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Bringing Health Care Debate To San Diego

Bringing Health Care Debate To San Diego
What's the latest news on the health care debate taking place in Washington, D.C.? And, what kind of hardships are local uninsured and underinsured people dealing right now? We discuss the national health care debate, and its impact on San Diego.

MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. Last summer, as the healthcare debate entered full swing, "These Days" did a week-long series of programs about the problems in America's healthcare system and the different reforms being proposed. Since that time, healthcare reform has become a political football, compromises have been made, public support has faltered, and now, the president has called for an up or down vote on the issue within the next few weeks.

During the next hour, we'll be discussing what is riding on the healthcare proposal before Congress and whether this reform package will actually solve some of problems we discussed way back when this whole debate began. We’ll start off by talking about the politics surrounding healthcare as it heads to the finish line and for that I’d like to welcome my guest, NRP White House correspondent Scott Horsley. Good morning, Scott.

SCOTT HORSLEY (NPR White House Correspondent): Good to be with you, Maureen.


CAVANAUGH: Now what has President Obama done, let’s say over the last couple of weeks, to get this healthcare legislation back to the top of the agenda in Washington?

HORSLEY: Well, it’s never really moved very far from the top of the agenda.

CAVANAUGH: That’s true.

HORSLEY: In fact, there’s a whole lot of other business that is kind of on hold until this gets resolved one way or the other. But in the last few weeks, I mean, I guess you’d have to go back to January and the election of Republican Scott Brown in Massachusetts, it sort of upset the applecart for the Democrats…



HORSLEY: …who’d been hoping to pass the measure on a straight party line vote in the Senate. And once it became clear that they weren’t going to be able to have the filibuster-proof majority in the Senate, there was several weeks of teeth gnashing and hair pulling on the Democratic side and finally the administration came out and said, okay, if we can’t get it through the Senate with the 60 votes, what we’ll do is try to get the House to pass the Senate bill and then push through a fix-it piece of legislation that would sort of harmonize the House and Senate measures and to do that on a reconciliation basis, that is with a simple majority in the Senate. And that’s kind of the strategy that the White House has been pursuing ever since then and there’s – in order to, I guess, provide some window dressing for that, they held the summit meeting with the – both the legisla – the Democrats and…


HORSLEY: …Republican leaders of the legislature and now the president is sort of in campaign mode. He’s in – going to be in St. Louis later today. Earlier this week, he was outside Philadelphia trying to sort of rally public support for this proposal.

CAVANAUGH: And the idea for the president now seems to be with this, as you say, campaign mode to really rally his supporters to put pressure on Congress to pass this healthcare legislation in this reconciliation way that you’re talking about. I wonder, though, there’s a new poll out from Associated Press that says Americans want a bipartisan solution to healthcare. That seems to have gone completely by the wayside. Scott, would you say that’s just not going to happen?

HORSLEY: I think that’s just not going to happen. The Republicans have showed that they really have no interest in making a deal with this president and the president has said he’s just not going to let the Republican minority sidetrack the train here. It is sort of interesting because the proposal that is on the table now has Republican roots. It’s similar in broad strokes to the proposal that Mitt Romney signed into law when he was governor of Massachusetts. It’s similar to the proposal that Republicans offered as an alternative to Bill Clinton’s plan back in the 1990s. But the 2010 edition of the Republican Party, as they sit up on Capitol Hill have no interest in this proposal even though it’s, you know, by the standards of what many on the left would’ve liked a fairly centrist proposal. In fact, that’s one of the challenges the president’s had in trying to rally his supporters is this proposal’s not nearly liberal enough for some of the people that voted Barack Obama into office.

CAVANAUGH: Right, Scott, if you could, tell us some keys ways that this plan has changed and morphed as this compromise has taken place over the last few months.

HORSLEY: Well, you know, very early on in this process, the president said the idea of a single payer government run healthcare system was just not on the table, and there is a constituency out there, a pretty vocal constituency, that really wanted that. And they were sort of never at the table. All last spring whenever the president would have a town hall meeting, invariably someone would stand up and say why aren’t we considering a single payer healthcare system? It has, obviously, an awful lot of efficiencies, it cuts out an awful lot of the administrative headaches and costs. And the president said, look, if we were starting from scratch that is probably what we would do but we’re not starting from scratch. There is an entrenched healthcare system in this country and a lot of people, for all its flaws, are more or less satisfied with their own policies so we’re going to preserve that system. Then the sort of middle ground position was, well, maybe we’ll have a government option, a public option, as an altern – as, you know, as one of the choices in the marketplace for people to shop for insurance from. And that was ultimately jettisoned by the president and taken off the table. So what you have now is, you know, basically a fairly market oriented insurance exchange for small businesses and for those in the individual market that’s designed to provide some competition at least and then, you know, people who get their insurance through their employer more or less status quo.

CAVANAUGH: And I’m wondering, as you say, since it’s basically up to the Democrats now whether this plan succeeds or fails, there are some very disappointed people in the left wing of the Democratic Party because this has essentially been compromised to become more – to become more attractive to Republicans who aren’t going to vote for it.

HORSLEY: Yes, although it’s also – I mean, a lot of these compromises were aimed not at winning over Republicans but winning over more moderate Democrats. I mean, there were a lot of moderate Democrats who were also resistant to the notion of a public option. So while the president would have loved to have had some Republican votes for this, I think he’s sort of moved as far as he had to move to win even a majority in his own party. But as you say, that – you know, the Democratic Party has a lot more variation right now than the fairly monolithic conservative Republican Party in Congress. And so no matter what you do, there are going to be Democrats who are going to be unhappy about it.

CAVANAUGH: Well, as I say, according to the White House, if this goes the way the White House wants it to, we’re in the – we’re heading to the finish line for healthcare. The president wants an up or down vote. And I’m wondering, now that we stand at this precipice, Scott, what is at stake for the Democrats and for the Republicans as this vote comes into view?

HORSLEY: Well, I have to say, Maureen, it’s interesting. Someone here in Washington today put together a list of all the times when we’ve supposedly been right on the finish line or…


HORSLEY: …on the precipice and, you know, going back to last July when we were supposed to be nearing the end game of the healthcare debate. So we’ve been teetering on that precipice for so long I think most of us are feeling a little numb to it. But assuming that we really are close to some sort of up or down vote, what’s at stake is if this goes down, there will be an enormous amount of recrimination among Democrats both amongst themselves and among the voters who will say, look, you’ve basically used all your political capital, all your time and energy during the first year of the presidency to come away empty handed. That would be a terrible fate. On the other hand, if they manage to pass it, there will also be a lot of unhappy folks because, you know, this bill, rightly or wrongly, has become sort of damaged goods in the eyes of much of the public. Even though the public likes independent pieces of what’s in the measure, the package as a whole has began, rightly or wrongly, been sort of tarred as a problem bill and people are sort of disgusted. What I think the White House and the supporters in Congress are hoping is if they can just get the thing passed, put the legislative sideshow behind them, then over time people will come around and like this measure a whole lot better than they are telling the pollsters they do right now.

CAVANAUGH: And what about Republicans just basically being, I don’t know, saying no, the party of no.

HORSLEY: Well, what they did with the stimulus by almost unanimously opposing the stimulus is allowed themselves then for much of the last year to say the stimulus isn’t working, and leave it, leave all the responsibility for the stimulus bill on the Democrats. That’ll be the same approach with the healthcare bill. If this is passed on a more or less straight party line vote, the Democrats will own this healthcare bill and the Republicans will point that out…


HORSLEY: …every opportunity they get between now and November. And to the extent that people are unhappy with the bill, the Democrats will pay a price for that. Now, of course, if ten years down the road people say this has turned out to be a good piece of legislation, no one will remember that the Republicans fought tooth and nail to stop it.

CAVANAUGH: Exactly. Well, I think you’ve already answered what was going to be my final question, Scott, and I was going to ask you how do you think this will play out over the next couple of weeks. Do you think that we may be close to a vote on this?

HORSLEY: Well, I think we are close to a vote. When I say close, I mean in the next few weeks only because it just can’t go on forever although who would’ve thought it would’ve gone on this long?


HORSLEY: The president has said he’d like to have at least the first vote, the House vote on the Senate bill, before he leaves for Indonesia and Australia late next week. The folks in the – on Capitol Hill are suggesting that’s a very unlikely timetable. But not too long after the president goes on his trip, Congress is due for another recess and every time Congress goes on recess bad things happen to the healthcare bill. So I think the supporters would very much like to get it wrapped up before the lawmakers go home to their home districts for their Easter recess.

CAVANAUGH: Well, thank you, Scott. Thanks for bringing us up to date on all this. I really appreciate it.

HORSLEY: Always nice to talk to you, Maureen.

CAVANAUGH: That is NPR White House correspondent Scott Horsley. We have to take a short break. When we return, I will introduce the panel for the rest of the hour and start to take your phone calls on healthcare reform. What do you think about the package before Congress? 1-888-895-5727 is the number to call. And we will be back in just a few moments here on KPBS.

CAVANAUGH: I'm Maureen Cavanaugh. You're listening to These Days on KPBS. We’re discussing what is riding on the healthcare proposal before Congress right now and whether this reform package will actually solve some of the healthcare problems we have in this country. I’d like to introduce my guests for the rest of the hour. Jan Spencley is Executive Director of San Diegans for Healthcare Coverage. Jan, welcome to These Days.

JAN SPENCLEY (Executive Director, San Diegans for Healthcare Coverage): Thank you, Maureen.

CAVANAUGH: Gregory Knoll is Executive Director of Consumer Center for Heath Education and Advocacy, which is an independent program of the Legal Aid Society of San Diego. And, Greg, welcome.

GREGORY KNOLL (Executive Director, Consumer Center for Heath Education and Advocacy): Thank you very much, Maureen. Good to be here.

CAVANAUGH: And Dr. Jeoffry Gordon is family physician and member of Physicians for a National Health Program. Dr. Gordon, good morning.

DR. JEOFFRY GORDON (Family Physician, member of Physicians for a National Health Program): Good morning, Maureen.

CAVANAUGH: We’d like to invite our listeners to join the conversation. Have you watched the healthcare reform debate play out over the last few months? What do you think about the proposal now before Congress? Should it pass? Give us a call with your questions and your comments, 1-888-895-5727, that’s 1-888-895-KPBS. Well, I know all of you have been watching this issue very closely over the last few months so let me start out with you, Jan. What are your thoughts on where we are at this point?

SPENCLEY: I think we’re at a pivotal point. I think that if we do not pass this bill at this point in time then we have – we’re lost. And I think history will repeat itself; nobody will have the political juice, the stomach, to continue on. And I think that if you look in 1974, Nixon had a bill. I mean, if you go on and on, it was actually more progressive than this but the progressives didn’t like it and didn’t pass and, look, here we are almost 30 years later. So I think we’re at a place where we need to move forward, as imperfect as it is. We need to move forward.

CAVANAUGH: And, Dr. Gordon, your thoughts.

DR. GORDON: Oh, I have to start by saying I don’t like the word progressive or liberal or left. I have to say I represent the humanist trend in American medicine, and the organization I belong to agrees with Congressman Dennis Kucinich and I personally, morally and experientially agree that this bill has to go down to defeat. When Barack Obama faced Yogi Berra’s proverbial fork in the road, he took the wrong fork. To depend on the insurance companies to solve the cost or the provision of medical services program problems in this country is to build the future reforms on a foundation of sand, quicksand, in fact. The biggest problems I have in taking care of people are created by the insurance companies.

CAVANAUGH: And Greg Knoll, where – your thoughts about where we are in this whole process of healthcare reform.

KNOLL: Yeah, I agree with Jan that we’re at a pivotal point. The thing that scares me is that if there is not something passed very soon, at this attempt that, as Jan said, we’ll be doomed. I’m far more concerned about the consumer. The consumer that I talk to every day – my days are filled with people who are 30 years old with rheumatoid arthritis that cannot find insurance on the open market, 60-year-olds that have had a stroke and whose insurance company has said you’ve reached the family maximum and, therefore, we’ve lost our home and we’re living in a one bedroom apartment trying to go to rehab. We are the only country in the entire world that allows that to happen. Over 50% of all bankruptcies are because of medical debt. It’s an outrage. It’s an embarrassment. And, quite frankly, when you talked about the new poll, about bipartisan solution, we’ve never had a bipartisan solution. If you go back to Medicare, Medicaid and Social Security, they were all passed by Democrats solely, and by Democrats with guts. And it’s time that people got some guts and decided that doing nothing is far worse than doing something. You’re talking about health expenditures going to 28% of GDP, you’re talking about 46 million uninsured going to 72 million, you’re talking about providers in 45 states having uncompensated care go through the roof. If anybody, Republican or Democrat believes that’s a good future for this country, I humbly submit they don’t deserve to serve.

CAVANAUGH: Now let me ask you, Jan, because I want to talk to Dr. Gordon in just a moment a little bit more, probe into why – into his feelings about starting from scratch with this bill and how inadequate it is. But, Jan, I know a lot of people have been put in a position by this healthcare reform bill that it has a lot of things in it that perhaps they don’t like but they feel a deep sense of, as Greg was telling us, urgency to get something passed. I wonder what – where that urgency comes from. Where – what is that feeling of just we have to do it now even if the bill, in your opinion, is flawed?

SPENCLEY: Well, Gregory just described some of it. We are sliding downhill and we’re sliding downhill fast. And when I say ‘we,’ I’m a humanist, too. It’s the consumer. It’s me. It’s the American people who are sliding downhill and their health is going with them. We do not have a healthy population and we do not have a healthy healthcare infrastructure that will be able to take care of them. Doubling of uncompensated care means you’re not going to have the same kind of healthcare system there to take care of you we already pay. So my sense of urgency is that the problem is getting worse. People are dying. And I don’t understand why more people are not outraged that people are dying every single day for lack of coverage and care. And coverage is only a means to care. That’s how I see it. I agree a great deal with Dr. Gordon in the sense of this is an imperfect bill but I do not believe this country has the stomach or the ability to move forward with a universal healthcare coverage package at this point. So my sense of urgency is do this, start turning that slide downhill, and let’s start working towards making this a more perfect system.

CAVANAUGH: Dr. Gordon, what do you say to that argument?

DR. GORDON: Well, I would say there’s two things that I would say, two different perspectives. One is, I can give you a whole long list of tragic problems involving fully employed, fully insured people who do not get adequate medical care. This reform has spent a lot of time focusing on premium control, outrageously limiting it to 10 or 12% of family income, which is, oh, my God, for a family earning $40,000 a year, still a huge amount of money, but it spends no time at all talking about co-insurance and deductibles. In my own healthcare group, over the past four – four years, the average deductible to see me, a family doctor, has gone from less than $10.00 to over $30.00. I have a fully insured patient I spent three, four months and several tens of thousands of dollars finding out his problem. He was about to have neurosurgery on his back. He came in the day before surgery, crying to my office, this fully employed fellow, said I can’t go through with the surgery. And when he stopped sobbing, I asked him why. He said I just found out my insurance requires me to pay a 20% co-insurance. I will not put my family into bankruptcy. I am going to suffer. And I spent the next 12, 24 hours talking to heads of hospitals and accounting departments, trying to find out what his surgery would cost him. I’m a doctor. I know the right people to call.


DR. GORDON: I couldn’t find out at all. So that’s one thing. What happens now to fully insured, fully employed people with the machinations of the insurance industry? Secondly, I have to point out that Aetna Health Insurance is documented to overhaul its business in between 2000 and 2003, trimming 8 million members from their health insurance and boosting their profitability from what they call 4% to 7%. They haven’t got a hoot care about the pain and suffering out here. They made $12.7 billion this year in net income, a 56% increase during the time of our country’s tragic disarray economically with pain and suffering all across the country. What have they contributed to this? More profit for their shareholders and executives. They haven’t got a hoot of an interest. When the public option came up, they buried it. When McClarran-Ferguson (sic), which we could talk about again, the bill that says that insurance is exempt from antitrust regulation, came up it was in the bill for about two and a half seconds. The insurance companies got it up. When there was a section that said states could have further reform if they wanted to, which would allow California to pursue SB-810, which is currently in the legislature, it was in the bill for two and a half seconds…


DR. GORDON: …they cut it out.

CAVANAUGH: …let me interrupt you and bring this over to Greg, if I may, but following your line of reasoning here. Greg, considering what’s happened with the healthcare reform bills since last summer, have we seen that the insurance companies are just too powerful and too entrenched to take on in a way that basically dissolves them?

KNOLL: Not yet but if we don’t vote on this bill and pass it – The biggest fear for the insurance companies is not only that a bill will pass, but that what will come with it will be a series of regulations that will force them to act properly in the marketplace and to consumers. The problem is, I mean, I’m not crazy, I agree with everything the doctor says but here’s the problem. We don’t have any structure for change. We have none. That’s why, as I learned many, many years ago that the essence of government is negotiation and compromise and the essence of compromise is not to let the good be the enemy of the perfect. This bill is not perfect but it is better than where we are today and it also will allow the regulatory structure where we can, as a government, do really one of the only things government needs to do and that is to regulate big business so that the little person, the consumer, benefit from the business and are not hurt by it.

CAVANAUGH: We’re taking your calls about healthcare reform at 1-888-895-5727 and let’s take a call now. Pat is calling us from Chula Vista. Good morning, Pat, and welcome to These Days.

PAT (Caller, Chula Vista): Oh, hi. Thanks for taking my call. I have a comment and a question. Is my understanding is as far as the question goes is that preexisting illnesses with this Democratic bill will not be covered for the first five years. And then my comment is to make this all simple why don’t we just go ahead and use what Congress has for their own medical coverage, use that plan and then start from there and then figure out the funding? And thanks. I’ll take…

KNOLL: That’s an excellent plan and I think it would be great but you’d have to do it in a bill that won’t pass. As to your first comment, in fact, the regulatory nature of this bill, which goes against preexisting conditions will go into effect immediately.

CAVANAUGH: Oh, I see. Okay. So, Pat was misinformed in that. Preexisting conditions that – that preexisting conditions barring you from insurance coverage would be an immediate – immediately go away, is that correct?

SPENCLEY: That’s – it’s my understanding that a number of the insurance regulations would be immediately implemented.

CAVANAUGH: And Dr. Gordon.

DR. GORDON: I’d like to comment on something Greg said and say we do have a model for a quantum change and it’s called Medicare. The fact is, that is as a practicing physician I don’t have the same kind of problems dealing with the Medicare system either in time or effort or even in payment that I do with the commercial insurance system. And the elderly, with many difficult and complex medical problems, get them taken care of expeditiously and efficiently at a far, far less overhead on the border of 5% instead of over 20%. The other thing I would say is, the only bad part of Medicare is Medicare Part D, which was supposed to be the insurance oriented, market oriented reform. I’m forever wasting huge amounts of time re-upping prescriptions which patients are already using because the computer in some distant place says we don’t like this medicine and then I have to personally go away from patient care to deal with a computer. I don’t get paid for that.


DR. GORDON: And it takes time away from patients in huge amounts. So the commercialism of medicine is incompatible and to build reform on that is inappropriate. Now I’d like to say one other thing. This business of the 39% rate increases that Anthem Blue Cross put forward shows you—and should show everybody—that the insurance industry is a doom and a death cycle. They’re hugely raising their rates and they’re cutting their enrollees. And the fact is that if we give this bill – if we don’t pass it, we’ll give them two more years and they’ll go out of existence and then Medicare can be available for all because the insurance companies cannot proceed down this path. They’ll have three clients and pay seven doctors.

CAVANAUGH: Let’s take another phone call. 1-888-895-5727 is our number. Boris is calling us from San Diego. Good morning, Boris. Welcome to These Days.

BORIS (Caller, San Diego): Good morning. I have two comments. I haven’t heard people talk about this. The first is about guaranteed issue provision of the bill.

DR. GORDON: Umm-hmm.

BORIS: The fact is that if you have guaranteed issue then people would just buy the basic plan, the cheapest plan that’s available to them and when they get sick, they would switch to more expensive plan. And that means that the more expensive plan will only have six people and will go out of business and so very soon, within, oh, maybe couple of years we’ll only have the basic plan. And people have to realize that anybody who has a plan better than the basic today, they will lose it because the plan will not be available anymore.

CAVANAUGH: Let’s address that. Thank you, Boris. Jan, what do you think about that critique of the bill?

SPENCLEY: Well, first of all, guaranteed issue allows it to be issued at any, you know, to everyone but it doesn’t say you can switch and so that’s why there are open enrollment periods. You can’t just enroll, disenroll, enroll, disenroll. And so there are guaran – there are regulations that protect insurance companies actually from – and groups, I should say, from that kind of switching. And so I don’t believe those would change under this at least as I understand it.

CAVANAUGH: Let me ask you a question, Jan, because as executive director of San Diegans for Healthcare Coverage, you are very attuned to the needs of small business and we have heard as this healthcare reform debate has gone on, the business is for it, business against it, businesses for it, businesses against it. So what is your take on what we’re looking at now, this version of the bill. Does it have the support of business?

SPENCLEY: You know, I think that just like you would ask almost any industry group, it would be very hard for me to come out and speak for business. And I…


SPENCLEY: …and I can’t and I won’t. I will tell you that for business there are a lot of benefits, this – especially for small business. Small business will get access to a larger pool and if you understand how pools work, through a health insurance exchange, they will get access to a larger pool, therefore lower rates, guaranteed issue. They will get not just deductions but tax credits. Their employees would have access to subsidies. And by everybody being in a pool or being in the system, if you will, or most everybody being in the system, you don’t – rates should get under control. Right now – And they’re also not allowed to underwrite and that means figure out exactly what your risk is based upon your profession, your location, your whatever. They can only underwrite based upon certain factors, age, geography, and it isn’t the individual underwriting and risk pooling of you as just a small business.


SPENCLEY: And so it will help business in those ways plus they get to – they do get tax credits.

CAVANAUGH: Let’s take another call. Greg is calling from Solana Beach. Good morning, Greg. Welcome to These Days.

GREG (Caller, Solana Beach): Thank you. My question is geared around the whole premise of our current healthcare system. One of my mentors is an economist for a former presidential advisor, Paul Pilzer. He wrote a great book called “The Wellness Revolution.” He, in that book, talks about the reality is we don’t have a healthcare system, we have a sick care system. You don’t go to a doctor for health, you go to them because you have a pain or a problem or a disease. And most of our money and research and dollars are time spent on treating disease or treating the symptoms of disease and I think that if we continue with the current business model, the health insurance business from all the people that have the power the way it is, they don’t want things to change. And so a public option or even a complete, you know, single payer option would be a huge step. So I’m kind of torn. Like both of your – some of your guests today, I’d really like to see them be more way aggressive than progressive but what is this plan (audio dropout) on the table going to do to move people towards prevention and wellness so that we don’t have as many sick people draining the system of the healthier people that need, you know, catastrophic because they get into a car accident?

CAVANAUGH: Thank you for the question and who would like to…

SPENCLEY: I’d love to.

CAVANAUGH: Jan, yes.

SPENCLEY: The one thing that this bill does that a – and especially the president’s extra additions to it, it does focus on prevention. I happen to agree that we need to focus more on prevention. In today’s model, there is no – there is no – if you look at the business model of insurance companies, there’s no return on investment for doing prevention because, in fact, people turn over too quickly in insurance companies. So they don’t – to invest in your good health today, to put – to do the preventive measures, they won’t see the benefit so as a business model, that doesn’t work. Under this prevention is – under this bill prevention is required. I think we, as a country, there are also other things – I think we, as a country, need to focus more of our not just insurance, not just coverage, but more of our energy and time on dealing with health and health education and prevention.

KNOLL: And we’re not going to do that unless we have a structure within which to do it. The caller, his mentor, are exactly right.


KNOLL: But the reason is, we are siloed. We have multiple systems within systems. We do not have a healthcare system. When I go back to what – the one thing that Teddy Kennedy said as a Senator, that he was the most disappointed in himself for was the failure to support Richard Nixon’s healthcare bill because he didn’t think it was good enough. Well, that was only 36, 40 years ago and we still have no change. That is why I agree with the caller, I agree with the doctor, I agree that this is not the best bill but it begins to give us structure. It begins to say where’s the regulatory issues come in. How are people not being helped? And there is a structure within which to fix it. But you’ve got to start with a structure. We have no healthcare structure. We have chaos.

CAVANAUGH: Dr. Gordon, we will get to you. We have to take a short break. When we return, we’ll continue to talk about the healthcare reform bill now before Congress and take your calls at 1-888-895-5727. You’re listening to These Days on KPBS.

CAVANAUGH: I'm Maureen Cavanaugh. You're listening to These Days on KPBS. We’re talking about the healthcare reform proposal before Congress. We’re taking your calls at 1-888-895-5727. Let me reintroduce my panel. Jan Spencley is executive director of San Diegans for Healthcare Coverage. Gregory Knoll is executive director of Consumer Center for Heath Education and Advocacy, which is an independent program of the Legal Aid Society of San Diego. And Dr. Jeoffry Gordon is family physician and member of Physicians for a National Health Program. And, Dr. Gordon, I promised I’d come to you but let me ask you a question before you start to say – to respond to what’s been going on. Not – no one is, you know, trying to change your mind. This is not what this question is about but I am curious to find out, since so many people, so many advocates of healthcare reform have basically bitten the bullet and said, okay, we need to support some kind of bill and get it through Congress, does that argument not sway you at all to perhaps get behind this bill?

DR. GORDON: It doesn’t. As I said, the examples I can give you on into the end of the morning all involve people who are fully insured. The insurance system is an incredible waste of money, time, effort, and a huge barrier to effective medical care. Let me respond to the previous question from the person in the audience. I am – I have a degree in public health. I practice preventive medicine. I’m very enthusiastic about that. But it’s horribly diversionary to bring that issue up at this time. Even the most healthy living yogi in the mountains in California is going to get sick and die someday. I’ve been in intensive care units with yogis getting maximum medical care at the rate of $50,000 a day. We all need it someday sooner or later. My problem is that it’s diversionary from the existent pain, anguish, suffering and death that happens. Every two months or so, someone comes into my office who is either uninsured or afraid of their deductible or copayment with – at death’s door. We have people going into bankruptcy. We have people dying because there is pain. There are deaths. There are anguish. There is suffering out there and to bring the discussion to talk about preventive medicine takes your eye off the ball. Most of the – I can’t believe the discussion in Washington. I was with Jan at a congressional town meeting here last summer when the Tea Party people came in. If they are so anguished about death panels and so on, why don’t they get in order and get out marching to prevent the people that are suffering now that are dying here today in this country of ours where we used to be wealthy. And we’re pushing them to the side of the road in the name of something. I don’t know whether it’s morality or profit. But it happens today and nobody’s doing anything about it. And if we give it to the insurance companies, I don’t believe it will happen.

CAVANAUGH: Let’s take another call. Peter is calling us from Rancho Penasquitos. Good morning, Peter. Welcome to These Days.

PETER (Caller, Rancho Penasquitos): Hi. Thanks for taking my call. I got two quick questions and I’ll take the answers off the air.


PETER: The first one, is there any kind of a website or a document anywhere where someone has whittled this big, hairy problem down to something digestible. What I’m thinking is like for every dollar that is spent in this country on healthcare, how much actually goes to a doctor’s salary versus a hospital’s overhead versus, I don’t know, nursing versus medication versus the…

KNOLL: I don’t know…

PETER: …hospital or tests.

CAVANAUGH: We’re going to address one of your questions now, Peter.

KNOLL: I don’t know that there is a specific report like the one you’re asking but there are a lot of websites that give a lot of great information. Kaiser Family Foundation has analyzed over and over the effects of the various proposals and how the system is stressed out right now. There’s ITUP or Insure the Uninsured Project has various analyses and what it means for Californians. I wish I knew where to go for your particular question on a research paper but there are many and maybe I can – you can contact me offline.

CAVANAUGH: And Dr. Gordon.

DR. GORDON: I would add one, is the Commonwealth Fund…

KNOLL: That’s another one.

DR. GORDON: …which has excellent analyses and…

KNOLL: Great.

DR. GORDON: …a wideranging discussion that’s…

CAVANAUGH: And, Peter, what is your second question?

PETER: It’s kind of a theoretical one and I’m not advocating this but as a person who’s not very enthusiastic about the government being able to run a big program with financial discipline, especially over the long term, I’m wondering what would it look like if the government just decided to take a very draconian libertarian approach and say, look, we’re not going to prop up healthcare. Let it – You know, if it’s falling apart, eventually what’s going to happen is the doctors won’t get paid by insurance companies, they’ll stop dealing with them and they’ll start looking at their patients, figuring out how much they can pay then do the – and start practicing medicine on more of an individual basis with the patients as opposed to with the insurance company.

CAVANAUGH: Thank you, Peter. And let’s have the doctor on the panel comment about that.

DR. GORDON: Well, my patient who needed back surgery, his hospital bill alone came to $123,000. That does not include doctor’s bills. And so I ask you whether a security guard at Padres stadium could save that much money and raise his two kids and be able to afford the necessary medical care under a chaotic system. The question is not appropriate. It doesn’t deal with the reality of the real world. People get drastically sick. My college roommate called me about a year ago, said his son had been playing frisbie in San Francisco and hurt his knee and couldn’t walk on it. Did I know any orthopedic surgeons in San Francisco? My advice to him was put him on a plane and fly him home, it would be cheaper. Where did he go? He went to Toronto where they are fully insured and any plane fare to Toronto from San Francisco would be about the quarter price of an encounter with an orthopedic surgeon and MRI in San Francisco.

KNOLL: I think the other answer to the caller is that that sort of let them eat cake approach could be okay if you were willing to put up with the political fallout of 250,000 people a year just dying. The fact is that government has a real role to play. And, I mean, and I’m – I just get very aggravated with many, many people who want to say no big government. Well, I think what they mean is no big government unless I can spend it on war. But big government for people is something that they – that’s what they mean they don’t want. But I will tell you, when you talk about government regulation, you can look at two places: Chile and Haiti. In Chile, they had a earthquake that was 500 times the power of the one in Haiti. They lost 2,000 lives, tragic to be sure. With a 500 time less of an earthquake in Haiti, they lost 250,000 and still counting. The difference: government regulation, and regulation of building codes. There is a role for government to protect those that cannot protect themselves from insurance companies or from builders.

CAVANAUGH: Well, I want everyone to know that our phone lines are jammed. I want to take another phone call but, please, if you have a comment, go online, post it online, And, Jan, you wanted to respond.

SPENCLEY: I think it’s important to point out—and I think Dr. Gordon has pointed it out—the Medicare program is one of the most efficiently run programs in the country. And the – So if you look at that, you can’t say that government hasn’t done a pretty good job in the health arena. The CHAMPUS program and the TRICARE program for military, also excellent programs. They are public-private partnerships and they work. And I think it’s extremely important to note that the government serves as the aggregator in that case.

CAVANAUGH: Let’s take another phone call. Mitzi is calling us from San Diego. Good morning, Mitzi. Welcome to These Days.

MITZI (Caller, San Diego): Thank you. Good morning. Just a quick comment. I guess my position is do whatever it takes. I would have preferred single payer but that’s gone down. Get your toe in the door. I agree with most of the comments that have been made. I think single pay – or, that passing this bill will result in problems. There will be gaps. There will be holes. One of two things will happen. Either they will, across time, start addressing and fixing the problems or they’re going to have to scrap it and start all over. As an American who lived abroad in Canada for a number of years and who had a child with cancer, three years of treatment, months of hospitalization, $100 out of the family’s pocket. I know what different healthcare systems can – how they can impact a family. Now I’m here and delighted to be so but I’m uninsured and hanging by my nails. And so I think we have to do something. This bill is – I’m frustrated by it. It’s imperfect. But it’s at least a toe in the door.

CAVANAUGH: Thank you, Mitzi. Thank you for your phone call. I want to address that toe in the door strategy and go to you, Jan, first because I know there are some Republicans who are against this bill who argue the same thing, this is a toe in the door to government run healthcare. And I – But looking at it from your point of view, how can getting this toe in the door eventually lead to better coverage for people?

SPENCLEY: Well, it – Right off the bat, it defines better coverage. It defines coverage for millions of people under the – of low income people under the Medicaid program, it calls for health insurance exchange and for subsidies for low and modest income individuals and it provides a health insurance exchange for people who currently can’t – guaranteed issue insurance regulation, so it starts to move the curve. I’m going to be very honest. I wanted a public option. I wanted a public option on the table to compete. Isn’t that what the marketplace is for? Let’s have a public option out there to compete with the private insurers. I’m not getting everything I want out of this bill. And – But I’m getting more than what I’ve got today and I don’t think it’s – I don’t think businesses, I think Dr. Gordon is right, I don’t think it’ll happen as quickly. People can’t afford coverage but that insurance industry is very, very clever so they get higher deductibles, they get higher co-pays. That means no access to care for preventive care, for early intervention. It means foregoing medications, it means foregoing things your doctor ordered.

CAVANAUGH: Dr. Gordon, do you think that if, indeed, this bill passes, this toe in the door kind of a scenario could improve this bill to the point or improve this healthcare reform package down the line to the point where you would begin to support it?

DR. GORDON: Frankly, I’m not optimistic about that happening. I really think, especially in view of Citizens United and the Supreme Court, that the distortion and the capability of our government to govern any responsible way for the benefit of the citizens is on the downslide. There was an interesting quote in a recent Tom Freeman column that called us the generation of locusts. We are locusts, the last two – 20 years, eating up the prosperity that was created by the previous generation of hard workers, and I don’t see this trend changed. And I think this bill is symptomatic of that. It’s going to rescue the insurance companies from the self-created demise and it will not make the functionality of the medical system any improvement.

CAVANAUGH: Greg, you know, as Dr. Gordon obviously is not a fan of this bill but, you know, we’ve been talking about it as if it is going to pass. It’s still a very big question as to whether or not this healthcare reform package will pass.

KNOLL: Absolutely.

CAVANAUGH: Do you think that it will?


CAVANAUGH: And why so?

KNOLL: Because I think despite my – I think my heart sometimes overrules my common sense and I cannot believe that the Democrats, with the greatest majority in half a century, will not do the right thing and continue to work, not on government control of healthcare but a foot in the door to government regulated healthcare so that we don’t have the tragic stories of the people on insurance or the people who cannot get insurance. That’s my view.

CAVANAUGH: I’m afraid we have to leave it there.

SPENCLEY: Okay, that’s fine.

CAVANAUGH: We’re out of time. I want to thank you all so much. I want to thank so many people who called. We weren’t able to get you on the radio but please go online, post your comment at My guests have been Jan Spencley and Gregory Knoll and Dr. Jeoffry Gordon. Thank you all once again for sharing your wisdom.

SPENCLEY: Thank you very much.

DR. GORDON: Thank you.

KNOLL: Thanks for having us.

CAVANAUGH: Stay with us for the second hour of These Days coming up in just a few minutes right here on KPBS.