Video: Sebelius: Health care overhaul ‘a work in progress’

  1. Transcript of: Sebelius: Health care overhaul ‘a work in progress’

    MR. GREGORY: I thought we'd frame our discussion by going through what the president says must be included in healthcare reform if he's going to accept it. Now, this is what you said on that topic back in June on PBS : "It really has to lower costs , cover Americans, drive quality and be paid for." So let's go through that.


    MR. GREGORY: And I want to start with that first principle of lowering costs . Most people may not know how expensive health care really is; $2.5 trillion per year, 16 percent of our economy. Here was the president on that score on Thursday.

    PRES. OBAMA: Even as we rescue this economy from this crisis, I believe we have to rebuild an even better economy than we had before. That means finally controlling the healthcare costs that are driving this nation into debt.

    MR. GREGORY: Controlling those healthcare costs . But on that very day, just hours before the president spoke, there was this from Capitol Hill from the nonpartisan director of the Congressional Budget Office . He's kind of the umpire for these plans. He says this:" Congress ' chief budget scorekeeper cast a new cloud over Democratic efforts to overhaul the nation's healthcare system , telling lawmakers Thursday that the main proposals being considered would fail to contain costs -- one of the primary goals -- and could actually worsen the problem of rapidly escalating medical spending. `We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount,' Douglas Elmendorf , director of the CBO , told the Senate Budget Committee . `On the contrary, the legislation significantly expands the federal responsibility for healthcare costs .'" So if lowering costs is the rationale, the president can't support what's going through Congress right now, can he?

    SEC'Y SEBELIUS: Well, as you know, David , first of all, this is a work in progress . The good news is the House and Senate are actively working and share the president's goal that overall costs have to come down for everyone. So they have an initial report on one of the initial bills that says in the long term this doesn't bend the cost curve enough. The president has a proposal that he hopes will be incorporated where MedPAC , an independent group of providers, will help to lower the Medicare costs long-term. But he's very committed to this, and I think it will be part of the package going forward. About 16 of the recommendations are already in the legislation in the House and Senate , and we want to include some more.

    MR. GREGORY: But wait, but this is a huge blow, it seems like, on the face of it. If the priority is lowering costs , you've got the person who's in charge with a nonpartisan way of looking at these saying it's not going to contain costs . That was goal number one. It doesn't appear to be getting achieved through this.

    SEC'Y SEBELIUS: Well, I think, I think, first of all, it's clear that this will bring costs down to a degree. It won't do enough over time, and I think we'll incorporate that. But I think you got to start from ground zero , which is the status quo is absolutely unsustainable. We have costs ratcheting up at this alarming rate, 16 percent of our GDP ; every business, every family, every organization, every government is paying more and getting less. We live sick or die younger and spend more than any nation.

    MR. GREGORY: Well, but that's fine. But you want to spend a trillion dollars to bring costs down, and that the CBO is saying you won't bring costs down. And all you're saying in response to that is, "Well, no, they actually will"? I don't understand the disconnect here.

    SEC'Y SEBELIUS: No, I think, I think that more will be done, the House and Senate are committed to working with the president with that.

    MR. GREGORY: All right. Well, what is the president committed to doing in terms of saying to both the House and the Senate leaders working on this, "You've got to control costs "? Because it seems to me this was a wake-up call, was it not?

    SEC'Y SEBELIUS: Well, he's been doing that all along. He's very engaged and involved. And I think the Senate and the House members want to do this. This is a, a sort of initial scoring, if you will. The House is still...

    MR. GREGORY: Was it a wake-up call to the president?

    SEC'Y SEBELIUS: Well, I think, I think we know now that more has to be done. As I say, he's got a proposal on the table that he hopes Congress will take a serious look at.

    What I think is, is somewhat disingenuous, though, is that the last real health reform put on the table, the incorporation of Medicare Part B , wasn't paid for at all and is part of the cost driver . We have some initiatives that are under way that we know we need to reform. There's no scoring at this point, no cost savings at all for the prevention and wellness investments that we know will pay off long-term. So we'll continue to work on this and...

    MR. GREGORY: So this isn't ready yet?


    MR. GREGORY: In other words, this is not ready, this does not meet the president's goals yet?

    SEC'Y SEBELIUS: Well, we don't have the bill even out of the Senate Finance Committee , that's still under way, the bipartisan effort that's going on. The House is still on markup. This is a work in progress . And I think the House leaders and Senate leaders share the president's goal that costs will come down.

    MR. GREGORY: Right. So the message here, the bottom line from the president to leaders working on this in the Congress is, "You had better lower costs before this gets to me."

    SEC'Y SEBELIUS: Well, it isn't that the president is scolding anyone.

    MR. GREGORY: Right.

    SEC'Y SEBELIUS: He's congratulating them for the work and saying we...

    MR. GREGORY: But it's his goal.

    SEC'Y SEBELIUS: Well, we need to keep...

    MR. GREGORY: But, Madam Secretary , it's his goal.

    SEC'Y SEBELIUS: I understand.

    MR. GREGORY: He said it's got to lower costs ...


    MR. GREGORY: ...and you're not contradicting the idea that the CBO says it's not.

    SEC'Y SEBELIUS: Well, we have gone, I think, a long way to, again, incorporating what the CBO director said needed to be in the bill. Many of those elements, the vast majority are already in the bill. And I think we need to take another step in terms of -- and it's probably the, the MedPAC idea, making sure that an independent group a step removed from Congress is able to continue to watch that cost curve and help us drive quality. I mean, that's what we're really trying to do.

    MR. GREGORY: Right. And we'll get to that in a minute.

    SEC'Y SEBELIUS: Out of the...

    MR. GREGORY: But in other words, an independent group watches costs after it's been passed...

    SEC'Y SEBELIUS: No, no, no.

    MR. GREGORY: try to contain them?

    SEC'Y SEBELIUS: It, it's part of the changes that we need so that we go ahead and implement a number of the recommendations, the cost-cutting recommendations that have been made year after year but Congress has failed to implement them.

updated 7/19/2009 10:55:13 PM ET 2009-07-20T02:55:13

Administration officials defended President Barack Obama's broad health care proposals on Sunday and urged a skeptical public not to judge the Democrats' overhaul until Congress writes a final version.

Facing independent budget predictions that contradict the White House's rhetoric, officials sought to refute Republican objections to massive changes in how Americans receive health care. They emphasized that Congress has not yet settled on an outline for health care legislation and reiterated Obama's desire for a bipartisan approach.

"This is a work in progress," Health and Human Services Secretary Kathleen Sebelius said, trying to calm nervous lawmakers whose re-elections could hinge on the legislation. "More will be done. The House and the Senate are committed to working with the president to get this done."

The United States is the only developed nation that does not have a comprehensive national health care plan for all its citizens, and Obama campaigned on a promise to offer affordable health care to all Americans. However, the recession and a deepening budget deficit have made it difficult to win support for costly new programs.

"The House has one approach. We put forward a different approach. The Senate is considering yet more options," White House budget director Peter Orszag said. "The key thing is we need to get there in a way that is deficit neutral."

Major challenge
Paying for the health care plan remains the major challenge, underscored by a nonpartisan Congressional Budget Office report that emerging House legislation would increase deficits by $239 billion over a decade.

"I don't follow why we've got to spend another $1.5 trillion to $2 trillion, most people estimate, on top of the $2.5 trillion we're already spending in this country and yet still have, under one estimate, at least 33 million people without health insurance," said Sen. Orrin Hatch, R-Utah. "I mean, these are things that are real serious problems."

Democrats insisted the budget analysis ignores savings and Obama's pledge not to add red ink to the federal ledger.

"It's clear that they're working with different assumptions than the White House and the Congress is," said Rep. Charlie Rangel, D-N.Y., the chairman of the House tax-writing committee.

Even so, the politics of adding to the deficit or raising taxes is tricky. Obama officials have refused to rule out a tax on the wealthiest Americans and oppose a tax on employer-provided health care benefits. They also want the Senate and the House to pass separate bills before an August recess, leaving reconciliation of their differences for September or later. White House officials grudgingly accept that such a timetable — which has shifted from being a demand to more of a goal — might force them into policy compromises.

"What we have said is this bill has to be deficit neutral," said Orszag, a former top budget chief for Congress. "We think there are better ways of obtaining additional revenue, and we have to let this legislative process play out."

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But it won't come cheap. That means increased taxes and political opposition.

Republicans paint Obama's proposals as a massive tax that would leave small businesses wounded, employers shifting away from private plans toward a government-based system, and workers without coverage. Some GOP members have also cautioned that the legislation could fund abortions, a fear crucial to the social conservatives who hold sway inside the Republican Party and a proposition Orszag would not rule out.

A key Republican, however, warned his party not to scuttle health care legislation over abortion.

"No matter what your views are on abortion, you shouldn't ask people to use their tax dollars if they think that abortion is taking a life," said Sen. Judd Gregg, R-N.H. "I would hate to see the health care debate go down over that issue. ... Hopefully we won't get ourselves wrapped around the wheel of abortion in this debate."

Obama's advisers have argued that overhauling health care is vital to the nation's long-term economic recovery.

About 50 million of America's 300 million people are without health insurance. The government provides coverage for the poor and elderly, but most Americans rely on private insurance, usually received through their employers. However, not all employers provide insurance and not everyone can afford to buy it. With unemployment rising, many Americans are losing their health insurance when they lose their jobs.

The insurance industry, which fought President Bill Clinton's health care effort in 1993 and 1994, is beginning to run its first TV ads of this year's health care fight. The multimillion-dollar campaign, being aired nationally on cable stations, restates the industry's support for an overhaul that provides universal coverage and its offer to cover people who are already sick. The ad campaign, which starts Monday, does not mention the insurers' strong opposition to creating a government-run insurance option.

Seeking to prod colleagues, Sen. Edward M. Kennedy wrote an essay for Newsweek magazine about the policy that has guided his decades in the Senate.

"Unless we act now, within a few years, 55 million Americans could be left without coverage even as the economy recovers," wrote the Massachusetts Democrat, who is being treated for brain cancer. "All Americans should be required to have insurance. For those who can't afford the premiums, we can provide subsidies."

Sebelius appeared on NBC's "Meet the Press." Orszag spoke with "Fox News Sunday" and CNN's "State of the Union." Hatch and Rangel appeared on CBS' "Face the Nation." Gregg also appeared on the Fox program.

© 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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