Tom Carper (Blue Dog on Baucus's finance committee but not on the "gang of 6" - gave a telephone town hall
The townhall is now over, and I have decidedly mixed feelings (as I suspected I would.) Carper is big on co-ops and huge on electronic medical records, but seems to believe that reform is essential. My impression is that if a bill gets to the floor with a public option he'll vote for it.
I'm interested in hearing what others think about extending the federal employees benefits to everyone.
What follows are my impressions from the townhall - which was almost entirely Q&A. The vast majority of what follows are not direct quotes, but loose paraphrasing. I tried to not slant or misrepresent any questions or responses, but I was trying to keep up, and it's possible that my perspective colored some sections.
Carper leads in with progressive talking points (?)
We spend the most
Don't get the best coverage
14,000 people a day lose coverage,
Conducts a poll... only 12% thinks those are true :( Remainder thinks at least one is false.
Q1: I'm 80 afraid of how it's going to be paid for
A: Medicare reforms etc
Q2: Why haven't we heard about tort reform
A: Wants to improve healthcare outcomes reduce the need for litigation
Q3: Commends Carper for compassionate care amendment. Mentions medical tourism. In favor of public option. It would be more efficient improve ordinary care. Every country has better health care than us.
A: President had it right - the important thing here is that we have something that keeps insurance honest - not necessarily a public option. Suggested taking the federal employee health benefit plan - and let other people buy in. Administration costs 3% of premiums for federal plan might be 33% for private plans. Some colleagues have suggested co-ops. Happy with medicare drug program.
Q4: Doesn't want illegal aliens to be eligible for the plan
A: Agrees, no plans contain that. No one's said whatever plan is adopted will cover everyone. If they're here illegally and we don't cover them they might be more inclined to go back wherever they came from.
Q5: What grantees that the fed gov won't ration healthcare?
A: We already have rationing
(interjects) mom wasn't rationed
(Carper) disagrees people are dropped all the time. Not interested in rationing. Interested in best practices. Talks about comparative effectiveness.
Q6: Doesn't want it to go through with reconciliation. Would like to see GOP participate. Against 51% thing.
A: Explains reconciliation. Doesn't lend itself to this - it's not appropriate. Interested in bi-partisan bill if at all possible. Talks about gang of 6. Talked to Snowe she will keep at it. Thinks committee will report out legislation with some bipartisan support.
Q7: Why do we have to do it all at once. Wants to see spending come down first.
A: Talks about immigration. Decided with immigration that it was more important to secure borders before path to citizenship. In this case need to reign in cost of care first. (2) Find a way to improve outcomes. (3) Extend coverage to the uninsured. Talks up Mayo, Cleveland Clinic, Wa State Co-ops.
Q8: If you don't have a public option how do you implement an exchange
A: Government has done a good job setting up the fed emp ben plan. Agree with president need a way to keep insurance companies honest. (me: way to give the blue dogs cover obama) Haven't had to use the plan for medicare prescription plan because insurance companies know the option is out there.
Q9: Hears medicare options will diminish as he ages. Talks about medicare renting a nebulizer for more than it costs.
A: Fraud, waste, and abuse not acceptable. Will have staff look into this. This isn't about diminishing medicare. VA system is a great example, focuses on primary care and wellness is a huge fan of electronic records.
Q: People with a pre-existing condition can't leave their job or they lose coverage. We already have single payer with medicare and the VA. Need to fight fox news disinformation.
A: Likes going on fox news into the lions den. Wants to stop hyperbole disinformation. Can't expect everyone to believe anything. VA very good system. Again talks up Mayo and Cleveland clinic. Medicare could learn some things. People with pre-existing conditions would be able to get coverage through the national or a series of regional exchanges. If insurers are going to get 30 million new customers they're going to have to accept people with pre-existing conditions.
Q: Have you read the bill?
A: There are 3 different bills in house, and the presidents proposal, and our senate finance committee bill which is not out yet. Expects to read the finance committee bill before it's out. Won't be able to read them all.
Q: If you don't cover illegals how will they be handled?
A: Don't want people from all over to think they can come here for free coverage. ERs have to cover them, but won't cover them through the exchange.
Q: Explain co-ops
A: Credit Union is a co-op, member run, member owned non-profit organization. Gives energy example. Some medical co-ops have been successful some have not. Puget Sound, Cleveland Clinic, Mayo are all good examples. Focus on outcomes, Docs are on staff. Different kind of approach.
Q: Concerns about cost and deficit. How are we going to pay $1 trillion every year when we're so indebted to China. There's nothing in the bank to pay for it.
A: I believe in balancing budgets, supports the line-item veto. Made more new debt in the last 8 years as we did in the first 208 years. Going to run up record deficit this year. 16% GDP goes to healthcare, more than any other country on earth for not as good outcomes. CBO said house bills increase deficit $250 billion over 10 years, doesn't reign in growth of healthcare costs. Impacts businesses esp Chrysler and Ford who can't afford healthcare. Not magic need to study health outcomes.
Q: Why are so many people afraid of living wills?
A: Talks about what living wills are. Death panels are nonsense.
Q: Has Daughter in navy, women can't appointments. Talks about Walter Reed. If we can't take care of servicemen how can the gov't take care of everyone.
A: Not enough primary care doctors in military or public. VA does great job with electronic health care records. Mom had 5 doctors taking care of her, doctors weren't communicating, electronic health record would have let them provide coordinated care. Active duty military doesn't have electronic medical records. Gates has ordered that military adopt electronic healthcare records.
Q: Vietnam era vet. Enjoyed VA care. Is a chaplain, worked in hospitals, knows that uninsured drives up cost of care. Hopes we can extend coverage to the uninsured.
A: People with insurance pay $1000/year to cover the uninsured. Large purchasing pool or series of large purchasing pools will extend coverage and get rid of this hidden cost. Fed benefits plan has cheep coverage because of the large pool.
Q: How do you rectify that a new gov't entity will be revenue neutral when CBO estimates $1 trillion.
A: President won't sign legislation that increases the deficit, he won't vote for it. President won't sign legislation that doesn't drive down health care costs, he won't vote for it.
That's it. Over 1000 people on the call, he thinks he'll do it again next week. Can't please everyone, thinks reform will benefit the lion share of the people.