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No more status quo for health care
Nancy-Ann DeParle, Counselor to the President and Director of the White House Office of Health Reform.
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TEXT OF INTERVIEW
Kai Ryssdal: It's been, I dunno, maybe three days since we've mentioned the health-care debate on this broadcast. House committees have passed their versions of reform and gone home for the summer. The Senate's about to do the same, go home, that is. It's still not clear what might make get done there by the start of the Senate's recess this Friday. Either way, it's going to be a long hot month of home-state politicking over how, or whether, to change the way almost 20 percent of the American economy works.
Nancy-Ann Deparle runs the White House Office of Health Reform. And I asked her what the president's going to be doing while Congress is at home hearing from constituents.
Nancy-Ann Deparle: The president is going to be spending quite a bit of time talking to the American people and listening to them about health care, as he did during the two years he was campaigning for president. And he heard a lot from them about the fact that they don't have security right now, that they feel like insurance companies make all the decisions, that they don't have a lot of leverage.
Ryssdal: What we are hearing as this whole debate progresses is a lot of negative context. I'm wondering how you and the president can make that a more positive message for yourselves.
DEPARLE: That's a message you're hearing from some people who don't want to change the status quo. And we've been at this for 60 years, trying to do something about our health-care system. And it's not surprising, but there are some out there who are defending the status quo. There aren't as many this time as there were before, because I think everyone realizes with premiums doubling about once a decade, with costs out of control, it's really a burden for families, for businesses and for governments.
Ryssdal: A lot of what they're hearing, though, Nancy, is that the reasons it won't work is because it's too expensive, because you're going to be denied care, because care will be rationed, because you won't be able to pick your doctor. Help us understand how people can individually benefit from what the president is proposing.
DEPARLE: Well, first of all for the vast majority of people who already have health insurance, nothing will change for them. They can keep their doctor, they can keep what they have. Except over time, as some of the reforms and changes that will be instituted will go into place, their costs should go down. Now, in addition they'll have a security that they really don't have today under the current system. Insurance companies won't be able to cherry pick people anymore. They won't be able to say, no, you've had a pre-existing condition so you can't get coverage. There will be preventive care without cost-sharing. They won't be able to drop people once they get seriously ill. Some of the saddest stories that you're hearing, that the president hears, are about people who have been dropped from insurance policies once they become seriously ill.
All of those are very tangible benefits that will be there for all of us who are lucky enough to have insurance, as well as for the people who right now don't have coverage, are in the individual or small-group market, and just find that coverage is unaffordable.
Ryssdal: Do you worry at all that perhaps the White House has lost control of the health-care message out there?
DEPARLE: No, I don't at all. I think we have the best messenger around in President Obama.
Ryssdal: If that's the case then, why isn't there more public support for this?
DEPARLE: Well, you know we've just started really. The president has been talking about this for two years. Remember what he is offering is something that just builds on the current employer-based system. And tries to fix the problems that we have, and doesn't fix what isn't broken. Now we're in the sausage-making, Kai. And so people are looking at three committees in the house, and two committees in the Senate, and who's up and who's down, and which members are voting for it, and what are the blue dogs doing. And all of that tends to confuse people a little bit.
Ryssdal: So can we expect in September if things are still up in the air that we're going to see the president more directly involved in negotiations with Congress?
DEPARLE: Well, I don't know what you'll be seeing, but I've seen a lot of that already. He's probably spending two to three hours a day on this right now, and has been for the last several weeks. He's calling some members of Congress on a daily basis. Today he had all the Senate Democrats here. He's all over health care. Whether you see or not, or whether your listeners see it or not, I can guarantee you that's what is happening. He wants to make sure that they keep moving forward in a direction that will lead to health-care reform being enacted this year, that lowers costs, and gets everybody covered. And we're confident that's what is going to happen.
Ryssdal: Nancy Deparle. She's the director of the White House Office of Health Care Reform. Ms. Deparle, thanks very much for your time.
DEPARLE: Thank you.
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To Bud Wilson: OUTSANDING suggestions! I've always said the underlying illness is ignored while they simply treat the symptoms. This is like trying to pay off your credit card by sending the minmum payment every month. The ONLY people receieving benefits are the DRUG companies. IF THEY CURE YOU THEY WILL LOSE MONEY.
Deparle states that those who choose to keep their current plans may do so and that "... over time .... their costs should go down." But in the very next breath she states that under the administration's plan, those insurers would no longer "... be able to cherry pick..." their customers. I.E. they would be forced to take anyone regardless of their current health status. These two ideas are completely incompatible. If insurers are forced to take all, they will pass the added expenses on to all of us. Thus our costs MUST GO UP!
Think of it this way: if you have no car insurance, wreck your 1984 Chevy Malibu, get Alstate to cover your car (ex post facto), and make a claim to fix it, Alstate loses money. Let's say $1,200 total. No big deal you say, right? So that would be like breaking your arm, THEN asking Blue Cross/Blue Shield to cover you. Not even a dent in their profits.
But let's say you bought a 2009 Mercedes and the same scenario played out. Cost to Alstate: maybe up to $50,000 before they even collected a penny from you. That is like the uninsured person going to BC/BS and the day after coverage saying, "oh yeah, I need a triple bypass."
Last year I paid $20,000 as my share of employer-sponsored health insurance, for my family and myself. This year I am covered by Medicare, but I am still paying $18,000 just for my family. And this is the "high deductible" option.
How can this happen? The insurer (the largest in the US) breaks down groups into small units that have no bargaining power. Then, they systematically price high-probability users out of the market. Florida (where my employer is located) tried to implement a small-business consortium, which would then bargain with insurers on behalf of all the employers who joined. You can guess whose lobbyists killed that one.
There is no true marketplace in the insurance market, so long as insurers can slice and dice the groups into manageable (for them) pieces. While I favor a public insurance alternative as a form of enhancing competition, there are other alternatives as well. First should be that any number of people or employers should be able to bargain as a unit. Second should be that any plan should be open to anyone who wants to join it. Openness of plans would force the insurers back into Community Rating, and that all by itself would go a long way toward making insurance affordable for all.
None of this will reduce healthcare costs themselves, however. Only eliminating multiple profit centers, who each quite naturally seeks to maximize its profit by providing more services, will contain healthcare costs. When there is one profit center, and it is reimbursed for total medical care of the individual, the only way to maximize profits will be by using tests efficiently, providing care that actually works, and by working to prevent the need for care through preventative programs.
So, the problem isn't that market principles have failed: they have worked as instituted, to the benefit of those who profit from the healthcare system. Change how they are instituted, and the beneficiaries will be those who receive the care.
It is reported that we spend more on health care than national defense (4.3 times more). It is projected that 20% of GDP will be spent on healthcare by 2017. National surveys suggest that the primary reason that US citizens are uninsured is the high cost of coverage. We pay six times more per capita administering health care than any other civilized nation.
My desired solution would be to get rid of the private health insurance companies. It is rumored that despite trillions of dollars in profits they continue to increase premiums and decrease service. It's possible this rumor isn't true.
I'm for Universal Health Care with a so-called Public Option.
Philip R. Shalen, MD
Dear Kai,
I appreciate you having the interview with the Health Reform Czar. I actually know her quite well: Nancy-Ann (Min) DeParle is my sister. She is very talented and probably has some solutions for the problems that face us, but at this point she is having to misrepresent a lot of things to the American people. I have not been very "political" in my life, but I do know my sister. In our family, the worst thing you could do is lie...so we never got very good at it! I have watched Nancy-Ann on some of the national shows and it is obvious from her mannerisms that she is not telling the entire story. You can even read between the lines in the interview and see that she distances herself from the message she delivers. It saddens me that the White House has put her in this position, but I am glad that she has not become come the type of person that can look you straight in the eye and tell a bare-faced lie (even after a lot of years in DC). She is much more talented than to be used in her present capacity.
Before losing my health care coverage at work i went to all my doctors for checkups. My bloodwork came back ab-normal. Never had a pre-existing condition. After I applied for health care coverage on my own, i soon realized what a headache. Because of my bloodwork being ab-normal the health care provider i was appliying for declined my application. I was in shock! The providers only want SUPER healthy people,I can't believe this is happening. I never thought it would be this difficult to obtain health coverage. The providers do not want to cover anyone that has any abnormality. Basically i don't think anyone is perfect and i am disgusted with Health Care in this country. Never did i think it was going to be like this. I guess when you have always been covered with work you don't realize the struggles others may be going through to obtain health care coverage. I hope something changes.
Kai asks: "If that's the case then, why isn't there more public support for this?"
But there is public support for health insurance reform. Consistently, polls show that a vast majority (around 70 percent) of Americans favor major reforms to the U.S. health care system. They are somewhat skeptical about the details (and who wouldn't be with the backroom politicking in the Senate), but pretty consistent on the need for major reform.
Any "reform" without a strong public option or - heaven forbid - a single-payer system is no reform at all. And I'm sure Americans are most skeptical about putting new drapes on the Titanic that is our health insurance system.
When you asked people to share stories about how health care has effected them, you probably expected horror stories about personal bankruptcy and businesses dropping coverage because it costs too much. There's a lot of those out there, but here's something that no one's talking about:
What "No Health Care Reform" will mean for me, you, and everyone else.
My son is 11 years old, smart, athletic, and popular (not that I'm biased). When he and his classmates graduate from college in 2020, most of those that get jobs in this country will not have health insurance- it will be too expensive. They won't care much until they get sick or have families.
At that point they will look at their classmates, older siblings, and even parents who have moved to other countries. They will see people making as much money as they are who also have access to affordable health care.
For the most part, those with marketable skills will leave, taking their skills and money with them. The US will become the employer of last resort, a hollowed out country with an aging population of retirees, younger workers in low-skill jobs, and a handful of "good" jobs with health care benefits-mostly in government.
That is our future if we don't do something about it.
My husband and I are both self-employed, and thus have individual health insurance. What I would like to see most from the proposed reforms, is a control over the health insurance industry. My premium goes up between 20 and 30% every year, without counting all of the changes in co-pays, deductibles, which doctors are covered, etc… I am obliged to accept all of these changes, as I do not have any choice in insurance (coverage will be denied because of existing conditions). I am stuck with the one I have for another 20 years, until retirement age. It is incredible to think that, without any changes to the industry, our insurance premium will exceed our mortgage!
Thanks for this forum on your program.
You asked what healthcare reform would mean to me?
We are a family of four, I freelance teaching music and my husband is an illustrator. He currently has a corporate job with very high stress levels and would like to work for himself and be able to watch the kids while I work more. One thing holding him back is the prospect of his whole family being without coverage and not being able to afford private insurance.
I come from a country with National healthcare and an option to purchase additional private coverage. The care I've gotten there has been wonderful, prescriptions are cheap and we ARE able to choose our doctors.
National health coverage would mean being able to opt out of the corporate machine without fearing bankruptcy if someone falls ill.
Michelle
Indiana
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