BILL MOYERS: Welcome to the Journal. Get out the stretchers and unroll the bandages. The fight is joined.
PRESIDENT OBAMA: In order to preserve what's best about our health care system, we have to fix what doesn't work. For we've reached the point where doing nothing about the cost of health care is no longer an option.
BILL MOYERS: Despite the speech President Obama made at a Wisconsin Town Hall meeting this week, the question now is will he push back against the profiteers of health care? A powerful coalition has emerged to keep the profit in sickness and disease - the Business Roundtable, the Chamber of Commerce, the big drug companies, the insurance giants, Rupert Murdoch's media empire, all of them opposed to what my guest says is real health care reform.
Robert Reich was Bill Clinton's Secretary of Labor; he implemented the Family and Medical Leave Act, and headed the Clinton Administration's successful effort to raise the minimum wage. Now you can hear him on public radio's MARKETPLACE and read his byline all over the mainstream media and across the Internet, including his blog at Robertreich.org. He is the author of eleven books, including this, the most recent, SUPERCAPITALISM: THE TRANSFORMATION OF BUSINESS, DEMOCRACY, AND EVERYDAY LIFE.
Robert Reich, welcome to the Journal.
ROBERT REICH: Hi, Bill.
BILL MOYERS: I wanted to talk to you because you do know how Washington works. TIME MAGAZINE called you one of the ten most effective cabinet secretaries of the last century. So take us inside for a moment or two into how you think this healthcare debate is playing out after the President's speech yesterday.
ROBERT REICH: Well, we're now just about in the real time of fight and conflict. Republicans and the healthcare lobbies, mostly big pharmaceuticals, their trade associations, also the big insurance companies, private insurance companies, they are bringing out the big guns, the lobbyists, the threats, the promises. They're swarming all over Capitol Hill. And the question is how hard the President's going to fight back?
So far the style of the White House is to set objectives and to let Congress come up with the details.
But I think the President's going to have to get involved in the details to a much greater extent because the lobbyists on the other side have so much to lose, they fear, and so much to gain, they expect, if they win.
BILL MOYERS: But this President seems given more to finesse than fight. He seems to want- you know, he said in his speech yesterday, "Let's get everybody together." Has consensus become his primary aim?
ROBERT REICH: Well, he wants a bill apparently that has some Republicans on it. He only needs 51 votes in the Senate to get healthcare through on a Reconciliation Bill. That's a big victory for the Senate Democrats that wanted him to be pushing hard but he seems to be indicating he wants some Republicans on that bill. The Republicans are not willing to budge. They don't want what's called a public option which essentially would be something like Medicare that gives people a lot of bargaining leverage to get lower drug prices and also puts some pressure on private insurers. That public option is going to be absolutely critical. That's where the fight is going to really be squared.
BILL MOYERS: One of the problems with the Clinton health plan when you were Secretary of Labor was that it was too complex to explain to journalists like me, members of Congress, and the public. So in a sentence, if you can, tell me what a true public option would be in healthcare reform.
ROBERT REICH: Well, regardless of what you want to call it, Bill, it could be called liverwurst. I mean, it simply means that the public- average members of the public have a choice, if they want it- of either their private for-profit insurers like they now use or a public not-for-profit insurer.
And that public insurer would resemble ideally Medicare- low administrative costs. And it would have the economies of scale. It would be so large that it could actually negotiate low drug prices and very, kind of low premiums. That's what the private insurers are scared of. That's what the-
BILL MOYERS: Why are they scared of that?
ROBERT REICH: Because that means that their profits will be squeezed. They don't want anything that's going to squeeze their profits. And, they're putting up smoke screens. They're putting up other things that may look like public options but don't have the bargaining leverage to get drug prices down and also to keep the private insurers honest.
BILL MOYERS: How do we know the real thing?
ROBERT REICH: Well-
BILL MOYERS: How do we know the duck from the decoy, right?
ROBERT REICH: Well, there's a very simple test. And that is the public option big enough and is it going to have bargaining leverage to get drug prices down and keep private insurers on their toes, forcing them to cut prices.
There's nothing actually pushing the system unless you have a public option that gives the insurers and the pharmaceutical industry and the hospitals a real run for their money.
BILL MOYERS: In other words, in one word, competition.
ROBERT REICH: Fierce competition.
BILL MOYERS: With the private for-profit insurers, right?
ROBERT REICH: Absolutely right. See, right now, Bill, we've got a medical system in which private for-profit insurers are spending a lot of money trying to avoid sick people. It's an absurd system. And all of that money they're spending, marketing and finding groups of people who are relatively healthy and at relatively low risk and avoiding the sick people, all of that money is being wasted.
And they're also- as anybody knows who has private insurance, you've had the experience, I've had the experience, they contest a lot of claims, not only our claims- but also doctors' claims. They are in the business of making money. They are for profit. I don't blame them. They are part of-
BILL MOYERS: Capitalism-
ROBERT REICH: -capitalist system.
BILL MOYERS: Right.
ROBERT REICH: But unless they are going to be pressured, genuinely pressured to reform through a public option, there is nothing that's going to change them.
BILL MOYERS: Well, I guess what puzzles me is whether you can squeeze them, as you say, pressure them without regulation or if you just think having a competitive rival out there that is negotiating for prices and trying to come in at a lower cost than the private health plan, you can really achieve anything.
ROBERT REICH: Well, that's a good question. You know, the single-payer system would be the best of all.
BILL MOYERS: Because?
ROBERT REICH: Because a single-payer actually would have huge bargaining leverage, be able to tell the providers what they can do and what they can't do without it being- this isn't socialized medicine. A single-payer would actually have the reins.
BILL MOYERS: You heard the President say yesterday that we can't go to single-payer because we're too late in the game. It would change the rules.
ROBERT REICH: Well, look it, I lived through Bill Clinton's healthcare attempt-
BILL MOYERS: Yeah, how did you do that? That-
ROBERT REICH: Not very well. But a President, to some extent, has got to be politically realistic. There is no real political option in Congress now for a single-payer.
BILL MOYERS: Wait a minute. The folks who are fighting for single-payer out there say it is feasible if only Congress would look at the economics of it.
ROBERT REICH: Well, a lot of things are feasible if Congress looks at the economics of them. But politically, no, unfortunately and I'm a big single-payer fan. Unfortunately, we cannot get there from here because the political forces are just too strong against single-payer.
BILL MOYERS: Are the business forces prescient when they say that if we get a public option, it opens the door down the road to single-payer?
ROBERT REICH: If the government simply requires that the public option pay for itself, can be not-for-profit, just pays for itself that's not going to be necessarily a direct opening to single-payer. But it is going to force the private insurers and the drug companies and the medical suppliers to be honest, to control costs, and to provide better quality.
BILL MOYERS: You've got these powerful lobbies that you've been writing about on your blog. And you said on your blog this week that the real question for you is the extent to which Barack Obama will push back against these lobbies. What's your answer to your own question?
ROBERT REICH: I don't know, Bill. This is the first test where there is huge organized opposition. And it's coming from very, very powerful lobbies who have prevailed- not just for ten or 15 years. You've prevailed for decades on this issue. So this is the truth time in terms of how able and willing the President and the White House is to really set boundaries and push members of Congress.
So it's at this point- and I'm talking about the next two or three or four weeks. I mean, we're talking about crunch time right now- that the President has got to step in and be forceful and be specific. And I don't know whether he will be. I hope he is.
BILL MOYERS: What will you be looking for?
ROBERT REICH: I'll be looking for whether he can say to Max Baucus, for example, of Senate finance, "Look, this is what I want. And if you're not going to go along with this, I want to know why. And if you're not going to go along with this, then would something else you want down the line you're not going to get." In other words, he's got to really create very, very specific conditi