Robert G. Kaiser
Washington Post Associate Editor
Wednesday, July 22, 2009 9:00 PM
Washington Post Associate Editor Robert G. Kaiser was online Wednesday, July 22, at 9 p.m. ET to discuss and analyze President Obama's primetime news conference which begins at 8 p.m. and is expected to cover health-care reform.
Robert G. Kaiser: Good evening. It's July 22; we are six months and two days into the Obama presidency. Once Obama had hoped to be able to sign a health care reform bill before Congress begins its August recess--which isn't going to happen. Polls suggest a modest but tangible decline in public support for this popular president. Polls also show that people are confused and concerned by the debate over health care reform.
This afternoon, thinking about the prospects for this news conference, it seemed to me that this just might be an early and important turning point. Now that it's over I'm not so sure. But I am impressed, once again, by this president's total command of the news conference format, and by his comfort while dealing with the loaded issues surrounding health care. The problem for him is, those issues are so complicated and difficult. He is obviously working very hard now to work out agreements with Congress that will give him the reform he wants, and now he'll have to wait until the football season to try to clinch that deal.
What did you think? I'll look forward to your comments and questions.
Hampton: Obama controls the White House, has a 38+ seat margin in the House, and has the 60 Senate seats needed to overcome any filibuster. How can Republicans be holding up health care reform? Aren't the Democrats in trouble here: if they fail to pass something, it's their fault. If they do pass something and it's a disaster, it's their fault.
Or can they count on the media to blame this on the Republicans?
Robert G. Kaiser: I liked this question up until the last line. But I am going to turn the other cheek.
Yes, the Democrats have enough seats in House and Senate to be held responsible for the fate of health care reform. Because Sen. Kennedy is too ill to come to the floor, however, they do not have 60 seats in the Senate, so could still be stymied by a fillibuster there.
But it's too early to predict a straight party-line contest. House Republicans may indeed be against Obama 100%, as all House Republicans opposed Bill Clinton's gasoline-tax increase in 1993. (Footnote: They predicted with total confidence that the gas tax would scuttle economic recovery; in fact of course Clinton presided over the strongest economy of any modern president.)
I expect some Republicans to support a health care plan that can get through the Senate, if one can.
Saint Paul, Minn.: Hi Robert -- Thanks for taking questions tonight. It seemed like the president displayed a pretty strong command of the facts when talking about health care, but what do you think the average American viewer saw?
Robert G. Kaiser: Thanks for this. I've been doing these chats for many years, and have had to say repeatedly that I never know how ordinary people react to these events. Those of us who have soaked up the details of these complicated issues just live in a different place than the average citizen. In fact we are besotted with our wonkdom sometimes. I can't say if knowing the details makes us good at what we do, but I know it makes us different than busy people who can't indulge their curiosity the way we can, or don't want to try. There's an interesting Pew Center poll out today which says "health care reform is an issue that most Americans find difficult to understand: 63% say it is hard to understand."
Of course that is true.
My hunch: People are impressed, we know this already, by Obama's command of the facts, and by his command of the news conference format. More than that I cannot say tonight.
Aurora, Colo.: Reducing healthcare costs includes reduction in presciption drug cost. Has their been any consideration in prohibting the TV advertising (that is so anoying)? The money saved could reduce presciption drug cost and fund research.
Robert G. Kaiser: I have to say that this question appeals to me personally. I haven't seen any discussion of this HUGE expense, which has only been legal for about 20 years. The Food and Drug Administration permitted drug advertising in mass media after many years of banning it. I don't have the numbers in my head, but I recall that hundreds of millions of dollars are spent on this advertising, and I cannot for the life of me come up with any benefit they produce for health care. I presume some people see the commercial then ask their doctors to prescribe the medicine that was advertised. Is a doctor who does that a good doctor?
Fargo, North Dakota: I think we can pretty well dispense with the current Republican congressmen and senators and just let the Democrats be the govering and the opposition parties - at least there would be two sides willing to govern and engage in some honest negotiations.
Robert G. Kaiser: Very clever. Well, to be fair to Fargo, it is a pretty clever comment. But not fair to all Republicans.
Obama singled out Grassley, Snowe and Enzi, three Republican senators who are deep in negotiations with Max Baucus and other Dems on the Senate Finance Committee. They're obviously not knee-jerk rejectionists.
But the ultimate outcome here may well be determined by the debate among Democrats, you are right about that. And it's an interesting fact that this 111th Congress has a House of Representatives quite unique in modern times (and more like the Houses of my youth 40 years ago). The New Democrats, self-styled, and Blue Dog Democrats are both moderate-to-conservative members who are going to be influential now because they are so numerous.
Comments from the heartland: At my job it's budget time. Our insurer has estimated an increase of 40% in health-care cost. That's an increase of about $2 million. Our insurer is Anthem. We have just under 500 employees.
I don't know the answer but something's got to give. I laugh when people say health care reform will make health care unaffordable. We are on that path right now. Where have these folk been!? All I'm asking the politicians do is to talk about this SERIOUSLY. Enough of the silly talk.
At least Obama talked to us seriously I appreciate that.
Robert G. Kaiser: I appreciate this comment. We have been kidding ourselves for years in this country about health care. When Bill Clinton made it a big issue in 1992, we had what, 15 or 20 million uninsured people? Now we are heading toward 50 million, and the number goes up every day? And the costs have gone through the roof. And we really do spend TWICE as much on health care as the European countries, and get worse results in terms of life expectancy and so on. And the insurance companies, like yours, do indeed keep pushing up the prices every year. Say what you will about the proposals now being debated, the idea that we have a good or an acceptable status quo seems to me to be, well, nuts.
Washington, DC: What I took from the press conference is that Obama is pushing for a paradigm shift in health care delivery and payments. And I don't mean "free market capitalism" vs. "socialism." He made a convincing point that the current way of doing things is not sustainable. We cannot afford, literally, to continue down the same path. A number of the ideas he noted made sense to me. I understand that a lot of the details are still being worked out, but I support his push to fix a broken system. Those who call this socialism or say we have to defend capitalism are stuck in a mindset that is far from the reality Americans are dealing with and is twenty years behind.
Robert G. Kaiser: Thanks for posting.
New Haven, CT: Why do members of the media who ask Obama questions keep insisting that there is going to be rationing, "sacrifice," reductions in "end of life" care, and other scary-sounding limits and caps?
The premise of the question confuses me, since (a) I face this kind of "rationing" from my insurance company now, and (b) I'm still going to have this same insurance company after the health reform bill passes. Why is my insurance going to be even worse after the reform than it is now? Is the government going to make them deny me care? I don't get it -- it doesn't make sense.
Robert G. Kaiser: Nor do I. On the other hand, I think it is true that Americans already have a bigger appetite for health care than the country can pay for, and that the imbalance is in danger of getting steadily worse. The statistics on the percentage of all health-care spending that goes to people in the last months of their lives are staggering. No one wants to talk about a problem that many Europeans have begun to face up to: some procedures late in life are so expensive that it can seem very hard to justify them--at least to some people, including doctors.
New York: Robert, Obama has been criticized for leaving most of the legislative work of health care to Congress, but it sounded like he has been very much involved. Aside from his obvious knowledge of the various plans' details, he often said 'We did this' and 'We did that,' as though he or his staff had been personally involved. Seems like lots has been happening behind the scenes; now he realizes he has to tell the public exactly what he's been up to.
Robert G. Kaiser: And the White House has decided that they have to both get more deeply involved, and convey to the public that this is what they are doing.
Those of us who were here for the Clintons' health care fiasco tend, I think, to give Obama a lot of credit for letting the process begin this year in Congress. But I have always expected the administration to be deeply involved before it was over.
Fairfax County, Virginia: How much of that was a message to the public (wavering supporters, independents, all these groups we've heard about) and how much was directed at the House and Senate (here's what I won't sign)? It almost seemed like long- distance negotiation at times, which is silly when he is talking to them in person all the time.
Robert G. Kaiser: Thanks. I don't think he was negotiating. I sensed he was trying first of all to build momentum for the idea of completing a plan.
Irvine, Calif.: I did not hear the President speak out against lobbyists in clear language.
The lobbyists are spending millions of dollars to beat health care...how come none of the reporters brought it up?
Robert G. Kaiser: Thanks. As the author of a recent book on lobbying -- all right, if you insist, it's called SO DAMN MUCH MONEY -- I am grateful for this question.
Lobbyists are not the ones "spending money." Their clients are spending the money. Their clients include every interested party in America, or so it seems. The health care debate is a fabulous bonanza for Washington lobbyists. We had a terrific story in The Post recently about how many of the former aides of Sen. Baucus, for example, are highly-paid health care lobbyists now.
But lobbying is legal, and should be. It is protected by the First Amendment to the Constitution. It should be exposed, in my opinion--it should be totally transparent. But we can't stop it.
Obama cannot at the moment denounce the lobbying paid for by insurance companies, medical associations, hospitals and pharmaceutical manufacturers, because he has been negotiating with all of them, looking for support for reform. That's a tactic he embraced. When he did so, he relinquished the opportunity to lambaste the same people, at least for now.
Northern Virginia: What do you make of the Gates question, and how the president answered it? I thought he must have been fed up not to end on a rousing push for health reform but he really took his time with a thoughtful answer that I liked. Okay, now that I type that, maybe of all people in American politics this is a guy who knows that you have to take your time and thoughtfully answer a race question. He's good at it.
Robert G. Kaiser: Dissect that answer: Instead of jumping for the easy "It was an outrage," the guy seemed to make a serious effort to see the matter through the eyes of those dumb cops in Cambridge before making clear his own evaluation of the situation. I was impressed by that.
DC: He seemed to focus less on the fact that there are 47 million people without health insurance and more on the idea that we have to contain costs. Is this an attempt to reach out to people with health insurance and try to get them on board with reform? Also, why reject the method most economists and the CBO director support for controlling costs: removing the tax exclusion on health benefits?
Robert G. Kaiser: Thanks. If there are 47 million uncovered Americans, that means there are more than 250 million who are covered, right? The political support is needed from those who have coverage, obviously.
On your second point, I think Obama is really hung up on his campaign promise not to raise taxes on the middle class--a promise which, ultimately, I don't think he'll be able to keep. He referred to it again tonight--he won't approve a financing plan that hits the middle class, which is what taxation of health care benefits would do.
Boston, MA: I applaud the President's efforts at explaining his plans for health reform. As a physician in training, I want to emphasize how crucial it is that we take the politics out of the Medicare payment system through the Independent Medicare Advisory Council. It is important because private insurers base their own payment rates on the Medicare model. Right now, hospitals' business models depend on providing services to sick patients. If we invest in prevention and wellness under the current payment system, hospitals would lose money from reduced admissions, and insurance companies would reap the profits by not having to pay the hospitals. The reimbursement system is really what is driving up the cost of health care, since it doctors and hospitals that promote wellness and prevention lose out.
Robert G. Kaiser: thanks for the interesting comment.
Los Angeles: In 1960, health care was less than 6% of US GNP/GDP. Today it's over 17% with no sign it'll decline anytime soon on its own. Can you think of a more compelling reason for reforming health care than reversing it's adverse cost effects on the US economy? Without reform, what will halt health care costs from continuing to erode the profits of companies providing employee health benefits as well as personal disposable income? By some estimates, health care costs have rose 3-5 five times faster than wages.
Robert G. Kaiser: Thanks for this. I said earlier I thought Americans like to kid themselves about health care. Your figures, accurate I believe, show how foolish that is.
DC: Why is broader entitlement reform not part of the discussion about containing costs?
Robert G. Kaiser: System overload, I think. But the Medicare proposal discussed above and by Obama tonight--letting real experts allocate Medicare dollars, not politicians--would be a significant, if rather narrow, entitlement reform.
washingtonpost.com: Lobbyists Spend Millions to Influence Health Care
Robert G. Kaiser: My good producer Rocci Fisch has provided a link to the Post story on healthcare lobbying that I mentioned earlier. Here it is. Read it and weep. Or whatever.
DC: The GOP and Blue Dogs can criticize the bills that are out there, but what are their ideas for health care reform?
Robert G. Kaiser: In fairness they have advanced a lot of them. I will not be able to try to enumerate them here, but if you look around on the Web you'll find some of them at least.
New York: Regarding lobbyists, Obama said he has been consulting with health care experts, which I took to mean the special interests. I suspect these players have been thinking about reform for many years, with the current system so unsustainable. Obama has implied, rightly so, I believe, that many have serious contributions to make, albeit to preserve their own interests. It would serve no good purpose to criticize them, especially when so many that opposed the Clintons' plan now support reform and have committed to cost-saving measures.
Robert G. Kaiser: thanks for this.
Northern Virginia: I think he did a great job in turning this back to the real issue that something has to change because the system is broken for all of us, not just the uninsured (due to the costs we're all absorbing), and there's no alternative proposal being put forward. It's not a fight between two proposals, but between fixing the problem or literally abdicating and doing nothing. Or at least, he put it that way, with anecdotes, facts, and even some humor, and I agree with him.
My problem is, who listens to TV in mid-July generally, and on a challenging, math-intensive topic in particular? What do you think? Do people who didn't watch it still get the same sense from coverage tomorrow and the next day, or will the coverage twist and turn things just because it needs to make the story shorter and simpler?
Robert G. Kaiser: National debates of this kind have a chemistry all their own. How people come to conclusions, absorb information, share judgments etc etc are all mysteries, I think. Lots of people will have watched; lots more will hear about it from friends and relations. The principal audience was Congress, I think.
To me, the most effective rhetorical tactic Obama embraced tonight was his repeated statements that what we've got just isn't good enough, and will only get worse. People, including some who have posted here tonight, understand that, and a great many agree with it.
Yorktown, Virginia: My husband and I, in our 60s, are happy with our health care coverage. We have long-term care, too.
We don't want government dictating our medical care.
Why can't the government just offer a low-income option for uninsured and let the rest of us keep what we like?
Total health-care reform is not needed, just fix what's broken or missing.
Government-controlled programs end up being badly mismanaged, costly and ineffective.
Robert G. Kaiser: Thanks for the post. I know your views represent those of many others, which doesn't mean they make sense to me. Who is talking about government dictating health care?
Let me offer you another real-life example: Me. My wife and I are on Medicare; it's a better insurance program that we had from The Washington Post for the last 20 years (once, when we were young, The Post plan covered every dime--in the misty past). Medicare is of course a government program. No procedure or drug ever proposed to my wife or me has been challenged or denied by Medicare with the exception of one eye test that Medicare simply doesn't cover, for mysterious reasons. Medicare is not cheap, but it works wonderfully well in my experience. My two daughters, in their 30s, would be thrilled to have it.
Chandler, AZ: Can you explain how you can fit 50 million more Americans into a health care system without more doctors, nurses, other practitioners and facilities, like hospitals? Answer: you can't. So, what happens? Medical care will be rationed. I am in favor of a national system, but one that works. This one doesn't. You must also plan to increase the number of providers. This can be done. But, the bill doesn't do it.
Robert G. Kaiser: I've thought often about this problem, which is obviously a real one. The answer would have to be that the system has to grow, change, adapt.
But your statement that "medical care will be rationed" strikes me as pretty silly. Medical care IS rationed--it goes to those with health insurance first, obviously.
DuPont Circle: Isn't Obama talking about socialized medicine?
Robert G. Kaiser: No. Some people wish he was, of course--supporters of the so-called "single payer" system, who are actually quite numerous, according to polls. But Obama is talking about extending the nutty system we have, largely intact, to everybody.
Columbia Missouri: I wonder how much of this "drama" (e.g., yesterday's meeting with the Blue Dogs) is like the Sotomayor hearings - lots of posturing, and in the end, the majority coalition holds. I have the feeling that nothing so far has been a surprise to the Obama administration. Nor will there be many surprises in the future.
Robert G. Kaiser: We in the news business are extremely partial to surprise as an art form. So I think you are wrong, no doubt in part because I hope you are wrong.
Detroit: The Republicans are constantly talking of the current health care proposal as government take over of health care, when all the bills preserve the current insurance options. Why is it that the administration has not aggressively responded to these false and misleading statements from the Republicans and their mouthpieces?
Robert G. Kaiser: Thanks for this, which, see above, I obviously agree with. Can't speak for the Dems.
Washington, DC: I don't know if it was the turning point. I do think that Obama (as he often does) presented himself as the grownup in the conversation, so he may have reframed the debate a bit. He clearly knows the subject well. He talked about how the proposed plans adopt Republican ideas even if the Republican end up not voting for the final because of politics. He did a fairly decent job of explaining reform not just in terms of what it is getting people, but what it is preventing.
Robert G. Kaiser: thanks for posting.
Arlington, VA: What is confusing is all the pieces written that purport to show this or that in the text of legislation. This piece from Investor's Business Daily says that the current House bill would outlaw individual private coverage. The article quotes parts out of the bill that seem to support the assertion.
Now, I'm not even sure what outlawing individual private coverage means to me, but I know I don't like the way it sounds.
So, my question is how do we get clear answers and understanding of this legislation when it is 1000+ pages long ?
Robert G. Kaiser: Thanks for this. I sympathize. Keep in mind that we are not yet close to a final product: the current House bill will not, I guarantee you, be the version that comes out of this process, if there is such a thing. I expect that your reliable Washington Post will provide useful details and descriptions of the contents of whatever does come forth in the end, and will do so before the end, so to speak--I mean, before final votes are taken.
Massillon , OH: After the press conference ended, I was surprised to hear the NBC commentator say that Obama had promised not to tax for health care anyone who made less than $1,000,000.
I didn't hear that promise, did you? I heard the president refer to the latest House proposal, which taxes those whose income is over one million, but I didn't hear a promise.
Actually, I think a lower threshhold for that tax is more realistic. What do you think?
Robert G. Kaiser: He didn't promise. He said financing the plan with taxes on people who made more than $1 million would be OK with him.
Of course a lower threshold would be more realistic. Taxing millionaires to pay for this doesn't seem like a sensible proposition to me.
Rochester, NY: Isn't it easy for six and seven figure journalists to talk about "sacrifice"? You think any of those reporters have ever had to sacrifice? And please, don't tell me about how Brian Williams used to be a volunteer fireman.
Robert G. Kaiser: Do you know how many thousands of journalists have lost their jobs in America in the last couple of years? Back off, Rochester. We are not all Brian Williamses by a long, long shot.
New York: Regarding Yorktown's comment, this is an example of what Obama's up against. He just had a news conference during which he (again) stated that health reform will not result in the government running health care or being involved in health care decisions, and set forth (again) why the current system is going to bankrupt both business and the country, and yet these people are afraid of losing their health care, government intrusion, and perhaps a Martian invasion to boot. There is no way to reason with people who prefer their own version of reality. I just hope Congress tunes them out.
Robert G. Kaiser: thanks. Of course, we have lots of members of Congress, on left and right, who also prefer their own versions of reality to, uh, reality.
Indianapolis IN: Line from a joke by Chris Rock: "The money is in the disease...there ain't no money in the cure."
That's our health care system.
Robert G. Kaiser: Not bad.
Can you explain how you can fit 50 million more Americans into a health care system without more doctors, nurses, other practitioners and facilities, like hospitals? : Yes, Physicians and hospitals spend over 20% of their time filling out forms for and fighting with private insurers. If we just give Medicare to everyone and eliminate private insurers, that will effectively increase the number of physicians by 20% which is a higher percentage than the numberof uninsured.
Robert G. Kaiser: Hmmm. Interesting idea.
Dupont Circle: To the person asking about rationed health care--remember, too, that the uninsured are actually very high consumers of emergency health care, because they have no access to preventative care. Insuring more people could well lead to less use of the medical system, since more people would be getting preventative care that requires less intervention, less use of facilities, etc., than the emergency care that's required when people don't take care of themselves.
This is not a zero-sum game. Healthier Americans = lower health care costs.
Robert G. Kaiser: Not sure it is so simple, but thanks for posting.
Vacation: There is talk that Congress will remain in session and not take a vacation this August. I'm working extra to pay medical bills; we're very much underinsured. Why shouldn't the Congress critters put forth some effort instead of vacationing as well?
Robert G. Kaiser: "There is talk" where? Not in Congress, I can assure you--as someone who is spending most of his days on Capitol Hill at the moment.
Helena MT: I always thought we would get some kind of health insurance reform as a result of pressure from large businesses who compete globally. Our system of employer-provided health insurance puts every company in the US at a competitive disadvantage with companies in Europe and Japan. I don't know if the business community doesn't understand this or they are so wedded to the idea of no government in the health arena - but having a system that makes our businesses more competitive globally will help our economy.
Robert G. Kaiser: In fact a lot of big businesses support reform and agree with you, and have for a long time. Health care costs may have been the single biggest factor (besides product choice) that drove Chrysler and GM off the cliff.
San Francisco bay area: Hello, one of the main reasons why I voted for Obama was because he supported universal health care without raising taxes on most people, wihout taxing employer paid benefits and with no individual mandate. Yet Obama seems willing to consider all three of these, which he rejected as a candidate, in a health care bill or to reduce deficits.
I think the mandate is a bad idea and 400% subsidies in the House bill, 300% likely in a Senate bill are inadequate. There would be for example no subsidies for a couple having more than about $43,000 - 47,000. My question is how are middle class people affected going to afford health care insurance costing thousands, with no subsidies for most of them, when tens of millions of people are financially struggling as is, saving little or no money?
Robert G. Kaiser: So how do you propose to pay for it all? There's the rub. Obama overpromised in the campaign.
Robert G. Kaiser: Thanks to all for a lively discussion. I don't think we figured out how important this evening may have been, but we never do. See you next time...
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