TEXT OF INTERVIEW
KAI RYSSDAL: We're taking some time this week and next to recap the year gone by in the American economy.
2010 brought the prospect of big change to the way $1 of every $7 is spent in this country. Health care, of course. The reform bill was signed into law last March. The year ended, though, with some questions about its future after a federal judge in Virginia declared part of the law unconstitutional. That would be the individual mandate, the requirement that everybody has to buy health insurance.
For more we've got Gregory Warner with us from our health desk in Philadelphia. Hey Gregory.
GREGORY WARNER: Hello, Kai.
RYSSDAL: So can we say now, given this court case in Virginia, that health care is off track?
WARNER: Politically, it depends on who you talk to. And legally, we're really in a wait-and-see mode. We're waiting for the Supreme Court. Economically speaking, though, it's not totally clear how much difference this individual mandate really makes. The reason I say that is because in this version of the mandate, the penalties for breaking the law -- for not buying insurance -- are not that high. It's really a more politically-compromised mandate. Not exactly toothless, but a lot of those teeth got extracted in that long political slog toward reform.
Here's Mark Pauly's take. He's an economist at the University of Pennsylvania, who helped design a tougher version of the mandate for the first Bush administration.
MARK PAULY: It really isn't likely to change behavior all that much. So it's had a lot more affect on law professors, then it's likely to have on actual buyers of insurance.
RYSSDAL: Well then help me figure out what health care reform looks like without the mandate.
WARNER: Well remember, Kai, the mandate was actually a Republican idea back in the day, an alternative to universal health care. The thought was better to make people buy insurance than give it to them in taxes. Compared to how insurance works now, which is this escalating cycle of more and more people losing coverage every year, most people say that some way of getting more people in the system has to happen to get premiums cheaper. That isn't necessarily a mandate though. You can have an opt-out system, where if you don't buy health insurance now, you can't buy it for five years. You could have an extremely strong employer mandate, or you could bring back single-payer, universal health care and see how far you get in Washington.
RYSSDAL: There is something that I think hasn't been talked about in a long time in this whole debate, which is the place that health reform started. The thing that we were going to do with this reform act, and that is get health care costs under control. Is anything we're talking about going to do that?
WARNER: No. And the public debate is all about this political question. Privately, though, I've been having this experience doing reporting the past few months where I'll call one of my sources -- maybe in academia or the think-tank world -- only to be told by that person, 'You know, Gregory, hey this is the last time we'll be able to talk. And I'll say, 'Why?' And they say, 'Because I'm going to work for the administration.' And then this happens so often I started to wonder, where are they all going?It turns out many of them are going to these various committees, which the idea is will do something about health care costs.
RYSSDAL: Yeah, these are the committees, the pilot programs, that the reform law set up, right?
WARNER: Exactly. And some of these committees are about incentivizing insurance companies to provide what is called high-value care, or more prevention, fewer knee replacements. Others are about making hospitals more efficient using electronic records. And then there's this thing called The Center for Medicare and Medicaid Innovation, which is creating rules for the accountable care organizations. I won't say much about that because we're going to hear a whole lot about them in 2011, but basically it's a new model for paying doctors and hospitals.
RYSSDAL: Speaking of 2011, there are some things happening in the new year with this health care reform law, yeah?
WARNER: Sure, 2011 we have seniors in the Medicare doughnut hole getting half-off brand drugs. Small businesses get grants to help workers lose weight. Wealthy Americans pay more for Medicare. And something called nutritional labeling, where chain restaurants have to post their calorie counts of everything on the menu. Everything except for the daily special, which means we might expect Americans to forsake their double cheeseburger and choose instead their daily special cheese-soaked, chocolate shake, rib and fries because Kai, what you don't know can't kill you.
RYSSDAL: And it just tastes so much better. Gregory Warner at the Marketplace health desk at WHYY in Philadelphia. Gregory, thanks a lot.
WARNER: Thanks, Kai.