Friday, November 6, 2009
The House and Senate Democrats have released health care reform bills recently. Although, the bills are very similar, finding agreement on a few of the key differences could take awhile. What are the key elements of the House and Senate bills? And, what are the main areas of disagreement between the plans?
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 some opinions on the momentum building in some sectors for the House healthcare bill, SDG&E’s proposal to raise electricity rates on people who use the least energy and lower rates for those who use the most, and shrinking paychecks for Californians as the state withholds more of your tax obligation. The editors with me today are John Warren, editor and publisher of San Diego Voice & Viewpoint. It’s good to see you again, John.
JOHN WARREN (Editor/Publisher, San Diego Voice & Viewpoint): Thank you, Gloria.
PENNER: Alan Ray, senior editor for KPBS News. Glad you could come back to us, Alan.
ALAN RAY (Senior Editor, KPBS News): Oh, happy to be here.
PENNER: And Tom York, contributing editor for San Diego Business Journal. Tom, I have to tell you that I have a mis – a typo on my intro here. I said ‘contribution’ editor for San Diego – You are not that. You’re a contributing editor, right?
TOM YORK (Contributing Editor, San Diego Business Journal): Well, it’s always good to be here.
PENNER: Yeah. Our number is 1-888-895-5727, 895-KPBS. Well, by the end of this week, it’s possible that we’ll see the House of Representatives approve the Affordable Healthcare for America Act and the Medicare Physician Payment Reform Act. I mean, that’s a lot of words, otherwise known as the House Democrats’ Healthcare Bill. 218 votes are needed or one more than half of the members of the House. Debate and vote is scheduled for Saturday. So, John, this would be a substantial move ahead for healthcare overhaul legislation. So let’s understand what’s good and what’s not so good about that bill. What would it do to improve healthcare?
WARREN: Well, number one, this bill would cover about 96% of the legal people in America that are under the age 65 in terms of providing healthcare, and that’s a major move in and of itself. It does leave out approximately 18 million illegal immigrants who are in the country and not covered in terms of the bill. It’s projected the cost’s approximately $894 billion, according to the figures that are coming out of the House even though we’ve seen figures as high as $1 trillion but when we look at the changes or the savings that are supposed to come through Medicare and other adjustments, that figure of $1.55 trillion drops back down to the $894, which is beneath the $900 billion figure that the president wanted for Medicare.
PENNER: You know, let me…
WARREN: So it’s a major move.
PENNER: Let me just interrupt you on this part. When you start talking numbers, I like to turn to Tom York with his credentials as an editor for the Business Journal. I mean, what’s the difference, really, between a bill that costs $900 billion and one that costs a trillion?
PENNER: I mean, what’s a billion here or there or ten billion here or there?
YORK: Well, the only thing I can think of is the former Senator from Illinois, Everett Dirksen, who once said, you know, a billion here, a billion here, a billion there, and pretty soon you’re talking real money, or something like that. I don’t think it really makes that much difference but I think in terms of, you know, contributing to the deficit and adding to the, you know, adding to that, it’s substantial.
PENNER: It is.
PENNER: So in other words, it could doom the bill if it’s too expensive?
YORK: Well, you know, we have unemployment nationally at 10%, we have a lot of people not working, not contributing taxes, not paying, you know, into the federal government, so I think the big question is how are we going to pay for this bill? How are we going to pay for national healthcare at a time when the economy is really kind of on the ropes.
PENNER: And notice, Alan, he’s calling it national healthcare, which I think is interesting because isn’t that one of the main objections of the Republicans? That it would be some kind of a government takeover?
ALAN RAY: Yeah, and, you know, it’s a bummer, that happened with fire departments and nobody complained. It happened with freeways in the fifties with President Eisenhower and nobody complained about those, about the nationalization of transportation. At some point along the way I think what needs to be done here is that we need to look at the weight of the public – the greater public good as opposed to the greater public hazard if we don’t do this. If we’re looking at an unemployment rate of 10% or 11%, a lot of those people have lost their heath insurance. They’re going to fall into the public health system, so the money’s going to come from the public one way or the other.
PENNER: Yeah, it’s interesting that of the jobs that were lost, this time around they were in retail and construction and in manufacturing but in healthcare, actually there was a boost in jobs.
RAY: Well, yes, in healthcare but I’d be curious to know whether or not that was doctors and nurses and physicians assistants or was that people doing processing and work for insurance companies?
PENNER: Yeah, that’s true. That may be part of it. Tom.
YORK: One thing I always point out in this debate is that we already have a national healthcare system and that is that, you know, if you’re sick you can show up at a county hospital or you can show up at an emergency room and you will be taken care of. And that…
YORK: Eventually. That cost will have to be borne either by the hospitals or by the government. It’s just a very inefficient way of doing it, so maybe having a healthcare bill, as we’re discussing here, in Washington might be a better way of financing this way of treating people.
RAY: We seem to have lost the sense and the terminology to describe these bills has changed over the last few months, over the last year. At one point we were talking about health insurance reform.
RAY: And we seem to have lost that part of the debate but I think the last I read, like thirty cents of every healthcare dollar is spent on insurance company processing.
YORK: Could be. Could be. I’m not familiar with the numbers but, you know, that’s the one issue with Medicare is that – and other government programs is just the cost of processing all the in – the paper.
PENNER: Let me give out our number because I’m sure our listeners are interested in what’s going on here. And I have a question for you, and that is that with what’s on the table now and what you know about it, would you like to see the Democrats’ healthcare bill passed tomorrow? Because if it is, that’s going to make a significant difference in the energy behind moving this one along. Our number is 1-888-895-5727, 895-KPBS. John, you wanted to respond.
WARREN: Yes, I think the very significant thing is it was pointed out that we started out talking about insurance before but the discussion has gone beyond insurance companies at this point. It’s gone beyond even the issue of public options, to a public option being one component that would be addressed but the whole idea is how this is going to – who’s going to benefit in terms of payment. And the significant differences between this bill and the Republican bill that’s been put on the floor is that under the Republican bill, the number of people assisted will leave us with a higher number of uninsured people by 2019 than we currently have because people at the lower end of the totem pole would not be able to qualify or benefit. Here, employers are exempt who have under $500,000 in terms of employees. The individuals can afford to buy into the plan at 2.5% of pay penalties and the individual tax, which the president talked about, is raised from $280,000 to $500,000 in terms of people being in the upper income bracket and $350,000 for couples. So there are multiple adjustments in the funding that makes this far more attractive and takes it beyond just the issue.
PENNER: However, if you are – if you do own a business and the annual payrolls are over $500,000 and if you don’t take out health insurance for your employees, you will be penalized.
WARREN: Yes. And the penalties have been factored in as a part of the financing of the program itself, which I think is very significant.
PENNER: All right, well, let’s go to the phones, I think. Yeah. Nope. Yeah, they’re ready. Let’s start with Len in Scripps Ranch. Len, you’re on with the editors.
LEN (Caller, Scripps Ranch): Thank you very much for having me on.
LEN: A couple of comments.
LEN: One is I’m not in favor of the health plan because I have, through my whole life, taken care of my own health issues. I understand there are people who aren’t covered. But my bigger issue is something with the AARP. They’ve been alleged to be supporting the plan and being representative of 40 million elderly or older Americans.
PENNER: This is true.
LEN: And, in reality, I’ve been a member for ten years and they’ve never ever asked me my opinion. They’ve never taken a survey, never asked for anyone’s opinion on any issues that they’ve ever brought forth with their – when they’ve had a position.
PENNER: That’s very interesting. John, do you know how AARP makes its decision? Don’t they simply have a board and the board makes the decision? They don’t really poll the members, do they?
WARREN: Well, I think there’s some polls might be conducted. I’ve been a member of AARP for the past 14 years and I’ve never been polled or asked either but I think that many of us, as American citizens, are not polled or asked and yet we see surveys every day in terms of what the majority of us think based on a formula that’s used. So I’m – I believe that AARP, within its governing structure, does have a means by which it conducts sample pollings and that perhaps we have not had the fortune of being included at this point statistically.
PENNER: You know, interesting, it’s not just AARP that has come forth to support the House Democrats’ bill, it’s also the American Cancer Society and also the – let me see, one other…
RAY: The AMA.
PENNER: Oh, the AMA…
PENNER: …American Medical Association. So there must be something in that legislation that appeals to this rather widespread group. And I’m wondering if it could be that it does say that when you have health insurance, there would be some new rules on insurance companies. Ban – There would be a ban on denying coverage based on preexisting conditions, and it would also end federal antitrust exemption for the insurance agency. I would think maybe, Tom, that these would appeal to groups like that.
YORK: Well, I was just thinking about the AMA, the doctors. You know, the way it’s set up now with private insurance, they go out and contract with doctors and small clinics and as – the way the trend’s been going in recent years is that the doctors are actually being paid less than what it costs to treat a patient. They’re just getting squeezed by the insurance companies, so maybe this is the way that they feel they can get out from under that and start getting compensated for their services at a fair rate.
PENNER: But aren’t they also being squeezed by Medicare payments?
YORK: They are being squeezed by Medicare payments, too.
PENNER: And that’s government.
YORK: That is government. But the insurance companies have become especially pernicious in last – in recent years just trying to get the most for their money, I guess, and trying to make the doctors pay for it. And – or I should say the healthcare providers.
PENNER: Well, Jim in La Jolla wants to say something about insurance companies. Jim, you’re on with the editors. Hi, Jim. Oop, Jim decided he didn’t want it. Okay, so we’ll take Mark in Escondido. We have phone calls galore. Go ahead, Mark. You’re on with the editors.
MARK (Caller, Escondido): Yeah, hi. I’m a physician. I’ve delivered healthcare for 30 years in California, and there are a few issues. The public option is necessary. Medicare is one of the most efficient delivery systems in the United States with a less than 6% cost of delivery as opposed to 30% with the insurance companies. The 30% that the insurance companies cost is their profit. Schaeffer, who’s the head of Blue Cross, when he made a public option as a deal with the State of California, who’s the director, got $437 million in profit to his pocket, which benefited nobody but him. The profits that the insurance companies make is egregious. Not only that, when they say the cost in healthcare’s gone up, the semantics are wrong. It’s the cost of health insurance that’s gone up. My rates as a physician have been fixed from ’96 and it’s a constant game of billing $50.00 and getting $20.00 or $30.00 or $40.00. That is not fair. When you bill Medicare, you know what you get paid even though we are getting squeezed. I’ve seen many patients who can’t get care or are scared to because the insurance refuses payment after the care is delivered.
PENNER: Okay, well, that’s – those are all interesting comments. John.
WARREN: And I think one of the benefits that we see under this package with the restrictions on the insurance is that for the first time the Federal Trade Commission will be given authority to go and look into the operations of the insurance companies, and I think that that will go a long ways to correct some of the items that Mark just pointed out because they will then have authority with teeth.
PENNER: I notice that in the Republican bill, John, it would make it easier for insurance companies to sell policies across state lines. Apparently this would drive up competition.
WARREN: Well, yes and no because if you’re going to sell policies across state lines but you don’t, for instance, have the Democratic antitrust and Federal Trade restrictions then you’re still going to move the same problem from one state to another, and so, yeah, they’re happy based on that. But let’s remember, Republicans didn’t have a choice. They’ve been identified as the ‘party of no’ on everything related to this, and the ideas that they’re pulling out under this new bill are the same kind of ideas that they had when they controlled both the congress and the White House but they were afraid to put them out there because the American people wouldn’t go for it. So now they’re running a risk in terms of political capital with what they’re putting on the table. And you look at their numbers and we still come out worse off but they reach big business as opposed to the small people.
PENNER: Okay, John, we’re going to get a response from our other guests on this when we come back from a short break, and from our listeners as well. Our number is 1-888-895-5727. This is the Editors Roundtable. I’m Gloria Penner.
PENNER: I’m Gloria Penner. This is the Editors Roundtable. And we are talking about the healthcare bill. The Democrats’ version is going to go into debate tomorrow and possibly to a vote, and they will have their version anyway on the table for discussion by the Senate and we’ll see where it goes from there. So we’re talking about that. And at the table with me today I have Alan Ray from KPBS News, John Warren from San Diego Voice & Viewpoint, and from the San Diego Business Journal, Tom York. And just before the break, Alan wanted to respond to something that John had said.
RAY: Well, the question is this Republican proposal to be able to sell insurance policies across state lines. The concern is that what that effectively does is completely deregulate insurance because insurance companies, under this law, would then go to the least regulated state since the states are the ones who regulate insurance companies and you could then have no recourse at all.
PENNER: So this would just open the door for more activity by the insurance company, right?
RAY: It does look to be a stealth provision to me.
PENNER: Okay, thank you, Alan. Let’s go to Christina in La Jolla and see what Christina has to say to the editors. Hi, Christina, you’re on with the editors.
CHRISTINA (Caller, La Jolla): Thank you so much. I just wanted to say that health insurance has a different delivery system than any other type of insurance we purchase. So if I have an accident with my car, I make a claim on my homeowner’s, I can take that money to any vendor that I feel like charges a fair price and I can get some service done. But with healthcare, you go and get the care at whatever cost it is and then your health insurance pays the full amount or refuses it, so there’s no market incentives. And this is a relatively new system that only started under Nixon’s administration. We can fix it. We can put it back. We can start seeing community doctors and family midwives and, you know, really put the care back in the doctors’ hands and in the patients’ choice.
PENNER: And what do you think is going to make that happen?
CHRISTINA: Well, I think that if people were able to claim insurance on an annual basis or deduct their medical costs by being able to go to a doctor based on choice through the tax system or even through a public option where you can, say, have a certain amount of healthcare expense per month but still go to the doctor that you choose under that same amount of cost.
PENNER: Okay, thank you, Christina. And, John, don’t the Republicans have kind of a tax credit for this kind of thing? Aren’t they pushing tax credits?
WARREN: Well, they push credits but there’s a bigger issue with what Christina’s saying because what – people do have choices right now. If you have a PPO, you can go to the doctor or the healthcare provider of your choice as opposed to an HMO, which locks you in. The missing part for Christina’s plan is that no one knows what the services are actually costing. And when you take this new plan and you put in the Federal Trade Commission and break up anti – the antitrust elements and the bid fixing, now you can allow a price to be posted and associate it with medical treatment, which you don’t have now, that would add to the strength of the PPO in addressing what she’s talking about because right now if you go to the doctor, you just get an explanation of benefits from the insurance company as they determine what they might pay and the two argue.
PENNER: John – uh, Tom.
YORK: Well, I was going to say that this is, you know, practice in the industry is that the insurance companies have negotiated rates with doctors and other providers but what that rate is or what that repayment is isn’t – no one knows. And so I think, you know, getting this out, getting this exposed might help to bring down costs.
PENNER: So you’re really talking about more transparency.
YORK: Transparency, that was the word I was looking for.
PENNER: Do you see transparency in any part of the Democrats’ bill?
YORK: Well, I think that, you know, if we have a national healthcare plan, as we mentioned earlier, I think we’ll start to see some transparency because we’ll know what the costs are unless the government chooses to put it under a veil.
PENNER: Tom, I notice in the GOP bill that there’s no requirement that individuals buy insurance. So there is a certain amount of freedom of choice. If you don’t want to buy insurance, you don’t have to.
YORK: Well, that’s the, you know, the Republicans’ way of adhering to the free enterprise system. But I think that in the debate over healthcare, I think it goes beyond business issues or free enterprise issues and it goes to a fundamental rights that individuals have in society.
PENNER: All right, let’s take a call now from Del in Oceanside. Del, you’re on with the editors.
DEL (Caller, Oceanside): Hello. I just wanted to answer the comment that someone made that they did not receive a questionnaire from AARP. I did receive quite a lengthy questionnaire from AARP.
PENNER: Okay. Good. So apparently they do send out material. Alan.
RAY: Well, they don’t send out material to 40 million members.
RAY: That would cost a – postage would be prohibitive at that point.
PENNER: It would.
RAY: But what they do is they take a selective sample, everybody does.
WARREN: Like I said, yeah.
RAY: It’s a statistical sampling like, you know, survey companies do, and then they project that. There are good formulas that tell them how the responses will generate across much larger cohorts and that’s how they do it.
PENNER: Thank you, Del, and – Yes, Tom.
YORK: I would just say that, you know, as far as sampling goes, you can do a sampling of a thousand or 1500 people and that will give you pretty much an indication of where people are nationwide with large numbers.
PENNER: And that’s what surveys and polls do.
YORK: Right. Right.
PENNER: Yeah, statistically they just – in fact, even the census to a certain extent has been accused of that…
PENNER: …of doing a statistical analysis of who is really in the United States.
PENNER: Kyle in Oceanside is with us now. Kyle, you’re on with the editors.
KYLE (Caller, Oceanside): Hello. I’m 23 and I don’t have health insurance like a lot of people my age. I just wanted to comment on another demographic dimension of this debate and that’s, you know, we all know that people who are 65 and up have, you know, government healthcare and they’re, you know, a lot of them are angry about Obama’s plan yet we’re cutting kids’ health insurance here in California. I think that this – that the healthcare plan in the House and the Senate are good steps. You know, and we talk about the debt and tax cuts, you know, at a deficit and unending war spending but this healthcare plan cuts deficit. And basically my point is that overall I think that this country needs to have more of a focus on what we’re doing that affects our children and our youth’s future, you know, how this health insurance plan is going to, you know, help people like, you know, my age and younger, you know, be able to have, you know, a healthy life and be able to have health insurance.
PENNER: So which of the plans that you’re familiar with, Kyle, do you think does that?
KYLE: Well, all I’ve heard about the Republican plan is that it doesn’t, you know, the one that was just released, that it doesn’t actually increase coverage for anybody. And I’m also talking about the larger picture here in California where the Republicans are refusing to increase taxes, therefore we cut children’s health insurance plans and also the Republicans being against SCHIP in the congress before. So, overall, I think, you know, it’s moving towards a policy that’s, you know, caring more about, you know, our youth and our children as well as everybody else in America.
PENNER: I do want to say one thing, Kyle, that the Republicans’ plan makes it easier for young adults to stay on their parents’ health policies. So, some, you know, some young adults who are still kind of dependent on their parents can hang onto those health policies for awhile.
KYLE: And that’s great but the problem is, is that, you know, we should be able to get out on our own and be able to share the risk amongst each other and, you know, not all of us have our parents to – I mean, I think that’s great but not all of us have our parents to be able to lean on, and I think that being able to have us all be able to have a choice of a public option or other choices to be able to get ourselves insured when we want to be but also being able to, you know, maybe have an individual mandate that will be able to bring a risk pool that’s larger to increase, you know, the risk share for everybody, therefore driving down cost is a good idea as well.
PENNER: Okay, thank you, Kyle. Thank you very much for engaging with us in this discussion. And there are so many others who would like to as well but our time has run out. So I suggest that you go to KPBS.org Editors Roundtable page and post your comments. We’d really like to know what it is that you’re thinking about it but we must move on. And while we’re moving on, any guesses, John and Tom and Alan, about how that debate is going to go tomorrow, whether we’re really going to see a bill voted out of the House? What do you think, John?
WARREN: Oh, I believe we will. The 218 votes that they’re talking about represents what’s necessary under the rules of the House to have a discharge petition. Now the effort is in picking up the other 40 Democratic votes that are holding out because of the abortion debate. And I believe that we will see a vote. The desire was not to see a vote that was just Democratic. We will see a reconciliation between the House bill and the bill in the Senate because they’re working out the differences even as they go, which is unusual procedure, and the conference should come soon. So we will – we could possibly have this bill before the end of the year as the president wanted.
RAY: Well, the last thing I heard was that it’s possible we might not get a vote until next week on this. There apparent – I don’t know if it’s connected with what happened at Ft. Hood but I know there have been some delays.
RAY: They’re trying to get some more people onboard. I had heard that the vote might not come until Sunday, might not even come until next week.
PENNER: Okay, thank you. So a delay until next week, potentially. Tom York, do you think when it comes to a vote it’s going to be voted out of the House?
YORK: I do.
PENNER: You do.
YORK: …it’s just a question of what shape and form it takes.
PENNER: Okay, thank you very much. Somebody asked me whether I’d read it, I said how long is it now? It’s two thousand page…
WARREN: Nineteen hundred pages.
PENNER: Two thousand, yeah, well, I exaggerate. Nineteen hundred pages. Let’s move on.