Friday, August 21, 2009
The Obama Administration has been on the defensive lately over its plan to overhaul the nation's health care system. With heated protests at town hall meetings across the country, the president and his Democratic allies have been trying separate fact from fiction in the debate.
GLORIA PENNER (Host): I'm Gloria Penner. I'm joined by the editors at the roundtable These Days in San Diego. Today, we'll have opinions on the latest developments in the healthcare reform odyssey, the denial of San Diego's sewage plant upgrade waiver, and Mexico's plan to screen cars crossing into that country from San Diego. The editors with me today are John Warren, editor and publisher of San Diego Voice & Viewpoint. John, it is so good to see you.
JOHN WARREN (Editor/Publisher, San Diego Voice & Viewpoint): Good morning, Gloria. Thank you.
PENNER: Good morning. JW August, managing editor of KGTV 10News. JW, welcome back.
JW AUGUST (Managing Editor, KGTV 10News): Top o' the morning to you, Gloria.
PENNER: And we welcome for his debut on Editors Roundtable, Hieu Tran Phan, specialists editor for the San Diego Union-Tribune. Hieu, thank you so much for coming to Editors Roundtable.
HIEU TRAN PHAN (Specialists Editor, San Diego Union-Tribune): No, thank you. It's good to be here.
PENNER: Thank you. Our call-in number, if you'd also like to be at Editors Roundtable, is 1-888-895-5727, that's 895-KPBS. Well, what started out last year during President Obama's election campaign, of course before he was president, was his idealist pledge to provide universal, affordable, quality healthcare. Well, it's disintegrated into a sad mess of suspicion, misconceptions and outright lies. What's worse is that distortions about the proposals appear to be dooming some of the most needed parts of reform. So, John, bring us up to date. What's in, what's out at this point? And I know that you brought into the studio two huge books that represent the legislation that's being considered.
WARREN: Yes, that's a total of 1017 pages so far, and it's important to have a physical copy of that for people to understand just how little of the total bill is being read in relationship to the discussion that's going on. What we have here is really two worlds colliding. On the one hand, the president with the affordable healthcare idea, and on the other hand, the status quo which does not want change, which fears the cost and the loss of revenues as they have it. And I guess I'd add a third component, 50 million Americans who are without healthcare. What we have right now is a discussion and the opponents have elevated the discussion around a provision of Title II of the existing bill which deals with a public option plan. And the whole idea from the Obama administration standpoint is not to substitute private plans but to give people an option that will
encourage private plans to bring their prices in line from a competitive standpoint. That is being taken as a step by the government toward a national government mandated healthcare plan. And various pieces of the plan are being pulled together into a stew, with the objection to that particular component, to give the idea that this is a government takeover. For instance, there's a provision in the plan that allows for counseling in terms of end of life. It does not require end of life but it says that if people want to look at hospice or some end of life option, then it is something that is chargeable to their plan, much like today's plan where we have people over 65 with a supplemental Medicare component. And so there's opposition to all of this. There's opposition to the idea of suggesting that abortions are allowed when abortions are not listed as a funded item permitted and there are laws against it. And so it appears that around the country we've had this orchestrated effort to bring people together with sound bites and with little tiplets of this is government intrusion, how do we pay for it, to stir that up enough to coincide with the Republican idea that does not want healthcare in the first place. So it's no longer what's best for America, it's what's best for public interest right now.
PENNER: So – So let me turn to JW on this. So why, JW, do you sense that this is bubbling up from the people? I mean, Obama is the president of a democracy. Certainly, he's going to turn to the people and their elected representatives to chew on his goal. His goal is to have affordable, quality healthcare for all. And in having the people chew on this, he now finds that stuff that's coming out is certainly what John was talking about. It's sound bites and material that is very destructive. Why is this happening?
AUGUST: Well, it's a – it's kind of a hang over from the Bush era when they'd have that bumper sticker policy where they make policy on things in slogans that sound good. It got us into a war, and they're using the same sort of system in order to demonize the healthcare program. They're looking at elements that they can tear to pieces, twist a little bit, and slap a slogan on it and then scare the hell out of people. They did it before. It's worked on a number of different issues. I'm not going to go into those but – and it's simply using the same sort of a strategy where you find something to hook their star on and then they just beat them up to – beat them to death with that. And I'm not so sure the – I know the polls are saying the public opposes some of this but the problem is, as in the past, you have a vocal minority who's raising hell. They make enough noise, the media picks it up, they keep feeding the beast, these talk shows, cable and AM radio, they keep driving this thing and even people who may be moderate are starting to hear this information and they're thinking, oh, maybe there's something to this. That is exactly how it worked before.
PHAN: Gloria, one of the problems I think we have, I think JW talked about the media and in terms of special interest groups fanning a furor and so forth. But part of the thing is, too, just as John brought in this huge binder, two binders, of the legislation, that's only so far. It's probably going to grow in the coming weeks and months. It's also because people are not getting direct information. They're not going to the legislation, looking at it, they're not reading factual information. They're getting their news from niche publications or niche radio shows or so forth and they are doing basically hearsay. And I think it works perfectly for a topic like healthcare because it is an intensely emotional subject. When it is about your grandparent, when it is about your child or is about your spouse, you want the world of healthcare, even if it's not the most efficient, even if it's not the most effective, you want to basically feel like your doctor or your hospital is doing every possible thing to save that person or make that person better. And I think that's a very irrational thing to do but it is what it is. And I think we're going to see more of this. As congress members return from recess, they're going to see more bombardment and they're probably going to be a bit more skittish to push for the most controversial parts of the legislation.
PENNER: Right, and I think that's something we really want to look at, what will happen when congress returns from recess. There's been talk among the Democrats that they're just going to go it alone and instead of looking for Republican cooperation on this, they're just going to try to get their own bill. But they, themselves, have a problem reaching consensus, don't they, John?
WARREN: Yes, they do, and it comes into three components basically. First you have your Blue Dog Democrats who are looking for a reason to oppose what the more liberal Democratic wing wants to do in terms of the bill itself. Now we have the more liberal left raising some real concerns with the president as to whether or not he is buckling on the public health option by saying maybe it's not necessary. The mixed messages that came out of the White House this weekend from the Health and Human Services Secretary and from some of the White House spokespersons led many to believe the president was changing his mind. He can't afford to do that because Nancy Pelosi made it very clear yesterday in San Francisco that any bill that comes out of the House must have the public option component. That is the essence of healthcare reform. And so there is the problem. We can't then have a totally Democratic bill when the Democratic party is divided in terms of threes and we have a Republican component which is basically taking the position it's not going to vote for anything that takes money away in terms of the status quo.
PENNER: Okay, so we've been talking about the importance of the people letting their representatives know, and I'd like to ask our listeners what is it that you would like to say to your representative if you were to pick up a telephone and speak to Congressman Filner or Davis or Issa or Bilbray or Hunter. There are five from the San Diego area, or even our Senators, Barbara Boxer or Dianne Feinstein. What is it that you would like to see in a healthcare reform bill? Our number is 1-888-895-5727, 895-KPBS. Jeff in Encinitas has been waiting for awhile to speak with us, even before I asked that question, so let's hear what Jeff has to say. Jeff, you're on with the editors. Welcome.
JEFF (Caller, Encinitas): Oh, thank you. What I would want to say to my representative, and actually everyone involved in the debate, is that there needs to be clarity between what needs to be reformed. American healthcare ranks 37th in the world and yet we have the most advanced hospitals, a tremendously successful pharma industry and very well trained doctors. But our problem is, is private for-profit health insurance. They add no value to healthcare in any form. What they do is they take people's healthcare dollars and then they deny them services. And along with that and the fact that they exclude 46 million people from any kind of healthcare access, that's the problem. And we do need a public option because that's the only way that these for-profit companies—and their profit, by the way, comes in part by unplugging grandma, and they've been the source of all the lies that have been thrown out in the public forum and that has obfuscated what the real truth of the problem is.
PENNER: Well, I thank you very much for your comment, and Hieu would like to respond to that. Hieu.
PHAN: Jeff, just following up on your comments, I wanted to say that Keith Darce, our medical and healthcare reporter at the Union-Tribune just wrote a story looking at why it is so expensive in the U.S. to have healthcare. We are the most expensive in the world and we don't have better results compared to many other countries, from Japan to Britain to France. And one of – I mean, you know, there's so many problems but one of the main reasons is we talked about the profit margins, people wanting to retain their revenue, but it's also the fact that technology is a hindrance. While you may think that that latest CT scanner, you may think that latest surgical method, is good, sometimes they're unproven, sometimes they have incremental benefit compared to older drugs or older therapies but they cost ten times, a hundred times, two hundred times more. So our innovation can also be something that hobbles our industry, and I think also there's defensive medicine. Litigation is a fact of life in the U.S. healthcare system and to safeguard themselves against this type of – these lawsuits, doctors have increasingly practiced defensive medicine where they give you as many procedures as possible to protect against the idea that they may not be treating you well. I want to just touch on one other point and go back to a foundational issue. The only reason, I think, the primary reason we're discussing healthcare here is this is not an economically sustainable method – model that we have in the United States.
PENNER: The one we now have.
PHAN: Yes. We are surpassing inflation every year. We have – I think last year it was $2.4 trillion dollars and that's 17% of the gross national product.
PENNER: That's huge.
PHAN: There's no way we're going to be able to continue that. Medicare's trustees said this year that we will run out of money for Medicare by 2017, that is in, basically, eight years, and that's two years shorter than their previous estimate. So we cannot keep going this way. I think we look – we talked about the number of people who are uninsured, we talked about the – there was a Harvard study out this year that followed up on other studies showing that more than two-thirds of Americans who filed bankruptcy have some kind of medical debt or some kind of medical financial challenge. And so the statistics are clear that we need to have some kind of change.
PENNER: John, is there any measure being considered that gets at the root of the problem? That costs have spiraled out of control and need to be drastically reined in and the whole system is not an economic model that can work?
WARREN: Well, the change is found that within, first of all, this particular bill, there are ideas there. I mean, even the Medicare Advisory group is being moved from the people who had control over it in terms of congress. Change will come with it. But let's remember that we have three committees in the Senate that have to report out a bill as well, Senate Finance, and when we – Hieu talks about the costs that we have added to this thing, we have to look at how it's been structured over the years. One of the ideas on the table is a cooperative plan, which we know they don't necessarily work. HMOs don't necessarily work. So we can't take the money part without the whole plan that we're looking at.
PENNER: Okay, well, at that point, we are going to take our break. We'll be back in just a moment. But I do want to say that we're going to take your phone calls right after the break and we're going to continue talking about the healthcare plan that's being discussed all over America. People are very engaged in this and something is going to happen. We're not quite sure what, but we'd like to get your feedback. This is the Editors Roundtable. I'm Gloria Penner.
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PENNER: This is the Editors Roundtable. I'm Gloria Penner. I'm at the roundtable today with Hieu Tran Phan from the San Diego Union-Tribune, John Warren from San Diego Voice & Viewpoint, and from KGTV 10News we have JW August. And we have you and your calls. And we are going to go to your calls but there's some – one point that I really want us to kind of clarify before we continue. What is stoking the fires and the fears that Obama wants the government to take over healthcare and perhaps even decide when very sick, very maimed old people should die. JW August.
AUGUST: Well, as I was saying earlier, it's that bumper sticker policy that they've adopted and the one thing that really seems to be having people fire off are these death panels, so-called death panels, that the government would decide who live or die when, in fact, that's not what it's about. They have nothing to do with euthanasia. And I was checking around. We – Actually what's being proposed at the federal level, we already have at the state level. We have – And what this end of life counseling is, is going to a family and tell them about living trusts, about what options a family has, nothing to do with euthanasia but it's been twisted that they're going to pull the plug on grandma. And I think that's pretty typical. I called the San Diego Hospice today and talked to Dr. Herbst, who runs the hospice and she told me the – that the program's been – this law has been on the books for about three years in California. It requires doctors to tell people, dealing with end of life situations, what their options are. There's nothing threatening there. The only thing, it's culturally people get uncomfortable talking about death.
PENNER: Yes, people don't like that.
AUGUST: And I asked her, well, has the hospice formed death panels and, of course, she kind of laughed. And, of course, they haven't. This is not about death panels, this is about demonizing the bill by taking an element that you can grind into the ground and get people to put bumper stickers on the cars and they just twist it.
PENNER: And it certainly has, so let's get a comment now. Our callers are waiting to speak with us and we'll start with Greg in Del Mar. Hi, Greg, you're on with the editors.
GREG (Caller, Del Mar): Hi. My comment is basically just responding to your question about…
PENNER: What would you tell your…
GREG: What would…
PENNER: Yeah. Go ahead.
GREG: And basically I'm the laissez faire type. I don't support any of the current plan and, in fact, I don't even support Medicare. I would actually say that reform should come in the form of allowing a market to operate, which is not what is happening today. And that, just like in any other market and free market, that costs would come down because people would want to pay less. And that having the government come in and mandate by the – in the form of a public policy, a public insurance plan, that you won't actually get that.
GREG: Fiat is not a means of bringing down cost.
PENNER: All right, well, that's certainly a, you know, more of a libertarian point of view, wouldn't you say that, Greg?
GREG: Exactly, but I have no affiliation to the Republicans or with any healthcare company. I'm just an individual and that's the way I feel, so that's what I'd be saying to my representative.
PENNER: Okay, thank you, Greg. I'm going to hang onto Greg's remark and hear what Don in north county has to say and then I want to get responses from all the editors on this. Don, please join us at the roundtable.
DON (Caller, North County): Yes, good morning.
PENNER: Good morning.
DON: Yeah, I'm, first of all, very disappointed that the little guy doesn't get their voice heard out there with the public because I'm a small business person and I talk to a lot of my customers and I think most people are very upset with current health status of our insurance companies and the increase in profits. I mean, our – I have a small business, as I said, and our costs have tripled in the last five years, plus we have high deductible and we're still talking about thousands of extra dollars because we never meet our deductible. But the biggest thing, I think, is that why are we, in America, as great as we're supposed to be, why are we allowing people—mainly companies—to make a profit on people's illness? I've been a social worker, I've worked with the elderly, and it's really disappointing that in America we have to make money on every aspect of our life. At some point, we need to change, we need to learn from maybe France, World Health Organization, they're number one, they're half the cost of what we do here in the United States. You know, how does the little guy get out except for doing something like this? I mean, we contact our Senators, we write letters, we write e-mail, but our voice is not being heard and we need help.
PENNER: Okay. Well, your voice was just heard now and, believe me, Don, a lot of people listen to this show, including many of our legislators, our community and business leaders, so thank you for that. I'm going to take one final comment from our editors on all of this. We might respond to what Greg had to say. Hieu, you might want to respond to that. Let the free market determine this.
PHAN: You know, as a journalist, I'm supposed to remain neutral and I think that…
PENNER: Not as an editor, though.
PHAN: It is easy to take potshots at pharmaceutical companies and insurance firms and so forth. What I will say is there is definitely a lack of competition. There have been numerous studies out this year showing that in the vast majority of states there is only one major insurance company or, at most, two. And that is not really competition, and rates have risen steadily for the past 15 years and will continue to do so unless, I think, we bring about some type of structural reform.
PENNER: John, is Don being too idealistic when he says, you know, we should not be making a profit on medical problems?
WARREN: Yes, I believe that he is but I think he misses something, as many people do. If we're going to worry about our voices not being heard, we have 12 million people in California alone that don't have healthcare and America has always functioned with this capitalistic idea that profit is good, and make as much as you can. Now we have a situation where we're in a recession, we don't have profit, we have people who are suffering. Pharmaceutical people are running the country. Doctors are charging what they want to in some instances. In other instances, the insurance companies are controlling the doctors, they give them sample medicines, the doctors give medicines to people and it's a chain where the consumer's being used to feed the system. I think the first caller needs to remember that there's a difference between a mandate and an option. What we have is an option in terms of a plan. What we have is a president who says we're going to have a plan that does not limit coverage or restrict them because of prior existing conditions. What we have is a plan that says we're going to allow portability so that your plans can move with you, we're going to allow for some creativity in terms of how it's done. We have some relief for the small businessman. We have changes in the internal revenue code that will go to make those pay who can. And we can't pick this like a smorgasbord of a banquet. We have to take the package, and that's the problem. The little guy can read. Hopefully, he will or someone will help him. But for now, the money interests are dominating the airwaves.
PENNER: John, just one fast question. The word co-op is now on the table along with public option. How might a health co-op achieve—just if you can do it quickly—the president's goal of universal, affordable, quality healthcare?
WARREN: Well, the co-op can't. They have a example in New York City where several businesses got together with a doctor and he decided how he would treat the people within that business. That's a co-op. They put so much in. But then when the needs extend beyond that particular doctor or that particular group, we don’t have a structure like the HMOs that have a capacity to offer all services on a broader scale. So the co-op is not the answer from a healthcare reform standpoint. I believe we need to have a public option because of the financial imbalance that we have for regular people.
PENNER: So, JW, we're going to let you have the final word. We mentioned that the congress returns to Washington very soon from their home districts. They've been dealing with the healthcare town halls and all this stuff that's going on. How do you expect those experiences will impact what they do with healthcare when they return?
AUGUST: I think it's going to divide along ideological lines. The Democrats will come back and even though with the Blue Dogs and in the – with one position and the Republicans with another, and we're not going to see any cooperation at all. They're just going to have to bull through a…
PENNER: But are we going to – are we going to see a healthcare plan?
AUGUST: Yes, I think so. The Democrats have got to push it through but they've got to do it.
AUGUST: You know, Lyndon Johnson said half a loaf is better than none.
PENNER: Lyndon Johnson was the one who got Medicare onboard.
PENNER: Yeah. And it's interesting, isn't it, that the polls I've seen, that people on Medicare—people on Medicare—say they don't want a government option but they're on the government option.
WARREN: Yeah, they have no idea.
PHAN: Between the Medicare recipients and our VA and military recipients as well, I think there seems to be a two-headed beast here where they appreciate the care they're getting and they don't want any changes or any loss of entitle – of benefits to it but at the other – on the other hand, this prospect of a public health option scares them.
WARREN: The military has been promised that there will be no change in that system.
PENNER: The military has been promised.
PENNER: All right. Let us move on.