-business owners following a town hall meeting on health care in Raleigh, N.C., on July 29. Sara D. Davis/Getty Images hide caption

toggle caption
Sara D. Davis/Getty Images

President Obama talks with a group of small-business owners following a town hall meeting on health care in Raleigh, N.C., on July 29.

Sara D. Davis/Getty Images

As members of Congress head home for the summer recess, they will use the time to either sell to their constituents the national health care and insurance overhaul being fiercely debated in Washington, or deep-six it.

No matter which side of the issue members come down on, they will find that the people who put them in office remain deeply confused about what the still-being-written overhaul might bring.

And most Americans are equally suspicious of — and confused by — claims being made by both supporters and opponents of President Obama's most ambitious domestic initiative.

With Congress still struggling to fashion legislation and Obama letting the details take shape on Capitol Hill while he sells its broader parameters during appearances that include town hall meetings, most outside Washington have no idea what the overhaul will look like, what it will cost and how it could affect them personally, says Mark Blumenthal of

NPR Poll Findings

The nation is close to evenly split in its assessment of President Obama's policies to date, the latest NPR poll found. Read more about the findings, including what voters had to say about plans to overhaul health care.

"Much of this story has been a big, inside-Washington debate about cost and bending the cost curve," he says. "It's a remote, technical discussion."

Polls show that the delays in reaching agreement on a bill — coupled with growing concern about the billions already spent on bailouts and the stimulus package — have spurred skepticism about whether Obama's biggest domestic initiative will help the country, and who it will benefit.

'Babble' From D.C.

Iowa's senior Sen. Chuck Grassley, a Republican, has been one of a half-dozen Senate Finance Committee members who have been struggling to piece together a bipartisan bill.

But that proposal, senators have said, won't be ready until after the August recess. That means voters back home, desperate for concrete information about the overhaul, will have to wait longer for clarity.

And after the Senate leaves for recess this week, Grassley is guaranteed to face the same questions back in Iowa that Congress members will face across the country. That group includes Grassley's fellow Iowan Rep. Bruce Braley, who is part of a group of House Democrats fighting for a fix in disparities in how Medicare reimburses rural and urban health care providers.

"There is intellectual acceptance that health care is a problem and that it costs too much," says Graham Gillette, who runs his own public relations strategy company in Des Moines, Iowa. "But for most Americans, the confusing babble that's coming out of Washington sounds worse."

"And after the fear-mongering and mud-throwing of the last few weeks," he says, "that's not hard to understand."

In Iowa, a national labor union has aired television advertisements that targeted Grassley's support for a proposal that would tax health care benefits. The state's Democratic and Republican parties have stepped up their rhetoric in anticipation of the August recess. Volunteers who helped Obama win the Iowa caucuses last year are being recruited to make phone calls to remind supporters that a national health care overhaul was one of the reasons they voted for him.

The Need Is Clear

For the past decade, David Lind's company, based in Clive, Iowa, has conducted an annual survey assessing the state of health insurance in the Hawkeye State. It's meant for his clients in the employee benefits sector.

What his surveys have found, he says, reflect not only conditions in Iowa but around the country. The numbers are sobering.

"We have found in the past 10 years, health insurance premiums have basically doubled," he said. "That mimics what we've seen on a national basis."

Employers facing these dramatic increases in premiums have increasingly had to pass costs to their employees, Lind says, by increasing deductibles that employees pay and hiking co-pays for office visits and prescription drugs.

The average deductible for a single person in Iowa has increased 200 percent over the past decade; family deductibles have gone up 180 percent over the same period, his data show. And the smaller the employer, Lind says, the higher the employee deductibles and copay requirements.

"Rather than drop health insurance, employers are reconfiguring plan design and ratcheting the [employees'] cost share upward," he said. "But employers are still taking the brunt of the increases in premiums."

Frog In A Pot

Des Moines-based pollster J. Ann Selzer likens the situation to the old frog-in-the-kettle analogy: "People are like frogs in a pot of warm water, with the temperature slowly rising," she says. "It feels warm now — but they don't realize how hot it's getting."

For many, she says, the status quo holds appeal — particularly in the face of heavy push-back from Republicans opposed to the tenets of Obama's overhaul goals.

Lind says his clients are particularly concerned about the status of a proposed public insurance plan that would compete with private insurers.

"There needs to be a meaningful discussion about what it means to actually have a public plan next to a private plan, so there isn't a hidden tax," he says.

"The dialogue seems to be more about politics than what's really happening," Lind says. "Let's get all the facts out there, have complete transparency of what it looks like, and then we can apply the facts to it."

A Message Problem

When pollsters ask straight-up questions about whether people favor or oppose revamping health care, there is a little more opposition than support, Blumenthal says.

But when the surveyors ask more specific questions about what the plan might include, there is "remarkably consistent support in the 50-55 percent range," he said.

What hasn't been communicated well enough to the folks back home is what an overhaul could do — including guaranteeing that you won't lose your insurance if you change jobs, for example, or if you have a pre-existing medical condition, Blumenthal says.

"I don't get a sense that Americans have a very good idea of what the 'it' is," he says. "In the absence of a real strong case being made for this [what's happening] is that people are hearing and processing messages from the other side."

The Politics Of Confusion

People are confused, and there's the fear of the unknown, says Gillette, who volunteered for Obama in Iowa during his presidential run. And that uncertainly is compounded by the complexities involved in the administration's push for sweeping changes in one big overhaul bill.

"If Washington could have broken the problem into pieces — cost containment, for example, and insurance portability — they could have hammered out some agreements and given people some confidence that progress was being made," he said.

"The approach they took was almost all-or-nothing," he says. "That is confusing, and, to many, scary."

And that's what Grassley and his congressional colleagues will face in coming weeks: confusion, skepticism and the still-lingering question of what the overhaul will look like and what will it mean for households in Iowa and beyond.

"The play's not over yet," Blumenthal says. "But proponents will be in a much better position to sell it when they have something concrete."