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The High Cost of Health Care (Part 4)

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The High Cost of Health Care (Part 4)

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We continue our 5-part series on the high cost of health care in America.

The High Cost of Health Care (Part 4)
Thursday, August 6, 2009

MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh, and you're
listening to These Days on KPBS. We've been bringing the healthcare
debate home this week on These Days. We've heard many points of view,
from letting the free market decide who gets healthcare, to requiring
the government to provide open-ended coverage to all. We've also
examined some of the key elements in the healthcare reform bills
working their way through congress.

This morning we'll address the hard political realities that
confront any change in our healthcare system. Some have likened the
process to turning the Titanic; it's necessary, but not very easy.
Special interest groups in the healthcare debate are pulling out all
the stops to make sure they come out okay in any reform deal. And while
the debate continues, the only thing that's certain is that the number
of uninsured Americans continues to grow. San Diego Congressmen Brian
Bilbray and Bob Filner will join me to debate healthcare reform in just
a few minutes but first we’ll get an update on how far the actual
proposals on healthcare reform have gotten in congress. With that
update is my first guest, NPR White House correspondent Scott Horsley.
Welcome to These Days, Scott.

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

CAVANAUGH: Now, the House is in recess. The Senate begins its recess
tomorrow. As they leave town, what’s the state of their various
healthcare proposals?

HORSLEY: Well, you ask how far they’ve gotten, they haven’t gotten
as far as President Obama wanted them to get. Of course, the House left
without taking a House-wide vote, although the three committees that
had control of the bill have all voted now, and now the House members,
like Congressman Bilbray and Congressman Filner are listening to their
constituents and trying to decide what they’re going to do when they
get back in September. On the Senate side, yeah, they go out tomorrow
and today the president is meeting with the ‘gang of six,’ the three
Republicans and three Democrats from the Senate Finance Committee
who’ve been working very hard to try to come up with something that
both parties might be able to agree on or at least a handful of
Republicans might be able to sign onto. So he’s going to have that
meeting today but this is going to drag on a lot longer than the White
House wanted it to.

CAVANAUGH: Now the Obama administration is being hands-off about
telling the House and Senate what to put into the bills. But what does
the president want to see in any bill that comes to his desk?

HORSLEY: He has limited himself to sort of outlining broad
principles as opposed to specific mechanisms. He’s said he wants to
cover the uninsured and he doesn’t want to add to the deficit. He wants
to keep the insurance companies honest. Last week, he gave some ground,
or at least appeared to give some ground, on the notion of a public
insurance plan. He had – He continues to say he’d like to see some sort
of public insurance option within this new marketplace that they plan
to create. But last week he and his spokespeople suggested that the
real test is not a, quote, unquote, public option but is there choice
in competition in the marketplace? And that seemed to leave the door
open for something other than a public option provided they could have
at least a fig leaf of choice in competition. But those are sort of the
broad principles that the president’s laid out and that’s left it to
lawmakers to wrestle with, you know, some of the tougher questions like
should there be a public option and, equally contentious, how do you
pay for the roughly trillion dollars over the next ten years that it’s
expected to cost to extend insurance to all the uninsured.

CAVANAUGH: Well, that was my next question, Scott, but I think you
might’ve answered it. The main sticking points, are they the public
option and the cost?

HORSLEY: I think those – those are, you know, the biggest ones.
There are also questions about employer mandates, you know, whether
employers should have to provide insurance for their employees, and I
don’t think anyone thinks that the smallest employers should have to
provide insurance for their employees but there’s a question about
where the cutoff line is and should there be an employer mandate at
all. There are questions, you know, about what shape an individual
mandate ought to take. There’s, I think, a growing consensus that there
has to be some requirement that everybody have insurance to avoid what
the experts call adverse selection where all the healthy people don’t
get insurance and the sick people do. But what mechanism you use to get
everybody to have insurance, those are questions. But I think the big
sticking points are, for now, the public option and what – how you go
about financing this thing.

CAVANAUGH: Well, what happens when the members of congress return in September?

HORSLEY: Well, I guess you should ask your other guests that. They
know better than I. But that’s the big question, you know, whether this
month long lull will be just a bump in the road and they’ll come back
and they’ll get right back to work and make forward progress on this.
Or whether this will really be a detour that doesn’t get back on track.
You know, there was a reason that the White House was so insistent on
getting a vote in the House and the Senate before this August recess
was there was a real fear of losing momentum, and so I guess that’s
what we’ll find out when they come back in September, is whether this
month at home listening to their constituents has gotten them as
committed or more committed about doing something about overhauling the
healthcare system or if it’s given them pause, and they come back and
say, geez, let’s take another look at this.

CAVANAUGH: And correct me if I’m wrong but didn’t Harry Reid, after
a White House meeting yesterday, pledge that there would be a bill to
reach the Oval Office on healthcare by the end of the year?

HORSLEY: Yes. Of course Nancy Pelosi pledged earlier that there
would be a vote before the House went home, so I think I’m – Count me
in the sort of believe it when I see it camp.

CAVANAUGH: I see. Well, thank you so much for talking with us, Scott. I really appreciate it.

HORSLEY: It’s great to be with you.

CAVANAUGH: I’ve been speaking with Scott Horsley. He’s NPR’s White
House reporter. Now, two of the members of congress who are on – at
recess that we were talking about are here in the KPBS studio with me
and it is my pleasure to welcome Democratic Congressman Bob Filner, who
represents the 51st District in San Diego and Imperial County. Welcome,
Congressman Filner.

BOB FILNER (U.S. House of Representatives, D-California): Good to be here, Maureen.

CAVANAUGH: And Republican Congressman Brian Bilbay – Bilbray, excuse
me, who represents the 50th District here in San Diego. Congressman
Bilbray, welcome.

BRIAN BILBRAY (U.S. House of Representatives, D-California): Thank you. That’s okay, Mary, don’t worry about it.

FILNER: He’s been called a lot worse.

BILBRAY: It’s a little village in Sherwood Forest…


BILBRAY: …so that’s how you can remember Bilbray.

CAVANAUGH: I will try to get it right for the rest of the show. And
I want to invite our listeners to join the conversation. We have here
two of the people who will actually vote on healthcare reform
legislation. Call with your questions and your comments. Tell them what
you think. Give us a call, 1-888-895-5727. You know, before we start on
the specific proposals that we’re going to talk about, for and against
the various healthcare bills, you’re both back home in your districts.
I want to know what you’re hearing from your constituents on what they
want to see in a healthcare reform package. And I want to start with
you, Congressman Filner.

FILNER: Well, you know, you called this a recess. It’s – We call it
a work period because we’re out and about so much it’s probably harder
work at home than it is back in Washington.

BILBRAY: We need to go back to work to rest.

FILNER: So, I mean, it – Up until the economy crashed last year, the
chief issue that I always faced in my district and continue to face is
the lack of health insurance from – In my district, you know, it’s
150,000 people don’t have health insurance. I mean, that’s almost 20%
of my district. That’s a significant factor and it leads to people not
having preventive care, it leads to using the emergency room more than
they should. It raises the cost of healthcare for all of us. So I still
hear from peop – that’s the biggest complaint I have and that they’re –
if they do have insurance, the HMO that they have, and the HMO market
is more than 90% of San Diego, that somehow they’re cut off when they
most need the insurance, that is there’s caps on their health, that
they’re – if they have some condition that because the insurance
company thinks they’re going to lose money on, they’ll cut them off for
that. I mean, on and on. The insurance companies are the problem for
most of the – my constituents.

CAVANAUGH: And Congressman Bilbray.

BILBRAY: Well, I’m having coffees up and down the district and the
first thing they’d ask is they’d like to be able to read it before we
vote on it. I think there’s been a real concern that this rush to get
everything done quickly is – and, in fact, as your former speaker said,
is it was almost like get it down now before the break, before the
public gets to see it because there may be a backlash. And I think this
– we should embrace the concept of the public being able to see things,
be able to have concerns. I had a great coffee where they were
concerned – that one side concerned they want to be covered, another
side was asking about is it the federal government’s position to force
us all to make these personal decisions and that is a major issue.
Cost, obviously, is a real one. You can’t continue to pile on all this
debt and then ignore it. And I guess the other issue they really talked
about is if three-quarters of this can be paid for – I mean, two-thirds
of this can be paid for by eliminating waste, fraud and abuse. A lady
stood up and said, well, why haven’t you gotten rid of it yet? Why
don’t you take care of that first and then come and ask us about the
rest of the deal. She – prove to us you’re willing to do the heavy
lifting in Washington before we start. So that’s the kind of back and
forth we’ve gotten. People are very concerned. They want to look at
this. Emotions run very high both ways.

CAVANAUGH: I wonder, how many uninsured are there in your district, do you know, Congressman?

BILBRAY: Nah, we’ve got – we’ve got lists of it but you – you go
back and forth of between a whole lot of numbers. I – We’re still
questioning which population you’re talking about. You talking about
U.S. citizens? You talking about just residents? Are you talking about
legal residents? Are you talking about foreign nationals who may be
just here, the student – student issues and others.


BILBRAY: It’s a huge issue in this district.

CAVANAUGH: Right but the 150,000, I would imagine, are U.S. citizens that you talked about.

FILNER: Yeah, you know, and leave it to Brian to introduce illegal
immigration into a decision on healthcare, you know, and coming from a
party that would give us a budget, you know, three hours before we had
to – a budget for the whole United States, three hours before we had to
vote on it, it’s sort of hypocritical to talk about, you know, these
bills. We’ve been talking about healthcare since 1948 when Harry Truman
tried to do it so 60 years is not too – is, I think, not rushing into
things. We need to do this now. People cannot – We have, literally,
hundreds and hundreds of bankruptcies from people who can’t afford
their healthcare and the only way they could get any help from the
government is to be bankrupt. That’s disgraceful here in America. We
have people, again, overcrowding the emergency rooms because that’s the
only healthcare that’s available to them. The cost of insurance rises,
you know, fifteen hundred, two thousand a year. So we’ve got a real,
real problem and, you know, maybe part of the difference is I
represent, you know, a part of San Diego County, southern part, that is
poorer than the northern county and people have – when you’re poor, you
have different concerns and if you – then you can afford the health


BILBRAY: Bob – Bob, it was wrong and it’s totally wrong for the
Republicans to push through a budget without giving people the chance
to look at it and that lasts for a year. But it’s outrageous to push
through a healthcare plan that we’d live with for 60 years. So I think
both sides have been wrong in the past but this is a huge step. We’re
talking about the largest healthcare system in the world. We’re not
talking Canada with about 30 million, the size of…

FILNER: You’re assuming that we haven’t discussed it at all. I mean,
I know what’s in the bill. You know what’s in the bill. That’s why
we’re here today debating it. To say we’re going too fast when people,
I mean, are literally dying because they’re denied access. I mean,
people talk about rationing or something with a healthcare bill, we
have rationing now, people – but it’s by economic status. If you can’t
afford healthcare, you may die. Now that – tell me that’s not rationing.

BILBRAY: Bob, Bob, wait a minute, wait a minute. I’ve provided
healthcare in San Diego County. I was a County Supervisor and
supervised the hospital, the healthcare system for the poor. You and I
know this is not about the poor not having healthcare. This is not
about the rich having healthcare. This is about debating about
accessibility and who chooses to have it and who doesn’t that’s in the
middle. So don’t talk about people dying…

FILNER: I’ve got 150,000 people who don’t have healthcare so I don’t…

BILBRAY: That choose not to do it in that boundary but they are not
going to die because somebody turned them down at the emergency room.
You and I know that’s a reality.

FILNER: Yeah, but they will be – have diabetes or they will have
health – heart problems or they will have weight problems because they
didn’t go to a doctor for the 20 years before they had – they had to
use the emergency room.

BILBRAY: And there’s all kinds of other sh – You – Let’s face it. If
you really want to talk about this and let’s – you – we’ll mark the
day. This is ’09. That in five years, the crisis in Bob’s district will
not be do you have insurance, but will you be able to find a doctor, a
nurse, or a hospital to be able to go to. That’s the next crisis and
nobody’s even talking about – Let’s talk about not just what we see
today but what we know is coming on in the future, and that’s not
what’s being discussed in Washington.

CAVANAUGH: Let me just ask a question, if I may, and I want to ask
you, Congressman Filner, is it fair to say, as Congressman Bilbray
does, that people are a little baffled about what’s going on when it
comes to healthcare reform in Washington right now?

FILNER: Well, when you get into this kind of complexity, yeah, but,
you know, that’s – that’s what – It goes for our budgets, that goes for
the Defense Department, it goes for every department. And that’s why we
have a representative government that we’re elected with a certain
trust to make those decisions. Now, of course, people have to
understand it—and they do—my constituents understand very clearly. They
want to have affordable quality healthcare that they can access. They
want a choice of doctor and hospital. They want to not to be able to
cut off. They want to not stay in a job that they hate because that’s
the only way to get their healthcare. They want that portable. They
want – I mean, there’s so many things that are hurting American
families today. My district is very clear about what we’re trying to do
in the congress and that is get them quality healthcare at an
affordable rate.

BILBRAY: And, you know, in fairness to Bob, he has been up front
about it. I think that if most people in Washington was as upfront as
Bob about saying, look, you know, where Bob stood. He’s always
preferred the single payer concept. He’s always prefer – was up front
about it. He didn’t try to hide it and kind of ease it into it. And I
think there’d be a lot less confusion if people were more up front like
Bob Filner when it comes to discussing this issue.

CAVANAUGH: We have to take a break, gentlemen. When we return, we’ll
be taking your calls because lots of people want to get in on the
conversation. Our number is 1-888-895-5727. Our healthcare debate will
continue on These Days in just a moment.


CAVANAUGH: Welcome back to These Days. I’m Maureen Cavanaugh. We’re
talking about healthcare and my guests are Congressman Bob Filner and
Congressman Brian Bilbray. And I want to get to the phones. We’re
taking your calls at 1-888-895-5727. But before we do, I want everyone
to be very clear on where you both stand on this issue. Now there are
close to 50 million uninsured Americans. There are many more who are
underinsured and can’t afford to get regular medical treatment. Rising
healthcare costs are breaking the budgets of families and corporations.
More than half of the people filing for bankruptcy cite illness and
medical bills as the cause. With this backdrop, I want to ask you both,
starting with you, Congressman Bilbray, what do you think needs to
happen to our healthcare system in order for it to meet the needs of
the American public?

BILBRAY: Well, I think we need to go back and talk about some of the
issues that California has addressed a lot of times. The portability
issue for the personal – being able to take their insurance is
obviously a legitimate issue but we also got to talk about the feds do
have an appropriate location here of stopping the states from stopping
people from being able to get insurance outside, to be able to form
PPOs and be able to form what I call the credit union model of not
having to choose between government or business but actually co-ops on
this issue. And then there’s also the, you know, the elephant in the
room that everybody’s avoided with this issue of not even talked about
but in California we know it’s very real and that is we have tort
limitations in California that even the most liberal Democrats know
have to be maintained here or the system would crash. We’re not even
discussing the issue of the fact that we need to get out of this
concept that quality control in healthcare should be done through
litigation and lawsuit, not through mediation and consultation. And we
need a – that is not even being talked about and that was a huge
number. When I was providing healthcare to poor women for perinatal
service here in San Diego County, there were volunteer doctors that
were having to pay $90,000 a year, and this was in the eighties, when
we could provide healthy born babies for $300.00 a unit. That kind of
thing’s not even being talked about, so I really think the insurance
companies need be gored but I think the trial lawyers need to both – If
Republicans, Democrats want to work together on this, they’ve got to
tell their friends, look, you both – both of you are going to have to
pitch into this. But I still say that we’ve got to be looking at this
in a serious way and right now the liability of the tort, the
procedures that are unnecessary are being talked about but they’re not
talking about that large driving force there and that’s litigation. And
that’s one of the things we can frankly talk about, especially as
Californians where we have one of the best limitation laws in the

CAVANAUGH: And Congressman Filner, recently you introduced an
internet video where you said that you will vote for the healthcare
proposals but only if they include a public option.

FILNER: Look, the only way we’re going to get to coverage of the 50
million people who are uninsured and the 50 million or so who are
underinsured is to have a public option, that is a choice if you cannot
afford the private insurance, if you’re sick and tired of insurance
companies coming between you and your doctor, then you have to have a
public option. That’s the only way that we’re going to move, that we’re
going to lower the costs of the system which is just incredibly
expensive because of the overhead of insurance companies and get to
coverage of all the people. That brings down the cost of healthcare for
our whole society. If people can have preventive care and can have
access to a doctor on a regular basis, they’re not going to use the
more expensive emergency rooms.

CAVANAUGH: I want to start taking some calls. And I want to let you
know that our number is 1-888-895-5727, that’s 1-888-895-KPBS. Peggy is
calling from Pacific Beach. Good morning, Peggy. Welcome to These Days.

PEGGY (Caller, Pacific Beach): Good morning. Thank you for taking my
call. I’m in Brian Bilbray’s district, the 50th District, as was my
daughter who died five years ago from a brain tumor. She had insurance.
She had Blue Cross insurance but her experience was expensive
co-payments, waits, rationing of care, and no choice of doctor who
operated on her brain. That’s very different from what happens with
Brian Bilbray and Bob Filner’s healthcare. And Brian Bilbray has both
said he’s against government takeover of healthcare and he’s also for
the consumer choice model that is based on healthcare for members of
congress. Which is it? And will he vote for that kind of healthcare and
to start single payer in California? Thank you.

CAVANAUGH: Thank you, Peggy.

BILBRAY: Well, Peggy, you got to understand that this issue of
providing the appropriate service at the appropriate time is not just
something that we have a problem with with HMOs. My – I lost a uncle
and a cousin in Australia over their government operated system over
something as simple as skin cancer and the delay that that – and
critical treatment. So I think you’ve got to remember that with our
frustration with the existing providers, don’t think that it’s not the
other way around and we’ve got – we’ve got major challenges. I think
we’ve got great challenges that Bob and I are working on and the
president’s looking at. I’m trying to save a lot of money with the
electronic systems of recordkeeping for medical records and Bob and I
can tell you, we’ve – the Veterans Department has been working on this
how long, Bob? Over a decade. And we still have those things that we
need to do that I think we can work together on but to – we’ve got to
understand it is not just Washington promises the world and then you
wait 30, 40 years for them to admit that it’s bigger and tougher than
we want. There’s a whole lot of things we can do and we ought to be
moving forward to, and it’s not as easy…


BILBRAY: …as a lot of people like to think.

FILNER: You know, one of the questions that Peggy asked Brian is
that you support sort of state experiments, I understand, and there’s
going to be an amendment by Dennis Kucinich who says let the states
experiment if – but with a single payer, if they so choose. Are you
going to vote for that amendment?

BILBRAY: I – I like that amendment. In fact, I think that Romney…

FILNER: Okay, that’s good.

BILBRAY: I think Romney ought to look at the fact – because, you
know, I think too often in our educational system we don’t remind
people that the great separation of power isn’t between the branches of
feds. Your most essential services are provided by local and state. The
feds are sort of up top and – and beyond that, and the more efficiency
tends to be there. Romney did an experiment. They have major problems
in Massachusetts. But I believe they can address that and they can
change it because they have a structure in that state to be able to do
it. What’s scary about Washington, as Bob says, it takes 60 years to
get to an issue. The question is, if you make a mistake, it takes 60
years to correct it. We’ll be all dead and gone by the time
Washington’s willing to admit that they made a mistake if we make a
mistake in here. So that’s why – You know, I much prefer the state
options because it’s manageable, it’s something comparable to Canada or
England. We’re talking about something as if the European Union had a
centralized control system, which nobody in the world has. I think the
last one that even got close to it was the Soviet Union and we saw what
happened there.

CAVANAUGH: Well, I just want to make the point, because Peggy makes
the point very clearly, that two of the oppositions to the healthcare
reform, bureaucracy and rationing, seem to be something we already have
in our system. So would you want to address that, Congressman Bilbray?

BILBRAY: Well, I think that – that there always is going to be this
problem of what gets provided by whom and the assumption that if the
government pays for it and controls it, it’s going to be a free for
all. The doctor who actually was offered the Surgeon General by
President Obama brought up the fact that if you take Medicare as being
the prototype, Medicare doesn’t provide a whole lot of services. Things
like cholesterol tests go five years instead of one year with the
average independent so you actually have more rationing on our – right
now on our public vehicle we have than we have before, so it tells you
either one of two things. Either the private guys are providing more
because they’re worried about litigation and suing or the public sector
one is denying people a central services. And I think that is a
legitimate concern we can have. And this isn’t Brian Bilbray saying,
this is a person who was a Clinton employee and was offered the top
medical job by this administration. It’s one of those things that we
got to understand that – hope no one believes that if the government
runs it—and I don’t think Bob would say this either—if government runs
it, all these problems would be gone because the government does it so
much better, never rations, never says no. I mean, everybody knows that
that’s not true. But we’re trying to see what’s the best way to improve
the system.

FILNER: You know, the opposition to the healthcare reform throws out
these expressions to scare people. Government run healthcare, that’s
not what any of the bills do. It provides a public option for insurance
so people can be covered. As a matter of fact, if you’re worried about
bureaucratic interference, it’s the HMOs today that do that. They’re
deciding what tests to have and if you’re deciding about – if you’re
thinking about overhead and the costs, it’s always the HMO executives
that make the highest money in any – in any market for companies. So
Medicare happens to have about three or four percent overhead costs,
which is far less than any of the private plans because in the private
plans, you got to make a profit, that’s the key thing. And Medicare
allows you to choose your doctor, to choose your hospital, and you’ve
worked for it all your life by paying into the Medicare system and we
have decided that at age 65 you should have some relief of these costs
overall. And why not, you know, bring Medicare, make it open to a lower
age? That opens up the system more and more. Brian sits on the Veterans
Committee of congress, which I chair, and he is – he works with me to
try to better that system. That is a government run system. And I don’t
see, you know, the five million people who are treated by that or 25
million veterans who say nev – don’t break up the VA, the Veterans
Administration. But that’s the archetypical government run system and
we’re trying to make it as high quality as we can but, you know, people
love it. And when you have Senators and congress people who are
screaming about the government system and yet go up to Walter Reed or
Bethesda Naval Hospital in Washington for free medical care, I find
that the height of hypocrisy that they don’t want to have anybody else
have the same benefits that they have.

CAVANAUGH: I want to take another call, and I want to remind
everyone we are taking your calls for Congressmen Bob Filner and Brian
Bilbray, and the number is 1-888-895-5727. Right now, Umang is on the
line from San Diego. Umang, I hope I’m pronouncing your name correctly.

UMANG (Caller, San Diego): Yes, correct.

CAVANAUGH: Welcome to These Days.

UMANG: Thank you. Hello. Good morning, Brian and Bob. I have written
a book which is called “Solving the American Healthcare Crisis.” It’s
coming out in September, after four years of work. And, actually, I’m
on the first page of a research engine if you fill in ‘american
healthcare crisis.’ So my question is—I have many questions—my question
is thirty – more than 30% of the money goes in paperwork and
administration in a $2.4 trillion healthcare economy. Last year it was
70% of the GNP. Now the current debate which is going on whether there
should be a public option or not for the healthcare insurance for those
who are not insured, now if out of that 30% which goes in
administrative and paperwork costs, if the cost was cut down by only
33%, there’d be saving of $2 trillion over a period of ten years. Now
countries like—rich countries—like France, Japan, Finland, Sweden spend
10% on the administrative and paperwork costs. Now this is amazing. Now
if it was a single payer system, there will be another saving of $200
billion per year. That means over a period of ten years, $2 trillion…


UMANG: …if you make this little sunt it’s $4 trillion saving.

CAVANAUGH: I have to interrupt you because you’ve given us so much
to consider in – and obviously you’re all over this healthcare issue. I
want to ask, it seems that Umang addresses the fact that, in a sense,
healthcare reform could pay for itself if it whittles down the cost of
administration among all the private insurers and he even talked about
single payer. So I’d like to get your response to that. Let me start
with you, Congressman Bilbray.

BILBRAY: Well, I think we’ve got to understand that the
administrative costs and the paperwork is not just a private sector
problem. It’s a huge Medicare problem. Ask the providers. Absolutely
drives them crazy. The fraud, waste and abuse in here, I agree with the
president, is a huge issue. It’s just a lot of us are saying that,
again, we need to address those issues. The issues that Bob and I are
working on over at Veterans, like I said, about the electronic data
systems, we’re still trying to work those out. Those are – may be
critical steps we could take but they’re all steps we can take before
we promise the world to everybody, before we take a leap that we’re
making a 60 year commitment on. Those are all things we can work out.
But I think this issue of the savings is something that is still
conjecture. But we are finding out about that in Massachusetts. We’ve
actually got a great test bed. I really support the concept that we try
some of these test beds, that we look at how they work out. We – we did
this with welfare reform. We gave states the latitude and they went off
and led and Washington followed. The – I think that’s one of those
things that there were mistakes made in welfare reform and they
corrected it. I think right now Massachusetts has gone to a universal
coverage system. They have major crisis. But I believe that in the next
few years they will be able to straighten it out. I don’t have the
faith in – for the federal government being able to do that. I know the
history of the federal government, I’ve worked with them as a local guy
and now in the system and, frankly, I think that let’s – let’s do these
savings. Let’s get the savings first. We’re talking about, you know, a
trillion dollars, we’re talking a billion dollars a page. This is
something that we’ve got to talk about. How to pay for this is
important. Some people say don’t worry about it, we’ll always get the
other guy. Everyone’s more sophisticated than that now. They know
better than that.

CAVANAUGH: Can we get the savings first?

FILNER: I – I – Well, I agree with your previous statement that the
reform effort will pay for itself not only in the paperwork, which the
caller brought up and I want to get back to in a second, but because
the federal government can negotiate, for example, pharmaceutical
rates, the pharmaceutical costs will come down as they do – and as they
are in the VA, which the government negotiates. In terms of – the
hospitals agreed that because there’ll be far less uninsured people
coming to, you know, coming to their hospitals, there’s great savings
there and they’ve committed to certain hundreds of billions of dollars.
But the paperwork thing is important. The stimulus package that we
passed in congress provided hundreds of billions of dollars for that.
The VA, by the way has a system called Vista, which is seen as the gold
standard of electronic records. And if we could get most of the private
sector’s use of the same kind of electronic health records, I think the
caller is right, you save literally enough to pay for the healthcare

CAVANAUGH: Let’s take another call before the break and go to Peter in San Carlos. Good morning, Peter. Welcome to These Days.

PETER (Caller, San Carlos): Hi. Thank you for taking my call. I have
two points. Number one is there seems to be a lack of discussion or
lack of coverage on the idea of what is the cost of inaction. I mean,
I’ve been on a – At my job, I’ve been on a health committee for years
and I’ve had nothing – and we’ve faced nothing but 10, 15% increases
for at least 15, 20 years. And it just seems to be unchecked. So,
number one, the cost of inaction. And number two, the – You know, if
the premise of competition and experimentation is as Representative
Bilbray brings up, if that is what we should do and I think there’s
merit to that point, why not then put a government option along with
that competition? I think it would keep – One of the things the
government option would do, it would keep everybody honest. And right
now I – when I deal with public insur – when I deal with insurance
companies for our employer, there’s no competition. They all pretty
much are in collusion to the same amount of rate increases and so
forth. Where’s the true competition? If – And it would basically make
the point, if government couldn’t compete then you’d have that resolved
and we could get forward. And then, lastly, the politics of this issue
is driving me absolutely crazy. I’ve got a daughter who has cystic
fibrosis and she’s, you know, thankfully, she’s very healthy and so
forth. But at some point she – I need Representatives to clear away the
politics and really do what’s best for this country, and I think that’s
being lost in this whole debate. It’s just shouting at each other and
we’re not really pulling together to get something done for this

CAVANAUGH: Peter, thank you so much for calling in. Well, it gives
us a point, a sobering point, to think about, gentlemen, and I’m
wondering, when it comes to the lives of the people that you represent
and their very real struggles, do you think that you can look past your
party’s politics and agree?

FILNER: Well, I would hope so. This is Bob Filner. But, you know,
American politics is about – is, especially as it plays out in
Washington, is about special interests and those people who will lose
from a moving toward a public option are the private insurance
companies, by and large, and they’re – they give tremendous amounts of
money not only to campaigns but, you know, the ads that you’re seeing
on television, which they hope will sway us, and organizing so-called
grassroots opposition to these. These are the people who are bringing
the politics into it because they’re afraid of change. The status quo
is – they’re making a fortune off because healthcare, to them, is just
a business. It’s not a service as it – as every American should have
the right to but it’s a – it’s a profit center. And they’re struggling
to maintain the trillions and trillions of dollars that they are making
that they’re scared of losing when it goes to a public option.


FILNER: And, by the way, the height of hypocrisy for – in Washington
is the people who say government can’t do anything, government can’t do
anything, government can’t do anything and yet they’re afraid of a
public option will put out a business to private people. I don’t
understand that. If a government is so bad, how is it – how does it run
a system so efficient that they could drive out the private guys?

BILBRAY: Well, I’ll tell you right over, Bob, and that is sit down
and talk to the private guys. You know, the option that we’re not
talking about is the people who are covered by their employers now.
There’s an – In this bill, if you’re willing to pay 8% on your payroll
taxes, you don’t need to provide healthcare. The fact is, you – how
many businesses do you think aren’t going to opt into that and just
drop the guys off because it’s a huge savings. Now that’s a great
argument when you do the great savings but the fact is, it’s a great
savings to the business. It puts it over into the fact that they (sic)
will be less services provided to those guy – to those employees for
the same reason but let’s talk about -- And, you know, I want to get
back to this issue because you can’t walk away from this. You can’t
talk about look at – don’t look at the man behind the curtain. Anybody
that’s looking at healthcare system long term knows that it’s not going
to be an issue about the government forcing you to get an insurance
policy. And let’s face it, the federal government, and when I – and I
got to correct it. Too many people say government programs, we’re
talking federal government program, which is real different. But let’s
us get down to it, is that we’re not going to be allowed as Americans
not to have insurance. We’re not going to be allowed that. The federal
government’s going to mandate that you have to have insurance and then
we’re going to mandate it that everybody’s covered, and that’s fine.
But the assumption is that if you’ve got insurance, you now have health
service, and that is an absolute wrong assumption in the next decade.
Anybody and everyone who is looking down the future and is aware of
this knows that the physicians are retiring en masse right now. They’re
baby boomers. You do not have a new supply coming in. You already have
a nursing shortage. The question is here, do we wait for that crisis or
do we discuss that now so that we don’t have that crisis? Because
what’ll kill you quicker than not having insurance is not having a
doctor when you need it.

FILNER: Well, what does it have to do, though, with the current
debate in that, I mean, you’re saying that’s going to happen no matter
what, then I don’t think…

BILBRAY: The current – the current debate needs to be up front and
personal enough to say that – The debate right now is mandatory
insurance. It’s not making sure we have a supply of healthcare. You
assume that if you’ve got the insurance, don’t worry, they’ll – you’ve
got medical. That leap is an inappropriate leap to make. We shouldn’t
take it for granted and we shouldn’t assume because all the facts and
all the statistics and all the experts say we’re moving down a crisis
that is not as (sic) insurance crisis, but actually having a doctor
who’ll be there when we’re sick.

CAVANAUGH: I’m afraid I have to jump in and take a break. We will
continue our discussion about healthcare reform with Congressmen Brian
Bilbray and Bob Filner, and we will return in just a few moments on
These Days.


CAVANAUGH: You're listening to These Days on KPBS. I'm Maureen
Cavanaugh. And I – My guests are Republican Congressman Brian Bilbray
and Congressman Bob Filner. He’s a Democrat. And we are talking about
healthcare reform in Washington and how it’ll affect us here in San
Diego. We’re going to try to take as many of your phone calls as we can
before the top of the hour. Our number is 1-888-895-5727. But if you
can’t get through on our phone lines, we’re asking you to post your
comments online at Let’s hear from Barry in San
Diego. Good morning, Barry, and welcome to These Days.

BARRY (Caller, San Diego): Good morning. Thanks very much for taking
my call. I’m just visiting from Canada and I happened to hear your
radio station’s announcements and I thought I’d just give you a bit of
input on what is currently happening in Canada with healthcare. And
first and foremost, as one of your guests said, I think preventive
maintenance is, indeed, critical. And what – How we are conditioned in
Canada is to go and see your doctor on an annual basis, have a
physical, have your blood work done, you know, an EKG, prostate cancer
checks, whatever may be the case, and then at the end of that checkup
you get another green light for another year. And it makes Canadians
live longer. It allows us a more active retirement and, in the long
run, it’s much like servicing your vehicle. It’s much cheaper in the
long run. And to live your senior years without the fear of going
bankrupt from not having healthcare is very critical to your wellbeing.
And that’s it.

CAVANAUGH: Well, thank you, Barry, so much. I appreciate the call.
Let’s take a call from Vera in Carmel Valley. Good morning, Vera.
Welcome to These Days.

VERA (Caller, Carmel Valley): Good morning. I’m Vera Kuplani (sp)
from Carmel Valley, and thank you for this chance. It’s – I’m in
Congressman Bilbray’s district but, unfortunately, his views are always
different from mine and my family. So I’ll address my remarks to
Congressman Filner. Congressman Filner, I definitely need your help in
getting the public option on the plate. Without it, we’ll not have
competition. I just don’t understand why the Republicans, who are all
for free enterprise and competition cannot stand government competition
at this point. Let us try. Let us see it. And, you know, when the
federal government goofs, we are able to say that with our votes and we
can, you know, we can get them out with our votes. So I really think
all this issue is, you know, this discussion, this debate, like I just
said, we’ve had for 60 years, really, the time has come now for the
public option. And you can talk to a lot of people, even in our
district, and you’ll find people support that. Thank you.

CAVANAUGH: Thank you, Vera, for your call. I wonder, Congressman Bilbray, would you like to respond to your constituent?

BILBRAY: I think the biggest thing is the prevention issue is more
than just going to the doctor. I think that’s one of those issues that
we really should be able to agree on. Lifestyle – Canada has a whole
different social, economic route. Their standard of living per capita
is a whole different group. They – the substance abuse, they – the
poverty issue is totally different. And, in fact, one of the biggest
determinations of your health is not your health insurance but your
social economic standing. Now even those who have – are on the public
option because they’re poor still have major health problems but we
need to talk, frankly, about the fact that are we going to mandate that
the federal taxpayer subsidize people with emphysema when they’ve been
a lifetime smoker? Is that an option that we’re going to say – or are
we going to now say you’ve got to start participating if you –
Obesity’s a major issue. Does the federal government, and is the
federal government, the proper agency or – you know, we may want to
look at locals more in this. Say, look, obesity, you have a right to be
obese but don’t expect us to have a responsibility to bear the burdens
of your lifestyle choices and, you know, and force, you know, want the
rights but not the responsibility. I think we need to do a lot of that.
There’s stuff like testing – testing for osteoporosis that we could be
doing at the end of high school where 85% of girls can be detected.
There’s a lot of things that we could be doing that’s very little
expense, doesn’t create a – need a huge federal commitment for 60 years
but that can move forward. But more importantly, it develops a
credibility to the average citizen that you can trust us to do the
right thing, not the political thing, and while Washington and this
proposal comes down, we still, Washington now, is still avoiding the
tort issue totally. You want credibility, the Republicans should take
on the – the insurance companies like I did in the nineties and the
Democrats should take on the trial lawyers and there you’ll start
seeing some consensus both ways of people saying that we’re willing to
do the right thing to do this right and not just playing to our – to
our, you know, extremes.

CAVANAUGH: Congressman Filner, Vera makes the point that there’s a
lot of support for healthcare reform but actually some recent polling
has shown that support has gone down as this debate rages in
Washington, D.C. Why do you think that is?

FILNER: Well, I think people get scared of change when the scare
tactics are being bankrolled by the very people who will – who will
lose some income by this, that is the insurance companies. So they call
this, you know, nationalized healthcare or socialized medicine, and so
they put labels on without ever talking about what the substance of the
legislation is. And the substance of the legislation is to make
healthcare accessible and affordable to everyone. You know, and it’s in
everybody’s interest, even those who think that they’re subsidizing
somebody else. I mean, if somebody in our society has a contagious
disease, it’s in my best interest for that person to get treated so I
don’t get that contagious disease. It’s in – it’s in our own best
interest to make sure that everybody has a healthy lifestyle. I mean,
it – it immeasurably improves our standard of living and our quality of
life and it’s not a question of subsidizing someone else, it’s a
question that we – do we want our own children and our own society
healthy? That means we have to make sure everybody is healthy.

BILBRAY: Mary, the polls have shifted and here’s the big difference.
If you ask the average citizen would you like to have a free house,
what would they say? Now if you ask them, would you like to live in
public housing, what would they say? That is where you’ve seen a shift,
is that it’s one thing to have a free – it’s something else – having
concerns about what really will be delivered and I think that’s a
legitimate concern and it’s something we need to talk about. Speaking
of that with public housing, we did used to operate public housing,
government operated, government built, government subsidized, and what
we’ve done in San Diego County is actually abandon that model and gone
to something that people in Washington call the private model, and I’m
not proposing this as healthcare but it’s interesting that I bring up
the health – the housing issue. We’re actually (sic) give people
vouchers so they can go pick out their own apartment and don’t have to
live in a public housing tract.

FILNER: See, this is part of the scare tactics. Oh, he says
government run healthcare. Nothing in any of the proposals is that. You
have your choice of doctors, you have your choice of hospitals.
Medicare – people on Medicare today have that choice. So to say that
we’re going to – that that’s why the polls are shifting means you’re
scaring people into think that that’s going to be the issue. The
bureaucrat I’m more afraid of is from the insurance company who steps
between me and my doctor.

CAVANAUGH: I want to take one last call. Clayton is calling from El Cajon. Good morning, Clayton, and welcome to These Days.

CLAYTON (Caller, El Cajon): Good morning, and how are you doing?

CAVANAUGH: Just fine. How are you?

CLAYTON: I’m doing okay. I have a question for both gentlemen
sitting on the panel today. My question is, how is this public option
going to help those with preexisting conditions, say HIV or cancer. A
lot of insurance companies these days tend to shy away or even raise
premiums based on a preexisting condition. How is this going to affect
those who already have something that they need treated but either
can’t afford or are paying too much for?

CAVANAUGH: Thank you, Clayton.

FILNER: You know, the provision of a gov – a public option is not
directly related to that but other parts of the other bill – of the
reform efforts are, that is an insurance company cannot deny you from a
precondition – preexisting conditions. It cannot deny. It can’t put on
caps on a long term illness because you’ve used too much. It can’t
throw you off. This is going to be part of the national healthcare
reform. That is, we are going to make insurance companies actually
insure people and not throw you off when they don’t like you or throw
you off because you’ve got a disease that costs too much or throw you
off because you’ve got a preexisting condition or you lose your
insurance because you change jobs. It’s going to be mandated that they
cannot do that. And, frankly, you know, the private system, if built
for profit, is making those decisions about your life and we’re going
to say, no, you cannot do that if you’re going to operate an insurance
company in this country.

BILBRAY: In fact, I think there’s one thing, one consensus that is
there, is looking at this preexisting and trying to address that issue
and when they – when you talk about the private sector, the public
sector cuts you off, too. So, you know, you’ve got procedures like
virtual colostomy that’s not allowed in the Medicare, not at all. And
so there’s a lot of this. Don’t think for a minute that a government
operated – and when – or let’s say a government supervises and Bob
says, it’s not government operated. You know, the fact is, when there’s
not enough doctors, whenever there’s not enough to go around, the
government is going to end up having to step in and start providing
these services because the private sector is not going to have it.
We’re going to have to go out and try to figure out where do we find
the physicians in the future. So you – you remember this, Mary, you
know when you look at this, that in ten years you’re going to say I
remember that – that crazy surfer from North County and he said this
crisis in doctors and hospitals and nurses was going to come along, and
now we’re talking about that. Everybody assumed if you – if the
government mandates that you have insurance, that that guarantees you
have doctors.

FILNER: But that’s…

BILBRAY: But that’s not – that’s an assumption.

FILNER: That should not be a reason, Brian, for you to vote against healthcare reform.

CAVANAUGH: Very quickly, gentlemen, we only have a minute. Are we going to have a healthcare reform bill?

FILNER: We will have a healthcare reform bill by the end of this year.

BILBRAY: Bob, that’s a reason for me to not promise that I’m – that
people are going to get it and I think that you’ve – the healthcare
bill has major problems right now. The moderate Democrats are really
catching – catching heck from their constituents. The – You’ve got to
be able to pay for it and that is the sticky little thing of promising
savings in the future. If you do the savings first and prove you can do
savings, the public will take it. I don’t think they – that
Washington’s willing to do that.

CAVANAUGH: Thank you so much, Congressman Brian Bilbray and
Congressman Bob Filner. Thank you so much for being here and talking
with us today. You know, I want to invite you to post your comments on
our website, And I’d like to mention that response
to our healthcare shows has been so enthusiastic, tomorrow we’re doing
a special edition of These Days. We’ll be opening up the phones, taking
your calls and comments on what you’ve heard this week. Did it change
your mind? Do you have an opinion that hasn’t been heard so far? Call
us with your comments tomorrow morning, special Friday edition of These
Days at 10:00, right after Editors Roundtable here on KPBS.