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

July 18, 2009 |  5:15 pm

Pelosi

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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