Health Care Debate Reaches A Climax
Friday, March 19, 2010
Demonstrators took to the streets of San Diego this week as congress focuses on health care reform. A UCLA study reports one in four Californians under the age of 65 were uninsured in 2009 as a result of the recession and the erosion of employer-based coverage. We discuss the latest in the intense debate over health care legislation.
GLORIA PENNER (Host): I’m Gloria Penner. I’m joined by the editors at the roundtable These Days in San Diego. Today, we’ll get reaction in San Diego to the health care overhaul legislation struggling through Congress, local response to the killing of Americans in Mexico, and the City of San Diego’s new deficit and new borrowing deal. The editors with me today are Kent Davy, editor of the North County Times. Good to see you again, Kent.
KENT DAVY (Editor, North County Times): Thank you for having me.
PENNER: Of course. And Vicente Calderon, editor of Tijuanapress.com. So glad you could join us, Vicente.
VICENTE CALDERON (Editor, Tijuanapress.com): Thank you very much again for the invitation.
PENNER: And Tom York, contributing editor with San Diego Business Journal. Oh, Tom, I’m so glad you’re back with us.
TOM YORK (Contributing Editor, San Diego Business Journal): Well, I’m happy to be back here, and thanks for inviting me.
PENNER: Of course. Our call-in number is 1-888-895-5727, 895-KPBS. The national debate over a health care reform bill spilled into San Diego streets this week. On Tuesday, members of the Southern California Tax Revolt Coalition demonstrated outside the district offices of Congress members Susan Davis and Bob Filner. About a hundred members of a Tea Party group rallied in Vista and at the San Diego Civic Center, pro-health care overhaul speakers praised reform efforts. This comes on the heels of a new report out by UCLA that the number of uninsured in California has reached 8.2 million people. When you figure that we have about 30 million people in this state, that’s 8 million out of the 30 who are uninsured. And whether the legislation will pass or fail is really unclear right now. So, Kent, why are people so polarized on this issue?
DAVY: One, it’s – first of all, it is politicized as much as almost any topic has been politicized in a long, long time in this country. The – And that process has split the American public opinion fairly roughly in half. Most of the polling shows there are slightly more people who think that this is a bad idea than think it’s a good idea in total. I think that is driven in part by the fact that it is – it represents meddling with or improving, depending on your point of view, about a sixth of the American economy, so there’s a great deal at stake here, and to the extent that there is not any bipartisan support moving forward. And this will be passed entirely on Democratic votes. It has this huge partisan divide on it. Given that the president’s favorability ratings have slipped below – his negatives have now slipped – are above his favorable ratings, Congress’s are at historic lows, there is a huge amount of distrust and anger out in the world. And I think that’s what adds to this mixture and that’s what sparks all this passion, is principally distrust.
PENNER: I’m glad you used the word passion because I wanted to check in with our listeners and see how passionate they feel about health care reform, sort of check the pulse of what’s going on in San Diego. Do you feel that this package should pass or do we need to delay it for 10, 20, 30 years, start from scratch? Our number is 1-888-895-5727, 895-KPBS. Tom, let’s stick with the numbers for a moment. The California numbers of medically uninsured are rising rapidly. Now it’s 25% of those under 65 years old, that’s one in four and that’s gone up considerably from two years ago. What options are being discussed now to insure the uninsured?
YORK: Well, I don’t think there’s any options on the table for insuring the uninsured. I think that it’s part of the ongoing crisis, the economic crisis that’s now entering its second year. And it’s of concern, I think to society because there’s so many people who don’t have coverage and what do they do? There is a health care system in place. You know, we have county hospitals and hospitals that care for the poor but at this point, you know, with 25% of the population without any kind of coverage and going to these facilities, they’re being overwhelmed. And then you have the crisis in Sacramento with the budget crisis, again this year they’re facing a $20-plus billion deficit. How will the state fund these public hospital delivery systems? And I think it’s coming to a, I hate to say the word, head, but I think it is. And I think the national health care debate plays into that in the sense that perhaps it will deliver some sort of coverage down the road but right now I’m not even sure where we are with it. It’s hard to follow the machinations of what’s going on in the state…
YORK: …in the national capital.
PENNER: Apparently the entire bill is on some website and is able to be read by all members of Congress before the vote on Sunday, which should be the last debate.
PENNER: I haven’t seen it. Has anybody taken a look at it yet on the web?
DAVY: It was just posted late yesterday, I believe, after the – The Democrats announced that they had preliminary results from the CBO grading it of in terms of the cost structure although, interesting, the CBO did not release its analysis yet.
PENNER: Tell us what those initials stand for.
DAVY: Well, CBO is the Congressional Budget Office. They are charged with trying to project a – the fiscal impact of a piece of legislation. And the numbers that the Democrats were trumpeting yesterday indicated that it would come in at $940 billion for ten years with a deficit reduction of $134 billion over the same period. The difficulty with those numbers and I think it’s really important to understand that this is – depending on which side you want to be on, you spin the numbers to fit your case, is that it is not exactly a apples and apples comparison. For instance, CBO was instructed by the legislature or the House to grade first year as 2010. Well, the reforms aren’t in effect then. If you take and take the first full ten years of the expense, instead of a $940 billion package, it’s probably more like $2 trillion. So there’s funny numbers all over the place with this.
PENNER: Okay, well, you know, numbers are hard to interpret but there’s another aspect of this, Vicente, that I would like to talk to you about. Even some people who are for a health care reform package are disappointed because there’s no public option in the bill, public option meaning an opportunity for the government to offer some kind of insurance, similar to Medicare, for example. Is it possible that we’re going to see things held up until some kind of government program that would offer insurance can come forth?
CALDERON: I think even as we speak they are twisting arms and making offers within…
CALDERON: …the corridors of the capitol. And some of that will be included there, I guess. I’m fairly confident that the Democrats are going to be able to get the 260, I think, that are going to be needed for Sunday.
CALDERON: 216, excuse me. And that’s where they’re going to include some of those promises because, I mean, they are selling this as either we do this or we do nothing, and we have a lot of people that is due to the economic crisis falling on the worst – in a worse scenario of health coverage.
PENNER: Okay, we’re going to go to the phones now. Every single one of our lines is up. If you get a busy signal, you can do one of two things; you can either call back in another minute or two or you can go online, go to KPBS.org/editors and register your comment there and we sure will read them. So will a lot of other people. Let’s start with Amy in Rolando. Amy, you’re on with the editors. Welcome.
AMY (Caller, Rolando): Yes, hello.
PENNER: Yes, go ahead, please.
AMY: I’m calling because I heard Gloria, you say, Gloria, that you wondered how much passion was out there for this health care bill, and I have enormous passion for this health care bill. I’m for it as a matter of social justice. I believe that people are suffering right now because we don’t have adequate health care coverage. We have needed health reform for a long time. We’re behind all the other industrialized nations in the world. I think it’s going to make our country a better place to live for everyone.
PENNER: Well, thank you so much, Amy, and, Kent, let me ask you about this. I guess we should look at what are the major objections? What Amy has to say makes sense. You know, there are people who are suffering. This would help people who are suffering. So what are the major objections?
DAVY: Let me go two different directions on trying to answer that. The first is, it is not the case that people don’t get health care in America, as the discussion alluded to earlier; it is how it’s delivered in general. Now there are certainly individuals who will lose out things but to the extent that America gives health care through its emergency rooms to a big slice of its population, that is still delivery of health care. It’s how you pay for it and what are the arrangements? The second thing is the comparisons to other countries is somewhat, I think, problematic because much of what happens to American health care is the way we live to the extent that we smoke, that we are overweight, that we do not exercise, although those things have a lot to do with the way our society is but also has outcomes in our health care. Then, finally, the other objection that comes across, I think, fairly clear if you look at some of the economists is that in moving towards a greater expansion of government supported or constructed health care, it doesn’t solve the cost problem because it – there really is no market incentive. There isn’t any reason – people respond to do I buy an expensive car or a more expensive car? To the extent that you take that away, the cost savings don’t exist there except to the extent that you regulate them out or try to, and that’s part of the problem.
PENNER: Okay. All right. Yes, Vicente.
CALDERON: Well, the thing is it’s – there’s – even with the health care system that we have, there’s a lot of people that’s – every day there’s more people unable to get any care and since they have to wait until, due to the restriction and conditions that you have to admit to be able to get that health care, it’s costing more eventually because there’s no prevention in many cases of going to the issues that you were talking about. It’s bringing us more – obesity’s not just because of the way people looks but problem – health problems associated with them.
DAVY: That’s right.
CALDERON: But the thing is, this bill claims to bring about 30 million people, uninsured people, with some kind of coverage.
CALDERON: And there’s also two things here, I guess, is the people who doesn’t have access to health care right now and also the people who’s working, they’re seeing every day more difficult to get access to their doctor to really treat them and the uncertainty of – with this, what will be the outcome of it? How more difficult or more costly will be for me to get that health care?
PENNER: Thank you, Vincente. Back to the phones. I just want to say that one of our very alert callers figured out that we have more than 30 million people in California; we actually have 39 million, so that’s the correct figure and thank you very much for the correction. We have time for another call before we go to our break. Nancy in El Cajon is with us. Nancy, you’re on with the editors.
NANCY (Caller, El Cajon): I just wanted to point out my frustration with the vicious cycle. People are uninsured in California because of the cost and until we address the cost issues, we’re not going to solve the problem. That’s why people are uninsured period. It’s too expensive.
PENNER: And is that the only reason that you can think of, Tom? Would you agree with Nancy?
YORK: I would. I think that one of the issues that’s being discussed, you know, at a more ethereal level is the fact that should health care be in the hands of private enterprise, in the hands of these private companies which charge large amounts of money and then shovel some of that money back to investors as shareholders and whatnot and to the administration. And I think some people are looking at a model that perhaps Kaiser has or some other HMOs have which – where all the money that’s spent or paid for health care goes back into the health care delivery.
DAVY: Yeah, but you’d have to put that in some context. The insurance companies have been a favorite whipping boy, particularly of late, in this discussion but their profits represent only .4% of the total health care bill. It’s not like they represent a huge takeaway out of the system. There is a lot of money spent around but it’s not really – I think it’s a little bit suspect…
YORK: Well, I think it’s – the private system, you know, the complaints are not only about the profit making but the denial of coverage, the denial of treatment. You know, people have coverage and all of a sudden they have an ailment, they go to the hospital, they have to have treatment, and then the insurers deny it. I think the lady on the phone talked about social justice and I think that’s what a lot of people feel, that the system lacks justice.
PENNER: Well, I think the two of you and Vicente have really hit the crux of the situation. You know, are you comfortable? Do you trust the system as it now is or is a change needed? We’re going to come back and talk more about this right after the break, and answer some of your calls. I want to thank Nancy for hers. This is the Editors Roundtable. I’m Gloria Penner.
PENNER: This is the Editors Roundtable. I’m Gloria Penner. And we are talking about health care reform. San Diegans have been responding and reacting with rallies and protests and demonstrations and certainly the phone lines tell us this morning that people are very engaged in this as is our panel. So before we go to the phones, I want to find out from you, Vicente, what political fallout do you think there could be from all of the procedural maneuverings and the political arm twisting that’s going on to get health reform passed?
CALDERON: If this will be enough to convince the legislature to vote for it, and I think it will. I mean, in such short period of time they’re going to have to offer some carrot for them to move ahead and going to – and being able to come across because all what is riding for President Obama with this decision. I’m not sure that – how they’re going to do it, if that eventually will be good for the health care system but he’s betting a lot on this because I guess since 1993 they haven’t pushed for so much changes on health care?
PENNER: Well, I think Bill Clinton and Hillary gave it a big push right at the beginning of his presidency but he was doing it kind of unilaterally as opposed to the way Obama’s doing it. Obama kind of turned it over to Congress to work out the details.
CALDERON: And right now they are trying to put this as a – the people’s choice against the medical companies or that’s the way they are selling this. I don’t know if this – how accurate is this because if you tried to get information on the details it’s very – you get a headache at least just trying to get it. And also, you get more coverage of how are they maneuvering to get it approved and how are they opposing it than to the actual health care plan.
PENNER: Okay, let’s hear from our listeners and we’ll start with Richard in Carlsbad. Richard, you’re on with the editors. Welcome.
RICHARD (Caller, Carlsbad): Good morning. Thanks for taking my call. I am passionately opposed to the health care bill for two basic reasons. First of all, the – things like health care and public education and mass transit should not be decided 3,000 miles away in Washington. We have our own dysfunctional legislature much closer at hand, we don’t need a second one. The second reason and totally absent from the debate is how to pay for it. I don’t want to be charged to pay for it. My taxes are high enough. Social justice is not having my pocket picked to pay for somebody else.
PENNER: Okay, Richard. And, Kent, this is true. There will be more taxes on some level of people, for example people who earn over $200,000 even in unearned income. Just an investment income will see a higher tax on their Medicare.
DAVY: Well, for instance, the high – the so-called Cadillac insurance plans will be – there’ll be a surtax put on those. Now at the behest of labor, that tax has been pushed off a couple extra years, which is part of the numbers game that the CBO’s scoring. There’s going to be a new tax on capital gains, up around, I think, 3.2% of capital gains is going to be hit with a tax. Insurance premiums, Robert Samuelson in the Washington Post yesterday, in his column, said that premiums should probably, for most people, are going to jump 12 to 14%. There’s going to be a lot of – this is – there’s nothing free about anything. Somebody’s got to pay for it.
PENNER: Okay, well, thank you very much for your call, Richard. Let’s go to Renee in Alpine. Hi, Renee, you’re on with the editors.
RENEE (Caller, Alpine): Hi. Thank you. You wanted to know how passionate people are. I am so passionate about this because I’ve been – I’m someone with a graduate degree who was hit with an illness and I’m self-employed so I have been financially devastated by the fact that I have a preexisting condition. And I really take issue with people who are opposing health care reform in general who have never been sick and who have never been confronted with the bureaucracy of this health care system. And I’m really tired of the pundits saying – talking about the political aspects of it and not the ethical problems about our country’s really terrible health care. And I’ve had health care in Venezuela when I wasn’t even a citizen. I was living there and I got better treatment than I got here so to say, oh, well, we can’t compare to other countries, well, I’m afraid we can…
PENNER: Well, let…
RENEE: …and I’m afraid we don’t look good.
PENNER: We have Vicente Calderon here. He is from Mexico. Compare, Vicente. What do you have going on in Mexico that might be better or worse than what we have?
CALDERON: I don’t think we can compare it because the system in Mexico’s very – it’s even worse. I’m sad to say but it’s even worse here. They are trying to make some changes, trying to expand coverage because there’s – they know it’s not possible to go to the same model that you guys have here but, for example, in Mexico you have to be employed to be a more decent and more resourceful help program immediately. When you have the formal labor market you eventually get a percentage take out of your payment and also there’s another part who’s taken from the employer. But also during the previous – the current administration, President Calderon has been promoting something called Seguro Popular, Social Security Popular, to just basically just – you have to go there and just register and they will give you access. That’s specifically access to health – some level of health coverage for the ones who doesn’t have. And she was talking about the Venezuela case, I don’t know how recent that was because the current situation will be probably better in the sense of making more affordable for anybody because they are copying a lot of the Cuban model with President Chavez bringing it from there or if it was previous to this, so that’s a very interesting point that she raised.
PENNER: Okay, thank you, Vicente. We have time for another call on this and we’ll hear from Carmen in Kensington. Carmen, you’re on with the editors.
CARMEN (Caller, Kensington): Hi. Thank you. I have two quick comments.
CARMEN: The first is I am passionately for the bill but I do not believe we should call it a reform bill. We should call it a regulation bill. A reform bill would knock out the middle man. The reason that we are in such disarray in our health care industry is we have this middleman whose purpose and responsibility to stockholders is purely to make profit and they’re not in the business of making sure they take – people are taken care of. So let’s not call it reform if it doesn’t have a public option. My second comment is if people are upset about paying taxes to cover this, they should think about the fact that we’re already paying through the nose for a very randomized haphazard process where people who are not insured are already being covered by our taxes and this would put those expenses more under control and emphasize well care. So, you know, let’s – as passionate as I feel about it, let’s use our heads a little and think about it in very pragmatic terms.
PENNER: Well, let’s hope that those people in Washington who are going to make the vote happen on Sunday, we believe, are using their heads as well. Thank you so much for your call. I really appreciate it, Carmen. And with that, I’ll take a final thought from Kent Davy and then we’re going to move on.
DAVY: I think chances are very good that Pelosi gets her 216 votes on Sunday doesn’t end the matter. There’s still Senate reconciliation of pieces of it. There are still threatened legal challenges. So the discussion is by no means going to be over this weekend.
PENNER: Okay, well, thank you, and thank you to our callers.