DiscoverVox's The WeedsSarah and Ezra Interview Obama About Obamacare

Sarah and Ezra Interview Obama About Obamacare

Update: 2017-01-06


Two weeks before he leaves office, President Obama sits down for a lengthy conversation about the lessons of the Affordable Care Act and the law's uncertain future.

Following script is auto-generated by Speech to Text Technology:

thus great to be here and thank you so much for all the reporting has been drawn to support mission the welcome to a bonus episode of the weeds and of the Ezra Klein show me paint the picture here from and here's where we are Donald Trump of course is president elect is going to be a Republican House and Republican Senate and the first priority of all three really is to repeal Obamacare repeal the Affordable Care Act that is a project is easier said than done as I think Republicans have really been figuring out this week you've really seen them over the past couple of days I think coming to realize that their current strategy which is to pass a bill repealing Obamacare but not having the pill go into effect for two or three years and then to later pass another bill an unspecified as of now bill defining their replacement for Obamacare that might be a bit clever maybe a little bit too clever you begin to see conservative health care wants come out against it is a fascinating piece in Health Affairs by Jessica Pratt of which I recommend checking out what you're seeing here is something that the Republican Party's never really come to Crips with which is what is their Obamacare replacement they know they don't like Obamacare itself they know that the American public doesn't like Obamacare but how do they actually come up with something that when its trade offs begin to be made clear people like better and even worse what if they repeal Obamacare and the markets begin to collapse insurers begin to flee in people get scared and the health industry becomes furious and the cat come up with a replacement and they have to own something much worse than either so that's the context right here in this context that Sarah cliff and I had the opportunity to interview Obama cares namesake President Obama we talked to him for seventy minutes at the Blair House and we went real deep across Obamacare we talked alot about obviously its future and he really laid out a challenge to the Republican Party he said look I am happy to support anything you can do that is in his words demonstrably better than Obamacare anything you can do that will have the coverage levels and the Costa level of Obamacare does obviously not a test Republicans are going to be but you can see what he sets it up that way they like he did before them have to figure out what their goals are and he thinks that when it comes down to their knock and be able to come up with something that is a better mix of coverage and cost and he was able to come up with what is right will see but he's really staking the future of his law on their inability to come up with better sounding specifics but we don't just talk about that we talk about whether or not something Obamacare should have done is regulate prices rather than putting so much effort into making insurance cheaper we talk about what worked and what didn't in the Affordable Care Act something he brings up is maybe not having had the effect yet hope is the transition to electronic healthcare records and that's a pretty interesting bit of this some of you may remember us talking about Sir Cliff's great piece on Kentucky where we spoke with among other folks kept the goal and an Obamacare enrollment counts are in Kentucky who voted for Obama twice but in part due to our dissatisfaction with the Affordable Care Act voted for Donald Trump because she believes and hopes Trump will make the Affordable Care Act better we brought her here to the Blair House and had her ask the president a question which led to a very interesting exchange with a good exchange on cost control the ways in which Obamacare sometimes controls costs by making turns feel more expensive people by giving them higher deductibles higher co pays potentially taxing higher value insurance and the ways in which maybe that does keep down national expenditures but makes individuals angry of that was a perfectly interesting discussion also want to say Obama goes a little bit long in the first couple of answers but the back and becomes a lot quicker after that so do not be deterred without further ado let's go into the interview here is President Obama begins with Sarah asking him I think that the central question right now there was an expectation that was shared of your staff may congressional Democrats that as the Affordable Care Act ruled out as it delivered benefits to millions of people that it would become more popular to be safe from repeal or even substantial reform and it appears at this point that doesn't seem to be quite true what do you think that theory wrong why did the health care law become more popular well let's back up and say from the start there's a reason why four hundred years no president could get expansion of health care coverage beyond the work that had been done for Medicare and Medicaid targeting primarily seniors and the reason that this is part of the healthcare system is big it is very personal families I think recognized the need for health insurance but it's not something that they think about except when things go wrong when you have an accident or SEC and so any costs particularly at a time when families are feeling stressed economically any added costs higher premiums higher co pays all that ends up having real impacts on families and so the challenge of getting it passed was always the fact that unlike other advanced countries we didn't start with a system in which everybody was covered and we have a very complicated marketplace we have third party insurers and what that meant was that even after we got the law passed anything that dissatisfied people about the health care system could be attributed to quorum Court Obamacare even if it had nothing to do with the doctor and that was something that we've recognized even when we were trying to get law passed the other thing is the fact that the unwillingness of Republicans in Congress and around the country including some governors to after the fight was over to say alright let's try to make this work the way Democrats did during the time when President Bush tried to expand prescription drug program party meant that the public never heard from those who originally been opposed any concession that you know what this is actually doing some good and that ends up affecting public opinion and the third thing is that whatever you look at polls that say Well forty something percent are supportive of the law forty something percent are dissatisfied in the dissatisfied column or a whole bunch or Bernie Sanders supporters who want a single payer plan and so the problem is not that they think Obamacare is a failure the problem is that they don't think it went far enough and that led to many people still uncovered that the subsidies that people were getting were as rich as they should have been that there's a way of dealing with prescription drug makers in the way that drive down those costs and so all those things meant that even after the law was passed there was going to still be a lot to talk politics having said all and the thing that I've been most proud of is the fact that not only have we gotten twenty million people covered not only have we been able to reduce the pace at which health care costs have been going up ever since the laws passed basically health care inflation has been as low as it's been fifty years which has saved the federal government hundreds of billions of dollars in extended the Medicare trust fund by eleven years but most importantly for the people who have gotten insurance through the exchanges there's been pretty high satisfaction rates as surveys have shown so rather than look at public opinion as a whole the thing I've been most interesting is how suspect in the people who got benefits these are real families who've gotten real coverage and I get letters every from people who say this has saved my life or this is saved my bank account or this as made sure that my son who got hooked on some sort of hope yours was able to get treatment or I was able to get a mammogram because I can't turn time and and that ultimately is the measure the success of law suit you think this dynamic where when you reform the healthcare system you own it goes to the other way Republicans are beginning with the repeal delay strategy President elect Trump has said that he does want to kill Obamacare but he also wants to replace it with something that covers as many people or so that Lisa certain points do you think that the dynamic in which you became responsible for what people don't like is going to hamper Republican Movement and their efforts to change a system that maybe they don't like but does have a lot of people relying on what might let me start from from a very simple premise that if it works I'm so I'm for it if something can cover all Americans make sure that if they are preexisting condition that can still get coverage make sure that prescription drugs are affordable encourage preventive measures to keep people healthy bat make sure that him and rural communities people have access to substance abuse care or mental health care that Medicare Medicaid continue to function effectively if you can do all that cheap bourbon we talked about cheaper than Obamacare achieves and with better quality and it's just terrific I'm for but I think that part of the challenge in this whole debate and this is true dating back to two thousand and nine back to two thousand and ten is this idea that somehow we had a fixed way of trying to fix the healthcare system that we were rigid and stubborn and would welcome Republican ideas and if we only had they had all these great solutions in fact if you look at how this waterfall said this publicly before if I would start from scratch I probably would have supported a single payer system because it's just easier for people to understand and manage and that's essentially what Medicare is is a single payer system for people with a certain age and people are very satisfied with it and it's not that complicated understand for taxi services but that's that was an avail we were starting from scratch so what I've been do I said well where's the system out there that seems to be providing coverage for everybody that politically we can actually get through Congress and where we could get Republican support and lo and behold in Massachusetts there was a plan that had been decided on a bipartisan basis including by a Republican governor who ultimately became the nominee for the Republican Party that came close to providing universal coverage and I would've thought since this was an idea that had previously gotten a lot of Republican support the continued low public support and yet somehow magically the minute we said is a great idea in this work are Republicans some this is terrible and we don't so I say all this Ezra simply to to make something very clear from the very start in the earliest negotiations in two thousand and two thousand ten I made clear to Republicans that if they had ideas that they could show would work better than the idea is that we have fought off I would be happy to incorporate them into the law and rather than offer ideas we got was a big NO we just don't want to do this after the wall pass for the last six seven years there has been the argument that we can provides a great replacement that will be much better for everybody than what the Affordable Care Act is providing and yet over the last six seven years there's been no actual replacement wall that any credible health care policy experts have said would work better in fact many of them would result in of people losing coverage and coverage being worse for those who kept it and so now is the time when Republicans I think have to go ahead and show their cards if in fact they have a program that would genuinely work better and they want to call it whatever they want they can call it trumped or they can call it McConnell care Bryant or if it actually works I will be the first one to say great you should have told me that back in two thousand the I suspect that will not happen and the reason it will not happen is because if you want to provide coverage to people then there are certain baseline things that you've got to do number one health care is not cheap and for people who can afford health care or don't get it through the job that means the government got pace my number to all those provisions that the Republicans say they want to keep and that they like for example making sure that people can get health insurance even if they have a preexisting condition well it turns out that the only way to meet that guarantee is to either make sure that everybody has some modest obligation to get health care so that they are not gaming the system or you've got to be willing to provide huge subsidies insurance company so that they are taken and people already sick and and I think what you're now now that the Republican president elect Republicans controlled both chambers in Congress is that all the promises they made about how they can do it better cheaper everybody's going to be satisfied are going to be really hard to me and this is why the strategy of repeal firsts and replace later is just a huge disservice to the American people and is something that I think whether you're Republican or Democrat you should be a poster these are real lives at stake I'm getting letters right now from people who say I am terrified because my son's or daughter's insurance to their ability to get life saving drugs their ability to get drug treatment their bill to get mental health services are entirely dependent on us being able to afford and keep our insurance and if in fact there's going to be massive on doing of what's one sixth of our economy than the Republicans need to put forward very specific ideas about how they're going to do it people need to be able to pay to be able to study at the same way they did when we passed the Affordable Care Act and let the American people gauge is this going to result in something better than what Obamacare is produced and if they're so convinced that they can do it better they shouldn't be afraid to make that presentation is really interesting to try to figure out why is it that they're trying to rush the repeal so what what what is it that they're afraid why wouldn't they want to say here's our plan and show side by side here's why our plan is better then what Obamacare is produced because they sae they have said absolutely adamantly that they can do about it I am saying to every Republican right now if you in fact can put a plan together that is demonstrably better than what Obamacare is doing I will stay I will publicly support repealing Obamacare and replacing it with your plan but I want to see it first comes the third party objective people whether it's the Congressional Budget Office or health care experts across the ideological spectrum or Vox over will be happy to you would just evaluate you and keep the public will not have to take my word for Macon we can designate some referees and if Bacon show that they can do a better cheaper more effective provide better coverage I would die before it's why were none before this idea that somehow all this about Obama preserving his legacy or I'm not the one who named it Obamacare they were the ones who named it Obamacare because what they want to do is personalize this and feed on antipathy towards me in their party as an organizing tool is politics but I don't have upright authorship on this thing if if if they can come up with something better for what you have to show and I would advise every Democrat to before you have to show that it's better and that's not too much to ask and that's the challenge and the question right now for Paul Ryan and Mitch McConnell is why is it you feel obliged to repeal it before you show what it is that's going to replace because the majority of Americans have been very clear that they think that's a bad idea you now have Republican governors some Republican senators who said We don't think that's a good idea and there's been explanation actually try to do this before her new presents even inaugurated the what what exactly is this rush be particularly if you're going to weigh the actual repeal if they were making the argument that this is so disastrous that we actually think we have to repeal it completely today because it's just terrible well I would disagree but at least I can understand but here you're saying we're going to vote to repeal the Don't delay its effects for a couple years why it's so bad and it's and if the answer is Well it would be disruptive and we don't want to take people's insurance away right away well then that means you have time to show us and more importantly show the American people who need health insurance what exactly you're replacing it with in that sense as Rhino that was long and I but but but in that sense the answer is the Republicans yes will own the problems with the healthcare system if they choose to repeal something bad is providing health insurance to a lot of people and providing benefits to every health insurance even if they get through the job and they haven't shown us what it is they're going to do then they do on it because that is irresponsible and even members of their own party even those were posed to me have said that as an irresponsible thing to have all the time the congressional fights we saw yesterday President elect Donald Trump he said on Twitter quote is time for Republicans and Democrats to get together and come up with the health care plan that really works which is something I remember you saying similar things in two thousand and two dozen time is covering this debate knowing what you know now about partisanship being a president has tried to do this was like you said unable to get Republican votes what three pieces of advice would you give someone trying to attempt to pass a bipartisan health care law well look I think I sorta gave the advice just now which is if in fact this is not about politics but this is about providing the best possible healthcare system for the American people and my advice would be to say what precisely is it about Obamacare that you think doesn't work because you already said there are some things you think do the Republicans keep on saying well we want to keep the things that people like and that are working well so they think it's a good idea but Obamacare says your kids can stay on your health insurance plan until they're twenty six they think that's a good idea they think it's a good idea that if you've got a preexisting condition you can still get health insurance I assume they think it's a good idea of the seniors have gotten discounts on the prescription drugs we close the doughnut hole during the course of Obamacare they approve of some of the changes we've made to encourage health care system that rewards quality rather than just the number of procedures involved and how we pay providers so we could make a list of all the things that as terrible as Obamacare is actually they think works according to them all right well let's make them a list of the things they don't like or the American people are concerned about well what we know is that people would always like more costs on their premiums and or out of pocket expenses and although the Affordable Care Act provides a lot of subsidies to a lot of people so they can for health insurance what is actually true is we would love to see even higher subsidies to relieve the cost even more costs money we also that where we've seen problems and the implementation of the Affordable Care Act it has been in certain areas particularly more rural areas less densely populated areas where we're not seeing as many insurers so there's not as much competition well one way that we've suggested you could solve the problem is to say that if in fact there are enough interest to drive competition and reduce costs and give people much choices then we should have a public option that's available so if you look at the things that people are frustrated about with Obamacare the Affordable Care Act the big things are the subsidies are his eyes big like and they don't have as many options is life and I'm happy to provide those both those things but signed on to a Republican plan that said we're going to give more subsidies to people to make it even cheaper and we're going to have a public option where there isn't an option here's the problem I don't think that's going to be one to do so but but but I guess my point is this bad of it is possible for people of goodwill to try to come up with significant improvements to the law we already have but it does require to be specific about what it is that you think needs to be changed and that so far has not happened and my advice to President elect in fact we talked about this when I met with them for an hour and half right after he got elected I said make your team and make the Republican members of Congress come up with things that they can show will actually make this work better for people and if if if they're convincing I think you would find that there are a lot of Democrats out there including me be prepared to support but so far at least that's not what's happening I think Obamacare has exposed an interesting tension between controlling costs in the system and controlling economic pain for individuals so the law has until now come in under budget but in part to waste on that are higher deductibles than people expected higher co pays in our networks in a couple of years it doesn't change the excise tax on high value insurance will come into play the individual mandate and these things to individual people while they keep the usage of healthcare down to keep the cost of healthcare down they make health care or feel more expensive they make health care field unusable you think the Affordable Care Act got the balance right
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Sarah and Ezra Interview Obama About Obamacare