Rep. Henry Waxman on the rebirth of the public option

The World

When President Obama made overhauling the U.S. health care system his top domestic priority, he supported the so-called public option to help cover some of the nation’s uninsured. As the debate lumbered forward over the summer, many Democrats said they would oppose any health care reform bill without a robust public option. But when Sen. Max Baucus (D-Mont.) drafted a health care bill in the influential Senate Finance Committee, there was no public option included, in part because Republicans stood united against a government-run health insurarnce agency, calling it the first step toward socialized medicine. As far as the Senate was concerned, the public option was dead. But in the House of Representatives, the public option is back in the center of the debate.

Rep. Henry Waxman (D-Calif.) has pushed for health care reform legislation to include a public option from early on in the debate. Even though it didn’t make it into the Senate Finance committee’s health care bill, the public option is now gaining steam. A new Washington Post-ABC News poll says 57% of Americans actually support it.

JOHN HOCKENBERRY: Let’s just start with the question that was posed to you by the CEO of one of the biggest urban hospitals in the United States ? Columbia Presbyterian hospital here in New York City. Dr. Herbert Pardes said what you need to fight for in the House of Representatives on health care reform is coverage for the maximum number of people, particularly to assist hospitals like his. Is the public option that you endorse the only way to do that?

REP. WAXMAN: It’s not the only way to do that, but Dr. Pardes is absolutely right, the urban hospitals and even rural ones ? when people come into emergency rooms and they don’t have insurance ? these hospitals don’t get paid. And what we need is to give people insurance and help them get it so that they don’t have to go to the emergency room; they can avoid getting that sick and get medical care through their ordinary doctors and providers and have the insurance pay for it.

JOHN HOCKENBERRY: The Speaker of the House reportedly is leaning towards using a very liberal version of the public option in the bill. That she would endorse using Medicare rates to reimburse providers which would reduce costs. This is believed to be a non-starter in the Senate. Are you on board with Speaker Pelosi’s idea here?

REP. WAXMAN: I do support the idea of a robust public option. It’s an option. People don’t have to choose it but they may have it available to them when they go to this exchange and then choose between competing insurance plans, most of which will be private, but there will be one public option. The idea of a public option is to, first of all, provide competition, because in some parts of the country there are only one or two insurance companies. Secondly, it’s one that’s transparent and it will compete with these private insurance plans based on Medicare rates. It will pay the doctors and the hospitals and other providers a decent amount of money. And it will drive the private insurer plans to start competing by lowering their prices.

CELESTE HEADLEE for The Takeaway: Congressman, when I was talking about insurance with one of my neighbors, in New Jersey, they said look, we don’t need a public option made law. There’s already a public option. If there’s something wrong with you, you go to the hospital they have to treat you. That’s our public option.

REP. WAXMAN: Well, that’s not a very satisfying public option because people have to go to the emergency room, wait around; they’re crowded. If there were any kind of real emergency a flu epidemic, or God forbid, a terrorist attack, our emergency rooms are overwhelmed already. They wouldn’t be able to handle it. We need to have access to health care before emergency rooms, and not have to use emergency rooms. That’s not insurance coverage, that’s just they go in, they’ll be put out as fast as they can because those emergency rooms can’t cope with them.

JOHN HOCKENBERRY: Now, Congressman Henry Waxman, you’re a democrat from California’s 30th district. You’re widely viewed as one of the progressives in the House of Representatives. But people who are uninsured and people who are really concerned about the health care reform debate, who I’ve spoken with, were very, very upset about what happened in the Senate. And Chuck Schumer, also believed to be a progressive Senator from New York, decided that instead of covering everybody, his compromise solution was to offer exemptions from the mandate for insurance that Barack Obama, the President, has endorsed and to say we’re not going to force you to pay for this insurance, we’re going to give you an exemption because we’re worried about your ability to pay. And a lot of people look at that like oh, great. Exemptions are a way to basically not insure people and say you are doing them a favor. Is that your plan here?

REP. WAXMAN: I think the idea here is to have everybody insured or at least as many as possible and if they can’t afford it we will give them subsidies. People who weren’t able to get insurance because the insurance companies discriminated on previous medical conditions or other underwriting, that will be prevented. Then, we want everybody insured because it broadens the base of people who are covered. The idea is to spread the risk over the largest number of people so that those who need health care services at any particular time will be paid for, but everybody will have insurance to protect them should they need it.

JOHN HOCKENBERRY: Were you at that meeting at the White House months and months ago, where members of health care providers and insurance companies and even doctors showed up and announced this agreement on cost cutting over the next ten years?

REP. WAXMAN: No, I wasn’t at that meeting. I was at other meetings with the health care providers. There wasn’t one meeting with all of these different doctors and hospitals ?

JOHN HOCKENBERRY: Well, I recall that, because it seemed at that time that there was some sort of arrangement made whereby the doctors and hospital providers were guaranteed a certain price level. And now in the House of Representatives, talking about reimbursing at the Medicare level, suddenly the doctors and the insurance companies are saying, hey, you’ve changed the goal posts here. You’ve changed the deal. We’re already in this for $80 billion. You’re going to make it a lot more than that. How do you get the doctors and the insurance companies on board here?

REP. WAXMAN: That’s not a correct statement that you made. The health care providers wanted people covered and the drug companies made a deal with the administration and the Senate, not with the House. And we don’t feel bound by that agreement. We feel that they ought to be paying a lot more by providing pharmaceuticals to the insured people at a much lower price because the drug companies have gotten a windfall and that money ought to go to close the doughnut hole for seniors in the Medicare program. But the hospital deal is part of the agreement. There was no doctor agreement except that we are going to make sure the doctors had a sustained Medicare reimbursement and health care providers generally want their ? they want people covered. They want to make sure that people get the care they need. That’s their goal and it is our goal as well.

JOHN HOCKENBERRY: How many people do you think will not be insured in your best case scenario if a bill gets out of the House and Senate? How many people will be uninsured? The Senate bill suggests that it will be, like, 17 million who will be uninsured.

REP. WAXMAN: We are looking at a lot fewer, but neither the House nor the Senate have bills that will cover undocumented aliens and there are millions of people here under those circumstances. They will not be covered by this insurance plan. They will get no subsidies of government help for them to buy insurance. And for the most part, we want everybody else covered. We want to require people to get coverage because if people go without coverage then when they need the medical assistance, everybody else pays for it. Well, everybody ought to share in the responsibility for the health care system.

JOHN HOCKENBERRY: Do you see the Senate and the House coming to some agreement on a real public option as part of this health reform package as opposed to the House backing down and the Baucus bill being really the template?

REP. WAXMAN: I do see a public option emerging in the final bill. It’s not just the House that wants it. I think a majority of the Senate wants a public option as well. And, as you indicated earlier in the program, a majority of the American people want it.

JOHN HOCKENBERRY: Well, then this is the curious thing to me. You’re in a safe district, the 30th in California. It seems to me the debate is being driven by the so called Blue Dogs who are in vulnerable districts and people like Olympia Snowe, who are moderate Republicans. How come it is the vulnerable, worried, hold-on-to-their-seats lawmakers that are driving this debate instead of the secure powerbrokers like yourself?

REP. WAXMAN: Well, I think that is an oversimplification. People do have different views on what health care ought to encompass. But a lot of people who are more conservative see the public option as a way to drive down costs. We cannot afford the unsustainable costs in our health care system. We have to accomplish holding down costs, especially in the future, the growth of health care, at the same time we’re asking people to get insurance to cover it.

JOHN HOCKENBERRY: Is it exciting to finally be doing this? Obviously you were involved in the Clintons’ effort to reform health care but this seems to be much farther along in the process.

REP. WAXMAN: I’m very excited. We wouldn’t have this opportunity if it weren’t for President Obama insisting that the Congress act. It’s something that people have been wanting to do in this country since Harry Truman’s days and maybe even before that. It’s inexcusable that our country, the richest in the world, has a health care system that costs us more than any other, and that we have 35 million people without any insurance, millions with under-insurance, and a system where hospitals like Dr. Pardes’ hospital have to worry whether they are going to have enough money to do specialty care and teach new physicians.

JOHN HOCKENBERRY: Well, Senator Henry Waxman, thanks so much for being with us.

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