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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.
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