A Partisan Divide On Health Care Reform

DATE August 26, 2008 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM
NETWORK NPR
PROGRAM Fresh Air

Interview: Journalist Jonathan Oberlander on both Obama and
McCain's plans for health care reform
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

In spite of his terminal brain cancer, Senator Edward Kennedy managed to give
a brief speech last night at the Democratic National Convention. Here's an
excerpt.

(Soundbite of Democratic National Convention)

Senator EDWARD KENNEDY: For me, this is a season of hope. New hope for a
justice and fair prosperity for the many and not just for the few. New hope.
And this is the cause of my life, new hope that we will break the old gridlock
and guarantee that every American, north, south, east, west, young, old, will
have decent, quality health care as a fundamental right and not a privilege.

(End of soundbite)

GROSS: Both the Obama and the McCain campaigns have proposals for reforming
health care. We're going to take an in depth look at those proposals with
Jonathan Oberlander. This month, he wrote an article in the New England
Journal of Medicine called "The Partisan Divide: Comparing the Two Plans." He
says the plans reveal some of the candidates' assumptions about the virtues
and vices of markets and government. Oberlander is an associate professor of
social policy and health policy management at the University of North Carolina
Chapel Hill. And he's a visiting scholar at the Russell Sage Foundation.
He's talked about health care policy several times on our show.

Jonathan Oberlander, welcome back to FRESH AIR. So let's see if we can
understand what's happening with the McCain and Obama health care plans.
Let's start with McCain, as your article starts with McCain. Now, you say his
plan embraces market forces and promotes individually purchased insurance. So
how does his plan promote market forces?

Dr. JONATHAN OBERLANDER: What John McCain wants to do is move away from the
employer-sponsored insurance system, and that is the way that most working-age
Americans get health insurance right now. About 160 million Americans get
insurance through their employer. And the individual insurance market, where
people go out on their own and buy insurance, is actually very small right
now. What he wants to do is give people tax credits to buy private insurance,
and they would buy that private insurance out on the individual market. And
the hope is that that would unleash competition by insurers, and they would
compete to offer lower prices on those insurance products.

GROSS: What changes would the McCain plan make in how health insurance is
taxed?

Dr. OBERLANDER: Actually a fairly radical change. Right now workers do not
pay taxes on what their employers contribute to workers' health insurance. So
when my employer here in North Carolina pays my insurance premium, that
doesn't count as part of my taxable income, and that is a huge subsidy that
the federal government gives to employer-sponsored health insurance. What the
McCain plan would do for the first time is it would count employers'
contributions to workers' health insurance premiums as taxable income. So if
this plan was adopted, I would start paying taxes on what my employer pays for
my health insurance.

GROSS: And how would the McCain plan deal with tax credits?

Dr. OBERLANDER: What the McCain plan would do is take the money they get
from eliminating the tax exclusion and put that money back into refundable tax
credits, and so any American who obtained private health insurance, either
through their employer or on their own, would get either $2500 as an
individual or $5,000 for a family. Now, if I'm an individual that does not
have access to employer-sponsored insurance, I would take that credit and I
would try and go out on the individual market and buy my own insurance. If I
was a worker who currently has health insurance through my employer, I would
have two options. I could use the tax credit to offset what I would now have
to pay in taxes on my own health insurance benefits, or I could take the tax
credit and leave my employer's health insurance plan and go out on the
individual market and buy my own coverage.

GROSS: I guess I don't see how the employee gets an advantage out of this.
They're paying taxes that they hadn't paid before.

Dr. OBERLANDER: Well, I think politically this is a very hard sell, because
when you think of middle-class Americans who are well insured right now--and
we should not forget for all the problems in the system, many of those with
employer-sponsored insurance like the coverage they have, like the benefits
they have--when they hear the word health reform, what comes to their mind
first is not, `Let's tax my health care benefits.' So this idea of taxing
employers' health insurance contributions has been around for a long time, and
it hasn't gone anywhere. And one of the reasons it hasn't gone anywhere is
politically it is very, very difficult for Congress to pass something that
says, `Look, we've done something great for you in American health care.
We're going to tax your health benefits.'

Now, what the McCain people say is they're going to take all the money they're
going to get from taxing people's health benefits--and it's a lot. It's about
$3 1/2 trillion over a decade, and they're going to turn around and convert
that to a tax credit. And so any American who has private insurance would get
this tax credit. And if you're a worker, you would use that tax credit to
offset what you would pay in taxes. And in the short run, for most workers,
that's probably true. The problem is that health care costs go up much more
rapidly than the rest of the economy. So over time, the value of that credit,
if it is indexed to the rest of the economy, is not going to keep up with the
price of health insurance. And if we go out 10, 15 years from now, many more
American workers will be paying taxes on their health insurance.

GROSS: So it sounds like this might benefit people who don't have
employee-based health insurance, but for the people who do have employee-based
health insurance, is it possible that they'll be losing out in this program?

Dr. OBERLANDER: I think that's right. The McCain plan is a roll of the
dice. We really don't know what the impact would be, but you can bet that
some employers are going to drop health insurance coverage. So some Americans
who are insured right now would lose their insurance coverage, and then they
would have to go out to the individual market and try and find coverage. Now,
for folks who don't have health insurance through work right now, they're not
getting any benefit from that tax exclusion because their employer is not
providing health insurance. So this would be a new benefit for them. Whether
it's an adequate benefit is a different story.

GROSS: If you have employer-based health insurance, what are the odds that
the taxes you're going to have to pay on the amount of money that your
employer kicks into your health insurance plan is going to be less than the
amount that you're getting in tax credits through the McCain plan? What are
the odds that you're going to come out on the winning end?

Dr. OBERLANDER: The McCain campaign has not released the detailed
distributional effects of their plans. It's very difficult to say. The odds
depend on where you live and who you work for. If you're at a company right
now that has a very healthy work force and you're in a low cost area for
health insurance, say Minnesota, then this is either going to be a wash or you
could do a little better. If you're in a company that has an older work force
in an area that has very expensive health insurance costs, then in the short
run, it could be for some people you're going to do worse.

But I really think the important question is not what's going to happen a year
after this plan is passed or two years after this plan is passed, the question
is a decade after this is passed. And in that circumstance, I think a lot of
people would come out on the losing end.

GROSS: Because the costs of health care are likely to have gone up
proportionately higher than the tax credits that you're getting.

Dr. OBERLANDER: That's right, and if you look at the tax credit amounts,
what McCain is proposing is $2500 for an individual and $5,000 for a family.
And those credit amounts over time probably would be indexed to the general
inflation rate, but health care rises much faster than the general inflation
rate. So over time they're going to be less and less efficient to buy health
insurance and to offset the cost of paying taxes on your health insurance.

GROSS: Say you don't have employer-based health insurance and you want to buy
insurance on the private market under the McCain plan, or you just decide you
want private insurance instead of your employer-based plan. What options
would you have under the McCain plan?

Dr. OBERLANDER: I think the McCain plan has two major problems, and the
first is the adequacy of the tax credits. If you look at the average cost of
health insurance right now on the employer-sponsored market, it's about
$12,500 for a family coverage and around $5,000 for individual coverage. So
the credits that he's offering are really not sufficient to buy comprehensive
health insurance. Most people, the only insurance they could afford is
high-deductible, catastrophic insurance. Now, if you're young and healthy,
you might be able to get a pretty good deal.

The problem--and this is the second problem with the McCain plan, the problem
with the individual market is that there's a lot of medical underwriting on
the individual market, so that people who are sick, people who are older,
people who are considered bad risks by insurance companies are charged
substantially more in premiums, or in some states they won't be offered
coverage at all. So for a lot Americans have pre-existing conditions, even
pre-existing conditions that may seem minor to them, they're going to have a
real problem finding affordable, comprehensive coverage on that market.

There's the second issue here, which is for young, healthy people, who are
insured right now by their employer, they actually might be able to get a
better deal on the individual market. And under the McCain plan, they would
have that choice. They could take the tax credit, leave their employer's
insurance, and go and buy individual insurance that's a better financial deal.
Now, that might be good for them. The problem is, what effect does that have
on the employer-sponsored market? If healthy people disproportionately leave
employer-sponsored insurance, then the cost of insurance for people who are
still getting their coverage from their employer is going to go up
tremendously, and we're going to have even faster erosion of
employer-sponsored insurance.

GROSS: Now, part of the McCain plan is based on the premise that, with more
competition in the private insurance market and more people buying private
insurance, that that competition will keep prices competitive, will keep
prices down. Is there evidence that it would accomplish that?

Dr. OBERLANDER: We don't know. The individual insurance market, of course,
has some price competition right now because there are Americans who go out
and buy insurance that way, and the question is, with this tax credit and by
offering a more limited tax credit, how much would insurers hold down costs?
My guess is that they're really not going to be able to hold down costs
substantially more than they do now, and I doubt very much that individuals
are going to be able to get a better deal out of insurers than employers do.
Because after all, employers have much more purchasing power. So what you
would see instead is insurers would offer high-deducible products, and there
would be shift in the United States away from comprehensive insurance and to
these thinner insurance policies where the coverage isn't as comprehensive.

And the McCain campaign believes that would happen and they believe that's a
good thing. There are a lot of health economists who think that one of the
problems in the United States is actually that we have too much health
insurance. And so one of the designs of the McCain plan is to shift towards
high-deducible coverage.

GROSS: And that's supposed to discourage us from frivolous tests and other
health care costs?

Dr. OBERLANDER: That's exactly right. The idea is that if you have--and
this is a terrible phrase that we have in health care--but if you have skin in
the game, then you'll think twice about overusing the health care system. The
problem, of course, is you may discourage medical care that is appropriate and
that is necessary, and we know from research that individuals are actually
lousy judges of what is necessary and what is unnecessary.

GROSS: Now, what if you are high risk and private insurers don't really want
to cover you because you're sick?

Dr. OBERLANDER: The McCain campaign took a lot of criticism for that.
Elizabeth Edwards in particular argued that she wouldn't be able to get
coverage with breast cancer under McCain's plan. And John McCain himself
wouldn't be able to get coverage because of his skin cancer. Eventually what
the McCain campaign responded with is what they call guaranteed access plan.
Right now there are about 34 states that have something that's called a high
risk pool, where they create a sort of subsidized insurance pool for folks who
are medically uninsurable, who can't get coverage on the individual market,
and so the state creates this pool where they can buy coverage. And what the
McCain campaign has in mind, although the details are vague, is sort of a
super high risk pool, where the federal government would work with the states.
And in theory, it's a good idea.

The problem with it is that high risk pools have a very mixed record across
the states. A lot of them are very expensive, a lot of them do exactly the
same things that private insurers do. In other words, they have pre-existing
condition exclusions, they have benefit limitations, and it's not clear at all
that you would be able to create a high risk pool that would be well funded
enough and comprehensive enough really to take care of those who are medically
uninsurable. So if we're going to put more people on the individual insurance
market, I think the reality is a lot of those people, especially if they're
coming from the employer market--which has a lot of flaws, but it does provide
broad pooling--those medically uninsurable folks, a lot of them just simply
aren't going to find coverage.

GROSS: Any other key points you think we should know about the McCain health
insurance plan?

Dr. OBERLANDER: I think his proposal around deregulation of the insurance
market is interesting. But insurance regulation is done primarily at the
state level, and it varies by states. And there are some states that have
very strict regulation of insurers. They require, for instance, community
ratings so insurers have to charge everybody essentially the same price
regardless of health status. They may have benefit mandates where they list
benefits that insurance companies have to cover. And one of the conservative
critiques of that has been that it drives up premiums and makes it hard for
people to afford coverage. And so what the McCain plan has is a provision
that would allow people to buy insurance across state lines, and insurers
could now market their products nationwide. What that means is that if I'm
living in a state that has highly regulated insurance market, like New York, I
could go out and buy insurance theoretically from a company that's offering
coverage in a state that doesn't have those regulations, and so their policy
is cheaper.

Again, theoretically, that offers people another option. The problem with it
is what it does is it effectively deregulates the insurance protections that
we already have, and, again, you risk healthy people dropping out of those
insurance pools and going to these states that don't have strong benefit
mandates. And that will leave sick people in states like New York in their
insurance pools, and that will drive up costs and that will drive a lot of
people out of those insurance plans.

GROSS: My guest is Jonathan Oberlander. His article comparing the Obama and
McCain health care reform plans was published this month in the New England
Journal of Medicine. He'll talk about the Obama plan after a break. This is
FRESH AIR.

(Announcements)

GROSS: My guest is Dr. Jonathan Oberlander. He's an associate professor of
social policy and health policy and management at the University of North
Carolina Chapel Hill. And he's about to take a leave there to join the
Russell Sage Foundation as a visiting scholar.

Well, we've looked at the John McCain health care proposal. Let's look at
Barack Obama's plan. You say that, whereas McCain relies on market forces,
Obama's plan relies on an employer mandate, new public and private insurance
programs and insurance market regulation. As far as employers, it's a pay or
play system revolving around employers. Would you describe employers' role in
health care insurance in the Obama plan?

Dr. OBERLANDER: Barack Obama would require that employers either have to
offer comprehensive health insurance to their workers, or they have to pay a
tax to the government. And the government would use the money from that tax
to cover the uninsured. Now, he has said that that employer mandate would not
apply to very small businesses. The campaign has not said exactly where they
would set the threshold for that exemption, but maybe for businesses under 10
workers, they would not be subject to the mandate. Other small businesses
would get a tax credit to help them buy health insurance. But all businesses,
except for those ones that are excluded, would have to either provide
insurance or pay that tax.

GROSS: Now, is that intended to have an effect of either encouraging or
discouraging employers from providing health insurance to their employees?

Dr. OBERLANDER: The Obama campaign says they want to build on the
employer-sponsored system, and really the reasons to do that is political and
financial. A lot of people have employer-sponsored insurance and they like
it. It's difficult to move them away from that coverage. And employers right
now spend over $400 billion on insurance premiums. So if you get rid of the
employer-sponsored system, you've got to make up a lot of money. So in one
sense, they want to reinforce the employer-sponsored system by having this
modified employer mandate, but really the effect of the Obama plan depends in
part on where they set that tax. If they set the tax for not offering health
insurance at a very high level, say 9 percent, then many employers will offer
coverage themselves rather than paying the tax. But if they set the tax at a
very low level, say 4 or 5 percent, then many employers will choose because
it's a better deal to pay the tax rather than offering health insurance. And
you would have people move out of the employer-sponsored system and perhaps
into the new national health plan that Obama wants to create.

GROSS: So for people who won't have employer-based health insurance, what
options does the Obama plan have?

Dr. OBERLANDER: He has two new options. And right now the campaign has said
that these options would be open to anybody who is uninsured and to small
businesses as well that want to enroll their employees in these options, and
perhaps over time they would be open to more Americans. The first option is a
new national health plan, and this would be modeled after Medicare. It would
be a new federal health plan for those under the age of 65, and so the federal
government would set the premiums and set the benefits and have ultimate
administrative responsibility for the plan.

The second option is they would create a new health insurance pool. They call
it a national health insurance exchange. And what you would have in this
exchange is multiple private insurance plans that would compete to enroll
people. And they would be heavily regulated. They cannot charge sicker
people more in terms of premiums. They would have to have guaranteed issue.
In other words, they would have to offer coverage to anybody, no matter how
sick they were. They couldn't dump you in the middle of the year, as
sometimes happens right now to people on the individual market. So they would
be highly regulated.

If you were uninsured or if you worked for a small business and your small
business chose to be part of this, you could choose. You could either join
the new national health plan or you could join one of these private health
insurance options.

GROSS: Jonathan Oberlander will be back in the second half of the show. He's
an associate professor of social policy and health policy management at the
University of North Carolina Chapel Hill and a scholar at the Russell Sage
Foundation. I'm Terry Gross, and this is FRESH AIR.

(Announcements)

GROSS: This is FRESH AIR. I'm Terry Gross, back with Jonathan Oberlander.
We're comparing the Obama and McCain health care reform plans. Oberlander
wrote about those plans in his article "The Partisan Divide," published in The
New England Journal of Medicine this month.

When we left off, Oberlander was explaining that under the Obama plan the
uninsured and small businesses who want to enroll employees would have the
option of a national health plan modeled on Medicare, or a new health
insurance exchange with a choice of private insurance plans.

What are the pros and cons of having a national government-sponsored health
insurance plan as well as private plans?

Dr. OBERLANDER: I think the advantage of a national health plan is that it
provides stability. We have had a lot of trouble with private health
insurance in this country. It is an industry that is very flawed. It is an
industry that in many ways has relied on medical underwriting and other
practices that deprive people of the ability to access affordable health
insurance coverage. The advantage of the government is we don't have to worry
about the government doing medical underwriting. It doesn't in Medicare. It
wouldn't in this. We wouldn't have to worry about the government trying to
make a profit off this. We don't have to worry about marketing expenses. So
I think a public plan would offer a more stable option, perhaps a cheaper
option, if they can hold down costs and if their administrative costs are
lower, as Medicare's are, compared to private insurance.

The disadvantage is, any time you have choice in health insurance, there is a
risk of what economists call "adverse selection." And what adverse selection
means is a disproportionate share of expensive sicker people choose a
particular health insurance plan; and when that happens the costs go up and it
becomes hard to maintain that plan. So if, in this example, you have small
businesses that have very sick employees, very expensive employees, and those
employees end up enrolled in the national health plan, then the national
health plan could experience very high costs.

And as we've learned from Medicare, I would say the second risk is it's not
easy to regulate competition and to ensure fair competition between a public
plan and a private plan. We have a lot of experience with that form of
competition in Medicare. Unfortunately, it's not very good experience.

GROSS: So Obama's plan is to finance his health care plan in part through
these taxes that employers would have to pay if they choose not to provide
health insurance to their employees. What are the other ways that Obama
proposes to fund his health care plan?

Dr. OBERLANDER: He has two other sources. The first is, he anticipates
substantial savings from a number of measures, including moving to electronic
medical records, doing a better job at disease management with chronic
conditions, having a much better system of public health and prevention.

The second way that he gets money to pay for his plan--and his plan is
expensive--is to let the tax cuts of 2001 and 2003 that the Bush
administration sponsored for Americans making over $250,000, let those tax
cuts expire and redirect that money to pay for covering the uninsured. I
think that probably the hardest part of health reform is how to pay for it.
It's what I called $100 billion question, because if you're adding the
uninsured to the existing system, it's roughly $100 billion a year to do it.

Both of Obama's financing solutions are problematic. In terms of the savings,
those are all very desirable things to do. Electronic medical records are a
good idea. Doing a better job with chronic conditions is a good idea. Trying
to reduce our obesity levels and increasing prevention is a good idea. I
don't think any of those are going to produce substantial sums of money in the
short term. They might in the long term, but not in the short term. So I
just don't think you can finance a health plan that way.

In terms of the tax cuts, the Congressional Budget Office is really sort of
the Oracle at Delphi. They really, because of the Congressional Budget rules,
get to say what counts as financing. And if you look at their projections,
they already assume that all the tax cuts from 2001 and 2003--not just those
for wealthy Americans--all the tax cuts will expire. So you actually don't
get any new money at all as far as the Congressional Budget Office is
concerned when you let those tax cuts expire and try to use them for health
care. So the bottom line is that if Obama wins, his administration would have
to come up with another way to get somewhere in between 60 and $100 billion.
And that politically is very difficult.

GROSS: There is a mandate in the Obama plan for health insurance for
children, so all children would have health insurance. Would they have to pay
for it, or would it just be a right that they would just automatically have
it?

Dr. OBERLANDER: This was a big controversy in the primary because Hillary
Clinton had a mandate for all Americans, and Barack Obama has one only for
children. And what the Obama people have argued is that most of the uninsured
are uninsured because they can't afford coverage, and so once we create
affordable options we won't need to mandate them; and furthermore that it's
putting the cart before the horse, if we have a mandate before we insure that
those affordable options are out there will just be punishing people. And
they think they can get to 98, 99 percent coverage without a mandate. I think
that, again, is a high number. I think the Obama plan would cover most of the
uninsured, but it certainly would not reach universal coverage without a
mandate.

In terms of how the mandate would work for children, we really don't know at
this point. And a mandate is an interesting concept in that it has bipartisan
appeal. Liberals like it if it's going to move towards universal coverage.
Conservatives like the individual responsibility associated with it. The
problem politically is it's only as good as the penalty; and if you don't have
a robust penalty, a mandate isn't worth much. And for good reason. Most
politicians running for president don't walk to talk about penalties, so they
haven't actually detailed how they would enforce this mandate. And, again, if
he's elected, there would be a battle over any kind of mandate, whether it's
for children or adults, about how exactly you're going to enforce it.

The Kaiser Family Foundation did a poll and they asked people what they
thought of having financial penalties for not having health insurance, and I
think around 80 percent of Americans said they didn't like the idea very much.
So politically this is dangerous territory.

GROSS: So in the Obama plan, for people who are buying insurance on the
private market, or for people who would be going to the government plan, any
estimate of how much it would cost?

Dr. OBERLANDER: No. The Obama plan itself has released an estimate of how
much they think they would save Americans, but I would say that estimate is
quite uncertain and it's based on those savings that I think, in the short
term, are exaggerated. We do know that they would make coverage more
accessible to Americans who cannot get coverage right now because they're
sick. And the reason for that is they're going to regulate private health
insurance and they're going to move to a system where you can't charge sick
people more.

We also know that the Obama plan is going to provide subsidies for people with
low and moderate incomes to buy health insurance, and so they would have
assistance from the government. But again, we don't know what the level of
that subsidy is.

The final thing that they're going to do, which I think is important in terms
of the affordability of private health insurance, is they have a provision for
what's called re-insurance. And the idea is that, in any given health
insurance pool, a few people are very expensive. So about 5 percent of
Americans account for almost half of all health care costs in this country.
So about 15 million people cost about a trillion dollars. And particularly
for small employers, if they have an employee who, God forbid, has cancer or
has HIV/AIDS, and they're very expensive, it really hurts their ability to
offer insurance coverage because they don't have a big pool. What the Obama
plan would do is have the government come in as a re-insurer. Above a
catastrophic level, the government would actually pay the costs for very
expensive workers. And theoretically that would enable employers to lower
their insurance premiums, I think the Obama campaign has estimated, by 5
percent because they're no longer covering the costs of those catastrophic
cases, the federal government is.

GROSS: Now you say in your article in The New England Journal of Medicine
that the health care plans that Barack Obama and John McCain have proposed
offer opposing visions of health care reform that reflect fundamentally
different assumptions about the virtues and vices of markets and governments.
Can you elaborate on that?

Dr. OBERLANDER: There is really a philosophical divide here. And there are
many issues on which John McCain and Barack Obama disagree. I'm not sure
there's any issue on which they disagree more than health care. And their
diagnosis of the problem and their solutions are entirely different. And I
think that stems in part from very different philosophical assumptions.

John McCain's assumptions are that he has faith in the market, that what we
should be doing in the health care system is really trying to enhance
competition, that health care at some level is an individual responsibility
and we should give individuals the chance to make choices in health care, and
it's really up to them to buy health insurance.

Barack Obama starts with, instead of individual responsibility, collective
responsibility, that health care coverage is a collective issue, that we're
all in this together; and he has faith in the government and believes that we
can't leave the market unfettered in health care, that the government has to
step in with a new plan, with regulation.

And so that the reason you get this huge divide between their plans is they
just have an ideological clash on health care reform. And that's part of why
this is such a difficult issue to settle, because both these candidates
represent really where the Democratic and Republican Parties are right now on
this issue.

GROSS: Now that you've done such a good job explaining the Obama and McCain
health care plans, let me ask you this: If either is elected president, what
are the odds that their respective health care plan would actually pass
Congress?

Dr. OBERLANDER: I guess I would say I'm a cautious pessimist about health
care reform. You know, my base is always to bet against health care reform
because, after all, we've had a century of failure. So I think, for either of
these plans, the odds frankly are not good.

If you take the McCain plan, although in some ways it's less ambitious than
the Obama plan because it doesn't cover most of the uninsured, in other ways
it's more radical because it wants to move away from employer-sponsored
insurance system. That is not going to be popular with a lot of workers.
It's actually not popular, surprisingly enough, with a lot of employers who
are paying for health insurance. And I think the politics of trying to get
rid of the tax exclusion and tax health care benefits is just awful. So I
think you would have a very difficult time getting that plan through.

If you take Obama's plan, if you look at what he wants to do, he wants to
adopt an employer mandate, he wants to enact a new national health plan, he
wants to regulate the American insurance industry in a way they've never been
regulated. If he could do any one of those three things as president, that
would be tremendous. If he can do all three of them, he probably deserves,
you know, his face on a stamp in the future. It's a very high hill to climb.

At the same time, you know, the chances really depend on the election. If
Barack Obama wins and if Democrats pick up seats in the Senate--and remember,
they really need 60 or close to 60 seats in the Senate to beat back a
filibuster--then I do think he has a chance. I would not bet on it, but I do
think there is a chance this could happen. If John McCain wins and
Republicans get a majority in Congress, then again, he has a chance. So it
really depends--we'll know a lot more after the first week of November.

GROSS: Well, Jonathan Oberlander, thanks so much for explaining those plans
to us. Thank you.

Dr. OBERLANDER: Thanks for having me on.

GROSS: Jonathan Oberlander is an associate professor of social policy and
health policy management at the University of North Carolina Chapel Hill. And
he's a scholar at the Russell Sage Foundation.

Coming up, "Hamlet 2," the rock musical. We talk with Pam Brady and Andrew
Fleming about their new film comedy. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Writers Pam Brady and Andrew Fleming discuss movie
"Hamlet 2"
TERRY GROSS, host:

In the new movie comedy "Hamlet 2," Steve Coogan stars as a failed actor
turned high school drama teacher whose theater program is threatened by budget
cuts. To prove that high school theater is essential, he unleashes his
pent-up creativity and writes a play he's confident will demonstrate the
transformative power of theater. Here's a scene in which he hands a copy of
his finished play to his wife, played by Catherine Keener.

(Soundbite of "Hamlet 2")

(Soundbite of clanking and music)

Mr. STEVE COOGAN: (In character) It's done.

(Soundbite of door closing)

Ms. CATHERINE KEENER: (In character) What is?

Mr. COOGAN: (In character) My original work that's going to save drama, the
thing I've been working on for the last 47 billion hours.

(Soundbite of papers crinkling and being thrown down)

Ms. KEENER: (In character) Oh, is that what you were doing? I thought you
were just having a nervous meltdown.

(Soundbite of sigh)

Mr. COOGAN: (In character) You're not far off, Lady Pants. Any creative
person will tell you you got to go a little crazy to write great art.

Ms. KEENER: (In character) "Hamlet 2"?

Mr. COOGAN: (In character) The deuce, correct.

Ms. KEENER: (In character) Doesn't everybody die at the end of the first
one?

Mr. COOGAN: (In character) I have a device.

Ms. KEENER: (In character) "The time machine door"...

Mr. COOGAN: (In character) That's--that's the device.

Ms. KEENER: (In character) "...opens, revealing Hamlet, Gertrude, Polonius
and Hillary Clinton having what appears to be group sex."

Mr. COOGAN: (In character) It's about my troubled relationship with my
father.

Ms. KEENER: (In character) But you're doing this at school with kids, right?

Mr. COOGAN: (In character) That's the plan, Stan. What do you think?

(End of soundbite)

GROSS: A scene from "Hamlet 2." My guests Pam Brady and Andrew Fleming wrote
the film. Fleming also directed it. Pam Brady co-wrote many episodes of
"South Park" as well as the "South Park" movie musical and "Team America."
Fleming directed "Dick," "The Craft" and "Nancy Drew." Before we talk, let's
hear the big production number of the teacher's musical "Hamlet 2." This is
"Rock Me, Sexy Jesus."

(Soundbite of "Rock Me, Sexy Jesus")

(Soundbite of clapping)

Unidentified Group of People: (Singing) He's totally a man
The man with the plan
He traveled through time in an awesome custom van

Moralistically, he taught us to be good
How to set our souls free
And do all the...(word censored by network)...we should

Now we do the right deeds
We go to church and such
And we stopped smoking weed,
Well, at least not as much

(Speaking) And we can't forget to mention the golden rule
(Singing) Do unto others as you would have them...
Slam, bam, spank you, ma'am

Unidentified Woman: (Singing) Do unto you.

(Soundbite of music)

Group of People: (Singing) Sock me, rock me
Oh, rock me, sexy Jesus
He died for our sins
You got to believe us
Rock me, rock me Rock me, sexy Jesus
All night long

Rock me, rock me
Rock me, sexy Jesus
We're really amazed
You got to believe us
Rock me, rock me
Oh, rock me, sexy Jesus
All night long

Lays down his life
It really blows our mind
But he also got...(unintelligible)...in space and time

He's the son of God and I think that's cool
But he got the swimmer's bod like nobody do

Rock me, rock me...

(End of soundbite)

GROSS: Pam Brady, Andrew Fleming, welcome to FRESH AIR.

Describe the premise of the musical "Hamlet 2" from which "Rock Me, Sexy
Jesus" comes from.

Mr. ANDREW FLEMING: It's conceived by an ex-, failed actor who teaches drama
in Tucson, Arizona. And it's his last attempt at greatness, and he's decided
to write a musical sequel to "Hamlet." And Hamlet uses a time machine to
travel back in time to save his mother and the king and Polonius, and
everybody who dies at the end of "Hamlet." But because he's not very good at
operating the time machine, he ends up in modern day Tucson with Jesus Christ
as his time traveling companion.

GROSS: What do you love or what do you hate about musicals?

Mr. FLEMING: Well, the thing that I used to hate about musicals is that
arbitrary moment where people just start singing. It always bothered me.
Like, why do they start singing? And now I now actually think that's the
great thing of them because it's sort of the id coming to life. It's people
expressing what they can't express just by speaking.

And I'd never done musical numbers before this movie, and I was slightly
terrified by it. It ended up being the most exhilarating, fun thing I've ever
done in a movie. It really was a blast, I have to say.

GROSS: And, Pam, what about you, what do you love or hate about musicals?

Ms. PAM BRADY: Well, you know what? The thing I think I love and hate about
musicals is the same thing, which is the earnestness. And sometimes it's too
earnest so that it just sort of pushes you away so you can't really connect
with it. But then sometimes, if you're earnest, like in this form, we try to
be earnest in the musical in this movie, but you can kind of undercut it.

GROSS: Now, your movie "Hamlet 2" is set in Tucson. And once the drama
teacher decides to like write and stage his creative masterpiece musical, he
enlists the Tucson Gay Men's Chorus to sing. And you give them the really
incongruous song to sing of "Maniac" from "Flashdance." Let's play a little of
it, and then we'll talk about it.

(Soundbite of "Hamlet 2")

(Soundbite of piano playing)

Unidentified Group of Men: (As the Tucson Gay Men's Chorus, singing)
Just a steel town girl on a Saturday night
Looking for the fight of her life
In the real time world, no one sees her at all
They all say she's crazy

Locking rhythms to the beat of her heart
Changing movement into light
She has danced into the danger zone
When the dancer becomes the dance

It can cut you like a knife
If the gift becomes a fire
On the wire between will and what will be

She's a maniac, maniac on the floor
And she's dancing like she's never danced before
She's a maniac, maniac on the floor
And she's dancing like she's never danced before

(End of soundbite)

GROSS: That's a version of "Maniac" from the new film "Hamlet 2." The
co-writers of the film, Pam Brady and Andrew Fleming, are my guests. Fleming
also directed the film.

So why did you want them to sing this song? Why, of all the songs that you
could have given them, why this one?

Mr. FLEMING: It's a--well, it's a good song. The lyrics are really strange,
but it's an enthusiastic song. And that was kind of the idea that it was
about, you know, a tough girl from the wrong side of the tracks making good.
And, I don't know, who doesn't love the "Flashdance" soundtrack?

Ms. BRADY: Especially when he plays it sadly, you know, after his wife
leaves him and he plays a sad version of "Maniac" on his personal Casio. And
that always kind of reminded us of the "Entertainment Tonight" theme. When
they do "Entertainment Tonight" after someone--they do, you know, someone
died, it's slower. It's like...

(Singing) "Entertainment Tonight," someone died.

(Speaking) So that just--that was an inspiration.

GROSS: Were you in high school or college when "Flashdance" came out, and was
it a big deal?

Mr. FLEMING: I was in college studying film, and I saw it and was horrified.
But now I love it.

GROSS: My guests are Pam Brady and Andrew Fleming. They co-wrote the new
film "Hamlet 2." Fleming also directed it. We'll talk more after a break.
This is FRESH AIR.

(Announcements)

GROSS: My guests Pam Brady and Andrew Fleming wrote the new movie comedy
"Hamlet 2." Fleming also directed it.

Now, your film "Hamlet 2" is, in part, a satire of inspirational teacher
movies where a teacher in an inner city school filled with gang members kind
of inspires them to turn their lives around. And why did you want to satirize
that kind of inspirational movie?

Ms. BRADY: Well, I just think over time that form has become very cynical.
And we didn't want to do something that--we are not very cynical. And I think
that the movie hopefully has sort of a sweetness to it, because, especially
with "Dangerous Minds," the idea that Michelle Pfeiffer is a Marine and she's
going to jack a young gangbanger up against the locker so he can get his head
on straight, I just think it's such a condescending idea.

Mr. FLEMING: And we didn't really want to satirize those movies. We wanted
to kind of make one of those movies, but one where the teacher thinks he's
living one of those movies, that he is inspirational, but in truth he's just
kind of an idiot.

GROSS: Oh, yeah. And he says all these pontificating things about how the
theater has the power to transform the actor and the audience. And, of
course, it does have that power, but his theater does not.

Ms. BRADY: Yeah, we always liked this guy because he has the form down. He
has the manner down, but he just has no content.

Mr. FLEMING: But I think, in the end, that his play does actually transform
everybody involved, that it's a really pretentious thing for him to say up
front, but then he in fact achieves that goal.

GROSS: When you were writing "Hamlet 2," did you make a point of going to
musicals or renting musicals for inspiration? And if so, what did you see?

Mr. FLEMING: Actually, the first drafts of the script, the play was just
kind of a series of images and you never really saw the play. You saw
people's reactions to it. And it had music, but it didn't have musical
numbers. And it wasn't until just a few months before we started shooting
that we decided to turn it into a full-on musical, much to the producers'
horror and chagrin. But I think we both felt that if we didn't see more of
the play it was going to be a cheat. So we made more of it than was there on
the page.

Ms. BRADY: But also one of the big inspirations, too, was that we went to
see the Madonna Live tour. And I forget what tour it was. It the tour where
she was on like a cowboy saddle, but also a stripper pole. And it was just
spectacle. And she had images behind her on this giant screen that was like
Condoleezza Rice, Hitler, you know, Darfur.

Mr. FLEMING: Starving babies, yeah.

Ms. BRADY: And it just thought it was so wonderfully irresponsible just to
not--to throw those images out and not put it into context.

Mr. FLEMING: And she crucified herself on a cross made out of video screens.

GROSS: Did she really?

Mr. FLEMING: We just loved--yeah.

Ms. BRADY: Fabulous.

Mr. FLEMING: We just loved the irresponsibility of it.

Ms. BRADY: Yeah.

GROSS: So you took inspiration from that?

Ms. BRADY: Oh, in a big way.

Mr. FLEMING: She is an inspiration.

GROSS: Steve Coogan is very funny in "Hamlet 2," and he's good at the verbal
humor and the physical comedy. Can either of you point to a scene where he so
surprised you with his choices and the way he brought your writing to life?

Mr. FLEMING: There's one scene where he does this monologue. He's found out
that drama department has been shut down, and he kind of goes on a rant in
front of the class about his childhood and his failed career as an actor and
about just his general frustration. And it's really funny, but he's also
weeping uncontrollably through it, so it's sad. And I just remember when we
were shooting that, I was just thinking, `That's amazing. I've never seen
something like that before.' He did it over and over and over. He really is
amazing.

GROSS: Well, Pam Brady, Andrew Fleming, thanks so much to both of you for
talking with us.

Ms. BRADY: Thank you for having us.

Mr. FLEMING: Thank you very much.

GROSS: Pam Brady and Andrew Fleming wrote the movie "Hamlet 2." Fleming also
directed it.

You can download podcasts of our show on our Web site, freshair.npr.org.

(Credits)

GROSS: I'm Terry Gross.
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