A look back: Top stories in the military, San Diego economy and healthcare access.
December 23, 2011 12:50 p.m.
Guests: Tony Perry, San Diego Bureau chief, Los Angeles Times
Dean Calbreath, columnist, San Diego Union Tribune
John Warren, editor and publisher, San Diego Voice and Viewpoint
CAVANAUGH: The year's big San Diego stories in healthcare. The end of the war in Iraq.
I'm Maureen Cavanaugh, it's Friday, December†23rd. If you'd like to join our year end review conversation, the number is 1-888-895-5727.
I'd like to welcome today's Roundtable guests. Tony Perry is here. San Diego bureau chief of the LA Times. Welcome.
PERRY: Good to be here.
CAVANAUGH: John Warren, editor and publisher of San Diego Voice and Viewpoint. Hello.
WARREN: Good morning, thank you.
CAVANAUGH: And Dean Calbreath is columnist for the San Diego Union Tribune. Good to see you.
CALBREATH: Happy holidays.
CAVANAUGH: Thank you. Tony Perry, the big story this year, of course, in the military was the end of US operation Iraqi freedom after nine years. Are all US forces now gone from Iraq?
PERRY: Indeed, they are, except for a small number of anymore ds at the US embassy there in Baghdad, are the largest American embassy in the Arab world. But the combat troops are out. They crossed the border into Kuwait, 72†hours ago. So the nine-year hour from this perspective is over.
CAVANAUGH: Now, there's been some criticism that there isn't a continuing presence or US bases in Iraq. How stable is Iraq?
PERRY: Oh, it's extremely unstable, if you've looked just in the last 24†hours, the car bombs are going off, the mala key government seems no longer to be interested in coalition governing. It's very, very unstable. It is a classic third world government with violence and schisms, political and religious. What it does not have is Saddam Hussein and his sons. They're dead. And for that reason, probably all of us should be thankful.
CAVANAUGH: You went to Iraq on a number of occasions, Tony. Will how large a role did San Diego and San Diego's military play in that conflict.
>>> A prominent role. The first conventional troops to cross the line of departure from Kuwait into Iraq were the Marines from Camp Pendleton. Where they were greeted by the seals from Coronado. And for many month, a couple of years, actually, Camp Pendleton had the dubious distinction of having had more personnel killed in Iraq than any American military base. Later they were surpassed by one of the army bases, fort hood, when the army surged into Baghdad. But for several years, Camp Pendleton was centric to the killing. And that area Alan bar province also has the distinction of having more US personnel killed than even Baghdad am this was both a foreign and international story. But for those of us here in San Diego, it was a local story. The tally, 345 marines from Camp Pendleton dead. Eight times that many wounded. Many of them grievously. You put on 115 marines from 29 palms dead. Eight times that number wounded. This was a local story for us here in San Diego and Southern California.
CAVANAUGH: A recent story you did brought that image home, brought that message home. You had an article in the LA Times on San Diego about Karen Mendoza, whose husband was killed in Iraq. And she exemplify, I think, the continuing cost of this war.
PERRY: Sure. We have had 4,500 dead personnel, military personnel in Iraq. By one estimate or one calculation, about 2,400 widows. 4,000 children now without fathers or mothers. It's a large, large number. Karen Mendoza's husband, marine major ray Mendoza, was leading an attack against insurgent positions near the Syrian border when he was killed. He was leading from the front, he was the only person killed in that attack. And he's been gone six years, two children left behind. What Karen has tried to do is nurture those children to tell them about their father. It's just that he's not here. But at the same time, not let them be crushed by the fact that their father is gone. Of a very, very difficult task for Karen, and 2,000 other widows in this nation.
CAVANAUGH: John Warren, a lot of people are speculating on what the other costs of this war in Iraq. What comes to your mind?
WARREN: Trillions and trillions of dollars. This is the only war that we have had that we financed with debt instead of doing things like in World†War†II, Vietnam war where there were bonds, there were all kinds of budget adjustments. We financed this war almost totally with debt. And the war has had an economic impact. Of course it kicked in the war time economy, but that economy was not enough in itself to sustain us through the kinds of losses that we have had recently. What comes to mind when I look at the money that went into this war, when I look at the efforts to help people locally, the sacrificing of local schools and fire services and domestic violence programs that could have been taken care of, trillions, hundreds of trillions of dollars gone that could have had me a tremendous difference in terms of where we are today in this nation.
CAVANAUGH: And it's going to continue to cost us, isn't it, Tony? Not only in very meaningful dollars, but in the suffering of the wounded warriors who are now home and coming home.
PERRY: Sure. The signature war from Iraq and to a les every extent, Afghanistan, is post traumatic stress disorder, traumatic brain injury from the explosions. Of hundreds of millions of dollars being spent looking for treatments for PTSD, TBI. And then of course taking care of, as you say, the wounded warriors and their families. The shooting may be over, or at least the involvement of the US in the shooting. But the cost as John suggests are continuing and are going to be with us for a long, long time. And then we can get into the unemployment problem of the returning veterans. So the shooting again may be over, but the cost of this war and this impact on this nation is still continuing.
CAVANAUGH: Not only did the war in Iraq end but we saw a significant drawdown in the number of US troops in Afghanistan. We can't forget, though, that there are many US service members still fighting in Afghanistan.
PERRY: Absolutely. We have 100,000 troops still in Afghanistan. That brought us up to 100,000. He has pledged to get them out by the end of next year. He has further pledged to have all combat troops out by the end of 2014. But there has been what they call pushback from the military saying we can't get the job done in the way that the commander and chief would like it to be done by 2014. General John Allen who's the top army -- excuse me, the top US general in Afghanistan just this week has started to say, no, we're going to need a residual force there to help the Afghans get on their feet so we don't just quickly abandon them. There are historians, I'm not an expert, so I can't validate their theory. But there are historians to say that's what happened in Vietnam. We didn't lose on the battlefield. We lost when we left, and then didn't support that government that we had propped up sufficiently, and the war became lost. I think that thinking permeates many of the general officer, both in the army and the Marine Corps. What they don't want to see happen is the US leave too quickly, leaving nothing behind, and not support in one case the Baghdad government, and in the other case, the Kabul government.
CAVANAUGH: No overview of military stories in San Diego or Southern California can be complete without the idea that the military budget is expected to take a hit. In fact, the Navy just sent out a round of layoffs, including some career Navy officers. I want to ask both Tony and dean, do you think the military cuts, first you, Tony, are more of an economic story, or does it affect initial security?
PERRY: Certainly it's an economic story. And you're right. There are layoffs, if you will, in all of the services, both the uniformed services and the civil service in. In the army, I think the figure is 7,000 civilian workers are being given pink slips. There's also talk of decreasing pension benefits, health benefits, making military families pay more for those benefits when they don't live directly on a base. In other words, all the things we've seen in private sector as private companies struggle with this economy. Layoffs, the end or trimming of pensions and trimming of health benefits. This is it all hitting the military. As Tom Filpot, like, the premiere military writer when it comes to benefits and things, and he basically said, you know, the golden years of increasing pay and benefits for the military that we've seen in the last decade, as part of the great buildup for Iraq and Afghanistan, those days are over. And tough times are ahead economically for these military families.
CAVANAUGH: Dean, we're going to talk more about the potential military cutbacks. But when I heard about layoffs going out to Navy personnel, especially career Navy personnel, I never heard of that before. Was that a surprise to you too?
CALBREATH: It's not a surprise at the end of a war. It's also part of Washington trying to cut the budget as much as it can before 2013 when the actual budget cuts are going to really start happening. And it does have a real impact on San Diego. 25% of our GDP comes from the military, from military contracting. Beyond these layoffs, there are cutbacks in contracts which affect civilian workers here in San Diego. So it is a slowing effect on the economy. You know, all -- we have such a high concentration of military here that it will hurt us probably more than any other area in the states.
CAVANAUGH: Besides, I guess, the services getting a little leaner, Tony, how do you see the military? Particularly the Marine Corps changing after the Iraq war after the end of hostilities in Afghanistan?
PERRY: One point to add onto what dean said, don't forget, these are all volunteers. So when you have volunteered for military service, and you're being told, sorry, we don't need you any longer, that's a different kettle of fish than being drafted in Vietnam and saying we don't need you any longer. Many of them volunteered thinking career. The Marine Corps really is searching for its post-Iraq, post-Afghanistan identity. It's been involved in two prolonged land wars, and done exceedingly war in Anbar province in Iraq, and in Helmand province in Afghanistan. The Marines have didn't magnificently. What do they do now? We don't need two land armies. What's left over for the Marine Corps? Marine Corps says we'll go back to our original mission, which is storming ashore from ships and doing the in addition's business. Well, are the question is, are we Donna need that? Is that the kind of war we're going to need? Are we going to need people fighting their way ashore? Probably not. For one reason, the bad guys are getting technology that would allow them to blunt that kind of assault. So there's a lot of scratching of heads and a lot of stroking of chins among the Marine Corps thinkers, what is our future? We'll see. Same is true of the air force by the way.
CAVANAUGH: Let me get John Warren into the conversation.
WARREN: I think our ground troop troops for all armed services total a little more than 400,000 actual boots on the ground. Of the thing that concerns me about that, when we look at north Korea, we have 28 to 30,000 troops there, we have the change in regime taking place, and north Korea has always boasted they could put a million soldiers in the field almost immediately if they decided to move amongst south Korea, which is why George bush was so concerned in terms of pulling back. So when I look at us putting emphasis on technology and reducing our manpower, yet we have places like Korea and China, you know, with large human mass, I think that the senior military people have some concern about whether or not we are at risk in some of these activities.
PERRY: And for that reason, the Marines are going to Australia. We're going to start sending marines to Australia to get ready should the Chinese get even more aggressive than they are. The Chinese don't like the idea of the US marines going to Australia.
WARREN: That's right.
PERRY: The action we believe is going to be in the Pacific. What that action is going to be, we don't know. But we think it's going to be there.
CAVANAUGH: I'd like to squeeze in a phone call. Peggy is on the line from Pacific Beach. Welcome to the show.
NEW SPEAKER: Thank you for taking my call. I wasn't able to hear the very, very beginning part of the discussion. But so far I have not heard anything about the cost to Iraqi people. They have -- this was an illegal, immoral invasion and occupation based on lies. We have destroyed their kitchen. They have hundreds -- we don't know how many thousands of civilians killed. Not just warriors, but civilians. And there are many widows and children, grandmothers, grandfathers killed. The infrastructure destroyed. Several million have left the country so they have very little --
CAVANAUGH: That's a point well taken. Of we were focusing, however, on the end of the Iraq war and how it affected San Diego and San Diego military. But indeed, the complications for Iraq?
PERRY: Without agreeing to Peggy's preamble there about the war and why it was fought, I certainly can agree that Iraq is in real trouble. They have had large casualties, often because of the insurgency that was fought. Often because they didn't step up to the plate fast enough with their own army. They're in a world hurt. And they also still have these sectarian splits between the al-Malaki government in Baghdad, and other folks. On the other hand, they have a couple of things that nobody else has to that abundance in that region. That is, they have oil. And they have water. Now, they once had an educated middle class. They all fled. But they have oil, and they have water. If they can get it together, they can make it work. Can they get it together? That's the question.
CAVANAUGH: We have to wrap up this topic but I don't want to leave it, Tony, without a quick last question. There was so much fervor about the ending of Don't Ask, Don't Tell. Any lingering controversy?
PERRY: I don't think so. The US military is a big action. There'll be a jackass or do that'll cause an incident. Strong leadership from the top of the Marine Corps, are the commandant, and the sergeant major, whatever they may feel in their heart, when the order was given by the commander and chief, they said, yes, sir, strong support. This is the new rule, let's move it.
CAVANAUGH: Well, thank you all.
CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. My guests are Tony Perry, John Warren, and Dean Calbreath. Our year-end review of stories affecting San Diego now turns to the economy. And we invite our listeners to join the conversation.
Dean, what's your assessment of how the San Diego economy did in 2011?
CALBREATH: Well, I think that we let me say this as --
CAVANAUGH: That's a big question!
CALBREATH: Yes. It's a complex answer. Toward the end of the year, we've been performing better than we expected. And maybe even better than we've been told. And this happens at the end, you know, at the beginning of every recovery. Sometimes the initial estimates you get from the government are actually worse than you would expect, or worse than reflects reality because the government is basing those estimates on what had happened before. And what's happened before is a terrible time. So there is a possibility that things are getting better. And the reason I say this is that every time for the past several months every time the state produces its unemployment figures and hiring figures for San Diego, they have to revise the previous month upward. This is again something that happens at the beginning of a real recovery. It might be a blip, it might be revised again as of February when the state rewrites all its records. But it seems like judging from what we know right now, it seems like we are actually in the process of a recovery.
CAVANAUGH: Let's start with unemployment. What are the numbers on unemployment for San Diego County now?
CALBREATH: Well, are I think that -- if you adjust it for the seasonal hiring of Christmas workers and everything, the unemployment rate is about 9.7%. Am I think it's 9.4% if you don't revise it. No, I'm sorry it's 9.4%, and 9.2 if you don't revise it. It's still high, but it's the third or 4th -- I think the third month in a row that it's been below 10%, which is the first time that's happened since 2008, I think. It's still high, and we still got a lot of problems. It'll still take four years maybe to get back to where we were before. But it seems like a beginning.
CAVANAUGH: Right. What's the number we need, actually, that we would need to say, you know, we really are recovering? We're really getting past these hard economic times?
CALBREATH: If we wanted to go back to 2007, 2006, we'd need 4.5%.
CAVANAUGH: It's going to take a while.
CALBREATH: It will take a long while. I'm not saying this is going to happen overnight. Three, four years at least. But it could be the beginning of that kind of recovery. That having been said, and this is it why I say it's a real complex subject. There are two huge sharks in the water. Europe, which seems like it's on the verge of collapse. They keep papering over their problems. Hopefully they're going to achieve some kind of solution this year. And there's also the US Congress, which is, you know, as we've seen this week with this whole debate over the payroll tax which should have been a no-brainer. Cut taxes, let things grow. It should have been a no-brainer, and yet it became this huge sticking point. It's just amazing to me what's happening in Washington.
CAVANAUGH: Now, John Warren, when we talk about that overall unemployment statistic, that's pretty high. But when we talk about statistics for people of color for minority communities, they go through the roof, don't they?
WARREN: There is no comparison. Because while the country might have an overall unemployment rate of, say, 10%, the unemployment rate in the African American community in particular always has hovered around 16%. That's for adults. And when you look at youth, it's in the '20s. The unemployment numbers, according to the bureau of laborer statistics only count those individuals who are looking for work. At one point, it was broken into subcategories. If a woman was expecting, even though she wanted to work, she was considered workable. Students weren't included because they were not looking for full-time employment. So these numbers are adjusted up and down in a tremendous way. But we can't talk about resolving unemployment. You look at San Diego, you got to remember the number of foreclosures here, the loss of jobs across the board. And those things just can't be pumped back up. There's a change taking place in terms of the economy. In terms of work, work as we know it, jobs as we know it. All of this is undergoing a transition. So it becomes unrealistic to just hop on the numbers like we can do things to boost the numbers without addressing the rest of the infrastructure that's connected to that.
CAVANAUGH: I want to talk about that addressing that infrastructure. But a quick word to you, Tony, about the idea of people being not welcomed back into the service, and therefore winding up having to try to find jobs in this economy. That apparently will add to our problems here in San Diego.
PERRY: It will be very difficult, particularly as men and women either leave after doing their hitch or if they're laid off as it were. Finding jobs for them is going to be very difficult. The federal government has hired a lot of veterans. A higher percentage of federal government employee hires last year were veterans, and about time in the previous decade. But that can only go so far. The question I have, and I'll fling it over to dean, one of the things I like but yet am frustrated about in San Diego is our tendency to think we're the center of the world or the whole world itself.
CAVANAUGH: We're not?
PERRY: I know, I'm shocked. Are we the master of our own fate on this, or do we have to wait until various international trends kick in? We've got all these mayoral candidates running around telling us they're going to create jobs. Can we do anything or do we just have to wait till that rising tide lifts our boat?
CALBREATH: I think it's a combination of the two. I think that we are affected, and I think we're going to be affected less by Europe than other places in the country. We're more tied to Asia than Europe. But we are affected by Europe because banks might go down over Europe, the credit market might freeze. That makes it harder for businesses in San Diego to gain loans. To that extent, we're affected. On the other hand, we do have some control over our own destiny. One of the things that John was talking about, I want to say that, yes, the government doesn't count people who aren't looking for work. But on the other hand, even -- well, it doesn't count those from the official unemployment rate. But even those numbers are going down. The government does count them but in a separate rate. Those numbers are going down. On the other hand, what we don't get in the unemployment rate is what kinds of jobs people are hired. And we have a lot of low-income people in San Diego County am even during boom times, even during the 1990s, half of the jobs created in San Diego County were jobs that could not pay enough to sustain a family here. They were lower than the living wage here. I think lower than $25,000 or something. 40% of the jobs we created at that time. And that's one thing that local leaders really have to focus on, how to restore middle income jobs. We've got a huge market of low-income jobs, a fairly good market of high-income jobs, enough to provide for the high-income people here. But we don't have any ladder between the two.
PERRY: But what can we do? I mean, this is a community that has been tax adverse for years. One would think is welcoming to businesses. And so cutting taxes, I wonder how that would work. What can we do to get a good company in here with a thousand middle-income jobs to hand out?
WARREN: Well, that's a whole 'nother ball game. Let me address the part of what you said, dean. They might not count individual job areas, but they do deal with seasonal employment. Of and the seasonal employments is where they make the allocation in terms of what kind of work. So that's one point I wanted to make. As far as Tony, you're talking about jobs for people, you have things like the economic development corporation, and all these efforts. But California as a state works against us having companies come here because of all of the tax issues and things. People are fleeing from this place as opposed to coming in because you just can't come and do a business in San Diego and not do business in the State of California.
CALBREATH: I don't know that that's true. That is something that we have heard a lot from the business community. Growing up here, ever since even during the Regan era, we heard that. I don't think that's necessarily true. We used to hear that, well, Nevada and Arizona are taking our jobs because they're got lower taxes, lower regulations. They've also got right now worse unemployment rate, worse hiring ratings. Our hiring rate right now is better than North Carolina which has one of the lowest taxes and regulation regimes of the United States. If you talk to businesses here, they don't -- the first thought out of their mouth is not businesses thinking about moving in here. It's not taxes, it's not regulations, it's the cost of living. It's the cost of property. It's the high costs here.
CAVANAUGH: Well, it brings me back to something that John brought up, and that is the vanishing middle class job in San Diego. We have, as you mentioned, a lot of jobs in the tourist industry where wages are low. We have really good high-tech biotech jobs. But it's a phenomenon that's -- that people are experiencing across the country. But I think it's sort of highlighted, accelerated in San Diego. Am I right in that?
WARREN: It's a sunshine tax. It's always been here. The places that are more desirable, California, Florida, Hawaii, the places that are more desirable to live, it's more difficult for people to come live, the wages are lower. Lake Tahoe is a perfect example where it's doing so well at the top but they can't find workers or housing for workers. People can't afford housing here because of the way it's structured in terms of who makes the money. You can't ignore that when you look at it. Of and I beg to differ. Buck knives is an example of a local business that was here for many, many years --
CALBREATH: That is one example.
WARREN: I think give you a lot more. But there are people leaving here. And it's not fair to look at -- Arizona has pretty much done something with their situation like Alabama in terms of driving people out. But let's not forget the inland empire. Of if we look at San Diego and how we're doing here, the inland empire is worse than Baghdad, perhaps.
CALBREATH: They have less taxes, less regulations, and they are doing worse. Which shows that that's not the name of the game. Bakersfield, the central valley, they have less taxes, and les regulations than we do. They are not attracting the people because for other reasons. Because people want to live where our universities are.
PERRY: We must be doing something right. I trucked out to Rancho Bernardo for the ribbon cutting of the French company that's going to make solar products. 400 direct jobs and a thousand indirect jobs? I just hope they don't move in a couple years south of the border.
PERRY: That's my fear.
CAVANAUGH: I don't want to leave this topic without talking about real estate. A lot of people in the middle class measure their wealth by how much their house is worth. And so what do you think the housing market is going to be like in this coming year of 2012? Do we see any trends that are going to go on through?
CALBREATH: I think that housing -- I think that the -- it depends on neighborhood by neighborhood. It's location, location, location, as they say. Some neighborhoods have already bottomed out, I think, especially the lower income neighborhoods. The upper income neighborhoods I think are still on their way down. And as they go down -- because these prices are in the millions instead of the hundreds of thousands, then is that drags down the median price of the county. But I do think that our median price is going to continue to go down over the next year.
CAVANAUGH: And foreclosures? Have we seen the worst of that?
CALBREATH: I think we've seen the worst. But there's still more to come.
CAVANAUGH: Now, you mentioned at the very beginning of this that you're thinking that you're seeing a trend that we're going in a positive direction. They thought they saw that in the middle of 2011 when they were boosting tax revenue estimates, both in the City of San Diego and the State of California. And what that actually turned out to be, much lower than the rosy projections that they had. So will we be seeing a return of that, or are there any solid signs that revenues are up and that business activity is increasing?
CALBREATH: I think there are signs that revenues are up. Am and we're finding that through sales taxes coming in, that retail sales are up. We're finding it through a number of areas. Car steals have gone up 30% over the past two years. 15% this year alone in San Diego County. So I think that things are -- that there are good, positive signs out there. On the other hand what derailed the -- what derailed it this summer was really the unsurety about Washington as they were debating over the debt ceiling, and unsurety about Europe.
CAVANAUGH: Well, we have to leave and move onto our next topic. Thank you, everyone.
CAVANAUGH: Is this KPBS Midday Edition Roundtable. I'm Maureen Cavanaugh. My guests are Tony Perry, San Diego bureau chief of the LA Times, John Warren, editor and publisher of San Diego Voice and Viewpoint, and Dean Calbreath, columnist with the San Diego Union Tribune.
Well, are as we wait for the main provisions of the healthcare reform law to kick in, 2011 found many Californians deciding to do without doctors' visits. High unemployment, and the high cost of the private policies has led to California becoming one of the most uninsured states in the country. John Warren, the cost of health insurance continues to rise in 2011. How much have rates gone up this year?
WARREN: Well, it's costing now -- you've got about a 9% increase when you look back. It's costing $15,000 a year in terms of family -- insuring of families with healthcare as opposed to, say, two or three years ago when it was 7,000 of the it's always on the march. To put it in perspective, we probably have close to 50 million Americans that are uninsured. The State of California has between 12 and 14 million uninsured people. And many of these figures existed even before the economic downturn came, in terms of employment. So we have a tremendous number of folks without healthcare postponing health visits. Then we have an aging population here, and we increase in terms of Social Security and Medicare and all of those issues that are on the table. And in the midst of this, we have this whole battle over affordable healthcare, so often referred to as Obama care bump affordable healthcare does a number of things spread out over a number of years, the ability to retain coverage for adult children up to age 26. The inability to drop people because of sickness or preexisting conditions, and the most litigated issue being the idea of requiring participation in terms of employers.
CAVANAUGH: Now, we started the year in California with rate hikes from blue shield. After significant increases by California insurers in 2010. What are the reasons that insurance companies are raising their rates now?
WARREN: One of the reasons they're doing it now is because in 2012 and moving forward, and I think maybe somewhat in 11, they're going to have to justify any increases they have. And they're going to have to show those increases going toward healthcare in terms of treatment of the people who are insured. So a lot of them are trying to get this money now while they can. You might also recall that anthem blue cross was pushing in a direction, and I believe they rescinded their effort because of the public outcry. So we -- this emergency bill that we just had the president receive that the Republicans backed off of had impact in terms of doctors having the amount of money that they would receive.
CAVANAUGH: Right. That didn't get a lot of coverage, but yes, it would have shrunk the reimburses, right?
WARREN: It would have cut the reimbursement.
PERRY: You say that 50 million people don't have healthcare, but isn't it the case that I can walk into an emergency room anywhere in San Diego? I don't have any insurance, I've got a strep throat, a broken toe, and they must offer me care? Or face legal consequences?
WARREN: Well, that's a very important your you raise. Because people have dry died across the country with questions being raised as to whether or not they were denied care as to whether or not they were insured. And yes, in San Diego, many, many people are walking in. The waiting room time is probably 12 to 14†hours in terms of trying to be seen. If you go, and I won't name certain hospital, but you would think you were in a combat zone in terms of the number of people sitting around the walls, waiting for care. And the tragedy is that the few people who are uninsured are paying more for services than are actually being charged for the ones that are not. And so the ones who are carrying the burden of the ones who don't have the insurance, and we thought at one point we would see more urgent care clinics pop up to take some of the relief off. And a couple of hospitals have created urgent care entities. But it's not sufficient. Remember, in San Diego, we have had hospitals close. We lost physicians and surgeons. We lost two or three other facilities. I don't remember off the top. But we are down in terms of the number of facilities, while we are up in terms of the term of people.
CAVANAUGH: I think many people, I know there's intense opposition in some quarters still to the health reform law. But many people support this law. But I think there's frustration even among supporters about why is it taking so long? Why are these things being rolled out year by year? Can you answer that for us?
WARREN: Sure. You know the affordable healthcare act is about 2,300†pages. And I remember when it first came out, I down loaded all of it. Of I had two large volumes of books and started going through it. And I think the president did something very smart. He realized this program could not be put in place overnight. So it had to be done in increments because it impacts Medicare, it impacts reimbursement, what's done by doctors, and a lot of the adjustments that are being made, if the whole thing was just thrown in it the system, it would probably collapse. That's why it's being done in an incremental place, a process, which is not unusual in term it is of how we put laws into effect in this country. We don't just pass a law today and implement it tomorrow. We have to do guidelines and regulations and discussion. And affordable healthcare is being presented as if this is some strange new approach. But yet it is a fixed part of the legislation process.
PERRY: Let me see if I can get you to grab onto that electrified third rail. In this case, illegal immigration. We're on the border, how much impact does illegal immigration have on our healthcare costs in San Diego County?
WARREN: Well, I don't know the figures. We know that the cost is tremendous. We know that this was one of the concerns that led to the action that took place in Arizona. And I have always been concerned that while we have a humanitarian approach here that if nine out of ten of us went across the border and had the same kind of issues, I doubt very seriously if we would be age to get the healthcare that you're able to get here just by showing up. That issue has been further compounded by the number of children where the expectant mothers are trying to get across the border so the children can be born here and have citizenship. And all of that is impacting the argument in terms of the count and the cost.
CAVANAUGH: Let me just interject here. We know that illegal immigration is significantly down lately. So whatever impact that might have on our system, it is decreasing instead of increasing. One of the things though, California got approval from the federal government this year. You talked about reimbursements to cut the amount of money that it pays doctors for Medi-Cal payments. What is the impact of that on poor people who need medical care? Do fewer doctors accept them as patients?
WARREN: Well, you have doctors who decided that they would not accept them as patients. They don't have to accept the patients. And the doctors are always complaining about their not being adequately paid. I think we have to remember why we moved in the direction of making reductions. The system was being abused. While there are good doctors out there, we have had tremendous abuse in terms of reimbursement. The codes that were being used, in some instances they didn't even have the services that were listed on the codes and they were submitting the codes for reimbursement. So the good suffers with the bad when the adjustment comes, like everything else.
CAVANAUGH: We've heard a lot about the cuts to schools that have had to be implemented by the California state legislature because of the budgeting. Healthcare services have found themselves squeezed through 2011. And before that, 2010. I'm wondering, do we not hear as much about that because the people who are affected by them tend to be poorer do you think?
PERRY: No. I'll act as the shill for my own company. We've done a great deal, journalistically, to talk about the impact on lower income people, medical and dental. We haven't mentioned dental. But it's also one of the problems. A lot of people are foregoing dental needs because they either don't have a job, or their dental coverage if they have it has been cut back. Go to stand down, the annual three-day event to help homeless or down on their luck veterans. I was floored last summer when I went to the event, and the lines to get dental care were greater than the lines to get medical care. So dental and medical, both being hurt, and it's a tragedy if you're poor and down on your luck and you have to decide between food, rent, and medical and dental.
CAVANAUGH: On top of all this, we hear about a shortage of doctors in California. It's hard to believe that there are a shortage of doctors if you live here in San Diego. But why is that happening, John?
WARREN: Well, if you talk to doctors, you know, there was a time it was a progression that people looked forward to. Am I talk to many friends who are in practice, and between malpractice and the burden of what's being put on them in terms of demands of services, many are just giving up. It's not cost-effective. You could make more money as a cable installer for AT&T almost than you can as a physician. And still maintain decent hours.
CAVANAUGH: I don't know if that's true or not.
WARREN: No, I mean if you look at what the costs, how the charge it is are made, one of the things that's going to happen is co-pay is being eliminated. If you look at this $15,000 it costs a family a year for care, at least 4,000 of that is coming out of their pockets. And you're looking at the deductibles that people carry is up to a thousand dollars. It's hard for most people to come up with a thousand dollars in advance before they start getting the benefit in terms of deductible. Meanwhile, the doctor is being controlled in terms of every test has to be approved, every procedure has to be justified. The.
CALBREATH: I was thought going to say, it's an incredibly inefficient system. The whole -- the entire healthcare system in the United States , it just has so many inefficiencies. We shouldn't be sending back to emergency rooms for in-grown toenails or something, but we do that because they don't have proper insurance. Other countries, every other industrialized country except the United States , has --
CALBREATH: Universal healthcare, paid through your taxes so you don't have to put a strain on your emergency room so you can take care of illegal immigrants, which is also a problem in Germany. Problem has Turks and other people moving in, yet they're able to provide care because there's universal healthcare. And people are paying for it through their taxes.
CAVANAUGH: Well, we have an example closer to home that many people have pointed to, and that is the veterans' administration healthcare. There are complaints from vanishes, but it's widely seen as an extremely effective form of medical care. Upon would you agree with that, Tony?
PERRY: I would. Veterans' affairs hospital situation is so complex and so large, almost everything you say about it is true. They've got this enormous pool of people that they're asked to take care of. And I think by and large, from what I know, they do an exceedingly good job at it. . We tend to publicize those things that don't go well. And they're struggling with the new veteran and traumatic brain injury, and post traumatic stress disorder, etc. And now of course the Vietnam veteran, he's also going in larger numbers to the VA. But we have an example of a government-run system, oh, my goodness, where people can walk in and get decent medical care that isn't available anywhere else in this society. Yet we still are afraid as dean suggests, we still have this deathly fear of government-run or single pear systems. Even though we have an right in front of us this works.
CAVANAUGH: Looming over this year to come, John, my final question is about the new healthcare reform law going before the US Supreme Court. What will the Court be deciding?
WARREN: Well, I think the heart of the matter goes to the commerce clause of the constitution as to whether or not one can be required, if the federal government can require someone within the state to make a purchase as the payment will come in terms of employers. That's the essence of it. We have had three US court of appeals side with the president, with his administration so far, and there's a strong feeling that the argument for this, that the Supreme Court will end up upholding the statute. It's going to be argued based on a commerce clause. Some of them are going to try to argue based on the 10th amendment, in terms of where responsibility goes. But at the end of the day, I think this law is going to stand.
CAVANAUGH: That comes up in March. The Supreme Court is going to pencil out a week for those arguments.
CAVANAUGH: I want to thank my guests thank you, and happy holidays.
CALBREATH: Happy holidays.
PERRY: Happy holidays.
WARREN: Happy holidays to you.