What's next for health care overhaul?
Health care reform expert Mark McClellan talks with Kai Ryssdal about rumors that President Barack Obama may drop the public option in a new health care bill and what's likely to happen next.
A patient with a sign that reads "What's happening with health care??" (iStockPhoto)
More on Health
Mark McClellan
TEXT OF INTERVIEW
KAI RYSSDAL: The White House insists the president still favors a public option -- some kind of government-run insurance program. But give and take is part of the political process. And there are reports that that option may be up for negotiation. To help figure out what that and the rest of the debate might actually mean we're called Mark McClellan. He's the director of the Engleberg Center for Health Care Reform at the Brookings Institution. He's an MD and an economics PhD. Welcome to the program.
MARK MCCLELLAN: Kai, good to be with you.
RYSSDAL: How much would it matter if next Wednesday night the president does do away with this public-insurance option? In the grand scheme of health-care reform, what does that mean?
MCCLELLAN: It would help bring Republicans on board Kai, and I don't think it's absolutely essential for getting health care spending growth down. There are many other ways to do that. So it could be a way to get Republicans on board. I'm not sure it's enough to do it by itself, but it could be an important step towards a bipartisan approach for health-care reform.
RYSSDAL: Does it make this discussion about health-care reform though more into health-insurance reform somehow?
MCCLELLAN: I believe this has got to be about health-care reform. It can't just be about expanding health insurance and changing insurance market rules. We've got to make it easier for doctors, patients, or other health professionals to take the steps that are necessary to prevent complications, to keep people well, and to avoid unnecessary health-care costs. In so many ways the health-care payment systems we have in place today don't make it easy for people to get the best care at the lowest cost, so that's got to change too.
RYSSDAL: You know, you mentioned this a moment ago. The idea that the Obama administration has to curb health-care spending, the growth in health care spending. Did they make a political/tactical error when they made cost-cutting sort of the centerpiece of their plan, of their proposal?
MCCLELLAN: A lot of Americans are understandably concerned given the complexity of the whole health-care debate that steps to lower health-care costs could result in reductions and access to care. And that's why I think it's so important to frame any discussion about health-care costs savings around the fact that there are plenty of opportunities in our health-care system to reduce costs while actually improving quality of care.
RYSSDAL: How much of the political problem the president faces in this debate is because those of us who have health insurance, generally speaking, are reasonably happy with it? And we just don't see what's in it for us to pay a trillion dollars for reform?
MCCLELLAN: I think a lot of people are not only reasonably happy with their current coverage and their doctor, but also understandably worried about health care reform changes. What needs more attention is the fact that the kinds of health care plans and the kinds of access to providers people have today is really threatened if we don't do reform the right way. Health care costs have been rising. Many employers have been dropping or cutting back on coverage. If we stay on this track, the coverage that you have now is just not going to be there.
RYSSDAL: Let me pick up on that last point. Is incremental change acceptable at this point?
MCCLELLAN: I think incremental changes that add up to fundamental reforms over time, Kai, is probably the only way to go. I don't think Americans are comfortable with radical changes in the health care system. I do think that many of the steps we've been talking about -- like doing a better job of supporting doctors are patients when they take steps to lower costs, like giving people better information on quality of care and paying more for better care -- those steps can be implemented gradually and in a way that adds up to big savings over time.
RYSSDAL: Dr. Mark McClellan runs the Engleberg Center for Health Care Reform at the Brookings Institution. He ran the FDA and the office for Medicare and Medicaid services in the Bush White House. He was in the Clinton administration too. Dr. McClellan thanks a lot for your time.
MCCLELLAN: Great talking to you Kai.
Comments
Comment | Refresh
From Austin, TX, 09/05/2009
The reason that health insurance is so expensive is the same as why flood insurance in New Orleans and hurricane insurance in South Florida are expensive. Too many people need to use it too often. If we took as poor care of our cars as our bodies and drove as carelessly as we eat, auto insurance would be unaffordable too. Insurance for pre-existing conditions is not “insurance” because it has already happened. Could you get a new home owner’s policy if your kitchen was already in flames? Could you get life insurance if you are already dead? 10s of millions of Americans in their 20s-40s are going to a doctor every 6 months to get pills for completely preventable problems like high blood pressure, cholesterol and diabetes. Then in their 50’s-70’s they get the heart attacks and failure, the strokes and kidney failure, the cancers and dementia anyway. I have been a doctor for 50 years. At age 40 I got health religion and saved my life. Now at 75 I still walk the talk. I tell my patients “if I can do it so can you”. That is our only hope in bringing health care costs under control. Large numbers of Americans need to start taking much better care of themselves. If not, the Baby Boomers becoming eligible for Medicare over the next 10 years bankrupts the country. Hey, that will finally bring us home from the Middle East!
09/03/2009
Kai Ryssdal, how can you say, with a straight face, that "those of us who have health insurance, generally speaking, are reasonably happy with it?" Polls show that this just isn't true. And you say that reform is actually going to cost us "a trillion dollars"? Where do you get this stuff? Please ask questions that give your interviewee more space to give you their own answer instead of framing the dialogue with your unfortunately slanted and inaccurate perspective.
From Vernon, CT, 09/03/2009
Give me a break. I can't think of one person I know who is happy with their health insurance. We pay too much for it. It covers too little. And when we really need it, we get dropped. Don't even get me started about work related injuries, or the catch 22 of pre-existing conditions. Yet, insurance companies are making billions. The health insurance system needs the American people to say, sorry, you've made more than your "allowed amount."
From Mountain View (currently), CA, 09/03/2009
Mark McClellan gives no good reason for removing the "pubic option" from the package of health care reforms, except that some Republicans might like it. Which ones, and are they willing to vote for it in public? Because from what I see, unless it's enough to pass the reforms, why bother?
Mr. McClellan doesn't say a word about the millions of people in our country who have no health care and are terrified of getting sick or injured. Beyond the moral imperative to take care of our citizens, he doesn't even touch on the economic advantages of preventive care, early treatment of epidemics such as swine flu, and a generally more healthy workforce.
No, his idea of reform is, "giving people better information on quality of care and paying more for better care." Most people can't pay any more: that's the whole point!
I assume he means that we (as customers) should avoid unnecessary tests and procedures, a free-market approach, but that's been proven wrong for the last decade -- in which he was in the White House, running things.
Considering the breakdown of health care, the way we pay too much and get too little, I think trying something else, a public option so no one will be left out, seems wiser.
09/03/2009
"MCCLELLAN: I think a lot of people are not only reasonably happy with their current coverage and their doctor, but also understandably worried about health care reform changes." This simply doesn't stand up to polling data. Most polls show that Americans are unhappy with the current system and overwhelmingly support reform. I do think that many people are worried that they don't lose what they have, but that does not mean they are pleased with what they have. This is the kind of question/answer the interviewer should have prepared for with research into recent and maybe pre-healthcare debate polls.
From Flushing, MI, 09/03/2009
How will "doing nothing" with health insurance reform help business compete globally over the next 20 years?
Post a Comment: Please be civil, brief and relevant.
Email addresses are never displayed, but they are required to confirm your comments. All comments are moderated. Marketplace reserves the right to edit any comments on this site and to read them on the air if they are extra-interesting. Please read the Comment Guidelines before posting.
You must be 13 or over to submit information to American Public Media. The information entered into this form will not be used to send unsolicited email and will not be sold to a third party. For more information see Terms and Conditions and Privacy Policy.