ROBERT SIEGEL, HOST:
So Senate Republicans have not been able to solve the cluster of complex equations that describe the U.S. health care economy. How much will be cut from Medicaid? How costly will health insurance be in the individual market? How big will deductibles be in order to arrive at affordable premiums?
Well, Drew Altman, the president of the Kaiser Family Foundation, has been grappling with questions like those for years, and he joins us to talk about them now. Welcome to the program.
DREW ALTMAN: Thank you. Thank you.
SIEGEL: We spend around $3 trillion a year on health care in an economy that's approaching $19 trillion in total. You could say that that is so much money that people are going to complain about paying for it, whether it's through federal income taxes, state taxes, Social Security taxes or insurance premiums. Can anything be done to bring down the national health care bill without significantly creating a decline in health care service?
ALTMAN: Well, I think the big problem when you talk about health care costs is that what everyone means by costs is really very different. What experts mean by costs, what Paul Ryan and many Republicans mean by costs, what the American people mean by costs that are freaked out about costs - they're just totally different thing.
Paul Ryan and the conservatives - they're focused on what the federal government spends on health care, reducing federal spending and cutting the federal budget and capping entitlement programs. And then you know what? The American people - they're focused on something entirely different - their own health care bills, their premiums, their deductibles and their drug prices and the impact of that on their family budget. So it's a pocketbook issue for people.
But I think it's fair to say that the biggest change in health care today has been the steady rise in deductibles and other forms of cost sharing. I would say that that change in insurance is probably a bigger change than the ACA, which has occurred under the radar screen while we've had this great debate about the ACA. And the biggest question in health care we're not debating is how much cost sharing is too much.
SIEGEL: Let's say that this round of health care legislation fails. And so far, we don't have both chambers agreeing to a bill, and the Senate hasn't even approved anything. Can you imagine another round of legislation three or four years from now that might take a look at some of those basic questions? Did you hear people getting ready for a more courageous, more difficult approach to the health care economy?
ALTMAN: No, I think it always used to be - I've been in this field a very long time - that the major obstacle to progress was health care's powerful industry groups. But in recent years, the most important force in health care has been partisanship.
SIEGEL: If you could somehow bring about a new era of bipartisanship or nonpartisanship to this entire discussion and started moving people in Washington toward a good solution, what would it be? What would be some of the elements of a smart move for the United States given where we are in our health care system?
ALTMAN: I might try and shift the focus of the debate in ways that might produce greater opportunities for bipartisan cooperation because what we're all talking about is repealing and replacing the ACA. And when we talk to the American people, they're not focused at all on repealing and replacing the ACA. They're focused on their premiums, their deductibles, their drug costs. The issue I hear about the most is surprise medical bills for care people get out of their networks when they think that a bill is covered and it isn't covered.
Today about 30 percent of the American people have problems paying their medical bills. Those problems translate into real issues for them. They rack up debt. They can't buy food. They can't buy gas for their cars to get to work. That percentage of people seems to be growing and could, if this legislation passes, grow substantially in the coming years. And that's what we really should be focused on.
It's important - really important to focus on the number of people without health insurance, but there's a much larger group of people, including people with health insurance, who are really struggling and paying their bills. And that's really what the American people are focused on.
SIEGEL: Drew Altman, president of the Kaiser Family Foundation, thanks for talking with us today about it.
ALTMAN: Thank you very much.
SIEGEL: And I should note that NPR partners with Kaiser Health News, which is an editorially independent part of the Foundation, which is nonpartisan. Transcript provided by NPR, Copyright NPR.