Transcript: Health On The Hill Discussion Of The Public Plan

Mary Agnes Carey: Hello and welcome to Health On The Hill. I’m Mary Agnes Carey of Kaiser Health News. Joining me today to discuss the latest in the health reform debate is Julie Rovner of National Public Radio. Thanks for being with us, Julie.

Julie Rovner: Thanks for having me.

MAC: Let’s talk a little bit about some of the signals the administration may be sending on its stance on the idea of a public option in health reform. Can you tell us a little bit about what’s been said and what you think it means?

JR: Well, it started Saturday afternoon in one of the town hall meetings the President had where he tried to make the point that the public option – I think he used the word – is just a “sliver” of what’s being talked about. And then on the Sunday talk shows yesterday, we had Health and Human Services Secretary Kathleen Sebelius saying that it’s not necessarily a make-or-break issue and we had White House Press Secretary Robert Gibbs pretty much echoing that. I think a lot of people took away from that ‘Oh my goodness, the administration’s backing off on a public plan, they don’t have to have a public plan.’ Well, I suppose if you hadn’t been paying attention to every day of this debate, you could say that, yes, the administration is sending signals that they don’t have to have a public plan.

The administration has been saying that they don’t have to have a public plan pretty much from the beginning. And I think what you really need to remember is that at this point in the debate, it’s still about getting a bill through the House and a different bill through the Senate. In the House, you pretty much have to have a public plan to get the bill through. You have more liberals than conservatives. Having a public plan is pretty much a make or break issue for getting a bill through the House. Having a public plan is going to be a lot harder in getting a bill through the Senate. We saw Kent Conrad yesterday on Fox News…

MAC: He’s the Senate Budget Committee Chairman.

JR: Senate Budget Committee Chairman, but more to the point, one of six members on the Finance Committee trying to negotiate a deal and the person who came up with this whole idea of having co-ops instead of a public plan, saying that we should stop chasing the idea of a public plan because there aren’t the votes for it in the Senate. So the administration is walking this fine line saying “we don’t necessarily have to have a public plan,” because he’s trying to get a bill through the Senate. But they don’t want to take it completely off the table because they have to get a bill through the House. So I think they’ve been trying to say the whole time that yeah, we’d like a public plan but we don’t necessary have to have a public plan.

MAC: I’m wondering if basically the President and the Administration officials were saying this in response to some of the things they’ve heard at these town hall meetings. “I don’t want government to interfere in my health care. I don’t want government between me and my doctor.” The President came out and said specifically, “That’s not my intent. Right now you might have an insurance bureaucrat in the way, but I certainly don’t want a government bureaucrat in between you and your doctors who decide your health care.”

My thought was it’s a reflection of what they’ve heard at these town hall meetings. There’s been a lot of anger, there’s been a lot of contempt, a lot of passion, which of course we know, surrounds the health care debate anyway. We’ve both covered this for a long time, and you can see it brings it out in people. I think they’re realizing now, there may actually be health care reform this year. But I had the same thought you did, they’ve signaled an openness, a willingness, and again, I think Linda Douglass, the White House spokeswoman came out yesterday afternoon saying, “Look, nothing’s changed, we’re still committed to it,” but David Axelrod had said on one of the Sunday news shows that it hadn’t been carved in stone, so I think they’re trying to continue this flexibility.

Let’s talk a little bit about this co-op idea. Kent Conrad, as you noted, one of the Gang of Six on Finance, heads the Senate Budget Committee, he’s been pushing the co-op idea for a long time and this gave him a great opening to pursue this again.

JR: Absolutely, he’s been ‘Senator Co-op’ from the beginning. He comes from North Dakota, as he points out, a place where co-ops are a fairly familiar concept. He talks about how Land O’ Lakes is a co-op, the big butter company, and the Associated Press, the big news organization, is a co-op. And there are co-ops that exist in the health care world. Health Partners, which is a very prominent HMO in the Twin Cities, is a co-op. Group Health, in the Pacific Northwest, is a co-op. And indeed it’s an idea that’s been catching on to some extent.

But then you get people who stand up at some of these town hall meetings and say, “How will this co-op work?” and the answer is “We don’t know because we haven’t really decided yet.” And I think these town hall meetings have really shown why it was that the President really so badly wanted the House and Senate each to pass a bill before the August recess. Because the problem is now, you get out to these town meetings, and people have really good questions. “How will this affect me?” And the answer is “We don’t know yet because the bills haven’t been written.”

So you’ve got different versions of bills floating around and then, in some cases, you’ve got people making stuff up to try to scare people. And then you’ve got people trying to read these bills and coming away with all kinds of interpretations and you’ve got a real prescription for a big mess. And I think that’s a lot of what we’re seeing at some of these town meetings is people who are legitimately afraid, people who are trying to foment fear and people who are just genuinely confused. People who want to understand but it’s difficult to explain because there are so many pieces right now that aren’t really jelling yet.

MAC: You mentioned earlier the idea that the liberals and progressives in the party really want this public plan. You need it to pass the House. Jay Rockefeller, who is also a member of the Senate Finance Committee, a Democrat of West Virginia, put out a statement yesterday reaffirming his support for a strong public plan. Can they build any kind of co-op system that will appease those concerns? Do you have any idea how they could craft a bill that could work in the co-op fashion but yet satisfy the concerns of the more liberal wing of the party that wants this broader government plan?

JR: Perhaps this co-op would create some kind of competition – it would be owned and governed by members rather than run by either local, state, or federal government. So that is at least the idea – this is Kent Conrad’s idea. Could you create it in such a way that would create that competition and keep those insurers honest? In theory, on paper, perhaps. No one has done it yet, to the extent that its been seen and done, and I think that is sort of the trick, that’s what we’re waiting to see. The other argument that has been made is that the liberals will have to go along with whatever comes along because what else are they going to do, where else are they going to go?

MAC: Where can they turn?

JR: Yeah, where can they turn? That has got a lot of liberals really, really angry.

MAC: The devil is always in the details; it’s the overused cliché in this town. But who knows? Maybe if they can draft federal requirements in a co-op arrangement, guarantee that the federal government will be watching to make sure, whether on a state-level or a regional-level, that these co-ops can work. Maybe that, plus the political reality, plus the pressure of the calendar – lets face it, we’ll come back right after Labor Day, we’ve got September, October, November, December – perhaps the calendar will also add a new urgency to passing something that maybe not everybody is going to like. But it could be the best possible option.

Let’s talk a little bit – we talked about the town halls and the pressure those create – lets talk about the ad wars. Millions of dollars being spent by both sides, focusing in on a particular provision, or perhaps just the idea: we need to pass health reform this year. How is all this playing out? Is it changing members’ minds? Is it changing the minds of the public? What’s your gut feeling on that?

JR: I don’t know how much impact the ads are having. Certainly what’s different this time from last time is that the ads this time are more pro-reform. The dynamic that we’re seeing is more Republicans want the President and the Democrats to fail for partisan reasons, plus overlaid over that are people who are very anxious about what this might mean for them. So I think that you’ve got a combination of people who are frightened and people who don’t like the idea of the government getting into health care. So you’ve got a combination of things. But I think that the usual big gun interests groups are either really pro-reform or are not doing anything. So, I think that the ads are having less of an impact than usual. Instead we’re having these fights over these things, like the whole death squads thing – that’s the strangest thing I’ve ever seen.

MAC: Tell me a little more about what you’ve seen in the bill, what the members are talking about, what the public is talking about, and how do you see that (end of life) issue playing out.

JR: This was originally a Republican idea, the idea was to have people be counseled about advance directives — these were living wills, durable powers of attorney. This is the idea of whether or not you would like to be kept alive and have everything done for you if you are incapacitated and unable to express your own wishes. Maybe you would like to be kept alive and have everything done for you, so this is not whether or not you want to be ‘euthanized,’ this may be whether you don’t want to be euthanized. So, if you’re into right to life, this is you chance to say: I want you to do everything for me and I want to be kept alive.

MAC: Well, stay tuned. Thank you so much for being here.