Examining House, Senate health bills

Marketplace Staff Jan 6, 2010

Examining House, Senate health bills

Marketplace Staff Jan 6, 2010


Kai Ryssdal: Another day, another health-care meeting in Washington. The president invited Speaker of the House Nancy Pelosi, and a handful of other top Democrats down to the White House this afternoon. They’re trying to manage the endgame of the reform debate — what elements to pick and choose from whose versions of the bill, the House’s or the Senate’s. David Leonhardt is a columnist for the New York Times. He spent much of 2009 breaking down the economics of health-care reform. David, it’s good to talk to you again.

David Leonhardt: It’s nice to be back.

Ryssdal: Do you have a sense of which of these bills — the House or the Senate version — that the president favors?

Leonhardt: Yes, the president prefers the Senate bill and there are really two reasons for that. One is just political reality. There is almost no margin for error within the Senate. The Democrats have 60 seats, they got 60 votes. In order to get this through a filibuster, they need to keep all 60 of those. And so the Senate version just has more political power. But I think on the substance, the White House also prefers a number or provisions in the Senate bill. Particularly provisions bidding to reduce the growth of health-care costs over time.

Ryssdal: Such as?

Leonhardt: The Senate bill has two things that the White House is quite high on that the House bill does not. One is an independent commission to take some of these decisions about Medicare reimbursement out of the political process. So this board would make recommendations, rather than having Congress do it, which often ends up — you’ll be shocked to hear this — doing it based on things like what a certain medical device maker in a certain district may want. And this board would try to make them based on the evidence of what’s best, rather than lobbying. The second is a tax on the costliest health-insurance plan. It’s an idea health economists really like.

Ryssdal: These are the Cadillac plans, right?

Leonhardt: Yeah, these are the so-called Cadillac plans. And these are plans that tend to have very low co-payments, and as a result people often get a lot of care that it seems doesn’t actually improve health.

Ryssdal: So will there be something, do you think, in the House bill that will be in the eventual joint version?

Leonhardt: I think there will. I think the House bill, broadly, is better on coverage. And I actually think the White House prefers a lot of the House provisions on coverage. So the House bill makes it easier for people to afford health insurance if they don’t now have it, and their family income is below $66,000 — that’s for a family of four. The House also has more serious penalties for employers that don’t offer health insurance, which makes it harder for them to game the system.

Ryssdal: I was about to ask you what you think the single biggest sticking point is, but it sort of sounds like you think it might be the cost factor — whether or not we can actually, as the president says, bend that cost curve?

Leonhardt: Yeah. Abortion and the public option are big sticking points. But it seems the House is just going to mostly lose on those. So if we’re talking about sticking points that are more in play, I think the two things really are: what do the bills do to reduce costs on the long term, and the Senate does more on that, and what do the bills do to expand insurance, and the House does more on that. The problem is that if you take the House provisions on covering people, you need to spend more money to do that. And finding more money is one of the most difficult things in congressional negotiations.

Ryssdal: It seems amazing to say this, but it seems — at least as far as the White House is concerned — they want something by the State of the Union, beginning of next month. Is that really going to happen?

Leonhardt: They want something by the State of the Union. I don’t know whether it will happen or not. I think they’ll probably try to push the State of the Union later to get it. They may or may not get it. Let’s keep in mind though, the White House has already blown through a number of deadlines here, right? Originally they wanted it by August, and then they wanted it by the end of the year, and now they want it by the State of the Union. We’ve been talking about health-care reform in this country for the better part of 60 years, on and off. Truman tried it and failed. Kennedy tried it and failed. LBJ tried it and got Medicare. At this point, whether or not we get it in time for the president to brag about during the State of the Union I don’t think is the important thing. We are on the cusp of an enormous bill here. And whether it gets signed on January 31st or February 28th won’t matter in 10 or 20 years.

Ryssdal: David Leonhardt, he writes an economics column for The New York Times. David, thanks a lot.

Leonhardt: Thanks Kai.

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