Health Care Controversies
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August 7, 2009 – "San Diego Week" looks into the issues that have delayed President Obama's push for health care reform.
Related story: Health Care Debate Comes to San Diego
GLORIA PENNER (Host): This month the health care debate is shifting from the halls of congress to the living rooms of America. Congress is in recess and lawmakers remain deeply divided over how to fix what nearly everyone agrees is a broken health care system. With costs running out of control more than forty-six million Americans have no health insurance, and millions more are not adequately insured. One of those uninsured is a professor of public health policy at UC San Diego who had breast cancer, and found herself caught up in America's broken health care system. KPBS reporter Sharon Heilbrunn brings us her story. SHARON HEILBRUNN (Reporter): When Norah Schwartz found out she had breast cancer, she didn't just lose normalcy from her life. She lost her health insurance. NORAH SCHWARTZ: I had HealthNet insurance, and I called them and I said, "My COBRA'S ending. I would like to continue with private insurance, I'd like to convert to private insurance," and they said "You will not be eligible for private insurance for 10 years after a diagnosis of stage two cancer." And I started calling, talking to supervisors. I called every insurance company in the book. I went through it, I wrote it all down. I was sick, I was in bed. I didn't know if I was gonna survive. And they're telling me that I'm not eligible for health insurance, for private health insurance, for 10 years because of my diagnosis. It got to the point where I spoke with one woman and I said, "I'd like to speak with your supervisor," and she said, "The supervisor will tell you the same thing," and I said, "OK, well, let the supervisor tell me the same thing." And we started talking, and she said to me, I will never forget this, she said, "Well, that's just the way it is," and I said, "That's just the way it is, is not good enough." HEILBRUNN: Were you able to get insurance? Do you have insurance now? SCHWARTZ: Nope. I have limited health insurance. I pay $300 a month. They pay for a small part of my care. God forbid if I get sick again. I won't be able to use anything. They pay partially for four doctor's visits, $75. My doctor's visits cost hundreds of dollars. They pay for part of my labs. I have to manipulate my labs so that I have, so that I break them out into three different days, and that's it for the year. I've used up all my benefits. If I get sick? I don't know what I'm going to do. HEILBRUNN: Schwartz has a doctorate in medical anthropology. She's a professor at a college in Mexico and also teaches public health reform at UCSD. SCHWARTZ: I took a job where I knew I'd have to pay for health insurance out of my own pocket, but as a professor, as an adjunct professor, it's also really difficult. I'm not going to find a job where they're going to pay for my health insurance. So I've always paid for my health insurance. HEILBRUNN: She tells her students to fight for change. SCHWARTZ: Everybody in this country deserves health care. It's a right. It's not a privilege. Everybody should have it. So we want universal coverage, we want affordable coverage, we want comprehensive coverage, and one of the major issues is a pre-existing condition. I'm being denied private health insurance because I did nothing to get sick. But I'm being denied health insurance because of that. We have to change the system. HEILBRUNN: Schwartz hasn't seen a doctor in six months. She's afraid of what she might find out. SCHWARTZ: Whether I'm healthy, I mean I just pray that I am. I'm going to see my oncologist next week, I'm going to go through the tests. I'm going to get some financial help to do that. I take my vitamins, I swim, I exercise, I do everything that I can. I'm assuming that I'm healthy, but I don't know. HEILBRUNN: What are your feelings toward this whole situation? I mean, I can imagine they've been kind of a roller coaster, but take me through how you felt. SCHWARTZ: Overwhelmed. Terrified. Enraged. I'm enraged. I am absolutely enraged. I pay my taxes here. I pay taxes in two countries. I pay my taxes, I pay for health insurance. Who are they to deny me health care? PENNER: Joining me now to talk about this great debate over what to do about health care in America is David Rolland, editor of San Diego City Beat, and Michael Smolens, politics editor for the San Diego Union Tribune. Welcome to you both, and you both just heard the story of Norah Schwartz, who said that she's enraged. Does she have a right to be enraged, Michael? MICHAEL SMOLENS (San Diego Union Tribune): Well sure, a lot of people are especially people that, you know as she said, paid her taxes, buys health insurance, and still she's having problems with coverage. One of the key aspects of the reform movement in Congress is to get rid of the pre-existing condition clause that a lot of insurance companies that allows them to withhold care from people or reject them from coverage. And that would go a long way I think in a lot of peoples' mind, at least for a peace of mind, even people that are healthy, that don't have cancer. That's always hanging over their heads, so I mean its multifaceted, but thats one of the key issues that does seem to be one of the less controversial issues right now of all the things that people are screaming about. PENNER: Yeah, but I wonder what's at the root of the problem of health care in America. What do you think it is, David? DAVID ROLLAND (San Diego City Beat): Well the root of the problem is that we're spending more and more money on health care and the quality of our coverage is not increasing along with it. Seems like its getting more expensive, but the quality is decreasing and I think that' s generally the problem. PENNER: And another aspect of it certainly has to be the expense of it. I mean, the quality, but then there's the expense. SMOLENS: Well, I think there's been reports infinitum about how expensive the health care system is in this country for what we're getting out of it. And one of the things that is of concern among the various reform proposals is that there's a question as to whether that's going to control cost. Thats one of the key thrusts behind the Obama administration, is that they're saying this is also an economic issue, not just a health care issue. But there is evidence that the reform proposals on the table may not control costs, therefore may not be that good of an economic saver in the long run. PENNER: Well thats kind of dismal to hear. I mean, are any of the proposals being considered by Congress likely to solve the problem? ROLLAND: Well it depends what problem you're talking about. PENNER: The problems that the two of you raised here. ROLLAND: Well, yeah the big problem in my mind is just what your segment there illustrated, and that is the problem of uninsured people and underinsured people. People who pay their premiums. I mean, insurance in this country is geared around helping healthy people, really. You know, the people who are healthy are who the insurance companies want to do business with. The people who are unhealthy, they don't. And so the problem is getting past that system and finding a way to insure people who are uninsured and underinsured, and that's where we get into this debate over the so-called public option - which really is a compromise from the point of view of progressives in Congress; most of whom would like to have something like a single payer system like they have in some places in Europe, and in Canada, and other places around the world. They compromised that even before the debate started, and they're really sort of trying to cling to this idea of a public option where the government would run a health insurance plan to help some of those people. PENNER: Well the House and the Senate have been working on their versions of health care reform bills for months. And now that Congress is in recess, many of the country's elected representatives are going back home. They're talking to their constituents about this very subject, including San Diego Republican Congressman Brian Bilbray and Democratic Congressman Bob Filner. So yesterday they were on KPBS radio's These Days program debating their positions on this issue. We decided to put them on the record about whether health care should be a right for all Americans. BOB FILNER (D-CA, 51st District): Thats the basic assumption which virtually all Democrats start with. That it is a right of all Americans to have affordable, quality health care. We're the richest country in the history of the world, we can do this. And besides, it's in everybody's interest that we all be healthy, that we all be well-educated, that we all be well-housed. The society is better - there'd be less crime, and less health problems. BRIAN BILBRAY (R-CA, 50th District): I think that we've got to understand that health care isn't a right. A right is more the ability to be left alone by government. We're talking now under the guise of a right of forcing everyone to have to have insurance - denying the choice not to be insured. So I think that we've got to understand that maybe a utility, but it's not a right. PENNER: A clear disagreement. I mean how much of this basically comes down to political ideology and attitudes toward the role of government? ROLLAND: Well, it all comes down to that. That's the whole ball of wax. I thought it was interesting the two words that Brian Bilbray used - "left alone" - that that is the right that he wants people to have, is to be left alone. And if you come from someone like Bob Filner's position, that means left to your own devices. If you cannot compete, this is survival of the fittest. You are 'left alone' out there. PENNER: So, is it the fear of government involvement of any sort in developing health care, a true fear of something like creeping socialism? SMOLENS: Well, a couple things, health care, if you look at it a different way, is a right. Through Medicare, people have the right to that. People have the right to medicate. People cannot be refused when they go to emergency rooms and that's one of the big issues in health care - in the health care debate - is that a lot the uninsured people go to the much more expensive emergency room situations. So, that's a whole different argument from the public option thing. One thing that always surprised me on the public option aspect, is that you hear Republicans, particularly here at the local level, managed competition is the one thing they want. They want the private sector to be able to compete with the government in City Hall and places like that. This sort of seems to be a little bit of the reverse, yet, they don't want the public entity to be able to compete with the private companies that dominate the market now. So that's just an interesting philosophical flip there. ROLLAND: Why is this any different than public safety or public education? Why is it okay that we have "socialized" public safety and public education, but it's not okay to have the government, at least, in this case, only simply compete with the private industry? PENNER: Well, there are extremes in that too. There are people who feel that education should not necessarily be public - that it should be privatized. ROLLAND: But not public safety? Nobody wants to hand over police and fire fighting to private companies. PENNER: You know, I read something in the Wall Street Journal. I have to read this to you about the American mindset about health care. They say it's schizophrenic. Quote: "I hate the health care system, but don't you mess with it." What's going on? SMOLENS: Well, people, most of the voters have health care coverage and are generally, if not generally satisfied with it, they're more fearful of the unknown. And that's always been the problem in health care reform and very complicated efforts to change things like health care, is that people like the idea, because they don't particularly like what they have, but then it's easy to knockdown the ... to bring up boogiemans when you don't have a specific program, as we don't have now. Suddenly, we're talking about socialized medicine, we're talking about killing off Granny with limiting coverage for the elderly and things like that. And if the debate doesn't get distorted, it does get distracted a bit. So, yea, people are schizophrenic. It's sort of like: We don't like our Congress. We don't like the legislature, but we keep re-electing all these folks. PENNER: So, we have another clip we'd like to play and this one, also, is from Congressman Filner and Bilbray, and this time we asked them, what they wanted to see in health care reform, and here's what they told us. BILBRAY: I support the concept that we look at non-profit providers like credit unions, basically medical credit unions. We're talking, basically, cooperatives where you share risks without having to go to an insurance company OR having to go to a federal agency. That, in the long run, gives the best choice to the consumer and that is something we're going at. FILNER: But, the basic thing that I think will pass are: a public option, that is, if people can't either afford or don't want a private health care plan, you will have the option of joining a public plan which will be affordable. There will be mandates to say to insurance companies to say that you cannot deny people because of pre-existing conditions. You cannot put caps on certain procedures because they cost too much money. You cannot charge excessive co-payments and that kind of thing. PENNER: So, let's see if we can make some sense out of these options. What is this public option that the Democrats are talking about? SMOLENS: Well, it would essentially be a government-run, health insurance program, that would compete with the private sector. Would they have doctors as direct employees of the federal government? I don't think that's been worked out yet. It's going to be more like a health insurance company run by the federal government. PENNER: Like Medicare? SMOLENS: The details? There's at least three plans out there, so I don't know that they've gotten that far down the line but the fear from the private industry is that this government will subsidize this so it will be an unfair competition. It's interesting Congressman Bilbray's brought up this co-op concept which is something that seems to be emerging from some bi-partisan efforts in Congress. And while that seems to be favored by some Republicans, other Republicans just don't seem to want any change. But, the question is, who controls that co-op? That could mimic much more government-run operation depending on; is there a board of directors and who appoints them? So, there's a whole political aspect to that. But that may be, in my view, that may be the fallback position that somehow they try to sell that as the public option. A lot of liberals in Congress won't go for that. PENNER: That's interesting. I mean, are we essentially saying that this co-op idea would keep government out or bring government in? ROLLAND: I think it's kind of to keep government out from my view. This is a way to avoid the boogieman of government being in charge of, you know, making decisions about your health care. This is, like maybe conservative Democrats and Republicans being able to say, "We acknowledge that the system isn't working. We need to do something." But there's no way you can call this socialized medicine. I think it's just more palatable. Although I would argue seemingly a lot more complicated and unnecessary than just allowing the government to come in and compete with private insurance. PENNER: Well, part of the whole thing is the requirement that everybody has to have health coverage of some sort. And given this prevailing attitude toward in the nation against mandatory anything -- you may not mandate anything or certainly health care coverage. Is it realistic to think that that will become a reality? ROLLAND: Yes, I do think it's realistic. We have it in car insurance in California right now. You know, you are required to have car insurance. The idea is there that you make sure that everybody is playing along. So if you are going to impose rules on private insurance about taking people with pre-existing conditions and that sort of thing, then you've got to make sure everybody is playing the game, to just make it a level playing field. The thing there is, if you're going to mandate that people spend their money, especially on private insurance, which generates more customers for insurance companies, you have to make it affordable or else it's simply not fair for people who don't have the income to be able to be able to buy it. PENNER: Well, earlier this week President Obama called the entire Senate Democratic Caucus to the White House and at the top of the agenda, the president's promise to reform health care this year. Senate Majority Leader Harry Reid had this to say about progress being made on health care: HARRY REID (Senate Majority Leader, D-Nev): Different ideas were expressed, but every idea was that we understand that before year's end we are going to have comprehensive health care reform. In spite of the loud, shrill voices trying to interrupt town hall meetings and just throw monkey wrench and everything. We're going to continue to be positive and work hard. PENNER: How likely is it that President Obama will have a bill on his desk to sign by the end of the year? SMOLENS: It's a tough call, I think he will, I think it'll be a compromise, it won't nearly have the sweep that he initially had thought, but it will give the Democrats something to build on. I think, like I said, that it will be some sort of hybrid of a co-op than public option and that will get some Republican votes. PENNER: How important is it, let's say, to the President's success that he has something to sign by the end of the year? Is that what the push is here, David? ROLLAND: It's tremendously important to the President. I mean, he can't, can you imagine the sense of failure that he will carry with him throughout this term and possibly a second term? It will endanger his chances for a second term. If people can say, health care was his number one platform and he couldn't get it done. PENNER: But Michael said that this is something that maybe Democrats can build on, do you see this as a first step, or the final step? ROLLAND: That's what I worry about a little bit. It's simply important for members of Congress and the President to say they had done something. And they'll tout, even if it's a health care tinker, rather than a health care reform, they will tout it as comprehensive reform. And I worry a little bit that if it's just tinkering around the edges that they will say, "Whoa, look, we did it, and we won't revisit it for another 20 years." PENNER: Comprehensive reform? Briefly. SMOLENS: I think that there will be, but I would point to Medicare, Medicaid, Social Security things that have grown dramatically over time since their inception, so those people that think it's an all-or-nothing, that they'll take a half a loaf now if that's what they can do with just to keep the ball moving forward. PENNER: Well, thank you very much. Michael Smolens. David Rolland.