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Costs, Government’s Role Split Advocates in Reform Debate

August 13, 2009 at 12:00 AM EDT
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In a debate over health care reform, former House majority leader Dick Armey, and Richard Kirsch, national campaign manager of the liberal advocacy group Health Care for America Now, discuss topics such as the role of government, and the cost of any overhaul.
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JUDY WOODRUFF: As the fight over reforming health care spreads from here in Washington, D.C., across the rest of the nation, we hear now from advocates on both sides of the issue.

Former U.S. House Majority Leader Dick Armey is chair of FreedomWorks, a conservative group that has rallied protestors at health care town hall meetings.

And Richard Kirsch is the national campaign manager of Health Care for America Now, a liberal group which has urged its supporters to turn out at the meetings.

Thank you both for being here. We thank you for being part of this discussion.

And, Dick Armey, I’m going to come straight to you on the basics. You believe that there should be some form of reform of health care, health insurance, but a more limited form than what the president favors.

DICK ARMEY, FreedomWorks: Yes, I do. And we go back to things I’ve argued for, tort reform is — estimates now as much as $100 billion of just sheer abject waste, which, by the way, is a hardship…

JUDY WOODRUFF: Tort reform, for those people who don’t know the legal term, means…

DICK ARMEY: Well, lawyers suing doctors and that which causes doctors to order up extra procedures on behalf of patients that are not needed medically, but they need them in case they end up in a courtroom.

I watch this process. The thing that breaks your heart about that is, especially with older folks, to be subjected to extra procedures that are not medically necessary is a very difficult burden for them to carry when they’re already oftentimes quite fragile and the procedures themselves can be quite a stressful experience for them.

JUDY WOODRUFF: So tort reform would be an important change for the system?

DICK ARMEY: That would be a good place to start.

JUDY WOODRUFF: Would that be enough, Richard Kirsch?

RICHARD KIRSCH, Health Care for America Now: That’s not the problem Americans face, Judy. Basically, what Americans face is a problem of they don’t have a guarantee of good health care they can afford.

Three out of five of the personal bankruptcies in this country are because of medical costs, and most of those people have insurance, but the insurance isn’t there when they need it, because if they get seriously ill, it stops paying.

Did you know that premiums in the last decade have gone up four times as fast as wages? People can’t afford to get health coverage.

And so we have this tremendous sense of insecurity, and what people need is a guarantee of good, affordable coverage at work or, if they don’t — if they’re not at work, to have that coverage there, too. And what we’re talking about is basically saying to America: You have good coverage that you can afford.

JUDY WOODRUFF: And you’re saying provide that how?

RICHARD KIRSCH: Provide that very simply. What the reforms that we’re looking at do two things. First of all, they say, if you’re at work, your employer is going to continue to provide coverage at work, or — and the coverage is going to be good, because there are going to have to be a specified set of good benefits, and if you don’t have coverage at work, you’re going to go into a new health insurance marketplace where you’re going to have a guaranteed choice of coverage that’s affordable based on what you earn. It’s very simple.

JUDY WOODRUFF: Why isn’t that a system that would work?

DICK ARMEY: Well, the biggest problem that they have with this — this sounds great. I mean, I have to tell you, you’re warming my heart.

RICHARD KIRSCH: It is great.

Government-managed care

DICK ARMEY: But the fact of the matter is there is a large and growing number of Americans who are actually reading the bills that have come through the House and they just don't believe that. They see this as a hostile government takeover of all health care, where they will be forced into a government-run program, and their health care lives will be managed by the government, just as today's the case in Medicare.

If you're over 65 years old in America today, you have no choice but to be in Medicare. Even if you want out of Medicare, you have to forfeit your Social Security to get out of it. Even if you're a Christian Scientist, you have to give up your Social Security. That's pretty heavy-handed, and people fear that.

JUDY WOODRUFF: What about this charge?

RICHARD KIRSCH: Well, I mean, I think what Dick Armey just said is absolutely to the point. He doesn't think Medicare should exist. Basically, Medicare is the system that provides a guarantee of good coverage for seniors in this country.

It is, in fact, what is meant -- your old age means you don't have to worry about not getting the health care you need. That's the same thing we need to do for everybody in this country, but we need to do it in a system that provides choices between regulated private insurance or public insurance. And the point is, we need that guarantee for people to have affordable health coverage.

DICK ARMEY: Let me just be clear about something. I have no problem with Medicare. I was talking to my minister just last night about it. If you want to voluntarily be a part of it, bless your heart, I'm proud for you. I want you to have it.

But I do have a problem is forcing people in it and be given very, very punitive government sanctions against anybody who would say, "I don't want to be in that program."

JUDY WOODRUFF: Well, let's address...

DICK ARMEY: You should have a right to say no to the government and say, "I don't want to be a ward of the state."

JUDY WOODRUFF: What about this very point? He's saying that, under the plan or the plans that are moving through Congress, people would be forced into government health care, either Medicare or some other...

RICHARD KIRSCH: First of all, that's totally untrue. Under the plans that are being introduced and passed by so far three committees in the House and one in the Senate, people at work would keep their coverage at work, but the coverage would change in the following ways.

Your employer's coverage would have to meet certain minimum standards, so the benefits would have to be good, and the employer would have to pay for a decent amount of your coverage. So that's private insurance at work.

And if you then don't get private insurance at work, what you would do is go into a new health care marketplace where you would choose from multiple private insurance plans, not government plans, private insurance plans, and one new public insurance plan.

That's not a government takeover of anything. It is government regulation so we're sure that health insurance works for you.

JUDY WOODRUFF: What's wrong with that...

DICK ARMEY: There's nothing wrong with his story as he tells it. But the fact of the matter is, even the Congressional Budget Office says 100,000 -- or 100 million Americans will lose their -- their...

RICHARD KIRSCH: That's not what they say.

DICK ARMEY: ... their employer-provided insurance. The Congressional Budget Office...

RICHARD KIRSCH: That's not what they say.

DICK ARMEY: This is not quarreling with me.

RICHARD KIRSCH: The Congressional Budget Office actually did an analysis of the House bill. And what it said is, under their bill, the number of people who will be -- not lose their private insurance. The number of people, mostly uninsured people now who will go into the public plan will be 9 million. That's the number in the analysis of the House bill.

DICK ARMEY: Well...

RICHARD KIRSCH: That's the facts. That's what it says.

DICK ARMEY: Well, so we have a difference of information here. But I have to tell you, if you take a look at the unrest that you see brewing in America today, it's precisely because the American citizenry at large does not believe what the government and agents of the government are telling them.

A public option

JUDY WOODRUFF: Well, let me come back to Richard Kirsch. You -- I understand your point, a big part of your point is that you think insurance companies today have too much power, too much say over what kind of care people get, how much they pay. Explain that to us. What's the problem?

RICHARD KIRSCH: The analogy is pretty simple. You wouldn't be allowed to sell a car that would kill people or a toy that would choke a child. Why should you be allowed to sell an insurance policy that doesn't actually provide good care?

We want to have a system where, when you have health insurance, it means it covers the benefits you need, and you can afford it, and it doesn't stop paying when you have a serious illness.

And we also want to be sure that insurance companies can't continue to deny care, to delay payments, to increase their profits. You know, insurance company executives made $690 million in the last decade of the 10 top companies. That's just not right.

DICK ARMEY: There are 1,300 insurance companies in America today. I'm free to choose from among them, except that the government restricts me from buying across state lines. Remove that barrier and let people be free to purchase insurance wherever they find it in the state.

Can you imagine if we passed a law in Michigan that says you can't buy a car that's made in Alabama? That would be outrageous.

RICHARD KIRSCH: That's not what we're saying.

DICK ARMEY: But that's what we're doing now, so there's plenty of opportunity. And I can fire my insurance company; I can't fire the government. And when the federal government gets control of your health care and exercises the power of the state to punish you, should you try to get out of it and go some place else, you're in real difficulty.

And let me tell you. I can tell you that, because I'm over 65 years old. I know you don't believe that, but it's true. And I have no place to go. Either I go to Medicare or I go without.

JUDY WOODRUFF: There's also discussion -- very quickly, Congressman Armey -- about a so-called nonprofit insurance cooperative, which would not have as much power as the government option would. Would you be willing to accept something like that?

DICK ARMEY: Well, you know, it's really funny. I always kind of laugh at these folks, because we have talked about risk pooling and voluntary risk pooling operations on the private sector through private initiative and they've been blocked in Congress by the advocates of single-payer.

Now they say, if the government sponsors the risk pool, this would be akin to Freddie Mae and Freddie Mac. We call it Fanny Med.

JUDY WOODRUFF: So it wouldn't be -- it wouldn't be acceptable?

DICK ARMEY: No, it's a government-sponsored operation, and government-sponsored operations generally malfunction.

JUDY WOODRUFF: What about you and your group, Richard Kirsch?

RICHARD KIRSCH: Right. Medicare has lower inflation...

JUDY WOODRUFF: Would you be willing to go along with a nonprofit cooperative idea?

RICHARD KIRSCH: No, because that's not a public option, because it doesn't have the ability to lower costs and keep insurance companies honest. Co-ops are very nice, but we need...

JUDY WOODRUFF: So here's one thing both of you agree on, but for different reasons.

RICHARD KIRSCH: Neither of us want a co-op, but the difference is, I think we need a public option. People choose private insurance, but we need a plan that will keep private insurance companies honest and make them compete.

AMA data, American Medical Association data, found that 94 percent of the markets in this country are highly concentrated by Department of Justice standards. That means you don't have effective choice. Want to lower costs and keep those insurance companies honest? We need a public option.

Anger at town halls

JUDY WOODRUFF: Congressman Armey, what about all the attention that's being given right now to these town meetings around the country? A lot of people angry. Are these a healthy way to reach the best outcome for the country, or is reason being drowned out?

DICK ARMEY: Well, I don't -- I was in Congress for 18 years. I had at least four seasons of town hall meetings every year, and town hall meeting are exciting things. People should come up. They go to a town hall meeting because they have something that's a matter of concern to them.

Think about this. This is one-sixth of the entire economy, and probably the most critically important sector of the economy to you and me is, does Mom get the right health care? Do I get it? Do my children get it? And they're fearful about it.

Now, here's the problem. If I were to tell you that I bought an insurance policy for my family and didn't read it, you would consider me a terribly imprudent person. And yet they go to the town hall meeting and the congressman says, "I haven't read the bill," and that's very disconcerting to them.

JUDY WOODRUFF: How do you see these town meetings?

RICHARD KIRSCH: Well, for the most part they've been really...

JUDY WOODRUFF: You're encouraging your folks to...

RICHARD KIRSCH: We're telling our folks, encouraging our folks to go, and civil discourse, and asking questions, and having real debate is great. Sometimes people are coming in shouting and not listening; that's not what this is about.

But more and more, we're seeing press reports around the country of meetings that are civil, that people are listening to each other. There's a lot of myths and lies being told about this legislation. But if people can ask questions and get those questions answered, it's great. That's what democracy is about, and we'd love to see more of it.

JUDY WOODRUFF: What's your sense today, quickly, of how this is going to turn out?

RICHARD KIRSCH: I'm quite sure the president is going to sign a bill that guarantees good, affordable health care coverage for everyone in this country this fall.

DICK ARMEY: I think the health care bill as it presently is presented out of the work of these committees in the House will not be able to obtain the votes in the House -- floor of the House because too many voting members of Congress will have heard too much dissension from their constituents back home and they won't dare vote for it.

JUDY WOODRUFF: We hear you both loud and clear. Richard Armey, Richard Kirsch, thank you both.

RICHARD KIRSCH: Thank you.

DICK ARMEY: All right.