Friday, August 7, 2009
Bills to overhaul the nation's health care system have been approved by committees in the House and Senate. What are the details of the House and Senate proposals?
GLORIA PENNER (Host): I’m Gloria Penner. I’m joined by the editors at the roundtable These Days in San Diego. Today, we’ll talk about the healthcare reform debate that is roaring through the nation, the court ordered release of 40,000 California prisoners, and how San Diego’s north county coast will be impacted by an extensive no-fishing marine protected zone. The editors with me today are David Rolland, editor of San Diego CityBeat. It’s good to see you again, David.
DAVID ROLLAND (Editor, San Diego CityBeat): It’s very good to be here.
PENNER: Chris Reed, editorial board member and blogger for the San Diego Union-Tribune. It’s called “America’s Finest Blog,” right, Chris?
CHRIS REED (Editorial Board, San Diego Union-Tribune): That’s meant ironically, yes. Good to be back.
PENNER: Oh. Thank you. Okay, well, we are America’s Finest City, why not? And Kent Davy, editor of the North County Times. And, Kent, welcome back and thank you for coming down from north county.
KENT DAVY (Editor, North County Times): Thanks for having me.
PENNER: Our call-in number is 1-888-895-5727, that’s 895-KPBS. Well, as people have been hearing these days, every president since Harry Truman in the 1940s has tried to fix the nation’s healthcare system and none has succeeded except for Lyndon Johnson. President Johnson got Medicare going, which has served older Americans pretty well for 40 years. And we’re now in the midst of the great national debate over how to, once again, repair the massive healthcare structure to make it equitable and affordable for all citizens while preserving and perhaps improving the quality of care. That sounds fair, doesn’t it? So, David, congress has been wrestling with the issue for several weeks now, has now taken a break to return to the districts and sound out constituents. Is progress being made toward a sounder healthcare system?
ROLLAND: Well, only – Right now, progress is only being made in a small Senate Finance Committee, I believe. The House, House of Representatives, in three different committees, have passed their versions of the bill and they’re, as you say, back in their districts hearing from constituents at some rather raucous town hall meetings, from what I gather, where some very, very vocal, very loud, very thuggish minority are trying to disrupt – trying to disrupt some of these town hall meetings. So it is – it’s kind of becoming a all-out war, not only, you know, at these town hall meetings but also within congress where, you know, now we’re getting, you know, the progressive caucus now starting to kind of get it back up a little bit and starting to get a little bit tougher, you know, in terms of what it wants in a more liberal reform.
PENNER: Why, Chris, has this debate started to deteriorate from civil conversation to these noisy disruptions to protests, even the AFL-CIO is going to get in on it. They’re going to start sending some activists out to those town hall meetings that are being disrupted by conservative protestors.
REED: Well, I really, really hope that you guys are not going to buy the Democratic talking point that there is not organic—organic—fear of what’s being proposed in congress as opposed to suggesting, oh, it’s all just a few activists who are being ginned up. You don’t get 1400 people to turn up on one day’s notice to a rally in Pittsburgh because Glenn Beck says they should go do so. There are lots and lots and lots and lots and lots and lots and lots and lots of reasons to worry about what’s being done in Washington, D.C. Now, you see so many smokescreens come out. Let’s forget what the Republicans say. Let’s look at what the Congressional Budget Office says. The Congressional Budget Office says this does not contain costs. The Congressional Budget Office says this has a fairly marginal affect on the number of coverage – I mean, expanding coverage. So, in other words, the Congressional Budget Office says that the fundamental claim of Obama that we can expand coverage and reduce costs is a lie. Now for you folks to say—for anyone to say—that, no, people don’t like this just because they’re partisans or because they’re thugs, give me a break. There is organic fear of what’s being proposed because it is being sold with a lie that it will contain costs.
ROLLAND: First of all, that’s not what I said. I didn’t say that the only people that are opposed to this are thuggish activists. I’m saying that there are thuggish activists out there disrupting these meetings. I don’t think it’s the people with genuine, you know, adult concerns, you know, that they can express in a civilized manner…
ROLLAND: …I’m not saying they’re not out there. I’m saying they’re not, you know, they’re not the ones disrupting these meetings.
REED: So it’s…
ROLLAND: And it’s – and these disruptions are organized.
DAVY: Isn’t this…
PENNER: Let me – Wait. Wait.
DAVY: …community organization going on?
PENNER: Kent, I just want to say this. Just listen to what’s happening right here in this studio, which is noted for its civil discourse. Now not that this hasn’t been civil but it certainly is ratcheting up the decibels a little bit, so there’s something about this healthcare debate that is touching a chord with the American people and I’m wondering, Kent, whether it is really the healthcare debate or maybe this is kind of a smokescreen for real feelings about President Obama. What do you think?
DAVY: Oh, I don’t think – I think that latter is a – not a incredible argument whatsoever. I think that – that there are real issues at stake. When there is this much money and a topic that is so close to people’s hearts as whether or not they’re going to get the kind of medical care that they want, there are real issues at stake that don’t have anything to do with personalities and the president.
PENNER: So what are the ideals on either side? What are the ideals? What’s the ideal situation, let’s say, from the progressive side? And what’s the ideal situation from the conservative side?
DAVY: I think from the progressive side it is that everybody gets access to – an access to quality healthcare. That’s why the push by those who, I think, are being candid. Representative Filner on your show the other day, talking about I want a single payer system that covers everybody, provides good healthcare. I think on the other side of the question is the great fear that, as in Canada and Great Britain, the single payer systems end up with rationed care that it is – that is considerably poorer quality than that which is available to the majority of Americans.
PENNER: All right, now, David, is it having to do also with the confusion in terms? For example, we talk about single payer and some people believe that single payer means ‘government delivers’ or ‘commissions health service’, when it really means healthcare financing from only one source of money, which could be national- or state- or community-based, and that saves on administrative costs and makes for administrative simplicity.
ROLLAND: Yeah, first of all, that’s the most infuriating thing for me, is when you have people who are either totally uninformed or lying trying to mislead other people into believing that a single payer system is socialized medicine. It is not. The medicine part of the deal would still be all totally private. As you say, single payer is just a financing mechanism for consolidating who pays the healthcare providers for service. You’re absolutely right. So we have, you know, for example, Steve Breen of the Union-Tribune doing a cartoon that shows Nancy Pelosi as Nurse Ratched from “One Flew Over the Cuckoo’s Nest” with a tray of pills that spell out – the bottles spell out ‘socialism,’ which is completely – it’s misleading and, you know, it doesn’t do anything for the debate. Now, the second thing I will say is that we’re not even talking about the progressive ideal here. I mean, the progressive ideal, as you say, Kent, is single payer but that’s not even on the table. We’re not even talking about it.
PENNER: Well, that’s what I meant when I started out this whole program with the billboard in which I said are we missing an opportunity by watering down the healthcare…
ROLLAND: We absolutely are and the progressives, basically, have compromised already. They compromised before we even started the debate.
PENNER: Chris Reed.
REED: I think David’s exactly right. I think single payer makes a lot more sense than what we’re lurching towards doing, which is this bizarre hybrid. However, it really isn’t accurate to say that single payer is just a financing mechanism. Single payer, in all its forms, involves government regulation of what private insurance plans must provide. As such, it’s a government dictating to private insurers who they must cover, what they must cover, etcetera.
ROLLAND: No, actually, what I – My ideal for single payer is getting rid of the insurance companies.
REED: No, I understand that. I understand that. But – but to say – For folks to say that what Obama wants to do is just tinkering with the edges, no. Under the Obama plan, there’s going to be a grandfather period of like five years for existing health insurance plans, and after five years, those insurance plans have to be approved and vetted by the federal government. And who wants to see it become a congressional fight every year over what procedures must be covered? Where, you know, the ophthalmologists are fighting it out with the chiropractors and it’s just a matter of what practices have to be covered by federal insurance guidelines. You know, it is a backdoor route to government control of what insurance plans must look like. And so this gets to the second big problem with Obama’s plan. The first claim that it won’t cost money is a lie. And the second claim that if you like your current coverage, you will be unaffected, well, in five years, under the House plan, those plans have to be regulated and approved by the federal government in which case it becomes a political football. So I really, really don’t care for the framing of the debate as being about, you know, this manufacturing of dissent that people are saying the Republicans are doing or this idea that, no, this is really a proxy fight over Obama.
REED: I really want to push back at that.
PENNER: Okay. Now, we have a full bank of calls here and I really want to give our listeners a chance to come in and weigh in on this one. So let’s take a couple of calls and hear first from Pam in City Heights. Pam, you’re on with the editors. Hi.
PAM (Caller, City Heights): Well, thank you. Thank you for covering this. I’ve really gotten upset over the past few days. It appears to me that we’re going to have reform for people who already have insurance. I have little to no faith that Rahm Emanuel, whomever, is going to force the public option and I think it’s – I’m considering after 44 years never voting for a Democrat again. If I’m going to throw my vote away on some alternative progressive party, it might as well be people I agree with.
PENNER: Okay, so thank you, Pam. All right, so now we’re getting to the point where apparently there seems to be some linkage there with Rob (sic) Emanuel and whatever it is that’s being proposed that Pam doesn’t like. Kent, can you clarify that?
DAVY: I don’t know what she’s – exactly what she’s referring to with regard to Emanuel. The – I think the interesting issue is that there is a crevice or a split inside the Democratic legislators in which you’ve got progressives who are saying that the deals that are being made to try and keep the so-called Blue Dogs in check…
PENNER: Blue Dogs, meaning the…
DAVY: Conservative Democrats.
PENNER: …fiscally – fiscally conservative Democrats.
DAVY: Umm-hmm. To keep them in check, have given up too much. And Blue Dogs and others who are wary of coming back, in this August recess, to districts where they’re finding a whole lot of heat over peop – from people who do not like the impressions that they’re left with. The other thing that I think is – I think is an interesting point in all this is that the administration of the most transparency has not forced the legislation, in all of its flavors, to be up on a website so people can start taking it apart and seeing exactly what’s in it. That, I think, goes straight to the heart of the issue of the speed with which things have to be done. If you can get the stuff up so people could read it because there’ve been plenty of legislators who’ve said, I don’t know, I’m not going to read all this crap, I’ll let somebody else read it for me.
PENNER: Is that…
DAVY: At least the public should.
PENNER: Do you see that as a problem, David? The fact that it seems to be there’s a time line here that’s in the president’s mind and his plans. And would it be a better approach to just carefully and methodically and transparently roll out all of the details of the plan as they start arriving and as they start changing? Rather than trying to say, okay, we’re going to get this through by the end of the year.
ROLLAND: Well, unless there are things that, you know, that are hidden in the fine print of these various proposals, I mean, right now we do – There is no single plan. There are several plans that are coming out of several different congressional committees. I think the whole – the whole, you know, going too fast and ramming this down our throats and it’s not transparent, I think those are distractions. We basically know what we’re talking about. We know the basic proposals out there. We can debate those.
PENNER: Okay, well, we’re going to continue with this and our kind of mini-debate here in the studio at KPBS with the Editors Roundtable and then we’ll take more of your calls and more of the discussion. This is the Editors Roundtable. I’m Gloria Penner.
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PENNER: This is the Editors Roundtable. I’m Gloria Penner. And I’m at the table today discussing healthcare reform with David Rolland of San Diego CityBeat, and Kent Davy from North County Times, Chris Reed from the San Diego Union-Tribune, and lots and lots of you who want to get in on this conversation. And, you know, this is the healthy thing, really, and that is that so many things go through congress and we hear about it afterwards. The public is involved in this, and all week KPBS has been involved as well through our These Days programs. And, in fact, right after this program, at ten o’clock, the conversation will continue with Maureen Cavanaugh and your calls. So if you don’t get in right now discussing healthcare with the editors, please know that you can get in, I’m sure, at ten o’clock with Maureen Cavanaugh on a continuation of the These Days discussion. Okay. So with that, let’s hear from Len in Scripps Ranch. Len, you’re on with the editors.
LEN (Caller, Scripps Ranch): You know, my topics got longer as I listened. But my initial comments were that I’ve heard on this program and other programs the vilification of the insurance companies and I’m – have been fortunate or I’ve planned my life, whichever you want to look at it, to always having a proper insurance plan. The insurance companies don’t prescribe tests, prescribe drugs or any of that stuff, the doctors do. Now, doctors do a great job and a wonderful job but I, as a receiver of the service, have a responsibility to make sure that what’s happening is in my best interest and, some reason, fiscally right interests. I’ve had doctors say I want to have this test. When I ask them why, they say I just want to have a baseline. That’s not necessarily a good reason to have a test. And then David got me really upset up front when he started talking about the thugs at the open meetings, and the change in terms from liberal to now it’s progressive but yet we’re still calling them Democrats and Blue D – or, conservatives and Blue Dogs. Those are pejorative terms. They have connotations to them that (audio dropout) …the color of the arguments that are put forth and…
LEN: …and this is all I’ve seen through the whole of this argument.
PENNER: Okay, well, thank you. In other words, we’re pulling on his emotional strings. I think that’s one of the things that you’re saying, Len, and Kent Davy wants to respond and then Chris Reed.
DAVY: I think one of the fundamental problems of healthcare, healthcare reform, and the state of current healthcare in America, is the fact that there is such an enormous disconnect between the delivery of services and any kind of economic principle that makes consumers make some decisions. So there is a, I think, an issue philosophically or economically that needs to be thought of, and that is how do you create some sort of discipline so unneeded tests don’t happen? Right now, the discipline for tests is, frankly, tort litigation and doctors being – doctors, hospitals, clinics being concerned about malpractice suits coming because they did not give enough tests. Unless you create a system that gives the consumer some sort of play in this, I don’t see how you reform that.
PENNER: Let me just say that recently I had reason to speak to a doctor who was telling me that she has a 94 year old patient and that the patient’s daughter is so concerned about her mother all the time that she insists on having MRIs, very expensive MRIs, ordered if a lump or a bump shows up anywhere on a hand or what have you, well, this drives up the cost of healthcare. Can a doctor say no when a concerned daughter says I want my mother tested?
DAVY: Well, that’s the – The difficulty is if I want my mom tested translates back into pressure vis-a-vis malpractice suits, then the doctor or the clinic, whoever owns the practice, is going to say no, give the test.
PENNER: Exactly. Chris Reed.
REED: Well, I just wanted to return to the idea that there’s a good reason to have haste in doing this. It doesn’t take effect until 2013 so why do we need haste? Why did – Why was it okay to take a year and a half to fashion much simpler Medicare? And the idea that all the issues are known so why not get on and vote with it, I don’t understand that argument at all. Look at – For public choice, consider the public choice option. If we really had a debate over public choice, that is a government offered insurance plan, everyone would be talking about something called the crowding out effect. It’s the most – one of the most familiar arguments in the social sciences or familiar analysis. When the government gets involved and starts subsidizing a program, it crowds out private alternatives. Now if we really had…
REED: …a thorough debate that we’re pretending we’ve had on health insurance, we would have – everyone – the word crowding out effect, the phrase would be well known. We have not had a thorough debate. Ramming this through is simply to build on the political momentum that now exists. It is not a constructive way to overhaul one-sixth of the American economy. It’s not.
ROLLAND: Who is saying it’s – Who is saying we’ve had a thorough debate? I’m not. We don’t even have a bill yet. What are we supposed to be debating? We don’t even have a bill.
REED: But – but that’s…
ROLLAND: I mean, are you – Do you want congress…
REED: The general principles are what…
ROLLAND: Do you want congress to go to every single American, nationwide, and talk this through?
ROLLAND: And find out exactly what everybody wants?
REED: Strawman, strawman, strawman.
ROLLAND: I mean, no, no…
PENNER: Wait, wait, wait.
ROLLAND: We don’t even have a bill. What do we have to debate.
REED: So some…
DAVY: The president came out and said, I want a bill by August. Then he gave up ground and said, I need a bill by the end of the year. There is an urgency that’s being pushed by the White House…
DAVY: …to seize on its own political momentum from the election…
ROLLAND: All right, but it’s not…
DAVY: …to get it done.
ROLLAND: You just said, it’s not working. Congress…
ROLLAND: …has other ideas.
DAVY: That’s right, it’s not working because there’s been a lot of push-backs and don’t go so fast.
PENNER: All right, now I want to ask one other thing and that is about the health industry. It is the largest industry in the United States. It provides more than 14 million jobs. It’s one of the fastest growing job sectors even in this down economy. With that kind of power, won’t the industry, which is made up of health firms, drug companies, hospitals, pharm – I said health – drug companies, won’t they actually end up making the decisions, David? That’s power.
ROLLAND: Yeah. I’m sorry. I’m still a little – a little lost on this haste thing and also…
PENNER: Well, come back in focus. I’m saying that kind of power, huge industry, big job factor in our economy, especially the economy now. With that kind of power, won’t that industry be making the decisions?
ROLLAND: Are you talking about the drug makers or the insurance industry?
PENNER: Everything, insurance providers, hospitals, doctors, drug companies.
ROLLAND: Well, they’re essentially already calling the shots amid this debate. I mean, we have this – this latest kerfuffle between the drug makers and the White House now with the drug makers saying, hey, we had a deal for, you know, for only cutting costs by $80 billion and now the House of Representatives wants to extract more from us and didn’t we have a deal with the White House? And the White House going, yeah, yeah, we sort of had a deal. But, you know, Nancy Pelosi, rightly so, saying I’m sorry, I’m not bound by that deal. You can make whatever deals you want with the White House but, you know, but, you know, if it’s not what the House of Representatives wants to put forth in a bill, it’s not going to be there. But why on earth does the – do the, you know, the drug makers get a seat at the table before the debate even starts? Because they already have that power that you’re talking about because they have money and they have high-powered lobbyists who used to be in congress.
PENNER: Okay, let’s hear from Arlin in Mission Hills. I think he may be dealing with some of that. Arlin, you are our final caller on this topic this morning. But remember, everybody else, you can call in again at ten o’clock and speak with Maureen Cavanaugh. Go ahead, Arlin. We’re waiting for you.
ARLENE (Caller, Mission Hills): This is Arlene in Mission Hills.
PENNER: Arlene, oh. How are you, Arlene?
ARLENE: Well, I’m fighting the pharmaceutical battle.
PENNER: Go ahead, Arlene.
ARLENE: I just am very, very disturbed about the pharmaceutical provisions or lack thereof or this agreement that has been made with the pharmaceutical companies and I understand that it’s Henry Waxman of the Finance Committee that came out this morning and said we didn’t sign onto this agreement, and I hope they haven’t because the bill that was passed for Medicare was a bad one. It was really a bad one. It was only good for big pharma. And I find this – myself, even though I have fairly good coverage that includes coverage for pharmaceuticals, that my co-pay can be higher than buying the cheapest of the blood pressure medications by 100 tablets. And my co-pay for a 30-day supply, which is 30 pills, will be as much or more. And it’s just a ridiculous system, and I don’t know where to turn. I – I’m better off going to Costco and buying my medication.
PENNER: Well, a lot of people do that, Arlene. I want final comments. And thank you for your call. I want final comments from the editors before we move on. We’ll start with Chris Reed.
REED: If President Obama and the Democratic congress think that this is a good idea and that it’s time for America to be a mature society and join the rest of western democracies in having much broader healthcare, fine. But let’s be honest about it. Let’s admit it’s going to cost a lot of money and let’s admit that eventually it will affect the insurance that every individual now has. That’s all I want: honesty, an honest debate.
PENNER: Thank you. Kent Davy, does that appeal to you?
DAVY: Well, I – One, I don’t think the debate is ever going to get all that honest. But the – I think what’ll end up happening is great bandaid compromises ultimately so Obama can someday claim some sort of victory. Some of his Democratic congressmen have some sort of fig leaf to go back to the voters and try and argue for protection.
PENNER: And David, you can wrap it up. I’m getting sadder and sadder. Go ahead, David.
ROLLAND: Well, I, sort of surprisingly, agree with both of those final comments. I was glad to say – glad to hear Chris say he – you know, it would be fine to talk about doing something about it if there’s just some honesty that’s going to cost some money. But the Congressional Budget Office is only – is only projecting out ten years here. There may – You know, this – these kind – these sorts of debates get very shortsighted sometimes. You know, to provide insurance to a lot of people is going to cost some money but the long term savings, I think, could possibly be there. We’re only talking about ten years out when we’re assessing these things.