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Rahm Emanuel: Changes To Health System Take Time

With one-sixth of the nation’s economy at stake, a debate over how to remake the health care system is not anywhere near being over, despite concerted efforts to hammer out legislation before Congress takes its summer break.

White House Chief of Staff Rahm Emanuel told NPR’s Steve Inskeep in an interview Thursday night that House Speaker Nancy Pelosi plans to pass a health overhaul bill out of her chamber before the August recess, despite indications that that timetable is slipping.

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“I can tell you what I know, which is that the speaker today announced to the caucus that their intention is to go next week, and she is working toward that goal,” Emanuel said.

Time To ‘Iron Out’ Differences

Despite an earlier push by President Obama for Congress to complete its work on the legislation before the break, he and his chief of staff have acknowledged that a final product is more likely to be seen at the end of the year.

Setting the deadline for August, however, was important, Emanuel says, because Congress “can use the summer months to basically work out and iron out differences.”

Those differences include debates over thorny issues like taxing the wealthy to pay for expanding health coverage, whether to create a government plan that would compete for patients with private insurers, and what kind of role businesses should play, among other things.

“Having a deadline focuses the mind,” he said.

Still, many members of Congress have raised concerns about leaving incomplete legislation unfinished over the summer to be picked apart.

Emanuel dismissed the idea that this would bring down the bills, noting that 14,000 people a day lose their health insurance.

“The public wants health care reform that fundamentally doesn’t put the insurance companies in control of the process, which is where they fundamentally are,” he said.

He also said lawmakers would welcome hearing from people in their districts about the issue. “Hearing from constituents will not be the same as hearing from the special interests,” he said.

Political Pressure From All Sides

Emanuel shrugged off Sen. Jim DeMint’s (R-S.C.) comments Wednesday that health care is Obama’s “Waterloo” and remarks Thursday by Sen. James Inhofe (R-OK) that Republicans are plotting the bill’s demise on a “week by week” basis.

“At least they’re honest about their motivation. Their view about health care is about defeating President Obama,” he said. “Politically, I actually appreciate what they said.”

But tensions have arisen within the Democratic caucus, as well, as the Senate Finance Committee struggles to put together its version of the bill.

The administration’s efforts to get and keep big health care interest groups on board has been worrying some Democrats in recent days. Hospitals, physicians, insurance companies and prescription drug industry groups have all pledged varying degrees of support for an overhaul.

Emanuel said it was important to keep the advocates who have been opposed to reform in the past on board, but “not at all costs. That has been a key part of this.”

Fiscally conservative Democrats have also raised concerns about cost, but Emanuel urged the country to take a step back and think about the scale of what Congress is trying to accomplish.

“For 40 years, we’ve had a debate about health care that was solely about expanding coverage. For the first time, you have the dual goals of controlling costs and expanding coverage,” he said.

“We’re not just running it up on the credit card, which is how they did the prescription drug bill,” he said, referring to the passage of a bill in 2003 under a Republican-controlled Congress that added a prescription drug benefit to Medicare.

“They charged it, which is a $900 billion charge,” he said. “And nobody paid for it.”

Emanuel sees giving more power to a commission already in place to advise Congress on how to hold down Medicare spending as key to keeping costs under control.

Fate Of The Overhaul

Inskeep asked Emanuel about the difficulties of holding together such a varied group of supporters and getting the new votes needed to pass legislation.

“I’ve seen places where people are trying to find a way to be a ‘no,’ and I’ve seen places where people are truly, earnestly trying to find a ‘yes.’ And I think we’re in the process of people trying to find out how to get to a ‘yes,’ ” he said.

At the end of the day, Emanuel expects a bill-signing ceremony.

“We will have a bill by the end of the year for the president to sign on health care that controls costs, expands coverage and provides choice,” Emanuel said.

But he declined to predict how, exactly, the president and Congress would get there.

“I don’t want to fast forward the movie; you’re just gonna have to watch the movie all the way through,” he said.

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