Public option remains main disagreement

By PAULA BARR
Daily Journal Staff Writer

Published: Friday, November 27, 2009
Updated: Thursday, October 29, 2009 3:02 PM CDT

CAPE GIRARDEAU – Former Vermont Gov. Howard Dean and former U.S. Speaker of the House Newt Gingrich presented their opinions on health care Wednesday night during a debate at Southeast Missouri State University.

The debate was part of this year’s University Speakers Series and drew nearly 2,000 people. Gingrich and Dean each spoke for about 10 minutes about proposals for a national health program that are being debated in Congress. Moderator Erik Peterson of the Center for Strategic and International Studies then asked the two to address several questions that had been turned in earlier by members of the audience.

The main disagreement between Dean and Gingrich is the proposal for a public option. Dean believes citizens should have an option to choose a public insurance program as well as private insurance plans. Gingrich believes any public option eventually would become a bureaucratic mess.

“We are the only country in the Western world that does not have health coverage that covers everyone,” Dean said. “All I want is to allow some people who are under 65 years of age and over 50 to sign up for Medicare where you can’t lose it if you lose your job, you can’t be denied for a pre-existing condition, and everyone pays the same.

“It sounds to me like a good system; it sounds like a good choice.”

Gingrich said a public option would be detrimental to the economy. “Every hospital I’ve talked to said if we had a system where people gradually migrated into a public option, we’d go broke,” he said. “How do you design a governmental bureaucratic system that doesn’t become political?”

Support for choice

Dean said that the cost of insurance in this country has driven some companies to Canada, where it is more affordable. Sixty-one percent of bankruptcies in the United States list health care as one of the reasons leading to financial hardship, he added.

President Obama’s proposal would allow citizens to keep their insurance plans if they prefer, but would give them another choice, he said. The country already has government-run health care through Medicaid, and socialized medicine through the Veterans Administration, which provides medical care to 25 million people, Dean pointed out.

“We also have a hybrid system for some people who have private insurance but they can also get free health care on their job,” he said. “There are 535 people who can go over to Walter Reed on their job — the U.S. Congress. If Congress and Veterans have this choice, why can’t the rest of us?”

In Vermont, citizens cannot be denied insurance for any reason other than refusing to pay the premium, Dean said. People who need more care cannot be charged much higher rates than others. Critics worried that a public option would force insurance companies to leave. Some did, he admitted.

“We were so pleased because those were the companies that were ripping people off and putting 50 percent in their own pocket,” he related.

The state offers a public option for children in families with no insurance and income of $66,000 or less. As a result, 96 percent of children under 18 have health insurance. Another three percent qualify, but their parents have not signed up, Dean explained.

Changes and crackdown

Gingrich agrees that the current health system needs to be overhauled, but believes the solution is to change the focus, not offer a government plan.

“I think the current system is a mess, it’s unnecessarily expensive, and it is ridiculous that we have people without insurance,” he said. “We need to shift the focus to wellness, not illness. We need to focus on prevention and reward people who take responsibility for their health.

“I know that would be a revolution in this country — taking care of those who take care of themselves.”

Gingrich said private sector, not Medicaid, creates aggressive efforts for wellness and makes a “real effort to get people to change their behavior.”

Gingrich wants to make it easier to develop new technology and increase Alzheimer’s and other research to help find cures more quickly. He said the bureaucracy of government health care would add more restrictions and would slow down research efforts.

One key to cutting costs is tort reform, which would lead to lower malpractice costs, Gingrich said. He gave an example of one area in Texas where doctors used the drop in malpractice insurance costs to form health clinics where people could get free or nearly free health care.

Obama’s health care plan contains unfunded mandates that California Gov. Arnold Schwarzenegger estimates will cost his state an additional $8 billion a year, Gingrich said. Instead, health care reform could be funded through eliminating fraud.

“Medicare and Medicaid combined lose $70 to $120 billion a year in theft,” he said. “I’m not talking about doctors marking up marginally or fudging. I’m talking about a dental office that claims to do 900 plus procedures a day. Or five pizza parlors in Miami that have been certified as HIV/AIDS transfusion centers and are filing daily reports.

“I saw where one doctor filed for four colonoscopies on one patient in one day… I hope that was fraud.”

Similar priorities

Both men called health care in this country the best in the world and pointed out that people from other countries travel here for medical care. However, Dean said for every rich person who comes to this country for medical services, many Americans head to Mexico because they can’t afford the prices in this country.

When asked how to deal with the cost of health care for the Baby Boomers who will retire in the next decade or so, Gingrich said the country needs to maximize new technologies to improve health, increase Alzheimer’s research and encourage older citizens to remain active in the work force by working part-time.

Dean suggested that whenever someone files a tort action in high risk surgeries, the issue must go to arbitration and that verdict would be admissible in court as evidence. He believes that would discourage people from filing suits that have no merit in the hope that insurance companies will settle.

The men agreed that primary care physicians should be paid better. Currently, about 75 percent of doctors become higher paid specialists instead of staying in primary care, Dean said.

Gingrich proposed options including incentives that would pay school costs for physicians who stay in the primary care field for a decade or allowing nurse practitioners to set up their own clinics to provide primary care in areas where there are no doctors.

The men agreed that Congress should take a more serious look at cutting health care costs, restructuring incentives to discourage doctors from ordering unnecessary procedures to make more money, and change from a focus on illness to wellness.

“I think if Gov. Dean and I could agree to put public option on hold for three years, we could work together on everything else,” Gingrich said. “We’d probably come up with 20 or 30 breakthrough ideas, all of which would save cost and improve health care.”

Paula Barr is a reporter for the Daily Journal and can be reached at 573-431-2010, ext. 172 or at pbarr@dailyjournalonline.com.

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