Kathleen Sebelius Nails The Public Option Debate: 'Higher Cost Does Not Translate To Higher Quality'

I actually found a pretty good segment on TV: Kathleen Sebelius, the Secretary of Health and Human Services was excellent today on CNN's State of the

I actually found a pretty good segment on TV: Kathleen Sebelius, the Secretary of Health and Human Services was excellent today on CNN's State of the Union. She spoke clearly and effectively of the importance that there be a public option available for health care to all Americans. No Luntz talking points, just straight talk about how the public option will benefit Americans.

SEBELIUS: Well, I think that competition is a good thing, that most Americans understand that choice and competition is what we want. So, if you look at a health exchange, a marketplace, where people can have some options -- in many parts of the country, private insurers have no competitor, in -- in a state like my own home state of Kansas. There is a dominant insurance company in a lot of the states.

So, we created a public option for state employees, so they could choose side by side benefits and prices. Competition is good. You can write the rules for a level playing field.

The president does not want to dismantle privately-owned plans. He doesn't want the 180 million people who have employer coverage to lose that coverage. He wants to strengthen the marketplace.

But, you know, I -- I don't think it's a big surprise that a lot of insurers say, you know, what we would really like is, everybody who doesn't have insurance to be told they must buy it, and buy it only from us.

The president feels that having a public option side by side, same playing field, same rules, will give Americans choice and will help lower costs for everybody. And that's a good thing

.

Wow, who would have thought that Insurance companies would be against a public option. She beat back the "trigger" that many HICers want to try and put in place. She said that we can't afford to wait for some trigger to go off. The time is now to attack this problem.

KING: ...So, how about a trigger? How about you enact reforms that give the private insurance industry, maybe it's three years; maybe it's five years, and if, by then, they haven't lowered costs, they haven't brought the uninsured into the thing, then the government option would trigger and kick in then"? What's wrong with that?

SEBELIUS: Well, there are a lot of, now, specific ideas being discussed on Capitol Hill. And, certainly, the trigger is one of them.

But what Massachusetts found when they moved to insuring all citizens of the commonwealth is that, unless you address costs from the very first day, unless you have a system where cost control and cost lowering is one of the goals, you don't do so well. You -- you can bring everybody into the system, but the costs may rise.

So, I think having a public option from the outset, having the design, being competitive, and making sure there is some choice, making sure that consumers have a choice of plan, and, for the first time ever in the United States, making sure that insurers don't decide who gets covered -- if you got a preexisting condition, we want you in the marketplace, we want you and your family to be covered, and we want you to be able to go to a doctor of your choice and have preventive care and wellness care. That's part of reforming the system.

Goodbye to the "trigger effect." It won't work and it gives the health care industry a license to fleece us. And I loved what she said here.

SEBELIUS: Actually, the comparative effectiveness research says, as part of the rules, that Medicare cannot use the research for payment decision. It prohibits, you know, the kind of rationing that people talk about.

What we're doing right now is rationing quality, not cost. Higher cost does not translate to higher quality. We want better health outcomes for every patient. If you come through the doors of a hospital, if you see your doctor, you should be getting the best possible information, the best possible strategies.

And that's happening some places. It's not happening every place. And we think that part of reforming the system is that every American should getting the best bang for their buck. And they're not doing it right now.

She's breaking past the idea that since we're paying more for health care then that means the quality is better.

CNN full transcript:

PRESIDENT BARACK OBAMA: Let there be no doubt, health care reform cannot wait, it must not wait, and it will not wait another year.

(CHEERING AND APPLAUSE) (END VIDEO CLIP)

KING: Many people will say, we have been down this road. And some, Secretary Sebelius, make the argument that President Clinton made the very same argument: Our businesses cannot survive. Our economy cannot survive. We must have health insurance.

And, yet, after the Clinton plan was derailed, we had the biggest period of growth in this country in the last 25 years. The unemployment rate was low. The government actually ran a surplus at the end of the Clinton administration, without health care reform.

So, there are many out there who will say this is, you know, boy crying wolf. SEBELIUS: Well, I think that the situation has changed. The good news, is a lot of the people who opposed, not only the plan that Harry Truman put forward -- and he did relentlessly during his administration -- and what Bill Clinton put on the table, they were back as opponents, they're now they're at the table.

Doctors understand the current system doesn't work. They're spending way too much time on paperwork and overhead, and not enough time with patients. Hospitals can't sustain it. The Medicare system is going to be broke down the road in the not-too-distant future, a system that millions of seniors rely upon.

Insurance companies are saying they are willing to change, they're willing to talk about this. That's a very different dynamic than even in the Clinton era, when those same folks were pushed away, saying the status quo is acceptable.

Everybody recognizes the status quo is the enemy. It's unacceptable, unsustainable. We can't continue down this path.

KING: Let's look at some of the policy options. You mentioned doctors.

The president tomorrow will speak to the American Medical Association. Doctors are skeptical about this public option. And let's look at -- we will show our viewers what our means. It's a government-owned health insurance plan, similar to Medicare and Medicaid. And it essentially would increase competition. And the goal is to lower prices by having competition with private insurers.

Those who argue against it say the subsidies from the government would be unfair competition, hurt private insurers, and perhaps drain the federal treasury, because, once you have a government option in place, you need to pay for it.

How will the president make the case to the skeptics, even in his own party, that this is too much government?

SEBELIUS: Well, I think that competition is a good thing, that most Americans understand that choice and competition is what we want. So, if you look at a health exchange, a marketplace, where people can have some options -- in many parts of the country, private insurers have no competitor, in -- in a state like my own home state of Kansas. There is a dominant insurance company in a lot of the states.

So, we created a public option for state employees, so they could choose side by side benefits and prices. Competition is good. You can write the rules for a level playing field.

The president does not want to dismantle privately-owned plans. He doesn't want the 180 million people who have employer coverage to lose that coverage. He wants to strengthen the marketplace.

But, you know, I -- I don't think it's a big surprise that a lot of insurers say, you know, what we would really like is, everybody who doesn't have insurance to be told they must buy it, and buy it only from us.

The president feels that having a public option side by side, same playing field, same rules, will give Americans choice and will help lower costs for everybody. And that's a good thing.

KING: And how do you answer those who would say: "We're not sure. We're not sure. Maybe we will be in that position of a public option, but we're not sure. So, how about a trigger? How about you enact reforms that give the private insurance industry, maybe it's three years; maybe it's five years, and if, by then, they haven't lowered costs, they haven't brought the uninsured into the thing, then the government option would trigger and kick in then"?

What's wrong with that?

SEBELIUS: Well, there are a lot of, now, specific ideas being discussed on Capitol Hill. And, certainly, the trigger is one of them.

But what Massachusetts found when they moved to insuring all citizens of the commonwealth is that, unless you address costs from the very first day, unless you have a system where cost control and cost lowering is one of the goals, you don't do so well. You -- you can bring everybody into the system, but the costs may rise.

So, I think having a public option from the outset, having the design, being competitive, and making sure there is some choice, making sure that consumers have a choice of plan, and, for the first time ever in the United States, making sure that insurers don't decide who gets covered -- if you got a preexisting condition, we want you in the marketplace, we want you and your family to be covered, and we want you to be able to go to a doctor of your choice and have preventive care and wellness care.

That's part of reforming the system.

KING: Another option put forward by those, including in your party -- Senator Kent Conrad, the chairman of the Budget Committee, will be with us later.

He says he's a little skeptical of having a national government- run plan. How about do something like they do in rural areas with electric co-ops? And, so, have a co-op plan. They're privately owned, nonprofit health insurance cooperatives. And he says that would get you your goal. You would increase competition and lower prices.

The argument against it is, it's hard to scope out how much that would cost the taxpayers. But is that worth trying as an alternative, if you have so many centrist Democrats and maybe even some Republicans who would join you if you did that way, not a government option?

SEBELIUS: Well, again, I think that having these ideas on the table is exactly where we need to be right now. The Senate is actively engaged in looking at strategies. There is no one-size-fits-all idea. The president has said: These are the kinds of goals I'm after, lowering costs, covering all Americans, higher-quality care. And around those goals, there are lots of ways to get there. So, we're going to look at idea by idea. I -- I think the good news is, the Senate and House are rolling up their sleeves. They're ready to go to work, and they're ready to work with the president to get this done this year.

KING: Another -- I'm going to use a term that might cause some eye-glaze-over at home, but it could become very important in this debate.

And it's comparative effectiveness research. And this is where you collect and compare data on everything that is done out in the health care. And you want to see essentially what therapies, what tests, what surgeries have a high effective rate and -- and what don't.

SEBELIUS: Right.

KING: The argument for is, you improve the quality of care and you eliminate unnecessary tests, unnecessary procedures, which saves money. The argument against is that, well, that will be used for rationing of some kind.

Will that be used in an Obama administration plan? And is there someone out there who might not get an MRI, might not get a CAT scan, might not get a certain test or a certain procedure because it only works in 50 percent of cases or it only works in 20 percent of cases, and, so, they will be told, no, sorry?

SEBELIUS: Well, John, I think the great news is, is there is fabulous medical care being delivered at lower costs all across America.

I was just in Omaha, Nebraska, and went to Lakeside Hospital, where it's a fully digital hospital. And the doctors have come up with protocol to deal with everything from heart attacks to trauma care.

And they are trying to drive quality, so that every patient who comes through the doors of Lakeside gets the same high-quality care. And they find, not only is it very effective in reducing costs, but it's very effective in terms of outcome. That's what we want to have happen across the country.

So, comparative effectiveness research says, you know, does paying twice as much in McAllen, Texas, as some other part of the country deliver better care? And the answer is no. What are the strategies that work?

Every patient, if you could choose not to be operated on, and have a -- you know, a medication that works just as well, I think, would opt for that. If three tests don't produce a better result than one test produces, I would rather have the one test, thank you very much. So, we want to empower doctors and empower consumers to know what works, how often it works, what is the most effective, and try to help with that care.

KING: You say empower doctors. But if you -- once you have that data, you will be telling doctors, won't you, especially if you have a government-run plan that is setting the tone of the marketplace and the rules of the marketplace? You will be telling them what's in and what's out, won't you?

SEBELIUS: Actually, the comparative effectiveness research says, as part of the rules, that Medicare cannot use the research for payment decision. It prohibits, you know, the kind of rationing that people talk about.

What we're doing right now is rationing quality, not cost. Higher cost does not translate to higher quality. We want better health outcomes for every patient. If you come through the doors of a hospital, if you see your doctor, you should be getting the best possible information, the best possible strategies.

And that's happening some places. It's not happening every place. And we think that part of reforming the system is that every American should getting the best bang for their buck. And they're not doing it right now.

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