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Marketplace
Fallout: The Financial Crisis

Taxpayers and the health care debate

Kai Ryssdal Jul 22, 2009
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TEXT OF INTERVIEW

Kai Ryssdal: Even though a health care overhaul has sucked most of the oxygen out of Washington, D.C., the past 10 days or so, a lot of people still don’t really understand what the heck is going on.

Beyond the fact that changing an industry that makes up almost 20 percent of the entire economy deserves attention for that reason alone, health care is not one of those things that most people have to deal with day in and day out. So how to make people understand what the problem is and then care about a fix?

David Leonhardt is a columnist for The New York Times. He writes about the economy a lot — health care today.

David, good to talk to you again.

DAVID LEONHARDT: It’s nice to be back on.

Ryssdal: You start your piece this morning with what might be the question about this whole debate. Why nobody can figure out, What’s in it for me? How come that’s so hard?

LEONHARDT: Well, in part, because this is a really complex piece of legislation, and this is an incredibly complex subject. And so I think if you ask people — and pollsters have done this — if you ask people are they in favor of covering the uninsured, they say yes by wide margins. But they look at it, and they look at the staggering sums that get tossed around, and they say to themselves, “Wait a second, why are we doing this?”

Ryssdal: Before we get to the legislation, let me ask you about the health care system itself. Why is it so resistant institutionally to any kind of change?

LEONHARDT: There’s a really funny thing with the health care system. We see the benefits, but we don’t see the costs. So health care is paid for by us, but it’s paid for in ways that we don’t see. It comes out of our paycheck and Medicare taxes. It comes out of our paycheck and insurance premiums. And that pays for the medical system. Then we go to the doctor, and we get some treatment. Or we go to the hospital and we have a procedure. We do see that. And so the services are very tangible, the costs are quite hidden. And as a result, what we want is more and more and more. But that is weighing on our wages, it’s weighing on our federal budget. It’s unsustainable. And yet, when you ask people how do they want to see health care change, they don’t often say we need to make it more efficient.

Ryssdal: There is a political question, many obviously political questions to be asked here. One of which is why nobody in this entire debate seems to be advocating for the people who are paying for it, that is, largely households and patients and taxpayers.

LEONHARDT: I think the White House would argue it is trying to take up that mantle. I don’t think it’s doing it enough. But the answer to your question is that there are very powerful lobbyists and very big industries for whom your waste is their income. And as a result, what you have is every time you propose something that’s going to take some waste out of the system, you have a huge outcry, whether it’s from the doctors, or the hospitals, or the drug makers. And what they do very cleverly is they don’t say, “Hey, don’t take our income away.” What they say is this will harm people. As a result, politically, Congress has not really been willing to stomach saying no to a lot of these parts of this industry.

Ryssdal: With all the groups who have so much invested in this, from pharmaceuticals, to hospitals, to doctors, to patients, how does the president cut through? How does he get a message out there that’s going to stick?

LEONHARDT: He starts with the advantage that he is the president, and the presidency comes with a megaphone unlike any other. But I think that he really needs to persuade people that the system now isn’t working that well. First of all, it’s so expensive that it really is robbing us of money we should otherwise have to pay for things. And when I say we I don’t mean the government, I mean actual families. It is a drag on our income. And the second thing is that, you know, the system really isn’t working as well as it should in terms of making us healthier. And there all these doctors out there who would love to spend time with patients, and help them counsel, and think about ways to be healthier. But the incentives aren’t for that, they’re for more procedures and more tests. So what I think the White House needs to do — for that matter the Democrats or the Republicans in Congress could do this — is they need to persuade people that the system isn’t working now, because it’s too expensive, and it isn’t delivering good enough results. And that we need a form of change that will deliver those two things. And that is broader than just covering the uninsured, but it really is the number one issue here.

Ryssdal: David Leonhardt writes the Economic Scene column for The New York Times. David, thanks a lot.

LEONHARDT: Thanks, Kai.

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