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Q&A: House Speaker Nancy Pelosi tackles healthcare overhaul questions


House Speaker Nancy Pelosi, the San Francisco Democrat, is trying to rally her caucus behind complex legislation to overhaul the nation’s healthcare system, President Obama’s top domestic priority.

It has not been easy. Since senior House Democrats introduced their healthcare bill this week, moderates, freshmen lawmakers and others in the party have expressed concerns about provisions to tax the wealthy, and have demanded more savings and complained about the speed with which the bill is moving.

The legislation would help insure more than 30 million people now without coverage, in part by creating a government insurance plan, or public option. And it would impose a new surtax on individuals making more than $280,000 a year and couples making more than $350,000. But critics contend that the bill would not do enough to control skyrocketing healthcare costs.

With the Senate still working on its bill and House leaders trying to get a vote on their....

...version before August, Pelosi sat down Friday to talk about the legislation and the challenges of moving such a mammoth measure.

Question: Americans consistently say they are most concerned about the cost of their healthcare. What kind of guarantee can you give that insurance companies or doctors or hospitals won’t charge Americans more if this legislation becomes law?

Pelosi: The purpose of the legislation is to lower costs for individuals ... for businesses so they can be competitive ... and for the federal government.... Putting ... more people in the mix, as well as improving the insurance coverage for many more people, we believe that will lower the cost.... Right now an insurance company can take the premiums it gets and spend whatever percentage on benefits. Under this bill, 85% of those premiums must be spent on benefits....

One of the biggest forces to [reduce costs] is health information technology, which we started [investing in] with the recovery package [that passed earlier this year].... Heath IT lowers costs, improves quality and makes American people healthier....

The increased number of people who are in the [insurance] pool who are healthier and younger who have not had access to health insurance — that volume will contribute to lowering costs, as well.... And prevention saves billions and billions and billions of dollars.

Question: Wealthy Americans already pay the most taxes. They may be best able to help lift the economy out of recession. Yet the House bill contains a large tax hike on the wealthy. Is that wise right now?

Pelosi: I’d like to wring more money out of the system ... but to the extent that this must be paid for, there has to be a revenue stream. The alternative that had been put forward was taxing [health] benefits. That’s a tax on the middle class.

What we are saying is, let’s leapfrog over the middle class to the wealthiest people in our country. They’ve had it pretty good the last eight years in terms of tax policy under President Bush. And we think that’s a place you can go.

I’d like to see [the tax on income above] $500,000 for an individual and $1 million a year for a couple. I think that is an appropriate place.... But in order for me to push it higher so fewer individuals are affected, we’d have to get more savings.

Question: President Obama still seems to be playing the role of cheerleader rather than insisting on specific proposals. Should he be clearer about what he will and will not support?

Pelosi: He has certainly laid out his principles — lower costs, improve quality, expand opportunity and expand choice. And do it in a fiscally sound way.... When we have a bill in the House and when we have a bill in the Senate ... priorities will have been narrowed. The choices will be clearer. Then he knows what can pass in one house or the other and can weigh in....

He has advocated for the public option and for passing a bill.... We are very receptive to what he wants. Now we just received a letter that said he is interested in [a new independent commission to take over Congress’ control of how Medicare pays providers]. Some in our caucus have been for that, some against.... Since it is something he wants, we are trying to figure out a way to accommodate that.

Question: Since you became speaker in 2007, there has been a lot of bills — on funding the Iraq war, stimulating the economy — that have been difficult to rally Democrats to vote for. How is the healthcare bill shaping up?

Pelosi: The TARP [rescue package for financial institutions that passed in 2008] was probably the hardest. But for me this year, the hardest bill was the Iraq war [supplemental funding bill that passed in June], because the members never expected that they had to vote for that again.... But it was, "Let’s help the president. This is the last supplemental. Let’s do this." ....

There is no easy lift here. But this is what we do.

-- Noam N. Levey

House Speaker Nancy Pelosi (D-CA) speaks on China during a news conference on Capitol Hill June 4, 3009 in Washington, DC. Photo: Mark Wilson / Getty Images

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Comments () | Archives (19)

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Just a small comment on the so called Health IT savings, There are currently at least 12 different federal agencies with overlapping oversight when it comes to health care technology. This dirty dozen already produces mountains of red tape and conflicting rules.

Do you really believe “more” is needed? Does anyone really believe somehow applying new layers will suddenly make it more cost effective?

Tax the rich! Thats always the answer for liberals. Let's punish those that work their buts off! Let's also ruin healthcare for 250 million American that already have healthcare for the 30 million that don't. Only a liberal would come up with that line of thinking. I wish I have an Aston Martin parked in my car. A lear jet at the airport, my own very private doctor and dentist, why should I wait in a waiting room? I'm entitled to all of this and the government should pay for it all! Let's get the money for all this from the rich people. Pelosi is a joke and Obama is a complete socialist. They need to be voted out before this great capitalist country becomes Cuba.

Pelosi knows that if she supports this bill she will not be speaker after the next election. The idiots in the white house insist on shoving a bad piece of legislation down America's throat. The socialist health care bill and the super tax cap & trade bills will be obama's undoing .
We cannot afford the obama schemes.
Get rid of the illegal aliens sucking the health care dry and things would be better. Enforce the immigration laws already on the books and fine the sanctuary cities that are breaking the law.

Healthcare is not a right or something that should be managed by the government. As a taxpayor, I do not want to pay for someone else healthcare. Furthermore, I do not trust the government of the United States to manage this correctly or do I believe they should be in the business of running healthcare. We cannot afford this...we are bankrupt already!

Tax the Rich? Who do you think creates jobs for the rest of us? Why should they be punished for being successful? Tax the rich too much and they'll take their jobs overseas!

We not only have big government, we have incompetent government!

it's extremely tiresome listening to the narrow minded neandrethals that keep serving up rush limbaugh quotes as their only reason for being against health care reform....can't these people think for themselves or come up with any original ideas of their own...? .america is still living in the dark ages with its' rapidly deteriorating medical system.....socialized medicine works in every other industrialized country and the only reason it hasn't been enacted in america is because of the massive PR campaigns by our greedy insurance companies.... that's real democracy at work when american insurance companies can prevent 50 million american citizens from attaining health insurance with their exorbitant premiums and ownership of the american political machine......jh

If we have enough money for two wars and a bailout, we have enough money for health care.

And, yes, we should tax the rich. Success doesn't happen in a vacuum. Most rich people are born rich and/or with well-connected parents.

Here's a cry wolf story involving obvious politics:

After caring for my mother Evelyn Calvert, 6 yrs at home after a large stroke I placed her in a Sun Healthcare nursing home -Sunbridge in Newport Beach, Calif. She died due to Sun's blatant disregard for human life.

When families complained SUN was breaking the law and violating their state injunction by understaffing with broken equipment, the corporate powers that be, fly in flocks of regional employees to meet you, then intimidate by posting visiting hours signs giving you 1 hour after a normal work week to visit your loved ones each week day. (This was not legal: So the Dept of Justice. Joe Fendrick called the Dept of Health, Jackie Lincer, who demanded they take the signs down within 24 hrs or risk a fine, this was illegal). Regional employees include a former girlfriend of the CEO, Julie Campbell who heads up their PAC (Political Action Committee) she was sent by the CEO to aplogize for SUN when their Administrator Gail Conser informed the CEO that their broken blood pressure monitor caused my mother to have a stroke when they neglected to give her medication. This was in the same town the CEO lives. SUN then caused my mother months of suffering (inability to swallow, renal failure, respiratory distress) which along with MRSA caught at SUN eventually killed her. I have written documents from a board member acknowledging equipment was inoperable for months yet still not ready to respond to the critical situation, claiming "hystorically" it's not been a problem. Because they were under a state injunction from 2001 for having the same broken equipment in a Burlingame, Calif facility that killed patients, this was willful misconduct, cause for termination for good cause by it's board of director's (making me eligible for treble damages). But the powers that be prevented that triple compensation. After major surgery at UCLA to remove a pancreatic precancerous tumor that was simply a miracle I survived, my attorney rushed me into mediation while still recovering, lied to me about the law, coerced, intimidated and threatened me into signing an agreement for damages based solely on SUN’s fraud. He dropped damages for wrongful death, elder abuse, pain & suffering while I was distracted and ill. Months later when I regained my strength, I sued Daniel Leipold for malpractice, he died 2 weeks later, sadly. I won that case in 2008.
SUN can’t bar me for telling my story because I refused to sign a confidentialty agreement after mediaiton -after being told by my attorney that SUN’s CEO was on the phone from his Irvine office with attorneys in the other room and that he would cause me bodily harm and ruin my reputation if I forced this case to trial.
SUN cheated the taxpayers of the State of Calif for millions of dollars in fines the State would have fined for my mother’s death and the four other deaths SUN was responsible for that I witnessed during my limited time there, and according to Claude Vanderwold deputy attrny gener'l this facility was NOT considered in the fine of $2.5 Million in Sept 2005 against Sun for violating the injunction to date.
The Dept of Justice turned a blind eye. The Dept of Health didn’t fine the usual $100,000 for her or any other's death.
Yet SUN’s own medical director, Dr L Scott Stoney, wrote an opinion SUN responsible for her death and he quit due to SUN’s lack of response.
Yes, I can testify SUN Healthcare Group Inc, of New Mexico, produces profits at the cost of elder abuse and manslaughter.
Does this sound like political corruption? Corporate corruption?
This is not rocket science, Buzz would say.
Deborah Calvert daughter of the late Evelyn Calvert, Newport Beach, California and former assistant to Buzz Aldrin

Pelosi should be tried for treason.

When Nancy Pelosi trades in her health plan for the one she's going to give us, I'll write to my Congressional delegation and insist they support the plan. Until then, I see no reason to accept a plan she doesn't want for herself.

I cannot believe the rancor of the Republicans, and their willingness to throw everyone else under the bus. Do you really believe that these millionaires and even billionaires are creating jobs for the rest of the country? The wealthy in this "great capitalist country" have EXPORTED far more jobs than they've ever created, while they often pay less in taxes than their secretaries. If they would all like to leave and move to China, or India, or Iraq, I say "good riddance!"

Health care for children is non-negotiable. Children aren't pets, they are the future of our society. Likewise, adequate healthcare for seniors is only just -- unless we want to cast our parents adrift on an iceburg. And the only people who are entitled to object to health care for immigrants are the American Indians, who were here when the ancestors of the whiners immigrated here in the first place.

The COST of health care has to be addressed, as well as its availability. The 30 million people who don't have heath insurance would love to have it, but they are either denied coverage, or simply can't afford it, or are young and healthy and think they don't need it -- until they land in the emergency room, and make everyone else pay the exorbitant cost of treatment there.


It is a shame that some Americans are so gullible, to the outlandish propaganda and lies spat in the newspapers, television and radio about Obama’s health care agenda. They have demonized the British, Canadian and other worthy plans. Hidden under a disguise cover, these radical entities are determined to keep the special interest organizations in absolute power. Comprising of the money-draining profitable insurance companies and their rich stockholders. They don't want any changes to the broken system of medical care, because it will hurt the status quo. I was born in England, in the county of Sussex and until the inception of the European Union and the European Parliament dictating to Britain. That they must accept millions of foreign workers, the nations medical system was exemplary. I never had to wonder if I would have to file bankruptcy, to pay my medical bills, or listen to the incessant ring of debt collectors on the phone.

On several occasions I ended up in the cottage hospital and their was never a cost applied to it, never a ream of paperwork. Incidentally, I choose my own doctor where I Lived. The longest I waited for surgery was three months, as it was not an emergency. No doctor, no hospital or specialist asking me for my Social Security number, drivers license or if I was covered by a predatory for-profit insurer. No premiums, no-cops and pre-existing condition clauses. Yes! Didn't have a private room, but who cares? Today the British Isles is being submerged under a barrage of legal and illegal immigrants, who have never paid into the system, have caused some rationing. Prior to the importation of foreign labor my trips to doctor, to hospital, the eye or a dentist was paid from my taxation. Unless we pass a national health care agenda, Americans will never know what it's like to breeze through their lives, without worrying about paying for health care? Tell your Senators and Congressman you want an alternative to the--GET RICH-- insurance companies, before a Universal health care is killed. 202-224-312 REMEMBER THE INVESTORS AND STOCKHOLDERS DON'T WANT THEIR PIECE OF THE $$$TRILLION$$$ DOLLAR PIE DISTURBED. EVEN SOME POLITICIANS HAVE THEIR DIRTY FINGERS IN THE PIE?

Hey Bob J: Better check with your rich employer, her may be exploiting you! No worry Nancy will take care of your health care plan!

Let's see...

"85% of those premiums must be spent on benefits." Private insurers, on the other hand, make wise investments and return something like 110% of of premiums paid.

Sounds like a good deal... NOT!

Just another liberal program to bankrupt America and turn us into a dictator state. Liberals love dictators.

It would be a simple matter of continuing to tax people for SSA tax without a cutoff at a certain acquired income. The rich always draw the limit on Social Security and pay a smaller portion of their income tward it. If that increase in tax was applied to health care it would be fare and it should pay the bills.

Basically, If ruling party changes, accordingly tax system also does, especially given the condition that the middle class is undergoing severe financial hardship as a consequence of the extremely high fuel price, mortgage rate, and insurance premium, which is a beauty and virtue of democracy as we know.

In case some people have enjoyed the benefit of exemptions, that might imply others have shouldered the equivalent of their share.
Now the time has come for the middle class and middle class-oriented party to take initiative.
In general, advanced states are characterized as a broad base of middle class, the recovery of which is what the last presidential election is for, too.

Alongside a tax on the richest, alcohol tax and ending subsidies for the private insurers can be considered, I guess.

" The purpose of the legislation is to lower costs for individuals ... for businesses so they can be competitive ... and for the federal government.... Putting ... more people in the mix, as well as improving the insurance coverage for many more people, we believe that will lower the cost.... Right now an insurance company can take the premiums it gets and spend whatever percentage on benefits. Under this bill, 85% of those premiums must be spent on benefits...."

The legislation is about controls on insurance and controls on health care providers, ultimately controls on every one of us -- with some agencies of the expanded government setting prices salaries and tax burden, rules that they themselves refuse to play by. With Social Security and Medicare nearly collapsed, this promised 'solution' is worse that the supposed problem.

There seems to be a serious disconnect here -- how are costs and fees going to be reduced by increasing the number of consumers or any increase in demand? we are not manufacturing widgets here, so that mass-production can promote efficiency and increase profits at the same time. It is actually a matter of forcing saturation of market capability and by putting a statutory limit on return to the provider. Clearly this 15% limit on the return leaves little for a profit margin, perhaps it would be more clear if I suggest that the government be limited to this same percentage for the work that it is supposed to do. As it is, government consumes more than 20% of the GDP, ignoring the debt/interest burden.
Perhaps all this will really do is paint a very large target on these overly protected shysters.
The poetry here is that it is easy to be a socialist in a capitalist society, but it quickly becomes impossible to be a capitalist or a socialist in a socialist society -- as it is, there is a government employee for every 7 workers, can it get much worse than that?

Government provided access to healthcare is a bogus claim.
If such were the case it would mean terminating Social Security and Medicare/Medicaid, the costs of which raises the health expense on everyone; it would also mean elimination of a number of different Federal Aid programs for the states (which were estimated to be about 815 in 2006) costing about $450 billion in fiscal 2007 and constitutes the third-largest item in the federal budget after Social Security and national defense [the only mandated item in the Constitution].
After 100 years of this perversion of the Constitution it is indeed time for a change.
As it stands each worker must generate about $50,000 after taxes to produce the GDP, whether they have the advantage of keeping any part of it to spend themselves or not.
A growing number of non-productive employees makes the situation worse; non-productive employees are not a product of the free market, industry or the private sector.
Governance is not a producer but a consumer.
The legislation is designed primarily to increase the size of government and provide for vast sums to be then laundered by power brokers. Another mandatory government insurance policy. It does nothing to enhance the quality or availability of care in any way, but makes them instead less likely.
What Congress is arguing to decide is an obscene case of the tail wagging the dog.

Personally, if I wanted to work for the government, I would run for office; I certainly will not allow a public servant decide in my place to whom where and when I shall see my cardiologist in any case.
Perhaps some one should have asked Pelosi if she anticipates being taxed and enrolled in this half-baked plan, to wait in line along with the people she is sworn to serve for this rather than her own more generous benefit package.


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About the Columnist
A veteran foreign and national correspondent, Andrew Malcolm has served on the L.A. Times Editorial Board and was a Pulitzer finalist in 2004. He is the author of 10 nonfiction books and father of four. Read more.
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