Is this 1994 All Over Again? An Interview with Nancy-Ann DeParle
Nancy-Ann DeParle is the director of the White House Office on Health Reform. But she's been around this issue a long time. In 1994, she was the Office of Management and Budget's point person on health care, and later in the Clinton administration, she oversaw the powerful Health Care Financing Administration, and served as a commissioner on MedPAC. We spoke Tuesday about the similarities between this health-care reform effort and 1994, what is left to be decided in the Finance Committee, and what the administration promised the pharmaceutical industry. A lightly edited transcript follows.
You were around in 1994. Is this all feeling eerily similar?
Up until now, no. There has been so much broad agreement. And when you step back, there is broad agreement about 85 percent of what we're talking about. The insurance market reforms. The efforts to change the delivery system. Really, there's much broader agreement about the things that need to happen here than in 1994.
But the tactics and the sudden charges about euthanasia and death boards. I just saw Linda [Douglas] on C-SPAN getting calls from people saying section 29 says this and section 29 says that. You've read the bill. There is no section 29. The numbers don't start till the thousands. That part does seem eerily reminiscent.
Or take your interview with Sen. Isakson [on end-of-life counseling]. I've also been talking with Sen. Mark Warner about this. He wanted to work on this in Congress. The idea of taking a step towards helping people who want to voluntarily understand what's available to them in terms of advance planning has been a bipartisan effort, and it's mainly been Republicans who have brought it up to me in my visits to the Hill. So that part does seem reminiscent.
A Rasmussen poll result said that in May, 35 percent of respondents rated the United States health care system as either good or excellent. Today, it's 48 percent. Why are those underlying perspectives changing?
I have no idea. If anything, I'd expect it to be slightly worse because there's been a lot of discussion about the need for reforms of the insurance market.
The public plan has received a lot of attention as an unfinished part of the bill. But what are the other pieces? You see 85 percent of the bill is basically agreed on. What else is in that 15 percent?
If you just talk to folks on the Finance Committee who are working with the Group of Six, there are a handful of issues. What will truly bend the cost curve over a longer period of time?
The Group of Six recently sat down with [CBO director] Elmendorf and others to ask about the right ways to attack this. His prescriptions and those of other economists are challenging. One set is changing payment systems for Medicare. Another is delivery system reforms with varying degrees of support. That's hard enough. But requiring beneficiaries to pay more for their care under Medicare? Changing the tax system? Those are really difficult.
Then there are things like Medicaid. The bills agree we should expand Medicaid as part of the first step of getting everyone covered. They'd all do it to 133 percent of poverty. Then CBO came in and said its probably a mistake to do 100 percent federal financing for this, so the Finance Committee spent some time talking about that this week. Geographic variation is kind of hard. Long-term cost containment around a Medpac on steroids commission. That's hard. Then abortion, illegal immigrants. I'd say there are half a dozen to 10 issues that they're going round and round about.
What's the day-to-day relationship between the White House and Senate Finance Committee's Gang of Six? Do you have a representative in their meetings?
Oh no. They talked about inviting me last week but it ended up not happening. I talk at least weekly to Republican staffers and to the Democratic staffers in the room and we talk to the members themselves. I talked to Senator Enzi just before he left town, and Senator Grassley separately. We have a cordial relationship. They're working hard. Anyone who works on health policy for more than half an hour sees how tough it is. There's a definite camaraderie among those of us trying to figure out these problems.
There's been a lot of talk lately about this deal with the pharmaceutical industry. Want to set the record straight on that?
Sen. Baucus was sitting down with various sectors in the health care industry with the organizing principle being everyone will benefit from health-care reform and everyone will have to help pay for it. You have to give a contribution towards this. There need to be savings.
We had proposed as part of our budget around $95 billion from our industry. They came forward and after some negotiations, said $80 billion is a number we can support. Having been through many budget reconciliation and health-care negotiations in my career in Washington, if you can get an industry to offer $80 billion in savings when you only wanted $90 billion, that's a good give-and-take. We agreed to support the number and we support the fact that one of the policies in there is the deep discounting of drugs in the donut hole. That's about four million seniors a year, and it's their number one issue of concern, if you look at the polling.
Is that locked in stone? Will you protect them from further savings?
No. We support the number. The policies are what the Senate Finance Committee and the House bill enacts. We have to see what they end up with.
Photo credit: Dennis Brack/Bloomberg News.
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