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Kai Ryssdal: The way I figure it we’ve got about a week left until the news cycle gets back to where it was just before Christmas. That is, buried deep in the details of the health care bill. Congress is back in session next Tuesday, at which point the end game begins. Negotiations between the House and Senate over what the final bill is going to look like.
Marketplace’s Nancy Marshall Genzer is with us from Washington to about where we’ve been on health care this year and where we’re going. Good to talk to you.
Nancy Marshall Genzer: Good to talk to you, Kai.
Ryssdal: It is kind of amazing that we are where we are with this bill, given everything that has happened in the past, I don’t know, eight, 10, 12 months on this thing, isn’t it?
Marshall Genzer: It certainly is, Kai. Remember those public protests at the town hall meetings back in August? Some members of Congress couldn’t even be heard above the shouting. And just to refresh your memory, Kai, here is some tape of a town hall meeting that Congressman Steve Kagen held in August. He’s a Democrat from Wisconsin. You can barely hear him above the din.
[Shouts at town hall meeting held by Rep. Kagen.]
Ryssdal: So that was him somewhere talking before getting shouted down. I guess listeners have to take our word for it. Let me ask you, Nancy, about some of the criticisms of this bill. Maybe the first one of which is it’s going to be painful before we see any benefits. It’s going to take a while for some of the good to kick in, isn’t it?
Marshall Genzer: It is, although there are some parts of it that kick in right away. Both the House and Senate bills would bar your insurance company, Kai, from putting annual or lifetime limits on coverage and new policies that limit how much they would pay out during your lifetime or during a year. And insurers wouldn’t be able to drop you, except in cases of fraud, and that’s supposed to take effect soon. They don’t exactly say when.
Ryssdal: This is, any way you look at it, an expensive proposition, although it is supposed to reduce the deficit, the Congressional Budget Office says. How is Congress going to pay for this? I mean, what are the differences between the House and the Senate versions on that?
Marshall Genzer: Well, the House would impose a surtax on individuals making more than half a million dollars a year or couples making more than $1 million a year. The Senate would impose a tax on what are called “Cadillac health insurance plans,” and those are the very comprehensive insurance plans, with very high premiums.
The Senate would also increase the Medicare payroll tax. Both bills would cut Medicare by about half a trillion dollars. And the Senate bill sets up a commission that would oversee Medicare payments to try to keep costs down. Now, a Harvard health care economist named Amitabh Chandra told me that he thinks that is a great idea, but he’s worried that even if the Medicare commission is included in the final bill, it won’t have any teeth.
Amitabh Chandra: As long as it can be watered down or if it’s advisory, this commission is going to accomplish nothing. It has to be binding. It has to be like the equivalent of the board of governors of the Federal Reserve.
Ryssdal: Well, Ben Bernanke being Time Magazine’s “Man of the Year” aside, how might that work with the Medicare commission?
Marshall Genzer: It’s unclear at this point, Kai. There could be a cost containment as far as doctor’s fees and hospital fees, which would annoy their lobbies on Capitol Hill. The AARP, which is the lobby for seniors, would not be too happy. And I talked to AARP lobbyist John Rother about this and he says, Hey, don’t pick on Medicare.
John Rother: And you can’t really lower costs in Medicare without taking into account a system-wide development in the way health care’s paid for and how much things cost.
Ryssdal: That’s the nub of it right there, that what we have is a health insurance reform bill in this package, not necessarily a health care reform bill, right?
Marshall Genzer: Exactly, Kai. The criticism is that neither bill does anything about the actual cost of health care; they just shift the burden of who pays for it under that so-called “public option.” The government-run insurance plan was supposed to help lower costs by competing with private insurers, but it probably won’t be in the final bill.
Ryssdal: On that final bill — quickly Nancy, before I let you go — the White House wants something by the State of the Union, right, end of January, plus or minus?
Marshall Genzer: End of January, early February. At this point, Kai, it looks like they might be able to do that.
Ryssdal: Nancy Marshall Genzer on the health care debate, in Washington for us. Thanks, Nancy.
Marshall Genzer: You’re welcome.
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