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Orszag Defends Health Care Overhaul Plan


It's ALL THINGS CONSIDERED from NPR News, I'm Michele Norris.


And I'm Robert Siegel.

As President Obama pushes to overhaul the nation's health care system, doctors, hospitals and others are raising sharp concerns. One worry centers on the president's call for a government run insurance plan to compete with private plans. And we'll hear the concerns of hospitals just ahead. First, we raised a few of these issues today with Peter Orszag, the director of the Office of Management and Budget.

NORRIS: I visited Peter Orszag in his office this afternoon. It's a large ornate office in the Eisenhower Executive Office Building next to the White House. The rooms once served as the temporary office for the Secretary of War. Mr. Orszag is engaged in another kind of conflict now. I asked him how long it could take to provide health coverage for America's uninsured.

Mr. PETER ORSZAG (Director, Office Of Management And Budget): The coverage is likely to ramp up over time. It takes the time to put in place things like a health exchange, which is the way in which people who currently lack insurance would have an opportunity to purchase it. And in terms of the numbers we want to be on the path to eliminating the number of uninsured people in the United States.

NORRIS: So is it realistic to think that 46 million people who are currently without health insurance, will, within 10 years, see health care coverage?

Mr. ORSZAG: It depends. The bulk of them - yes. Depending on the plan that is adopted, it may not be possible to cover everyone. But I think the goal is to get solidly on the path and cover the bulk of them.

NORRIS: Let me ask you about the public plan as envisioned by the White House. How do you make sure that enough doctors and clinics and hospitals and health care providers participate in that plan? And how much muscle is the White House willing to use to make sure that they participate?

Mr. ORSZAG: The goal of a public plan option is to expand choice, introduce more competition, and thereby drive down premium costs for beneficiaries. Beyond that, there are lots of ways of accomplishing those goals through a public plan option and we're seeing a healthy debate about different mechanisms for doing so.

NORRIS: And how much muscle is the White House willing to use to make sure that doctors, and health care providers, hospitals participate in the plan?

Mr. ORSZAG: Well again, I think our goal here is not to force doctors and hospitals to do things that they don't want to do, but rather to create a plan that we think they'll want to participate in. And that beneficiaries will find helpful, also, in terms of having more choices available.

NORRIS: On the other side, I'm curious about how you plan to make sure that patients participate in the plan. My colleague, Robert Siegel, has been spending time examining the health care system in Howard County…

Mr. ORSZAG: Mm-hmm.

NORRIS: …not far outside Washington, D.C., in suburban Maryland. And he found there that people who have the option of participating in a relatively low cost system, $50 a month, choose not to do so for all kinds of reasons. So without a mandate - a word that's floated for all kinds of reasons - how do you make sure that the public participates in the public plan?

Mr. ORSZAG: Well, first, no one is saying the public has - that anyone has to participate in a public plan. There are proposals and the president is open to - to have some form of personal responsibility where you would have to carry insurance, just like you do, you know, when you drive a car. But you could purchase that insurance through a health exchange where the public plan would be one of many options. So that's, I'd say, the leading approach. It's also the case that, for example on retirement saving, one of the things that's been various effective at encouraging participation is to automatically enroll beneficiaries or workers in a 401(k) plan and allow them to opt out.

But I think the leading proposal that's emanating from Capitol Hill right now, is one in which you would be required to participate unless that imposed very significant hardship and there'd be a hardship exemption. But again it's not -you wouldn't be required to participate in a public plan. In fact, if anything the opposite, you would be given a wide array of choices and the public plan is intended just to expand that number of choices.

NORRIS: How do you get the hospitals on board? There are 5,700 plus hospitals in the country. They certainly do not speak with one voice. But a lot of them don't like what they're hearing from the White House. How do you bring them on board?

Mr. ORSZAG: The American Hospital Association was part of the group that came to meet with the president and agreed that we could wring more efficiencies out of the existing health care system. Now, it may well be that, as specific ideas are put on the table, this group or that group have objections that are part of the process. That makes - we're not going to transform a two trillion dollar sector of the economy without some jostling occurring and some objections being raised, or concerns being raised - that's natural.

NORRIS: Let me address one of their principal concerns. They're saying the proposed - and I want to make sure I get the figure right, I believe it is $200 billion in cuts in federal payments to the hospital system - the proposed cuts to the hospital system will have the biggest impact on the people who need the health care system the most. That it will hit the infirmed, the elderly, the poor. Why are they wrong?

Mr. ORSZAG: Well, I think they're wrong. Let's take for example, the so-called disproportionate share hospital payment proposal. Currently under both Medicare and Medicaid, the federal government provides funding to hospitals to help - in large part to help meet the cost of the currently uninsured. Our argument is, as the number of uninsured goes down, the hospitals in a sense would be being double paid, if the number of uninsured people decline significantly and they were still receiving payments to meet the cost of the uninsured. So we scale those back and we also would target those payments more efficiently towards the hospitals that are disproportionately serving the remaining uninsured.

NORRIS: Mr. Orszag, thank you very much.

Mr. ORSZAG: Thank you.

NORRIS: That was Peter Orszag, the White House Budget Director. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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