Health Care Reform: A Healthy Skepticism?

Fox Valley Candidates Discuss This Year’s Most Controversial Issue. By Paul Stukel (Registration required)

When a writer has a particular perspective on an issue that he is writing about, it behooves him to say so.  While I have done my best to provide an objective and faithful representation of my discussions with the candidates above, the reader should be aware of any unintentional bias that may be present.  Therefore, in an attempt to lay bare my personal views, and hopefully to assist in analyzing the various elements of this crucial issue, I have presented my own thoughts on health care reform at the end of this article.

A note about the construction of the article.  One thing that concerned me in presenting the interviews above was the potentially misleading nature of the split between Rep. Foster, the incumbent Democrat, and the three Republican challengers (a fourth, State Senator Randy Hultgren, R-Wheaton, did not respond to several requests for his input). Simply put, the Republicans had similar views on several subjects, all of which were contrary to those of Rep. Foster, and all of which were repeated by each candidate.  Thus, since the reader will repeatedly see some of the same viewpoints from each of the Republican candidates, it might appear as if Rep. Foster is taking a minority position on the issue.  Of course, this is not necessarily the case.  It should surprise no one that in a group of one Democrat and three Republicans, the Democrat would be in the minority.  Whether it is Rep. Foster or the Republicans who represent a minority viewpoint in terms of the electorate is something for elections to determine.  Therefore, the reader will note that I devoted significantly more space to Rep. Foster than the Republican candidates individually, and I placed Rep. Foster at the forefront of the article.  As for the placement of the Republican candidates, I simply went in alphabetical order to avoid suggesting that any one of them is the frontrunner.

Something remarkable happened in America this summer.  In fact, in political terms, it might be one of the most remarkable summers in a generation. Sparked initially by the Obama administration’s trillion dollar stimulus package, a broad, vocal and aggressive grass-roots movement has arisen seemingly out of nowhere, putting pressure on lawmakers at virtually every level, and shaking up the body politic in a way unseen since the turmoil of the 1960s.  Loosely referred to as the “Tea Party Movement,” these activists have shifted their focus to President Obama’s health care reform agenda, striking similar themes of fiscal conservatism, smaller government and general distrust of both Administration and Congressional ambitions.  So far, their impact has been significant.

Conversely, the Administration and its Congressional allies have seemingly been caught flat-footed.  Having failed to push through legislation prior to the August recess, Congressional Democrats, who enjoy a wide majority in the House and a filibuster-proof majority in the Senate, were subjected to intense opposition at so-called “town hall” meetings across the country, while President Obama’s rhetorical skills have apparently failed to turn the tide.  Throughout this period, polls have shown consistent and dramatic erosion of public support for the plans being presented (with the exception of a brief  “bump” following President Obama’s address to a joint session of Congress – a bump that dissipated within a few days).  As of this writing, most polls show a majority of Americans opposing the President’s plan, and with an intensity that suggests a difficult road ahead for reform advocates.

This week, Senator Max Baucus (D-MT), the powerful Chairman of the Senate Finance Committee and the majority’s point man on health care legislation, unveiled his long-awaited draft legislation after failing to garner any Republican support on the Committee.  Baucus’ proposal pointedly avoids the highly controversial “public option” – the establishment of a government-run insurance plan designed to compete with private insurers, and which opponents argue will ultimately lead to a government-run, “single payer” health care system.  However, the proposed bill still contains highly contentious elements: an individual mandate requiring all citizens to purchase basic health insurance or face sizable penalties, creation of government-chartered “co-ops” that would provide lower-income Americans with subsidized insurance through a (theoretically) user-managed health care organization (similar to electricity co-ops established in various rural areas of the country), potential penalties for employers with more than 50 employees who do not provide health care coverage, an excise tax of up to 35% on higher-premium plans, and, perhaps most controversial, reduced  Medicare and Medicaid reimbursements of approximately $400 billion. 
The initial response to Baucus’ proposal has been fairly tepid on both sides of the aisle.  Indeed, Senator Jay Rockefeller (D-WV) was blunt in his criticism, largely due to the lack of a public option provision: “There is no way in its present form that I vote for it unless it changes in the amendment process by vast amounts.”  Finance Committee member Ron Wyden (D-OR) was equally scathing.  Republicans, on the other hand, objected more broadly to the plan, with criticisms ranging from opposition to the individual mandate to the complete absence of any element of tort reform, considered by many to be a key element in cost containment efforts. 

In the House, where the GOP opposition has virtually no power, Speaker Nancy Pelosi (D-CA) faces significant difficulties from her own caucus.  While almost all versions of legislation being considered in the House include the public option, a group of roughly 30 moderate Democrats, the so-called “Blue Dogs,” have threatened to join Republicans in opposition if such an option remains in the final bill.  On the other hand, more liberal members have threatened opposition if the public option is not included.   Meanwhile, a group of similar size has threatened to vote “no” if a strong, unambiguous provision barring any federal monies being applied to funding abortion is not adopted.  In short, while the Democrats enjoy complete power in the House, the divisions within the party are posing a significant challenge to the leadership’s desire to pass a bill amenable to both the ascendant liberals and the less numerous, but crucial, moderates.

With all this in mind, we interviewed key political figures in the Fox Valley to get their views on this most crucial of issues.  We focused on we considered the fundamental issues:  cost containment, coverage, tort reform, pre-existing conditions and the public option, the latter of which goes most directly to the philosophical issue of the role of government in health care and beyond.  Finally, we asked our friends at Delnor Community Hospital to give a provider’s view of the key issues facing our health care system.

Congressman Bill Foster, D-Batavia
“The most important thing to remember,” says Rep. Bill Foster, “is that 80% [of issues related to health care reform] is agreed on both sides.”  Foster was responding to what he called “a window for compromise” he felt President Obama opened during Obama’s address to a joint session of Congress in early September.  “So we’re really not as far away as you might think from listening to the media.”

Foster is a supporter of the public option, although with the caveat that “it must compete [with private carriers] on a level playing field – meaning, no hidden subsidies.”  Foster believes that a public plan is necessary to provide competition with private insurance providers in many markets, and that a government-run plan would prove “more efficient” than private carriers who, he asserts, “waste” money on “big CEO payouts and benefits, needless marketing and, of course, profits.”  When asked how private carriers with limited capital and shareholder responsibilities can compete fairly with a government entity with no such constraints, Foster responds by pointing out that that “there are many non-profits out there currently competing against private concerns,” so a government-run entity would be no different.  “Further,” he points out, “research suggests that roughly 96% of people would stay with a private carrier rather than choose the public plan, so I don’t think the private market is in jeopardy from this proposal.”

Foster is also adamant that an individual mandate is essential.  “It’s two sides of the same coin,” he says. “Every American should have access to basic, good quality health care.  But, having been provided that access, they should be required to take it, with appropriate subsidies for those who can’t afford it.” 

The absence of tort reform is not something Foster worries about.  “The AMA [American Medical Association] estimates that 100,000 people die each year from medical errors,” he noted.  “About half of these are from improper use of drugs – bad prescriptions, wrong quantities, bad timing, etc.  That’s a real problem.”  Foster suggests that the most important issue to be addressed is the reduction of medical error. “Award caps [arising from any tort reform legislation] will not have much of an impact.  We’ve seen this in Texas and California, where caps haven’t significantly reduced the cost of malpractice insurance premiums.  In fact, most awards are based on real damages, not nuisance suits or crazy jury decisions.” Reducing medical error, and therefore litigation costs and extensive “defensive medicine,” is the key for Foster.  “A large number of those 100,000 people die of errors that are entirely preventable.  Infections at the hospital, for instance.  Drug errors.  Inaccurate patient information.  All of these things are preventable through proper protocols, better technology and greater transparency for consumers. That’s where the opportunity is.”  Foster did, however, speak approvingly of a proposal by Senator Richard Durbin (D-IL) requiring a “pre-screening” of malpractice lawsuits by a “disinterested medical board” to determine the validity of the claim that a medical error had occurred.

How to pay for his plan?  “Well, half of the cost is already in the system in the form of treatments for currently uninsured patients,” Foster says.  “Here in Illinois, for instance, it costs every citizen approximately $1200 per year to treat the uninsured.  Having everyone insured will eliminate that hidden cost.”  The other half?  “I’m in favor of tax surcharge on the top 1% of earners.  As I recall, these folks did okay during the 1990s, so I don’t think it’s that much of a burden.  If the plan works the way I think it will, I think we’ll get that back through costs savings over time.”

Any room for compromise?  “Look, I’m still waiting for the fine print on this, so nothing is certain yet.  But compromise?  Yes, I think I’d be comfortable if we tried some state-level experimentation for the public option, allowing states to determine their own approach and see what works.  It’s funny, that’s kind of a ‘states rights’ thing, which Republicans generally tend to support, so I don’t know why they’d object to it in this case.”

Jeff Danklefsen, R-Elgin
Jeff Danklefsen, didn’t buy the idea that there is a compromise available on health care reform.  “Congress does not have the authority to take over health care in this country.  The Constitution doesn’t allow it,” he says definitively.  “Now the states, that’s a different matter.  But not the federal government.”

Given this fundamental position, Danklefsen stands solidly against the public option.  “The [federal] government isn’t well-known as a great solution-provider,” he states.

Danklefsen’s prescription for health care reform relies on the combination of consumer empowerment, elimination of government mandates and litigation reform. “The solution to rising costs and coverage is a consumer-driven market,” he says. “We need to expand things like Health-Savings Accounts that provide the consumer so much more control over how they spend their health care dollars, which providers they want to utilize, how much risk they want to take on or eliminate.’

Danklefsen is equally insistent on the need for what could be called “mandate reform.”  Government mandates, which vary from state to state, require insurers in a given state to offer or provide specific coverages for certain drugs or conditions that might otherwise not be offered or provided.  For instance, some states mandate that all insurance plans in that state must include coverage for female contraception drugs in response to insurers covering anti-impotence drugs like Viagra.  “We’ve got to eliminate these costly government mandates and let the free market determine what is covered and what is not.  Government shouldn’t be in the position of dictating that.”

Interestingly, when asked about proposals allowing for insurance providers to sell across state lines, thereby vastly increasing both availability and choice to consumers while reducing administrative costs for the providers,  Danklefsen balks.  “It certainly would increase competition,” has says, “but such a proposal would bypass the rules of the States, which is unacceptable.  But it does show you the direction the Democrats want to go:  a health care reform bill at all costs.”

As for litigation reform, Danklefsen agrees that it is necessary, and questions why no mention is made of it in any of the bills currently in consideration.  “Look, medicine is a practice, not a perfect science.  Things are going to happen.  Sure, if a doctor makes an egregious error, he or she should face litigation.  But the frivolous suits and insane awards are causing a big problem.” Regarding the Democrats, he is blunt. “The current bills have nothing to say about litigation reform because the trial lawyers [who, as a whole, reject the need for litigation reform] are some of the biggest donors to the Democrats.”
With respect to pre-existing conditions, Danklefsen agrees that something needs to be done, but he would “rely on the free market” and help develop “larger pools” of insured individuals to allow insurance carriers a greater ability to diversify risk.  “It’s absurd to think that government can make it better.”

What does Danklefsen think of Baucus’ idea of federally-chartered co-ops?  “When I hear the word ‘co-op,’ I hear ‘single-payer’ system.”

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