\t\t\t<\/p>\n
\tJulie Rovner
\n\tKFF Health News<\/p>\n
\t\t\t \t\t\t \t\t\t \t\t\tJulie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.\t\t<\/p>\n This month marks host Julie Rovner’s 40th anniversary reporting on health policy in Washington. Over that time, she’s covered a vast range of topics, from the response to the AIDS epidemic, to Medicare and Medicaid changes, to the fight over the “Patients’ Bill of Rights” \u2014 and a half-dozen major reform fights, including the introduction of the Affordable Care Act and the efforts to repeal it.<\/p>\n In honor of the occasion, Rovner invited two of her longtime sources to chat about what has \u2014 and has not \u2014 changed in health policy over the past four decades.<\/p>\n \t\t\t\t\tClick to open the transcript\t\t\t\t<\/p>\n \t\t\t\t\t\tTranscript: 40 Years of Health Policy<\/strong>\t\t\t\t<\/p>\n [Editor’s note:<\/em><\/strong>\u00a0This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.]<\/em>\u00a0<\/p>\n Julie Rovner:<\/strong>\u00a0Hello from KFF Health News and WAMU Public Radio in Washington, D.C.\u00a0Welcome to\u00a0What the Health?<\/em>\u00a0I’m\u00a0Julie Rovner, chief Washington correspondent for KFF Health News.\u00a0Usually\u00a0we’re\u00a0joined by some of the best reporters covering Washington, but today\u00a0we’re\u00a0bringing you something special. I hope you enjoy it.\u00a0We’re\u00a0taping this episode on Friday, Feb. 27, at 4 p.m. As always, news happens\u00a0fast, and things might have changed by the time you hear this.\u00a0So here we go.\u00a0<\/p>\n I have two special guests today, who I will introduce in a moment. But first\u00a0I’m\u00a0going to explain why I chose them. I started reporting on health policy in 1986, covering health and welfare on Capitol Hill and at the Department of Health and Human Services for what was then the Congressional Quarterly\u00a0“Weekly Report.”\u00a0This month marks my 40th anniversary on the health beat, and as anniversaries so often do, it got me thinking about everything I’ve seen and covered, including a half a dozen major health reform fights, a dozen budget reconciliation bills, years-long fights over everything from the Patients’\u00a0Bill of Rights and human cloning to bioterrorism and a pandemic. It also got me thinking about where I thought the U.S. health system would be four decades after I began, and where it\u00a0actually is. And I thought it might be fun to reminisce with a couple of people who not only were there when I started, but who also taught me a lot of what I know.\u00a0So\u00a0without further ado, let me introduce my guests.\u00a0Chip Kahn\u00a0just stepped down as president and CEO of the Federation of American Hospitals after 25 years in that post. Chip previously worked in both the House and the Senate for the major health committees\u00a0and also\u00a0headed\u00a0the Health Insurance Association of America, the industry group now known as AHIP.\u00a0I’m\u00a0pleased to announce that Chip is not actually retiring\u00a0\u2014\u00a0that,\u00a0among other activities,\u00a0he’s\u00a0going to be a colleague of mine here at KFF as a senior fellow. Chip will also host a podcast starting later this spring on the business of health care. Chip, thanks for being here, and\u00a0welcome.\u00a0<\/p>\n Chip Kahn:<\/strong>\u00a0Really happy to be here and celebrate with you.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Joining Chip is Chris Jennings, who not only worked in the Senate for a decade, but also worked in the White House as a senior health staffer for Presidents [Bill] Clinton and [Barack] Obama and\u00a0advised\u00a0President [Joe] Biden as well. Today, Chris is president of the health care consulting firm Jennings Policy Strategies. Chris, welcome and thanks for playing along.\u00a0<\/p>\n Chris Jennings:<\/strong>\u00a0Julie,\u00a0it’s\u00a0been great to age together.\u00a0<\/p>\n Rovner:<\/strong>\u00a0So\u00a0let’s\u00a0start with a little bit of a tour of each of your careers. Chip, you go first.\u00a0How did you first get started in shaping health policy, and what was your trajectory to today?\u00a0<\/p>\n Kahn:\u00a0<\/strong>It was a scary long time ago.\u00a0I guess I got started in politics in 1968,\u00a0actually, when I met Newt Gingrich in New Orleans and then managed his two congressional campaigns.\u00a0But then I went to graduate school in public\u00a0health, and finally broke into the\u00a0Hill in 1983 and worked for a year for Dan Quayle, and then worked in the Senate, worked in the\u00a0House, went out and worked for the health insurers, came back and worked in the\u00a0House again during the\u00a0’90s\u00a0\u2014\u00a0many, many years of health policy.\u00a0And then, as you said, for almost 25 years, worked at the Federation of American\u00a0Hospitals,\u00a0representing\u00a020% of the hospital industry and all the health policy battles.\u00a0<\/p>\n Rovner:\u00a0<\/strong>And behind your head it says\u00a0“AEI,”\u00a0so in your not-retirement,\u00a0you’re\u00a0going to be here at\u00a0KFF, and\u00a0you’re\u00a0also going to be at AEI\u00a0[American Enterprise Institute]. What else are you planning\u00a0on doing?\u00a0<\/p>\n Kahn:\u00a0<\/strong>Well, other than being a think tanker\u00a0\u2026\u00a0and a podcaster,\u00a0I’m looking at a number of areas where I’d like to do some writing on the health policy issues that I’ve been involved with over the years, and maybe try to impact their future by some of the things I have to say.\u00a0That’s\u00a0my,\u00a0will be primary, although\u00a0I’m\u00a0also working with the\u00a0dean of the School of Public Health at Tulane on developing a\u00a0health\u00a0policy\u00a0center there.\u00a0And I do photography, street photography, and I’ve got a project there too.\u00a0So\u00a0I’m\u00a0not retiring.\u00a0I’m\u00a0just moving on.\u00a0<\/p>\n Rovner:\u00a0<\/strong>You are busier than I am, and I thought I was busy. Chris, how did you come to health policy?\u00a0<\/p>\n Jennings:\u00a0<\/strong>Well, I know\u00a0you’re\u00a0a Michigan\u00a0gal, Julie, but\u00a0I’m\u00a0from Ohio.\u00a0And I came,\u00a0actually,\u00a0the same year that\u00a0Chip came in, in 1983.\u00a0John Glenn hired me as\u00a0a very, very young\u00a0assistant. I\u00a0don’t\u00a0think I got to know you until\u00a0\u2026\u00a01986,\u00a0shortly behind.\u00a0But I remember in\u00a0’86 I was hired by the chairman of the\u00a0Aging\u00a0Committee, the then-chairman of the agency committee\u00a0[Special Committee on Aging], John Melcher, and he held the first hearing in a blizzard on the Medicare Catastrophic\u00a0[Protection]\u00a0illness coverage\u00a0Act, and I worked through\u00a0\u2026\u00a0that was\u00a0’88-’89,\u00a0we repealed the policy, as you will recall.\u00a0By that time, you may have moved on to the National Journal. I\u00a0can’t\u00a0even remember when you were there and in NPR, but I followed you as you followed me. And I worked on another\u00a0chairman, David Pryor, on the\u00a0Pepper\u00a0Commission, where I got to know\u00a0Chip\u00a0\u2014\u00a0love, hate, mostly respect Chip\u00a0\u2014\u00a0on the\u00a0Pepper Commission, which both succeeded and\u00a0immediately\u00a0failed.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0And\u00a0we’ll\u00a0get to that.\u00a0\u00a0<\/p>\n Jennings:<\/strong>\u00a0And it set the stage, really, and\u00a0that’s\u00a0where\u00a0I think people\u00a0started to know me on the\u00a0Aging\u00a0Committee, on the Finance Committee, on the\u00a0Pepper\u00a0Commission. And then,\u00a0I’d\u00a0go on and on. But,\u00a0of course, I was eventually tapped to help Hillary Clinton do the Health Security Act, where we spectacularly failed, but learned our lessons, and we moved on. And I was there for all eight years of the Clinton administration, set up my own consulting firm, went back into the White House, as you said, and have been proud to be involved with some, you know, both extraordinary successes and failures, but progress that I think sometimes people don’t acknowledge in this debate. So hopefully we get to talk about that as well.\u00a0<\/p>\n Kahn:\u00a0<\/strong>You know, Julie, one thing I think you can say about both of us is that there\u00a0hasn’t\u00a0been anything congressionally in delivery or financing,\u00a0over your entire 40 years,\u00a0that Chris and I were not\u00a0involved in\u00a0in one way or another.\u00a0<\/p>\n Rovner:\u00a0<\/strong>That was why I decided I wanted\u00a0you guys.\u00a0I well\u00a0know that\u00a0you’ve\u00a0had your fingers in everything this entire time. Well,\u00a0let’s\u00a0go back to the spring of 1986,\u00a0when I first started covering health care on Capitol Hill.\u00a0Congress was just finishing the COBRA [Continuation of Health\u00a0Coverage]\u00a0budget reconciliation bill,\u00a0for which the health care continuation provisions that everybody knows are named, even though that was just one of\u00a0literally hundreds\u00a0of provisions,\u00a0of different health care provisions in that bill.\u00a0And from the\u00a0“Some\u00a0Things\u00a0Never\u00a0Change”\u00a0file, that bill was\u00a0very late. It had been kicking around since the middle of the year before one of the first big feature stories I wrote that spring was about how the U.S.\u00a0had no real program to pay for\u00a0long-term\u00a0care for the elderly, something that is still true today. What were\u00a0you guys\u00a0focused on in 1986?\u00a0<\/p>\n Kahn:\u00a0<\/strong>I think in 1986,\u00a0as you said, every year during the\u00a0’80s and into the early\u00a0’90s,\u00a0almost like\u00a0clockwork, there was a budget bill, although some of those budget bills, like COBRA, lapped over.\u00a0And I could, I could recite, until about 1990,\u00a0I think, all the key provisions of every one of those bills.\u00a0So\u00a0whether it was Medicare in terms of payment modifications and payment improvements,\u00a0or payment reforms, or whether it was Medicaid in terms of incrementalism, in terms of expanding to different populations. You know, we\u00a0sort of saw\u00a0it all.\u00a0<\/p>\n Jennings:\u00a0<\/strong>There were notable reforms. In fact,\u00a0it’s\u00a0important to remember back\u00a0then,\u00a0health care really was the domain of the Congress.\u00a0Presidents, barely, you know, they were for technical\u00a0assistance, they provided information. But the big players in health\u00a0care in the\u00a0’80s were\u00a0\u2014\u00a0and\u00a0it’s\u00a0a very impressive group of people, both members and staff. And I\u00a0don’t\u00a0want to sound like an old person, but those were days when you\u00a0actually did\u00a0get bipartisan policies done. They\u00a0weren’t\u00a0easily done, but they were done, and I think\u00a0it’s\u00a0important to recognize that.\u00a0I go\u00a0\u2014\u00a0you’re\u00a0saying\u00a0’86,\u00a0so I’m going to stick with\u00a0’86.\u00a0But\u00a0’86 was a\u00a0big year\u00a0\u2026\u00a0I think that\u00a0was also\u00a0\u2014\u00a0when did we do COBRA?\u00a0’85-’86 we were implementing\u00a0COBRA.\u00a0\u00a0<\/p>\n Kahn:<\/strong>\u00a0It was done in\u00a0’86.\u00a0<\/p>\n Jennings:<\/strong>\u00a0Yeah,\u00a0’86.\u00a0<\/p>\n Rovner:<\/strong>\u00a0It was in\u00a0COBRA.\u00a0<\/p>\n Jennings:<\/strong>\u00a0Yeah,\u00a0yeah. So, you know, that is, again, a policy that a number of people actually do\u00a0utilize\u00a0and it’s very, very important.\u00a0<\/p>\n Rovner:<\/strong>\u00a0And EMTALA was in that bill.\u00a0<\/p>\n Jennings:\u00a0<\/strong>EMTALA was in that bill, yes.\u00a0<\/p>\n Kahn:<\/strong>\u00a0But besides these bills, and you brought it up,\u00a0Medicaid\u00a0Catastrophic, which was started a little bit after that,\u00a0actually was\u00a0a Reagan\u00a0administration initiative. Dr\u00a0[Otis]\u00a0Bowen, the\u00a0secretary of HHS\u00a0[Department of Health and Human Services],\u00a0was the major proponent. Then it became,\u00a0obviously,\u00a0very congressional. And so\u00a0the\u00a0major piece of health legislation that was just a health bill that\u00a0wasn’t\u00a0connected to one of these big budget bills, these\u00a0big reconciliations, it passed, and it passed overwhelmingly in both chambers. After a lot of work, we could talk about that, if you want. And then within a year, you know, it was repealed. And one of the weird experiences of my\u00a0life,\u00a0was that, on the one hand, Bill\u00a0Gradison\u00a0in the\u00a0House was one of the original framers of that legislation.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Your boss at the time.\u00a0<\/p>\n Kahn:<\/strong>\u00a0One of my bosses at the time. But\u00a0the day before repeal was considered in the\u00a0House, I had to\u00a0write for\u00a0Bill\u00a0Gradison\u00a0a draft of a statement for him.\u00a0And I, but I also worked for Bill Archer, who was one of the authors\u00a0of the\u00a0Archer-Donnelly amendment, which would repeal Medicare\u00a0Catastrophic.\u00a0So\u00a0I also had to write a draft of a statement for him.\u00a0Actually, let\u00a0me say,\u00a0I\u00a0didn’t\u00a0write\u00a0them\u00a0on the same day because I\u00a0couldn’t\u00a0bring myself\u00a0to.\u00a0But I was really sort of\u00a0\u2014\u00a0I got to be careful here\u00a0\u2014\u00a0“schizophrenic”\u00a0on the issue, because I worked both on the legislation and then on its repeal.\u00a0<\/p>\n Jennings:\u00a0<\/strong>Julie,\u00a0also, I just have to say there’s another irony that I think no one knows really about, but the lead sponsor of the repeal was John McCain.\u00a0John McCain,\u00a0who raised all the\u00a0issue\u00a0of the\u00a0so-called surtax,\u00a0OK?\u00a0Do you remember this?\u00a0<\/p>\n Rovner:\u00a0<\/strong>I do. I\u00a0wrote\u00a0a big story about John McCain.\u00a0<\/p>\n Jennings:\u00a0<\/strong>People think\u00a0John McCain is Mr. Savior of the Affordable Care Act, but he also repealed the most significant,\u00a0at the time, bipartisan, bicameral health care reform bill\u00a0that actually,\u00a0we\u00a0should also say,\u00a0did include an incremental Medicare prescription drug benefit.\u00a0<\/p>\n Rovner:<\/strong>\u00a0John McCain was\u00a0very sorry.\u00a0He actually felt bad that he ended up\u00a0\u2026\u00a0he tried to undo the repeal that he led.\u00a0<\/p>\n Kahn:\u00a0<\/strong>And also,\u00a0there was a secret weapon in there, which\u00a0actually was\u00a0very expensive, which was a\u00a0Bill\u00a0Gradison\u00a0initiative, which was to change the skilled nursing facility benefit so that Medicare would\u00a0basically cover\u00a0six months without three days prior hospitalization.\u00a0\u00a0<\/p>\n Jennings:<\/strong>\u00a0Yeah.\u00a0<\/p>\n Kahn:<\/strong>\u00a0And that was something that CBO\u00a0said,\u00a0the\u00a0Congressional Budget Office said would just cost a few 100 million dollars. It was\u00a0actually costing\u00a0billions almost\u00a0immediately, because all the states\u00a0immediately\u00a0changed those dual-eligible patients, dual eligible for Medicare and Medicaid, and made them Medicare patients because of the six months.\u00a0So\u00a0there was even a long-term care\u00a0provision in\u00a0there, despite the fact that some felt that Medicare\u00a0Catastrophic didn’t touch long-term care.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Well, while\u00a0we’re\u00a0on the subject of the\u00a0poor,\u00a0be-knighted,\u00a0repealed Medicare\u00a0Catastrophic bill, which we all experienced,\u00a0that led to the Clinton health reform bill.\u00a0Chris, you were instrumental in that.\u00a0What had you learned from the passage and repeal of catastrophic that you tried to put into place when you were working on the Clinton plan?\u00a0<\/p>\n Jennings:<\/strong>\u00a0Sure.\u00a0Well, first, Julie, I think we learned from all of our mistakes, and you learn more from your mistakes\u00a0than\u00a0you learn from your successes.\u00a0And sometimes you\u00a0mislearn\u00a0your successes in major ways.\u00a0But I do want to say the one thing that we did not repeal in the Medicare\u00a0Catastrophic\u00a0[Protection]\u00a0coverage\u00a0Act was the\u00a0Pepper\u00a0Commission. And the\u00a0Pepper\u00a0Commission was the first attempt to do the comprehensive reform proposal, and it was reported out, but in a really humorous, terrible scene, which I won’t bore people with,\u00a0but\u00a0\u2014\u00a0Chip was there,\u00a0and I was there, and it was painful, and that people actually almost came to blows over that policy. Physical, physical blows\u00a0between\u00a0my boss, David Pryor,\u00a0and Pete Stark, of all people. So\u00a0that’s\u00a0another story. But yes, after that, there was a[n]\u00a0election in Pennsylvania\u00a0\u2014\u00a0and this is\u00a0sort of interesting\u00a0historical context\u00a0\u2014 it was\u00a0a special election by\u00a0[Sen.]\u00a0Harris Wofford, who won, and it was all about health reform. And his political advisers, interesting,\u00a0was James Carville and Paul Begala, and health\u00a0care suddenly became,\u00a0comprehensive\u00a0health care reform became, oh, this is a big issue. And every candidate who was running at that time\u00a0\u2014\u00a0really,\u00a0people who\u00a0\u2026\u00a0no one even knew the people running, because no one wanted to run against George W.\u00a0Bush\u00a0\u2014\u00a0but Bill Clinton was running against it, and he, he ended up winning, as you know, and then he chose\u00a0\u2026\u00a0<\/p>\n Rovner:<\/strong>\u00a0It was George H.W.\u00a0Bush.\u00a0<\/p>\n Jennings:<\/strong>\u00a0George H. \u2026\u00a0George H.\u00a0was so popular that the\u00a0primary Democratic candidates\u00a0didn’t\u00a0want to run against him.\u00a0So\u00a0people just said,\u00a0I’ll\u00a0just try.\u00a0And,\u00a0long story short, Bill Clinton wins.\u00a0And he\u00a0designates\u00a0Hillary Clinton.\u00a0And Hillary Clinton,\u00a0because I had done some work for their campaign and helped in the transition,\u00a0I was asked to become the congressional liaison. So now, what did I learn from that? Well,\u00a0there’s\u00a0so many things to learn, and we applied them\u00a0almost all\u00a0to the Affordable Care Act. And of course,\u00a0we’re\u00a0going to have to give\u00a0Chip his\u00a0\u2014\u00a0you know,\u00a0Chip’s\u00a0the star of\u00a0“Harry and Louise,”\u00a0and proudly contributed\u00a0to \u2026\u00a0<\/p>\n Rovner:<\/strong>\u00a0We’ll\u00a0get to that.\u00a0<\/p>\n Jennings:<\/strong>\u00a0\u2026\u00a0the demise. But I will say, even if we had perfectly executed the Health Security Act policy,\u00a0because of the time and the delay of it and how in the environment in which it was in, it probably would have been very, very difficult to\u00a0pass and enact at that time.\u00a0We can talk about that.\u00a0But one thing we learned is\u00a0it’s\u00a0really important\u00a0for presidential candidates to have a vision and a way to finance their vision, but not to micromanage exactly the specific policies you need to get congressional investment in those policies. And if you impose details, the details will get,\u00a0will be picked apart before you get the momentum to pass legislation. And you\u00a0won’t\u00a0have time to get both members of Congress and stakeholders,\u00a0who inevitably you\u00a0can’t\u00a0pick, you\u00a0can’t\u00a0have everyone be your enemy if\u00a0you’re\u00a0going to pass health care reform, and we succeeded in getting most everyone against us. That\u00a0wasn’t\u00a0completely my fault, but sure,\u00a0I’ll\u00a0take whatever responsibility there is.\u00a0But those are two big reasons. You know me, Julie. I could go on forever, but\u00a0I’m\u00a0going to stop with that and let\u00a0Chip take his victory lap or whatever.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yeah, because\u00a0Chip,\u00a0at that point, you were with the health insurers,\u00a0who were not thrilled with the Clinton plan.\u00a0<\/p>\n Kahn:\u00a0<\/strong>Well, let me say this. I always have to say this when I talk about the Health Insurance Association of America. Bill\u00a0Gradison\u00a0went over there in early\u00a0’93,\u00a0and he took me with him. I was his executive vice president at that point.\u00a0And the health insurers that we\u00a0represented\u00a0were for some kind of universal coverage structure. They\u00a0weren’t\u00a0for the model that was developed by the Clinton administration that they took to Congress. But\u00a0I think Chris\u00a0made\u00a0a very important\u00a0point: All the noise from the campaign around\u00a0“Clinton\u00a0Care,”\u00a0pro and con, there were a lot of things going on. First, a new administration only gets so many bites at the apple, even if\u00a0they’ve\u00a0got big majorities in Congress.\u00a0And they chose to do their big budget bill and a gun bill, which were\u00a0very difficult\u00a0votes for many members of Congress, before starting,\u00a0in September,\u00a0on the\u00a0Hill with the presidential speech to lead into health reform.\u00a0So\u00a0I think they\u00a0went in with a clock that was against them,\u00a0in terms of how much a new administration has.\u00a0Second,\u00a0I don’t think everybody completely understood it at the time, but we had congressional control by the Democrats of the\u00a0House for 40 years, and in some ways, they were a bit bankrupt, and there were a lot of issues around, you know, their unity.\u00a0And we\u00a0didn’t\u00a0know it until the election in\u00a0’94\u00a0\u2014\u00a0and Clinton\u00a0Care had had some effect\u00a0on that election\u00a0\u2014\u00a0but we were about to see the Republican\u00a0revolution taking place.\u00a0But the soundings of that and the effects of that played out in Clinton\u00a0Care.\u00a0But,\u00a0all that being said, if\u00a0you believe that campaigns make a difference in policy process and elections, there were campaigns that said Clinton\u00a0Care, as proposed, needs to change.\u00a0And\u00a0the Health Insurance Association of America did the Harry and Louise campaign, which\u00a0I\u00a0managed. And\u00a0actually\u00a0there was one point\u00a0\u2026\u00a0<\/p>\n Rovner:\u00a0<\/strong>I would say,\u00a0for those who\u00a0don’t\u00a0remember,\u00a0Harry and Louise were a couple of actors. Those were their names, actually, Harry\u00a0and Louise, who sat around their kitchen table wondering how they were going to pay for their health insurance if the Clinton plan passed.\u00a0<\/p>\n Kahn:<\/strong>\u00a0And that concept came from over the summer, leading into that August, before the Clinton\u00a0Care process began in Congress.\u00a0Bill\u00a0Gradison\u00a0had been going around giving speeches,\u00a0saying that health reform was going to be decided around the kitchen tables of America.\u00a0So\u00a0I told our advertising firm,\u00a0First Tuesday\u00a0[Strategies],\u00a0go\u00a0test that. And\u00a0that’s\u00a0how it all got started. And they\u00a0came up with\u00a0the concept, and we spent a lot of time on scripts.\u00a0And our whole point was not to defeat but to raise questions and actually just get a seat at the table.\u00a0Well, I could give anecdotes about why we\u00a0didn’t\u00a0get a seat at the table, and thus we began a campaign that was one of the components of the opposition to health reform that really defeated Clinton\u00a0Care.\u00a0<\/p>\n Jennings:<\/strong>\u00a0And Julie,\u00a0I’ll\u00a0just say I think\u00a0it’s\u00a0important to note that we also played into it by complaining so much about\u00a0[how] it\u00a0got\u00a0lot\u00a0of free\u00a0airtime,\u00a0too.\u00a0So\u00a0then the media covered it even more than the other one. And\u00a0so\u00a0it was the amount of money they paid for those ads versus the\u00a0amount\u00a0of\u00a0ads\u00a0people who see that ads was an extraordinary ROI\u00a0[return on investment]\u00a0for Chip\u00a0Kahn\u00a0and Bill\u00a0Gradison.\u00a0But\u00a0I do feel it’s important to note that a lot of the predicate for rationale behind and policy underpinning the Affordable Care Act, you’ll find a lot in the seeds of the Health Security Act, and then you’ll see them again\u00a0in the debate between Barack Obama and Hillary Clinton.\u00a0And in many ways, Hillary Clinton’s policy is more like what\u00a0ultimately was\u00a0passed and enacted in 2008 and 2009.\u00a0So\u00a0it’s\u00a0a very interesting\u00a0circle of the process. And the other thing that I think people don’t understand, is, right after that we had another health care debate, which was the\u00a0“Contract\u00a0With America”\u00a0and, or on America, as we used to call it, and, and that was a huge Medicare-Medicaid fight, which didn’t, which also failed. But I think you almost had to\u00a0have\u00a0these two\u00a0attempts to have an attempt\u00a0to make some progress. That led to things like the Children’s Health Insurance Program and beyond,\u00a0so all of which\u00a0\u2014\u00a0and by the way, HIPAA,\u00a0insurance reforms beyond that\u00a0\u2014\u00a0which began to lay the predicate for it. Yes.\u00a0<\/p>\n Rovner:\u00a0<\/strong>All right.\u00a0Well,\u00a0we’re\u00a0going to take a quick break. We will be right back.\u00a0<\/p>\n OK,\u00a0we’re\u00a0back.\u00a0In the 1990s, after the death of the Clinton health reform plan, there was this huge sort of flow of big, important health bills:\u00a0the Children’s Health Insurance Program;\u00a0like you say, HIPAA, the Health Insurance Portability and Accountability Act, which was a whole lot more than just the confidentiality provisions. In fact, my favorite piece of trivia is that there were no medical\u00a0records\u00a0confidentiality provisions because it was a requirement for Congress to write them, which they never bothered to do.\u00a0\u00a0<\/p>\n Kahn:<\/strong>\u00a0If you\u00a0want an anecdote on that,\u00a0I’ll\u00a0give you an anecdote.\u00a0\u00a0<\/p>\n Rovner:<\/strong>\u00a0OK.\u00a0<\/p>\n Kahn:<\/strong>\u00a0That’s there\u00a0because of me.\u00a0But I can only take credit for a few things:\u00a0diabetic shoes and HIPAA confidentiality.\u00a0<\/p>\n Rovner:\u00a0<\/strong>I do remember diabetic shoes, but I will not make you explain that.\u00a0But do explain how the confidentiality\u00a0\u2026\u00a0because HIPAA was\u00a0actually about\u00a0being able to change jobs without losing your health insurance\u00a0\u2014\u00a0it was\u00a0literally about\u00a0portability of health insurance, and the confidentiality stuff got tacked on at the last minute.\u00a0<\/p>\n Kahn:\u00a0<\/strong>No, no, no. It\u00a0didn’t. It\u00a0didn’t. No, the point of HIPAA\u00a0\u2014 and,\u00a0frankly, I\u00a0wasn’t\u00a0the author of this;\u00a0I\u00a0sort of stole\u00a0this idea\u00a0\u2014\u00a0but HIPAA was either the seven-point plan or the nine-point plan. And the idea of the way we structured HIPAA in the\u00a0House was to take four or five different things\u00a0\u2014\u00a0and it was, it\u00a0was much more than just insurance reform\u00a0\u2014and build out aspects of health reform,\u00a0sort of small-ball\u00a0health reform. And\u00a0the confidentiality\u00a0was one part of it. And we thought at the time that there was an\u00a0administrative\u00a0simplification portion of the bill, which came from a congressman from Ohio that, frankly, as a staffer, I was the one in the\u00a0House that put that in the bill, and I and our expectation was that Congress would come back and do confidentiality, but we needed to require it, to set a framework for it. And there was one day when the bill was\u00a0in\u00a0conference, when Dean Rosen, who was working for Ms. [Sen.\u00a0Nancy]\u00a0Kassebaum\u00a0\u2026\u00a0\u00a0<\/p>\n Jennings:<\/strong>\u00a0Yeah, it was\u00a0Kassebaum.\u00a0<\/p>\n Kahn:<\/strong>\u00a0\u2026\u00a0called me and said,\u00a0Do\u00a0we really have to leave those lines in the bill?<\/em>\u00a0And I said,\u00a0Boy, it’s really, really important<\/em>.\u00a0And the\u00a0congressman\u00a0from Ohio feels strongly about it, and Mr.\u00a0[Rep. Bill]\u00a0Thomas feels strongly about it<\/em>.\u00a0And so\u00a0that’s\u00a0why we got HIPAA, and\u00a0then, then\u00a0they\u00a0couldn’t\u00a0legislate on\u00a0it because it was too sensitive, but we put language in,\u00a0and HHS wrote the rules.\u00a0<\/p>\n Jennings:\u00a0<\/strong>I think it’s really important to note that in the olden days, when we started this, Congress actually gave much more explicit guidance to the executive branch as to how they\u00a0implemented.\u00a0HIPAA was a good example as a bridge to where we are today, which\u00a0was\u00a0we will do something<\/em>. This is what we were saying in HIPAA.\u00a0But if we\u00a0fail to\u00a0do so, we authorize you, executive branch, to implement the provisions of HIPAA<\/em>, which is what\u00a0ultimately the\u00a0Clinton administration had to do.\u00a0And\u00a0a lot of\u00a0that is because the Congress\u00a0couldn’t\u00a0agree on the details, as they often\u00a0can’t, but they still want to be associated with the underlying policy. But anyway,\u00a0it’s\u00a0just another lesson of the life that we were at and where we are now.\u00a0<\/p>\n Kahn:<\/strong>\u00a0And when you say,\u00a0wouldn’t\u00a0agree on the\u00a0details,\u00a0the trouble is that the poison pills, those cultural issues,\u00a0frequently\u00a0come into issues here. I mean abortion and other issues,\u00a0which are extremely\u00a0important issues, but\u00a0they’re\u00a0cultural issues, and people are not\u00a0generally willing\u00a0to compromise on those. And those are the issues that ended up holding up things like confidentiality, which Congress should have acted on.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Yeah, I want to get to the Affordable Care Act, but before I do,\u00a0Chip,\u00a0I want to talk about the strange bedfellows. Because I want\u00a0\u2026\u00a0you were talking about in the context of the Clinton reform, that the stakeholders\u00a0weren’t\u00a0really against it. They were only against parts of it.\u00a0I think I\u00a0wrote in a monograph on this that everybody wanted to cut off just one finger, but,\u00a0in\u00a0the end, the patient bled to death. You wanted to prevent that from happening when there was the next round that became the Affordable Care Act, and you got together with Ron\u00a0Pollack, who was, you know, a very liberal, also outside group. And\u00a0you guys\u00a0tried to put together a framework, right?\u00a0<\/p>\n Kahn:\u00a0<\/strong>Well, when I\u00a0went to\u00a0back to the\u00a0Health Insurance Association of America in 1998,\u00a0Ronnie Pollack and I got together and wanted to see what we could do. I mean, in a sense, we both really agreed that we needed various kinds of coverage expansions. We started\u00a0incremental. And as part of that, the Rob[ert]\u00a0Wood Johnson Foundation came in with a major initiative\u00a0to fund us and to fund the conversations we began, and to fund other groups coming in and joining us in a big coalition. And,\u00a0frankly, we were very close\u00a0on\u00a0some subsidization. We had\u00a0a\u00a0Republican and Democratic senator right before 9\/11 and then 9\/11 happened, and it just\u00a0\u2026\u00a0killed us. And\u00a0\u2026\u00a0we got put on the back burner. And\u00a0so\u00a0then we went through many years of Ronnie and I doing a lot of different efforts with many other stakeholders\u00a0\u2014\u00a0around either doing small-ball expansions or pushing for the ultimate\u00a0\u2014\u00a0and that, ultimately, I\u00a0think, at least helped fuel what happened in\u00a0’09. I mean, a lot of things led to\u00a0’09,\u00a0but at least, I think,\u00a0our effort laid a base of commonality across stakeholders that made\u00a0’09\u00a0very different from\u00a0’93.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Chris, you said that, you know, one of the things that you learned from the failed Clinton\u00a0health\u00a0reform is it\u00a0\u2026\u00a0you’ve\u00a0got to have at least some of the stakeholders inside the tent, right?\u00a0\u2026 That\u00a0seemed to me one of the\u00a0big changes\u00a0between 1993 and 2009.\u00a0<\/p>\n Jennings:\u00a0<\/strong>Yes, I mean, like every story that sounds black-and-white, there’s\u00a0grays\u00a0in those.\u00a0But yes, for sure, and I do agree that the larger insurers knew the market\u00a0couldn’t\u00a0\u2014\u00a0at least the individual, non-group market had to be reformed so that they\u00a0didn’t\u00a0\u2026\u00a0they’d\u00a0make their money on avoiding sick people. They needed to have a pool of people that they could insure, and it\u00a0wasn’t\u00a0an irrational, expensive, immoral health care system.\u00a0So\u00a0I felt, and to\u00a0Chip’s credit a lot,\u00a0and others, they wanted to have.\u00a0\u2026\u00a0And actually, the other argument that happened in 2008 and\u00a0’09,\u00a0there’s a lot of different things that came together.\u00a0Bipartisan\u00a0Policy Center was there. There was interest in doing comprehensive reforms that were very consistent with what the Affordable Care Act ended up happening. But there was also this notion of all the stakeholders were\u00a0just tired\u00a0of fighting, and it was like,\u00a0Let’s\u00a0get something together<\/em>. There’s one last point\u00a0that I think people\u00a0neglect to cite, and I know\u00a0Chip would agree.\u00a0At the time, there was a concern that a lot of the savings from health care would go to something like deficit reduction or tax\u00a0cuts, but\u00a0not reinvested in health care for coverage expansion. And so when,\u00a0you know, if you’re a stakeholder and you’re going to contribute something to the offsets, you want to be reinvested in your system so you have paying customers, and that’s why I think the hospitals and the physicians and the insurers all came together to say,\u00a0let’s figure out a way that this can work<\/em>.\u00a0So that at least helps paint the picture about how you could tie it together.\u00a0<\/p>\n Kahn:\u00a0<\/strong>And one experience that I had was that I brought\u00a0\u2014\u00a0I was then working by\u00a0the\u00a0early 2000s for the hospital association,\u00a0the\u00a0Federation\u00a0of\u00a0American\u00a0Hospitals. And at that point, you know, obviously my members were supportive of the work I was doing with Ronnie. But there came a point,\u00a0I can remember it to this day, in October 2006 we were having a meeting, and a number of the CEOs of the systems I work for\u00a0came to me in a meeting and said,\u00a0This\u00a0isn’t good enough<\/em>.\u00a0There are just too many patients that\u00a0we’re\u00a0treating that\u00a0don’t\u00a0have insurance,\u00a0where their finances are getting in the way of the care they need, and\u00a0we got to\u00a0have something comprehensive<\/em>.\u00a0So\u00a0they moved away from,\u00a0not that they\u00a0didn’t\u00a0support incremental changes, but they wanted to see the big picture done, and that led the Health Insurance Association\u00a0\u2014\u00a0we were a small group\u00a0\u2014\u00a0to\u00a0develop our own plan, the health\u00a0care passport.\u00a0And there were other plans out there. And the increment, the very important thing about that plan and the others and the way that\u00a0’09 worked was that in the administration\u00a0and\u00a0in\u00a0Congress, they wanted to build on what works in the system, and reform the individual market and lay in enough subsidization and expansion of Medicaid so that we could say everybody has the opportunity for coverage. Now we could say\u00a0that\u00a0was not that different from\u00a0’93 and\u00a0’94,\u00a0but it was handled completely differently. And\u00a0I think it\u00a0was more sensitive to all the concerns of all those that were stakeholders, that were players.\u00a0And that was the framework, but it was building on what exists with those kinds of playing with the knobs that really made the difference, that you could say everybody could have access to coverage.\u00a0<\/p>\n Rovner:\u00a0<\/strong>So\u00a0as we’ve kind of talked about, up to 2009 health care was pretty bipartisan. I mean, you know, there were partisan fights. There are obviously fights that\u00a0Chip,\u00a0you noted,\u00a0that\u00a0were going to be perennial, like fights over abortion.\u00a0But,\u00a0generally,\u00a0big things\u00a0that got done got done with\u00a0Democratic and at least some Republican votes, or, you know, Republican\u00a0\u2026\u00a0in the case of the Medicare prescription drug bill, Republican and some Democratic votes. And yet, you know, in 2009,\u00a0it just suddenly became partisan in a way that it still is today. I mean, what happened?\u00a0<\/p>\n Kahn:\u00a0<\/strong>Well, let me say\u00a0it’s\u00a0very, very important\u00a0to think of the broader context and not just focus on health care for a second. A lot was changing. The Tea Party, we go on and on about how we got to where we are today, and the great divide.\u00a0So\u00a0there was a great political divide. There was no more getting\u00a0\u2026\u00a0there was much less getting to yes in Congress. And I think that health reform, in a sense, suffered from that. And the other dilemma that health reform had, I think, which was it\u00a0was successful because of the vast\u00a0Democratic majorities.\u00a0They\u00a0didn’t\u00a0need the Republicans.\u00a0On the other hand, the fact that\u00a0\u2014\u00a0and the Republicans wouldn’t play, so I’m not saying there was a possibility there\u00a0\u2014\u00a0but the fact that it got done in a partisan fashion, you know, fit into a larger context that made it part of the divide. And,\u00a0frankly, after it passed\u00a0\u2014\u00a0and,\u00a0obviously, hospitals were\u00a0very supportive\u00a0of it\u00a0\u2014 there\u00a0were a lot of Republicans that would never speak to\u00a0me again.\u00a0<\/p>\n Jennings:<\/strong>\u00a0Yeah. And Julie, I think it’s important to recall that even back in\u00a0’93-’94,\u00a0around the Health Security Act, there were Republicans who wanted to do this, but\u00a0\u2014\u00a0and I’m sure\u00a0Chip will yell at me about this\u00a0\u2014\u00a0but Speaker Gingrich was not interested in having a health\u00a0care achievement signed into law by Bill Clinton. He made that very, very explicit.\u00a0So\u00a0I think different people will say,\u00a0When\u00a0did partisanship around health\u00a0care really start? But I would say there was a big one. Then we had the big fight around the\u00a0“Contract\u00a0With\u00a0America,”\u00a0and from then on, even though there were significant reforms that were bipartisan, I would call them important, but incremental, you know.\u00a0And\u00a0Chip’s right.\u00a0I\u00a0don’t\u00a0think you could have gotten anything close to the Affordable Care Act on a bipartisan bill.\u00a0Maybe\u00a0he’d\u00a0disagree, but I just, I\u00a0don’t\u00a0think there are some Republicans\u00a0\u2014\u00a0I’ll\u00a0tell,\u00a0I can even tell you\u00a0\u2014\u00a0who would say,\u00a0Oh, if\u00a0you’d\u00a0only tried or whatever<\/em>\u00a0\u2026\u00a0I think\u00a0[Sen.]\u00a0Max Baucus\u00a0[the\u00a0Finance Committee\u00a0chairman]\u00a0really wanted,\u00a0you may recall this. He worked for a long time. He desperately wanted to have\u00a0bipartisanship. I\u00a0don’t\u00a0think that was going\u00a0\u2026\u00a0\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yes.\u00a0And I sat in the hall during those meetings for weeks at a time. I remember.\u00a0<\/p>\n Jennings:\u00a0<\/strong>Yeah, yes. You remember?\u00a0I mean\u00a0\u2026\u00a0and to the criticism of\u00a0a lot of the\u00a0Democrats, what are you holding up for? So unfortunately, there are elements of health care, and\u00a0I think a lot\u00a0have\u00a0to do with coverage\u00a0\u2014\u00a0Medicare, Medicaid, marketplace, the three M’s, if you will\u00a0\u2014\u00a0that are\u00a0very hard\u00a0not to politicize. And\u00a0unfortunately, public health has now become very politicized, too.\u00a0So\u00a0we’re\u00a0having a smaller\u00a0[unintelligible] of\u00a0elements of health care that you can see bipartisanship.\u00a0But\u00a0\u2026\u00a0there are some, and I’m sure we were going to talk about that, but I look back and reflect about that debate, and I don’t see a possibility of where it would have worked and Barack Obama would have been able to achieve what he said he was going to achieve.\u00a0<\/p>\n Kahn:\u00a0<\/strong>Well, let me say a couple of things. First, I think,\u00a0to\u00a0modify\u00a0your history. I think that in the\u00a0House\u00a0\u2026\u00a0<\/p>\n Jennings:<\/strong>\u00a0Yes.\u00a0<\/p>\n Kahn:<\/strong>\u00a0\u2026\u00a0Newt\u00a0wasn’t\u00a0speaker at the\u00a0time,\u00a0he was\u00a0minority\u00a0leader.\u00a0Clearly, there\u00a0was nowhere to go with Clinton\u00a0Care. I mean, the Republicans just were not going to go.\u00a0I think you saw something quite different in the Senate.\u00a0And there were many Republicans in the Senate, probably not a majority of the conference, but a very large minority who were willing to at least try\u00a0\u2026\u00a0but I think the environment completely changed over time, and by the time you got to 2009,\u00a02010,\u00a0despite some\u00a0kabuki\u00a0theater on the part of some Republican senators,\u00a0who I won’t name, who sort of played along, they were not going to cooperate. But let me say, one of the turns in history\u00a0that’s\u00a0important is that\u00a0you’ll\u00a0remember the Democrats had 60 votes in the Senate until the end, when, unfortunately, Sen.\u00a0[Ted]\u00a0Kennedy died.\u00a0But actually, I\u00a0would argue that it was his death, in a sense, that\u00a0ultimately led\u00a0to health reform passing, because a conference report on health reform between the House and the Senate\u00a0probably\u00a0wouldn’t\u00a0have gotten all the Democratic senators. I\u00a0don’t\u00a0think Sen. [Ben]\u00a0Nelson\u00a0[D-Neb.]\u00a0could have done it, so you would have had a filibuster against it. But by\u00a0[Kennedy]\u00a0dying, the\u00a0House was forced to take on,\u00a0for the bulk of health reform, the Senate bill, and they passed the Senate bill. Yes, there was a reconciliation later, but it was really,\u00a0that was the framework for health reform, and in a bizarre way, it was the contribution of his death and the\u00a0\u2026\u00a0House having to accept the Senate bill that led to health reform really passing, you know, by the skin of its teeth, even though there were these vast majorities of Democrats in the House and Senate.\u00a0<\/p>\n Jennings:\u00a0<\/strong>Yes, I think\u00a0that’s\u00a0a very insightful comment, and I rarely say that about\u00a0Chip. [Kahn laughs.]\u00a0So, no, I\u00a0do\u00a0all the time. It is,\u00a0but Kennedy,\u00a0the sacrifices Kennedy would make to become the ultimate legislator, even to go\u00a0so\u00a0far as\u00a0to die. But I will say, I think\u00a0that’s\u00a0right, because there was\u00a0a very significant\u00a0frustration amongst the House Democrats, and they desperately wanted to have a true conference, and that would have made it\u00a0very hard\u00a0in the Senate. It would\u00a0\u2026\u00a0have been hard to clear through reconciliation rules in the Senate.\u00a0And there would have been lots of challenges, and,\u00a0ultimately, this\u00a0is why Nancy Pelosi gets most of the credit, and so too should Harry Reid. They brought it home in a way that\u00a0probably was\u00a0the only way to get it done. And\u00a0subsequently, one of the problems was\u00a0it\u00a0probably\u00a0wasn’t\u00a0drafted as cleanly as we would have liked it to be. You know what\u00a0I’m\u00a0saying?\u00a0<\/p>\n Rovner:\u00a0<\/strong>Yes, I know what\u00a0you’re\u00a0saying. For those who, for those of us who had to follow this\u00a0sort of ins and outs of the not being able to make technical corrections to it for its entire history\u00a0\u2014\u00a0which,\u00a0flash-forward to today, is there any chance of ever getting back to bipartisanship on health care?\u00a0<\/p>\n Kahn:\u00a0<\/strong>I\u00a0don’t\u00a0think\u00a0on\u00a0anything\u00a0regarding\u00a0delivery and financing\u00a0that’s\u00a0major\u00a0is there much likelihood of consensus.\u00a0Now, if you remember, not too long ago, there were bills on, you know, FDA processes and\u00a0the such, and they were done in\u00a0a\u00a0bipartisan manner. And\u00a0maybe some\u00a0of those things\u00a0at\u00a0the edges.\u00a0I think there\u00a0are some hospital issues and others that still could be dealt with in a bipartisan manner. But that gets back to\u00a0context.\u00a0You’ve\u00a0got to have the\u00a0sun\u00a0and the moon come together on political context that would allow some\u00a0\u2014\u00a0I\u00a0won’t\u00a0call them marginal,\u00a0but\u00a0\u2014\u00a0relatively\u00a0small changes\u00a0to be legislated. Other than that,\u00a0we’re\u00a0in an environment right now where I just\u00a0don’t\u00a0see compromise on anything big, because the divide that we saw coming out of\u00a0’10\u00a0is still there. And if anything,\u00a0it’s\u00a0just deeper than ever.\u00a0<\/p>\n Jennings:\u00a0<\/strong>Right, and\u00a0\u2026\u00a0although I\u00a0don’t think\u00a0Chip would disagree with\u00a0\u2026\u00a0what I’m about to say,\u00a0is,\u00a0there are issues that are not so much ideological in coverage:\u00a0biomedical research, transparency, even physician payment reform, rural health,\u00a0telemedicine, community health centers.\u00a0I’m\u00a0just mentioning these\u00a0out loud, because\u00a0you’ll\u00a0see bipartisan agreements on some of those things.\u00a0But in terms of\u00a0real structural\u00a0reform, and particularly when\u00a0you’re\u00a0talking about where people get coverage and how much you subsidize it, boy, is that tough. In fact, I would even argue, and this is\u00a0really unbelievable\u00a0to say out\u00a0loud,\u00a0that cost containment in some fields, which is\u00a0almost always\u00a0impossible, is easier than how you spend the money. Because\u00a0people\u00a0don’t,\u00a0can’t\u00a0agree on the structure by which you would reallocate the savings to make health care work.\u00a0So\u00a0it is a frustrating time, which is why\u00a0it’s\u00a0hard to make\u00a0the\u00a0argument against people who say,\u00a0then we need to have all one party or the other party to get something big done<\/em>.\u00a0<\/p>\n Kahn:\u00a0<\/strong>Now, let\u00a0me say I think there could be some surprises next year if the Democrats took over in the\u00a0House. You know, is there some possibility that there could be a big compromise with a Trump administration in the future on drug negotiation or drug costs?\u00a0So\u00a0I\u00a0don’t\u00a0want to say that\u00a0there’s\u00a0nothing that can be done. And I agree with,\u00a0and\u00a0I think I\u00a0said,\u00a0with Chris that there are these issues around the edges that could be dealt with, and the ones he outlined are the ones that I would agree with.\u00a0I think the one big one\u00a0is there is some possibility around drugs. But I think, other than that, I\u00a0don’t\u00a0see the Republicans being willing to help on Medicaid.\u00a0<\/p>\n Jennings:\u00a0<\/strong>And that is a cost containment as opposed to\u00a0kind\u00a0of\u00a0a coverage, you know.\u00a0And\u00a0it’s\u00a0sort of a\u00a0one-off. It\u00a0isn’t, you know, big, big reform. But I agree with\u00a0Chip that there you could see Democrats in the House push something that\u00a0[President Donald]\u00a0Trump would endorse, that Republicans in the Senate\u00a0wouldn’t\u00a0like to pass but would. \u2026 They\u00a0probably would\u00a0want to have\u00a0come up\u00a0with\u00a0an\u00a0excuse not to.\u00a0But that’s,\u00a0that is a target area that could happen. Although, you know,\u00a0I’m\u00a0\u2026\u00a0Democrats\u00a0aren’t\u00a0catching,\u00a0counting our chickens just yet,\u00a0Chip.\u00a0\u2026\u00a0We’re\u00a0knocking on wood here.\u00a0[knocks]\u00a0<\/p>\n Kahn:\u00a0<\/strong>Yeah, let me say, if the Congress doesn’t change,\u00a0in terms of who has the majorities in both House and Senate, I don’t see anything major, other than some of the things, you know, transparency and some of these other issues, getting attached to something bigger.\u00a0And then\u00a0you’ve\u00a0got to have context, as I said, the right context to have it. But I\u00a0don’t\u00a0see anything big unless we get split government. I think split\u00a0government\u00a0could lead to some interesting things in some of these areas.\u00a0But what we think of\u00a0as health reform writ large,\u00a0right\u00a0now,\u00a0it’s\u00a0just politically charged.\u00a0<\/p>\n Rovner:\u00a0<\/strong>We’re\u00a0going to\u00a0have to wrap up. But one thing that I’ve been sort of thinking about a lot is that we seem to be getting to this place that we were in in 1993 again, and in 2008 again, where everybody is unhappy with the system\u00a0\u2014\u00a0that,\u00a0particularly patients, even people with insurance, are unhappy with the way the system is working. Doctors are unhappy, hospitals are unhappy, insurance\u00a0companies are unhappy.\u00a0Is it possible that that’s going to push this big divide a little bit back together, at least in an effort to do something?\u00a0I mean, clearly\u00a0President Trump knows that people are unhappy with the cost of drugs, if nothing else in health care. Do you think\u00a0we’re\u00a0heading for another round of major health reform debate?\u00a0<\/p>\n Jennings:\u00a0<\/strong>It feels like that,\u00a0Julie,\u00a0for sure,\u00a0’91-’92-ish,\u00a0or, you know.\u00a0It does not feel like in any way.\u00a0\u2026\u00a0I think people are really frustrated with costs, really frustrated with complexity, really frustrated with how they think the system is not necessarily responsive.\u00a0They’re pretty good at kind of defining the problems, but in terms of developing a consensus around how best to do that, which is, you know, typically what people say,\u00a0I want comprehensive reform that doesn’t disrupt me<\/em>, you know, which is\u00a0a\u00a0hard nut to crack sometimes.\u00a0But\u00a0\u2026\u00a0it feels like\u00a0we’re\u00a0seeing it. And\u00a0you’re\u00a0going to hear a lot about talk, but I think\u00a0you’re\u00a0\u2026\u00a0the\u00a0big thing\u00a0will happen around a\u00a0’27-’28 period, when the two open electorates for presidency come up, and\u00a0\u2026\u00a0this issue will be absolutely debated.\u00a0But the big,\u00a0big thing\u00a0probably\u00a0isn’t\u00a0going to happen until the next president is elected.\u00a0<\/p>\n Kahn:\u00a0<\/strong>So let me say this, and\u00a0I’m\u00a0going to give a plug to\u00a0KFF’s\u00a0Business of\u00a0Health\u00a0With\u00a0Chip Kahn<\/em>, a podcast that will come sometime in April.\u00a0<\/p>\n Rovner:<\/strong>\u00a0Absolutely.\u00a0<\/p>\n Jennings:<\/strong>\u00a0He’s\u00a0shameless.\u00a0<\/p>\n Kahn:<\/strong>\u00a0We’re\u00a0going to\u00a0\u2026\u00a0focus\u00a0on AI\u00a0[artificial intelligence]\u00a0for the first three or four months. And I\u00a0don’t\u00a0want to say\u00a0it’s\u00a0going to change the world.\u00a0It’s\u00a0going to change the world. I\u00a0don’t\u00a0want to say\u00a0it’s\u00a0going to change health care.\u00a0It’s\u00a0going to change health care. Is it going to solve all these problems? I\u00a0don’t\u00a0know, but I think many of these issues could be different five years from now because of the effect of AI,\u00a0and will doctors be practicing the same way they are now?\u00a0Will all these issues of\u00a0thousands\u00a0of people working with green eyeshades\u00a0in\u00a0hospitals to make sure the claims are done right, they go to insurance companies. With respect to those\u00a0thousands\u00a0of people,\u00a0it’s\u00a0going to be\u00a0AI.\u00a0\u2026\u00a0They’re\u00a0not going to have jobs anymore, and\u00a0it’s\u00a0going to change a lot. Now, is it going to solve any of these problems, or is it going to raise risks and challenges we\u00a0can’t\u00a0even foresee?\u00a0I don’t know, but I think we’re going through, about to go through,\u00a0an evolutionary period, and I don’t know what it’s going to look like on the other end.\u00a0<\/p>\n Rovner:\u00a0<\/strong>Well, I think\u00a0that’s\u00a0as good a place as any to leave it. I want to thank both of you. I could\u00a0definitely go\u00a0on for another hour, but we\u00a0won’t.\u00a0Chip Kahn,\u00a0soon to be a fellow at\u00a0KFF.\u00a0Chris Jennings, Jennings\u00a0Policy\u00a0Strategies. Thank you very much.\u00a0\u00a0<\/p>\n Kahn:<\/strong>\u00a0Thanks a lot.\u00a0<\/p>\n Rovner:<\/strong>\u00a0OK, that is this week’s show.\u00a0As always, thanks to our editor,\u00a0Emmarie Huetteman, and our producer-engineer this week, Taylor Cook. A\u00a0reminder:\u00a0What the\u00a0Health?<\/em>\u00a0is now available on WAMU platforms, the NPR app,\u00a0and wherever you get your podcasts, as well as,\u00a0of course,\u00a0kffhealthnews.org<\/a>. As always, you can email\u00a0us\u00a0your comments or questions.\u00a0We’re\u00a0at\u00a0whatthehealth@kff.org<\/a>.\u00a0We’ll\u00a0be back in your feed next week\u00a0with all the health news. Until then, be healthy.<\/p>\n \tTaylor Cook \tEmmarie Huetteman Click here to find all our podcasts.<\/a><\/em><\/p>\n And subscribe to “What the Health? From KFF Health News” on Apple Podcasts<\/a>, Spotify<\/a>, the NPR app<\/a>, YouTube<\/a>, Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n
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