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Health Care Reform, Who's Covered?

Health Care Reform, Who's Covered?
Health care reform is one step closer to a senate vote. How would the bill impact San Diego's uninsured? This week on the Editors Roundtable, can real change be achieved while cutting healthcare spending, and how much will change before the final vote?

ALAN RAY (Host): You’re listening to Editors Roundtable on KPBS. I’m Alan Ray in for Gloria Penner. On the table for discussion today: the passage of a healthcare reform bill by the U.S. House of Representatives and what that might mean for San Diego’s uninsured, San Diego military veterans coming home from war only to face new battles trying to obtain mental health and other support services, and a discussion of term limits. A local labor union seems to have gathered enough signatures—that would be about 80,000—to ask county voters whether the County Board of Supervisors should be subject to term limitations. Joining us around the table today are Hieu Tran Phan, specialists editor for the San Diego Union-Tribune. Good morning.

HIEU TRAN PHAN (Specialists Editor, San Diego Union-Tribune): Good morning, Alan.

RAY: Kent Davy, editor of the North County Times.


KENT DAVY (Editor, North County Times): Morning, Alan.

RAY: How you doing?

DAVY: Great.

RAY: And Dave Rolland, editor of San Diego CityBeat. Good morning.

DAVE ROLLAND (Editor, San Diego CityBeat): Good morning.


RAY: Okay, Dave, you first. It can’t have been much of a surprise when the votes were finally counted, that the San Diego congressional delegation split along party lines in this vote on Saturday.

ROLLAND: No, not a surprise at all. It was pretty much a party line vote all the way through the House of Representatives, sure.

RAY: Where do we – where do you imagine this goes when it gets to the Senate? Or can the bills that came out of the House be reconciled with what the Senate’s working on?

ROLLAND: Well, they’re going to have to reconcile it. You know, we have two – or, two – there were two bills that came out of two different committees in the Senate. Now we’ve finally got one from the House. Harry Reid has enormous amounts of power as the leader of the Senate. Now he is – he has apparently reconciled the two bills that were in – that came out of Senate committees. He has drafted his own measure and is waiting for it apparently to be scored by the congressional budget office, which will come out with a highly anticipated, widely talked about analysis of the finances associated with whatever bill he comes up with. And then – So there’ll be some tough sledding in the Senate over the vote of that bill, whatever it is, and then it’s going to have to be reconciled with the House bill. So there’s a long way to go.

RAY: This is the Editors Roundtable. I’m Alan Ray, in for Gloria Penner. You’re certainly welcome to join the conversation, 1-888-895-5727, 1-888-895-KPBS. There is discussion that I guess Senator Reid is saying he can have a vote by Christmas. If it doesn’t get to Christmas, if we get past the new year, if we get into a new election year, does that complicate things?

ROLLAND: Well, from what I understand people do say it complicates things. The closer you get to next year’s elections, the more complicated it gets because, you know, you have to start doing a lot more calculus in terms of different legislators, different congress people and Senators who are facing different environments in their districts.

RAY: I have to wonder, Hieu Tran Phan, does it seem to you that the congress is relying perhaps too much on the Congressional Accounting Office in this?

PHAN: I think this discussion, this debate, finger-pointing and guessing about how much it’s going to cost and whether this will actually save Americans more money in terms of the staggering amount of healthcare expenses is multi-pronged. I don’t think it’s going to end between now and December even after legislation passes out of congress, if it does, and the Senate. We’re still going to have this situation and I think it’s going to be pretty much a guessing game for the next five years at least as any program rolls out. But I want to bring back to this point whether we agree about the specifics of the House bill or the Senate bill or any other proposal, the current situation is not doable. It’s just not going to be workable in the long run. The healthcare cost is at $2.4 trillion last year, it’s going to double in another decade, and it’s going to outpace inflation by 2% every year. That’s not a feasible situation and unless Americans realize that they’re going to have to sacrifice in various ways, whether it’s a Medicare recipient, whether it’s somebody 35 years old like me who barely accesses the healthcare system or whether it’s middle class families struggling to meet their household budget, everyone’s going to have to give a little bit in order to get more insurance for more Americans.

RAY: Kent Davy, what do you think the bottom line will be for the Catholic Democrats in the Senate? Can this get through with abortion being such a critical issue being raised by their Bishops?

DAVY: If the matter is taken out of the bill – Let me put the background. A Michigan congressman got the votes to insert language that prohibited federal and state expenditures through this to be used for abortions. That is a bitter pill for the Pro Choice segment of the political – or the population of the politicos to try and take. I suspect there’ll be an attempt to try and remove it in the Senate version or at least in reconciliation. But I think it will be a sticking point for some Catholic senators. Additionally, I think it is not close to a given that Reid is able to get a vote on this before Christmas. He is making noise that this is going to have to slide until later in the – or, earlier next year. If that’s the case, as David’s pointed out, it becomes more and more fraught that this thing is going to be able to pass through in anything like its current fashion.

RAY: Let’s get a little bit real about the possibilities here. There are so many unintended consequences to so many of the things we do with good intention. Nineteen hundred and ninety pages in the House version of the Healthcare Reform Bill. Is it possible that when this is done, we get reform that actually makes healthcare worse rather than better?

ROLLAND: Anything’s possible. I think when you have – When I was reading about some of the past stories on this issue this morning, I kept thinking how you have – what you have is 535 cooks in the kitchen and, you know, that – that’s 100 senators and 435 members of the House of Representatives. And when you’re trying to appease so many different constituencies, the soufflé, the stew that you come up with, you know, is likely to be a colossal mess in the kitchen. So we don’t know yet. I mean, we have no idea what’s going to come out of this. I think a lot of people on the left, myself included, would have preferred that we just at least get a single payer system on the table that a lot of people think would contain costs the best over the long term when you have – when you focus on preventative medicine and getting everybody check-ups when they need them and that sort of thing. But we don’t know, you know, we don’t know how all these efforts to pay for the bill are going to work out, you know, as the interplay between private insurance and whatever public option comes out of this, you know, we don’t know how it’s all going to work.

RAY: Okay, all hands went up a moment ago. Hieu.

PHAN: Alan, I think this is the difficulty of the ordeal, I would say. Legislation of this massive size, most Americans don’t want to pore through a document like that much less even get a summary of it. They’re just going on their pocketbook fears and concerns and so forth. And I think this is probably incumbent upon the media, including the Union-Tribune, and other publications and radio and so forth to try to give people a clear outline of what is being offered through the legislators and then they can make up their minds better. I think here’s what I would say is the current status of our bills. It focuses a lot on trying to get more Americans health insurance coverage and that’s about it. In terms of the effectiveness of that medical care, in terms of the efficiency of it, in terms of whether we are emphasizing end-of-life issues, other things are really important to not just giving people the quantity of care but actually making them better, I don’t think that’s being addressed yet at this point.

DAVY: One of the problems in this is that in order to extend care to even—and this doesn’t extend care to all uninsured Americans but to a substantial piece of those uninsured—you’ve got to have the money to pay for that. The net effect of that is going to be either taxes on Cadillac health insurance policies, which are opposed – a proposal opposed by unions because the labor unions tend to have members with very fine health insurance policies. There are also consequences likely to be a dramatic in the premiums for the rest of the general middle class because you’ve got provisions that extend benefits, say you cannot no longer exclude people for preexisting conditions. Those sorts of dynamics have to push the actual cost back on most people up. So I think that as people start to understand this, they become more and more disinclined to like what’s going on, and it’s part of the political problem that they’ve got. In addition, you’ve got Lieberman sitting out there saying I’m not voting for a public option and he is a necessary key in this to get through the Senate.

ROLLAND: And not only is he not voting for a public option, he is vowing to kill the bill through the filibuster process.

DAVY: Yeah.

ROLLAND: So he is not only just saying I’m not – simply not going to vote for that because I don’t like it, he’s saying I’m going to prevent this bill from even being, you know, reaching the floor.

RAY: Let’s get to the telephones. Richard in Escondido, good morning. You’re on Editors Roundtable.

RICHARD (Caller, Escondido): Hello.

RAY: Yes.

RICHARD: Hi. What I see is that we in World War II helped the Europeans and now almost each and every country over there has what is considered socialized medicine and, you know, who really won the war? Did they or us? Because they take care of their people better than our own country takes care of us. Our Senators and congressmen have an excellent health plan so why can’t we have the same thing? You know, we could spend millions of dollars to fight a war but we can’t spend the money here on our own people. There’s something wrong.

RAY: Well, the question arises then how did the rest of the world get to the kind of medicine it has and why didn’t we?

PHAN: Well, I think this is part of the situation. America ranks very low compared to everything from Canada to France, Great Britain and so forth, Australia, in terms of the mortality rate, the recovery rate and so forth. And this is basically the reason why we go after the latest technology, we always have interests groups, whether it be doctors, hospitals, health insurance companies, patient rights advocates, we all don’t want to give up anything. We don’t want to have lower payment rates, we all don’t want less revenue. And I think that kind of self interest perpetuates this cycle of double digit annual health insurance premium increases. And whether people think they’re going to pay more or less under the new system, they already are paying more every year.

DAVY: I think Hieu’s making an apples to oranges comparison. When you start comparing homogenous populations in some European countries and their mortality rate, their infant rate, to a much more diverse population in the United States, all of a sudden those are not a valid way to analyze why it is – are the – which of the systems is better. The real fundamental difference between the European system and the American system is that Europe has been willing to live with 10 to 12% unemployment for decades. That is part of the tradeoff in order to have the social goods to give health insurance to everybody.

RAY: And they all seem to like it. Let’s look closer to home and healthcare here. 360,000 people estimated to be without health coverage in San Diego County, 36 million across the country. Any idea how healthcare reform, if it happens, might actually look in the face of San Diego County?

PHAN: Well, one of the things is this, community clinics provide a huge back loan for our county. Our county outsources much of its healthcare services and I think the clinics welcome any type of reform because it would bring more dollars to their system and it would allow a lot of not only low income but lower middle class and even average middle class people, especially during the recession right now, to access care better. I think, otherwise, we’re going to see probably a greater impact as the years go on of emergency room services, which then get translated to higher premiums for everybody else. So I do think that it’s going to help the community clinic system in terms of doctors. Here, we already have lower Medicare rates compared to the many other areas of the country, especially urban areas. I think doctors are concerned that their rates will be lowered further and they – they’re looking for the Senate to void those rates and give them some incentives.

RAY: Dave?

ROLLAND: No, I don’t have anything to add to that.

DAVY: Yeah, I would guess that nobody has a clue of what this does on the local landscape.

ROLLAND: Because we, again, we don’t know yet because we don’t know what the bill’s going to look like. There are vast differences between what the House came up with and what the Senate might come up with. We just don’t know yet. We don’t know what the Lieberman effect is going to be. We don’t know if Harry Reid is going to try to attract, you know, Olympia Snow from Maine to replace Lieberman’s vote. You know, she’s no more enamored of the public option than he is. So we have no idea what’s – what it is that’s going to get a bill even to the floor of the Senate yet.

DAVY: There’s a philosophically interesting, and I think diametrically opposed problem trying to be solved, you have on the one hand people saying we’ve got to control cost of healthcare, on the other hand saying we need to expand and cover health costs for an additional 30 million people. Those two directions are vectors going in opposite directions.

RAY: That’s a collision course.

PHAN: Well, but that’s why I bring back to the point that we are not talking about the quality and efficiency of healthcare. There are numerous ways that you can cut huge amounts of money out of the system but that is a much thornier topic to take on than just expanding coverage. I want to go back to the point that while there are many questions in the healthcare legislation, there are also many areas of full agreement between the president and both parties and one of those areas is the expansion of Medicaid and that’s where the community clinics come in. The other areas, clearly, we talked about some of the things such as preexisting conditions would no longer be a valid cause for insurers to cancel your policy, things like that. There are numerous areas that have already been spelled out and are set, basically, in stone that we know that will come through the House and the Senate and is supported by the president.

RAY: You’re listening to Editors Roundtable on KPBS. Matt in Ocean Beach, good morning.

MATT (Caller, Ocean Beach): Yeah, hi. I actually just had a quick question. Basically, I’m curious to know how the healthcare coverage for everybody would work. You know, I know that there’s like a mandate and it’s being described as basically like everyone has car insurance if you’re driving. I’m curious to know if you’re unemployed or don’t have income or just can’t afford health insurance, how do you end up getting it if it’s like car insurance where everyone has to pay for that if you have a car.

ROLLAND: Well, you get a subsidy from the government to get some basic care through an exchange or a public option or something like that.

PHAN: There are various options out there. One is what Dave just mentioned. Two, you can get an exemption in the House bill. I don’t know how that’s going to stay or not stay in the Senate version. You can also qualify for a government insurance programs whether it’s a public health option or for Medicaid, which is MediCal in our state.

RAY: You’re listening to Editors Roundtable. I’m Alan Ray in for Gloria Penner. Our guests today are Hieu Tran Phan, a specialists editor with the San Diego Union-Tribune, Kent Davy, editor of the North County Times, and Dave Rolland, editor of the San Diego CityBeat. When we come back, we’re going to talk about veterans and mental healthcare.