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Transcript of Rahm Emanuel Monitor Breakfast

(Page 4 of 12)

Another way of saying it, the heads and tails of this process, of bringing competition, of bringing choice to the marketplace, that doesn’t exist today, is through a public plan, a not for profit public plan, with a organized or structured marketplace, i.e., the exchange that’s regulated. You do that, and you will wring out huge costs that exist today in the private plans, that spend the bulk of their money – I don’t think I can look around here that not one of us hasn’t dealt with insurance companies on an individual basis, look at your own experience in this, either with a sick child, a sick partner, or a sick parent. If you don’t have it yourself, you’re lucky. Working through with an insurance company that has spent a lot of their administrative costs fighting through denying or limiting coverage. And that is a bulk of the overhead, or not a bulk, it is a sizable portion of the overhead. And that public plan, with the exchange, would create the kind of competition that doesn’t exist today, would force the insurance companies to be more competitive, more price conscious, that doesn’t exist today, and allow the consumer the choice to be more price sensitive and cost conscious. Those are all the values that you would want in a system today that lacks any of that.

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You don’t have today competition among insurance companies on a price basis. And they’re allowed to ring up huge administrative costs because there isn’t that price sensitivity. And if you bring choice, you bring competitiveness, you have an organized slash market, like the federal prototype, that is like the federal healthcare plan – system, rather. And you have a public plan that people can then use as a measure to measure against, you’ll give that type of choice and that competitiveness and bring a price sensitivity that does not exist today. And it doesn’t exist in healthcare. You can do that for cars, you can do it for a lot of other stuff, it doesn’t exist today. And every one of us – this is not, you know, you just gotta go – I mean, if you haven’t, you’re lucky. Every one of us have had that experience with their insurance company.

Q: How do you ensure that the competition is fair, so that at the end of the day, the price –

RE: You gotta write it. That’s what the drafting, the legislation process is about. I mean, it’s like the president said the other day, we’re not gonna give, you know – the federal treasury is not going to just be a printing press for the public plan. We’re not gonna do that.

Q: So cost is a huge thing. [inaudible] Other ideas to share? How do you prepare public for that? Is it a matter of selling them on the concept first, then dealing with the money?

RE: Let me do one thing. Over the last few days, and I’m losing – even like in Chris Dodd’s committee, he got numbers the other day from CBO that brought the numbers way down below – In another life, I’m coming back as CBO. That’s a joke, guys, just relax, OK? [laughter]

Let me say this about the whole issue of cost. It’s rearranging the dollars within the healthcare system. It’s not a trillion new dollars. It’s the money is within the system itself that we’re dealing with. And it’s making it more efficient and more effective, so there’s parts of this both on the coverage side, the cost side, and what I would call on the delivery side. And one of the reasons the president has been so strong about this MedPAC – and I happen to be a big advocate of this as I know, as Peter Orszag is, as others are – Rockefeller who has a great bill up in the Senate – is, there’s been hundreds of billions of dollars of recommended savings in Medicare and Medicaid by MedPAC. Some have been acted on by Congress, but a bulk of it hasn’t. In ways to be more efficient in the way we spend money. So it’s using math to reassign how dollars get distributed in the system, in a more efficient, more effective way. Ya know, part of that will be, ya know, ultimately, moving resources more towards preventive care, more towards dealing with chronic illnesses early on, that represent about 60 percent of all healthcare costs, the five major illnesses that all are basically the way we act and are behavioral, for lack of a better way –