Since emailing Susan Collins a while back about some issue she was dead wrong on, I have been receiving her friendly missives detailing all the wonderful things she has been doing for us. There was a brief interview on healthcare about a month ago on her blog; there was a longer one in today's email. Since she hasn't exactly been answering a lot of difficult questions, I decided to transcribe it and comment.
You get the whole thing. I'll just blockquote it and break when I see something I want to comment on.
This diary is a followup to my diary about a trip to her office to talk about health care and a protest I attended at the forum in Kennebunkport that she mentions in this interview.
RIC TYLER: It’s our opportunity to have a discussion about health care with Maine Republican Senator Susan Collins on the PDQR telephone line, now George.
GEORGE HALE: Good morning, Senator.
SENATOR COLLINS: Good morning. I have advocated for a go-slow approach. When you look at the stakes and the consequences for everybody, literally everybody, not to mention that healthcare comprises 17% of our economy, it’s important that we get this right. So far what I’ve seen hasn’t gotten it right.
I would debate whether a hundred thousands people dying each year (according to one estimate) is more "right" than doing nothing for an indefinite period of time.
I don’t support the House bill, because it would add an estimated 1.6 trillion dollars to the deficit over the next decade. I think our focus should be on cost. It is cost that is the barrier for the, for people who lack insurance.
I am fascinated by this approach. As you will see, she has no plan to lower cost. How much do you think the cost of medical care and insurance will have to come down to make it affordable for those who currently cannot afford it? Will 50% off a $100K hospital stay that your insurance company failed to pay make it affordable?
It’s cost that is causing small businesses to drop insurance. It’s cost that makes healthcare such a struggle for middle income families. So to me, the focus needs to be on reforming the healthcare delivery system to focus on reducing the cost for everyone.
George: Senator, it’s no secret to you or anyone else, there’s been a lot of controversy across the country with these town hall meetings, and uh, we haven’t uh had these type of uh meetings here in the state. I know I had a conversation with you last week. How many health care meetings have you actually attended, and uh, how do you get the input from your constituents?
Collins: You know, I think I’m up to now, a hundred and eleven, since the beginning of the year. What I have found to be most constructive is to meet with people who want to meet with me, and just give you an idea of the variety in just the last couple of months, I’ve had a lengthy conversation with Herb Hoffman(sp?). You may recall he ran for the Senate, and he was an advocate of a single payer system. I’ve met with AARP to hear their concerns, I’ve with business groups, I’ve met with virtually every kind of health care provider, from nurse anesthetist, to cardiologists. I have met with hospital administrators, I’ve met with home health care people. I’ve met with consumer groups, and that kind of exchange is what I find to be most helpful. You know, I think a lot of the members who hold these town meetings do so because they’re not in touch with their constituents that much. By contrast, as you know, I live here. I’m home weekends. I’m home right now. Plus I do a lot of forums. Today I’m heading to Kennebunkport where I’m joining with the Concord Coalition to do a public forum on fiscal issues, and I’m sure that healthcare will come up at that forum as well.
Okay, I'm not familiar with the guy she mentions seeing, but it doesn't sound like he's someone who falls into the same tier of "constituents" that I do. In fact, it looks like her meetings have been strictly with business and interest groups. Let me guess, SEIU wasn't one of them.
For anyone who wants to know about how her local office treats constituents who walk in off the street wanting to ask questions on health care, I put the link in the intro to the diary.
The "forum" she is mentioning is the one I posted a diary on a week or so ago.
Also, I no longer call her office in Washington. The last time I called to express my opinion (just so they could know that a constituent with that opinion had called), the woman who answered the phone tried to argue with me that I was wrong. I kept saying that I didn't want to have a discussion...
Ric: Maine Republican Senator Susan Collins is on the line with us, and if you have any question we ask you to email it. We’re going to get on as many as we can.
Steve writes in and asks, "Why should Congressional members have better health care plans, paid for by taxpayers, than available plans, than any taxpayers, and even better than active military and disabled vets?" He follows up by asking, "if something akin to HR3200 passes, should not Senators and Representatives be subject to the same healthcare?
Collins: Well I, I think what Steve’s talking about is the House proposal for a government-run public plan. I don’t support that, and I think he’s making a good point, that I don’t think most members of Congress, uh, would want to be part of that plan. Actually, we belong to the Federal Employees Healthcare Plan, which is the same plan that covers all Federal employees, and our coverage is no different, but I’ll tell you, when I worked for State government years ago, the State’s health insurance coverage was far more generous, uh, than what I get now, which is not to say that what I have now isn’t a very good plan, it is.
I wonder how long ago that was. Insurance costs have been changing rapidly. The company I was working for when I gave birth some years back paid 100%, as was the custom at that time, and there was no deductible or copay. For me to say this is therefore a great company to work for would be misleading, as I'm sure their health care coverage has been gutted, like everybody else's.
But I think that Steve is, is bringing up a really important point, and that is—and this has really troubled me—we’ve heard over and over again in this debate, if you like your health care insurance, you can keep it. Well, under the House bill, and under one version that has been reported by a Senate bill, by a Senate committee, I don’t think that’s true. The estimates are that it would, that creating a public plan would cause the private market to collapse...
Should health insurance companies lose profitability it would mean the end of civilization as we know it.
...and that the incentives are such that employers would have an economic incentive to terminate the insurance that they provide for their employees, and instead dump people onto the public plan.
Like there is no financial incentive for employers to drop their employees' insurance now?
So that’s one of the flaws with the House-passed bill, and the bill reported by the Senate Health Committee.
GEORGE: Alright, Senator, um. There are five bills out there, total, uh, so far, a couple in the Senate. Now your, your friend in the Senate, Senator Snowe is one of the "Gang of Six", and all of the political observers I’ve heard have said, "Look at all these arguments, it’s that group writing the health care bill. How important is this Gang of Six that Senator Snow is a member of?
COLLINS: There’s no question in my mind at all, that that is the critical group. Of the six Senators, including Olympia, who serve on the Finance Committee, then laboring hard to try to come up with a compromise bill. I don’t know whether they’ll be successful. That’s the one area where there’s possible hope, of a reasonable bill. The bills I’ve seen so far have failed the test that I’m looking for, of controlling cost. But you’re right, those six Senators are absolutely critical, I believe that they set, the internal deadline of September 15 to come up with a bill.
There’s also another group of us that’s been meeting quietly with, um, I’ve been meeting with some more conservative Democrats like Joe Lieberman, and Ben Nelson, to see if we could come up with a bill that focuses on reducing cost, and...You’re right, we’re sort of a sideline group. The focus is very much on that Finance Committee group.
Translation: I really am doing something. We do meetings. I meet with other conservatives who already agree with me, and we talk about what we would do if we intended to do something. I'm good at meetings. We don't have anything to show for it and nobody cares, but at least we decided to have meetings!
Ric: Maine Republican Senator Susan Collins on the line. Stacy writes in to us, a question for you, Senator: "If polls show that health care reform is not wanted by the majority of Americans, will you vote down this current bill?" And again, "current bill", you’ve got to put that in quotes, nothing is firm on paper yet.
"Stacy" is clearly under the impression that the overwhelming majority of Americans are opposed to any sort of health care reform. Either she is unbelievably ignorant and sheltered, or the question is a plant.
COLLINS: Right. As, as I’ve already indicated, I would vote against the House bill, and against the Senate Health Committee bill, regardless of what the polls show, because I don’t think it’s good policy. I think it would plunge us deeper into debt and that it would cause uh, uh, people to lose insurance that they’re perfectly happy with, so I would vote against those bills regardless of what the polls show. Look, I always care what my constituents think, that’s why I’m in touch with them, we’ve had thousands of letters and emails on this issue...
...and ignored every one...
and, to, as I’ve said, I’ve had well over 100 meetings, so I want to know what my constituents think, and reach out to them...
Say what? The people in those business and special interest groups are your real constituents, right?
...but I don’t make decisions based on looking at polls. I think people expect me to apply my best judgment, and I look at the long term, and I don’t like what I see when I look at the long term on these bills, the Administration is supposed to announce this morning that the accumulated, the cumulative deficit for the next 10 years, is now going to be 9 trillion dollars, rather than 7 trillion dollars, and you heard me right, that’s trillion, 2 trillion dollars more, than estimated just a few months ago, to me the most important issue is the cost.
OMG, it's in the trillions! Who knew?
GEORGE: Senator, um, there’s been a lot of misconception if not downright lying on both sides, of, of, this issue. Uh, what maybe would you say to the audience that can’t meet with you one-on-one, what they should be looking for, to look for truth, in the upcoming debate?
COLLINS: There has been, there have been misinterpretations, as well as downright, examples of people misleading, about what is in these bills, but there’s plenty in these bills that are troubling. I think that the questions that the public ought to ask, are these: what does it mean, in four different areas:
- Affordability – by that, I mean what’s going to be the impact on the insurance that people have now, what’s gonna be the impact for small businesses, what’s gonna be the impact for individuals who can’t afford insurance. What’s going to be the impact on the State and Federal governments? Medicare, and Medicaid plans, so affordability is one issue.
In her previous interview, she talked about saving money in Medicare by providing more preventive services. I certainly believe that such services should be covered, but there's not a lot of money to be saved by trying to get the elderly to do things that needed to have been done in their twenties, certainly not the scale she is looking to save money.
Second, choices. Is the bill going to constrain choices? Are choices and decisions still going to be made by patients and their health care providers? Or is government going to be making those decisions, so that’s an important issue as well.
Presuming, of course, that Mainers are getting to make these decisions with a doctor now, rather than with a series of insurance company lackeys or through self-treatment.
Quality – I think this often gets overlooked in the debate, and I think it’s absolutely critical. Maine generally is considered to be a high-quality low-cost state. Louisiana, not surprising in my view, it’s exactly the opposite. So we should look at will this legislation help to improve the quality of health care. That’s an important issue as well.
Does that mean it's a good thing we have Louisiana to look down on for having expensive low-quality medicine? Because last time I looked the price for me to get medical care was sky hig.
So affordability, choice, quality, and the final issue is access. And I’m talking not talking only about extending coverage to people in small businesses that can’t afford insurance now, but access in the sense that we realize that here in our state, are there, are the policies in this bill encouraging more physicians to go into primary care? Is it encouraging healthcare providers to go to rural underserved areas of the state?Or are all the incentives directed towards specialists who provide high-tech care, rather than to family doctors, nurse practitioners and others, who are providing what I would call "daily care".
Wait a minute, when did the purpose of health care reform become the government deciding what specialty a physician should practice or what part of the state they could choose to live in? Doesn't that sound a lot like socialized medicine where the government makes that kind of choices for a doctor?
So I think those are the four areas that we should all evaluate the bills by.
RIC: Senator, can I try to squeeze in one last question?
COLLINS: Yes.
RIC: And because you brought up affordability. We are told that there are 47 million Americans without insurance, that’s the number that’s bandied about in this debate. As I understand from the Census, the latest Census, nearly 10 million of those, 9.4 million, are not American citizens. We could take that to a discussion of illegal immigration, but for now 10 million are not Americans, 17 million, according to the Census Bureau, are making more than $50,000 a year. Arguably, people can afford to insure themselves. I’ll even look to the Kaiser Foundation, which says it’s more like 14 million people. Kaiser. 14 million people without insurance. Those are the people we need to cover. Giving each of those people $300 a month, we could solve this insurance problem for about 50 billion dollars. That’s a lot less than the 2 trillion over 10 years that we’re talking about in this health care reform debate. We need some solid numbers, you talk about affordability. Senator, I think it’s there, but I think our numbers are greatly swelled.
COLLINS: You know, Ric. You’ve brought up such an important issue. It’s so important that we let data guide our decisions...
Translation: Which is why I get all my data from the Lewin Group.
...and I very much want to help people who cannot afford insurance, to make sure that they have health care coverage. And what I proposed for years is that you give generous tax credits to allow small businesses to provide insurance for their employees, and low income people to match their share of the premium, self-employed people who are low income to purchase insurance. And so I’m very interested in that kind of approach, uh because I think it meets the criteria that I have been talking about. Let me add another interesting statistic: more than 70% of people who are uninsured work, they work or they’re in families that work. And overwhelmingly they work for small businesses. Small businesses want to provide health insurance for their employees, they don’t do so in several cases, in many cases, because they simply can’t afford it. So if you gave generous tax credits to small businesses it would dramatically reduce the number of uninsured Americans, and you are right, that there is a certain percentage that is, that is uninsured by choice, that essentially, can afford insurance, but is gambling that they’re not going to need it.
I just love how not having insurance is a by-product of issues that small businesses are having, which can be solved by throwing money at the small business. It not an issue in itself, nor are people who have no insurance people with a big problem. Susan used the phrase "small business" 7 times in the interview, but 4 times in that one paragraph.