An interview with Kaiser's Drew Altman
Drew Altman is chief executive of the Kaiser Family Foundation, the largest and most respected health-care foundation in the country. He also writes the "Pulling It Together" column. So he seemed like a good guy to ask about the bill. A transcript of our conversation follows.
Tell me, in the simplest possible terms, what this bill does.
To boil it down, it does four things, and I’m putting them in order of importance and power. First, the coverage expansions and subsidies. Second, the insurance market reform. Third, cost containment. And fourth, there's a prevention component. And if you wanted to go a bit more concrete, what it does is cover about 32 million people, reforms insurance and makes a start on cost containment, while, according to CBO, decreasing the deficit and saving a trillion dollars.
There are some things it doesn’t do. It doesn’t cover everyone. It comes reasonably close. It helps an awful lot of people pay their bills, but it doesn’t fundamentally alter the cost curve. Instead, it makes a start on altering that cost curve. It throws most of the best ideas on the table, but we don’t know which will work and which won’t. It doesn’t change how most Americans get their health care now. That was, of course, by design: The lesson of the Clinton effort was that the third rail of health-care reform was people’s current arrangements. And while some of the bill starts soon, some of it doesn’t start for several years. If you go to 15,000 feet, I guess I would say it is centrist legislation leaning a little bit left.
When you talk about the Clinton plan, past efforts at health-care reform were really health-care reform. You pass the bill and you wake up to a different system. But not this one. This is sort of a health-care expansion with components that encourage gradual reform. Is that a fair way to put it?
That's a fair way to put it. It is in fact insurance reform more than it is health delivery reform. And while health reform people are often dismissive of insurance reform, I’m not. This debate has traction because of average Americans who have problems paying their bill and problems with insurers and this is directly responsive to that. The bill got into trouble in June and July and August when the message began to stray from the focus on affordability and people’s problems with the health-care system and began to focus on the concerns of experts. Experts and average people look at this very differently.
What happens now that it's passed?
Moving forward, this is a giant improvement over the status quo. It will do more to help people than any domestic legislation in 40 years. But how it will actually work out will be as much a function of how the American people react to the law as what’s written into the law today. The lessons from every other nation is that health-care reform doesn’t stop when you pass the legislation, it is always evolving.
What concerns you about the legislation?
I think you have to worry about an expectations gap. Premiums will continue to go up. There are some questions when we get to subsidies whether everyone who gets a subsidy will feel the policies are affordable. The other side of it is that for most Americans, little will change. But premiums will continue to go up. So there might be an expectations problem.
The other thing is that the debate about subsidies has been about premiums. But you also have to look at total out-of-pocket costs. There are two things people really understand in insurance: Their premium and their deductibles. And some of these deductibles could be pretty large. So most people will find there is nothing to fear and little will change, but affordability will continue to be a challenge.
Finally, the midterm elections are the next great focus for health reform and so the effort to inform the American people about what the law does will be critical. We’ve discovered in our polling that while the law itself plays to mixed reviews in the public debate, most of the key components are quite popular. The question is whether the American people find out about them. Only 15 percent of people know that CBO said the legislation will reduce the deficit. If you ask people how they’d feel if they knew that, more than 50 percent say they’d become much more likely to support it.
March 22, 2010; 4:59 PM ET
Save & Share: Previous: Who is left uninsured by the health-care reform bill?
Next: Ron Pollack explains how the bill might cover even more than 95% of the country
Posted by: Kevin_Willis | March 22, 2010 5:05 PM | Report abuse
Posted by: visionbrkr | March 22, 2010 5:08 PM | Report abuse
Posted by: srw3 | March 22, 2010 5:36 PM | Report abuse
Posted by: FatTriplet3 | March 22, 2010 5:56 PM | Report abuse
Posted by: CatfishHunter | March 22, 2010 6:06 PM | Report abuse
Posted by: FatTriplet3 | March 22, 2010 6:10 PM | Report abuse
Posted by: paul65 | March 22, 2010 6:19 PM | Report abuse
Posted by: Holla26 | March 22, 2010 6:33 PM | Report abuse
Posted by: srw3 | March 22, 2010 6:39 PM | Report abuse
Posted by: justin84 | March 22, 2010 6:42 PM | Report abuse
Posted by: srw3 | March 22, 2010 6:44 PM | Report abuse
Posted by: justin84 | March 22, 2010 7:03 PM | Report abuse
Posted by: bmull | March 22, 2010 8:57 PM | Report abuse
Posted by: visionbrkr | March 22, 2010 10:15 PM | Report abuse
Posted by: SD619 | March 23, 2010 12:13 AM | Report abuse
The comments to this entry are closed.