Thursday, February 25, 2010; 12:34 PM
OBAMA: OK. Max is going to go, and then I'll go to you, Rob.
Max, do you want to address this issue of how we can allow people to buy into large groups, how the Senate bill accomplishes it. And I don't know if you want to remark on what John just said?
BAUCUS: Yes, absolutely. I'd first like to say something that strikes me just in spades, frankly. We all have studied this issue a lot, health care reform. We basically know what the problems are, all of us. We basically know that the current system is unsustainable. We are actually quite close -- there's not a lot of difference -- close in the sense, without being corny or dramatic about this, but the American people want us to do something that's basically reasonable, doesn't have to be one congressman, one senator's provision, but basically reasonable.
It is -- we -- we are on the verge and the cusp, with not too much effort, to try to bridge a lot of gaps here, because the gaps, in my judgment, are not that great.
Let's take the list, for example, that Lamar mentioned. As you said, Mr. President, we are basically, including most of those provisions, if not all, in our joint legislation -- selling insurance across state lines, for example; we allow for that, not exactly in the way that some would, but, sure, with compacts. And once state exchanges are up, people will be able to buy and sell insurance across state lines and achieve that competition.
In addition, you mentioned lawsuits. Secretary Sebelius is working to try and find ways to encourage states to settle, resolve issues before they become big, bad lawsuits.
After that, Lamar says we should find ways for states to be able to lower their costs. So we do that. We let states opt out. They can do what they want to do. And Senator Wyden also has a proposal. Senator Cantwell has a proposal. We give a lot of flexibility in that regard.
Expand HSAs. That's buy-in. There's nothing wrong with HSAs, but we also have to have products for poorer people, lower-income people. HSAs work pretty well if you middle or high income. Pre- existing conditions -- clearly, we all agree on that. We have those provisions in our bill.
Back to small business, we're not that far apart. Some suggest solicitation of health plans, where small-business people can band together in an association, pool, and get better insurance. That's -- that's fine.
What we provide for in our legislation is something similar. It's called the SHOP Act -- (inaudible), bipartisan, that worked on this. And basically it allows -- sets up a small-business arrangement and exchanges. Small business participates in their own exchange and gets the advantage of all the pooling. And then they can do what fellow employees do; they can shop and compare to get the best deal. And I would guess that most small businessmen would like to do that.
I might add that we're also providing tax incentives, tax credits for businesses, small business that want to purchase health insurance for its employees. And it's pretty good. It's a 35 percent tax credit the first couple of years. Then, once the exchange is up, it's 50 percent.
So the main point is, we're not really that far apart. We're trying to find ways for small business to pool, small business to take advantage of competition, to shop and compare, and also some tax provisions that enable it to encourage businesses to get health insurance.
So I might say, too, that, if you look at all the provisions that Steny outlined, and (inaudible), we agree. We agree on prevention. There are major prevention provisions in our legislation, as -- as Senator Coburn mentioned.
BAUCUS: We also agree on trying to change the way we reimburse docs. I think the biggest game-changer, here, frankly is how we reimburse our doctors, based more on quality, rather than quantity. I know -- I know Tom Coburn really agrees with that, as a doctor. Most doctors do.
And it's another example we really are close. And I think that once we keep pushing on those areas that we're close, it's going to make a difference.
The exchanges, as you mentioned, Mr. President, it's a Republican idea. It works. What I like about exchanges, it's like Orbitz. It's like Expedia. You know, you go to Orbitz or Expedia to buy an airline ticket, you compare, get the best price. That's basically what this is. It's an exchange. You go to an exchange and you shop around and you get your best price. That's going to help, in my judgment.
I also think that we should -- the hospitals should publish the cost of their basic procedures, whether it's appendectomy or colonoscopy or what not, to enable consumers to shop around where is the best price. We all know that there's a wide disparity in what hospitals charge for the same procedures. You know, I think the disinfectant of sunshine helps. It helps consumers. It helps our people.
And fraud and waste, we talked about that. We have major provisions in our bill to (inaudible) fraud and waste. Mr. President, I compliment you because in your proposal, you go even farther.
(UNKNOWN): We took some additional ideas from folks like Congressman (inaudible).
BAUCUS: They're -- they're great ideas and address, you know, unnecessary readmission rates from hospitals, et cetera.
The main point is we basically agree. There's not a lot of difference here, and I'd just like us to kind of just, you know, it's an opportunity for us to work out some (inaudible).