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THE MacNEIL/LEHRER NEWSHOUR
HEALTHY DIFFERENCES
TUESDAY, JULY 14, 1992
MS. HUNTER-GAULT: The big item on the agenda at Madison Square Garden tonight is ratifying the platform, the formal document that lays out the Democrats' policy on the issues. The party plans to present a united front tonight, but Just beneath the surface lie big differences on some of the major Issues. Take health care, the platform will endorse the principle of making it affordable to all Americans, but that's where the unity ends. Since last fall the issue has been on a fast track in Congress where, as Kwame Holman reports, the Democrats are of two minds.
HARRIS WOFFORD: (Nov. 5, 1991) The first Democratic Senator in twenty-three years reporting for duty.
KWAME HOLMAN: Last November, Democrat Harris Wofford pulled one of the biggest political upsets of the year when he defeated former Attorney General Richard Thornburgh in the Pennsylvania Senate race. That stunning victory was credited largely to Wofford's focus on health care reform.
SENATOR HARRIS WOFFORD: (Political commercial) The Constitution says those accused of a crime have the right to a lawyer, yet millions of Americans aren't able to see a doctor. They either don't have health insurance or they are afraid medical costs will bankrupt them. If criminals have the right to a lawyer, I think working Americans should have the right to a doctor.
KWAME HOLMAN: Democrats were buoyed by that win and by polls that showed ninety percent of the public favored a major overhaul of the current health care system. They quickly latched on to what they saw as a winning issue. In the Senate, Majority Leader George Mitchell continued to push a wide ranging plan called 'Play or Pay' which he introduced last summer.
SEN. GEORGE MITCHELL, Majority Leader: We have three objectives, the first is to provide health insurance for every American, second we must control cost, and third preventive health care. It's comprehensive, it's complicated, it's controversial, all of those things, but basically we try to build on the current system which is health insurance through employment.
KWAME HOLMAN: The 'Play or Pay" plan guarantees health coverage while retaining the current private health insurance network by requiring that all businesses play by providing health coverage for their employees or pay into it government fund that would ensure coverage for anyone who didn't have it. Supporters point to Hawaii where a system similar to 'Play or Pay' has been in place for more than a decade and by most accounts has provided health care for all and kept costs down. A number of large corporations support the Mitchell approach but small businesses are fighting 'Play or Pay" saying the cost to them would be devastating.
SEN. GEORGE MITCHELL: We recognize the unique problems of small business. The fact is of course that of employees in companies with twenty-five or fewer employees, nearly three-fourths are already covered. What we say to the remainder is, we create new and we think significant economic incentives to encourage employees to be provided insurance by their employers.
KWAME HOLMAN: The Mitchell plan closely resembles the reforms Bill Clinton has endorse, still 'Play or Pay' has failed to take off in Congress. To date, Mitchell has only ten co-sponsors for the plan. A growing number of Democrats say 'Play or Pay' doesn't go far enough. Over in the House of Representatives, many Democrats are lining up in favor of a system like Canada's where the government guarantees health care for all citizens. That plan is called "One Payer." Representative Marty Russo of Illinois has been one of its key backers.
REP. MARTY RUSSO, (D) Illinois: So what I'm doing by going to a single payer, which means basically you go from fifteen hundred different insurance companies to one insurance company, the federal government. You make it a very efficient system. You eliminate the unnecessary administrative cost and you take that money and plow it back into the system.
KWAME HOLMAN: Russo would finance the estimated six hundred sixty billion dollar a year cost of the plan with a tax increase. He says the tax hike would be more than offset by eliminating insurance premiums and medical bills Americans now pay. The Russo Plan closely resembles Canada's health care system under which clinics and physicians remain in the private sector but the government picks up the entire expense of the services provided. That includes costly long-term care. Republicans in Congress also have a plan. Backed by President Bush, it is at the opposite end of the health care reform spectrum from the Canadian system. Republicans want only moderate reforms arguing that the current system only needs fine tuning, not the major overhaul most Democrats favor.
PRESIDENT BUSH: In our proposal, it helps small businesses pool together to offer their
employees affordable health insurance, it lets the self-employed deduct one hundred percent of their health insurance premiums from their taxes, it makes it possible for workers to change jobs without the fear of losing their health insurance and it curbs the runaway cost of medical malpractice litigation. Just as important, our proposal does not saddle our businesses and workers with costly new mandates or taxes or allow federal bureaucracies to regulate prices and to ration services.
KWAME HOLMAN: At this point none of the health care proposals has mustered a clear conscience. John Iglehart is editor of a health policy journal, Health Affairs. He has spent years watching the battle over health care reform.
JOHN IGLEHART, Editor, Health Affairs: An issue of this magnitude in a society this
diverse is simply not going to occur in an election year. I means it won't happen. A debate has to build over a period of time, at the center there has to be presidential leadership which is currently lacking, I would say. The President has to be willing to really Invest a substantial number of his or her limited chits on this basis and you don't see that today. You've got to see that, whether the President is Democratic or Republican or an Independent in the future.
CHARLAYNE HUNTER-GAULT: The Democratic platform calls for a uniquely American reform of the health care system and universal access to quality affordable health care. Here to help us understand just where that leaves the debate are two Democratic Senators with different ideas about how their party should go about pushing for health care reform. Senator Jay Rockefeller is from West Virginia; he was one of the champions of 'Play or Pay.' Senator Paul Wellstone is from Minnesota; he sponsored a one payer health bill in the Senate. They join us from our sky booth at the convention. Gentlemen, thank you for joining us, and Senator Wellstone,
first of all, where exactly does this artfully worded plank leave the Democrats on health care?
SENATOR WELLSTONE: Well, Charlayne, I think it leaves us in agreement in some ways. I mean we agree that the health care system is in crisis all in capital letters and therefore we are talking about fundamental change. We are talking about universal health care coverage. So the differences between Bill Clinton and George Bush make a world of difference. I mean where it leaves us also is a real good discussion that we have to have about what direction to go in. I think we've got to have a system that controls costs and provides care for people in a dignified and humane way and I do think the single payer system is the most desirable proposal.
CHARLAYNE HUNTER-GAULT: But why is the platform so vaguely worded. I mean I don't understand really what it is saying?
SENATOR WELLSTONE: Well, I think the effort right now is to try to bring people together and to be unified and to send a signal that we are committed to universal health care coverage. I agree with that. The danger is that you don't to make it a symbolic issue. I mean health care has become the functional equivalent of kissing babies. I mean we do have to be specific. We are going to have to sharper and I think we'll develop that. Bill Clinton will develop that. We will work together on it.
CHARLAYNE HUNTER-GAULT: Senator Rockefeller why do you think that it is so vague? I mean why was it left this way?
SENATOR ROCKEFELLER: I think it is useful in fact that it is vague because one of the most
important things about health care is that it is a brutally complicated, very controversial subject and you know what is interesting is in our Democratic Party there is some dispute whether we job based system of health care or a single payer system of health care. But there is no dispute number one that there must universal coverage and secondly that there must be very rigorous cost containment. George Bush offers nothing except malpractice reform and a kind of measly tax credit thing which doesn't help fully unless you are making less that $6700 a year.
CHARLAYNE HUNTER-GAULT: Senator Wellstone what about you mentioned small business a few minutes ago, I mean, what about the political heat from small businesses. Are you concerned about that? They don't like the idea of being required by law to pay for their employees health insurance. Is that going to generate political heat? Can that be sustained?
SENATOR WELLSTONE: Charlayne, I am concerned about small businesses, I think Jay is. I held some Small Business Committee hearings back in my state last week and I will tell small businesses are just getting by the costs and they do want to see effective cost control and I think Jay knows that. Again, I think the single payer [system] makes the most sense. We'll see the direction that we will ultimately go in. I do believe that cost control is going to be a part of whatever major reform we have in this country. It has to be. And I think small businesses have every right to demand that, I think the majority of the people in this country want to do that. We agree on preventive health care benefits that is really important, we agree on streamlining the financing and the administration of it. That is really important. We agree on including long-term care. I have never heard, Jay and I were talking, I have never heard the President talk about long-term care for people with disabilities, for senior citizens. Both my parents had Parkinson's Disease. Those are the things that we agree on and I think that we are just going to have to make health care the major, major issue this year.
CHARLAYNE HUNTER-GAULT: But Senator Rockefeller, while Senator Wellstone gets his ear piece back so he can bear the discussion, is this going to be a winning issue for a candidate in November? You heard John Iglehart on the tape piece, you may have heard it just before this segment began, that in an election year it is just not going to be an issue that is going to be joined.
SENATOR ROCKEFELLER: What I think is going to happen during the election year, Charlayne,
there is going to be very sharp debate. I don't know what Perot has come up. But I do know what Bush has come up with and it is nothing and I know what Clinton is coming up with and it is terrific. And I think what you are going to see is laying of the predicate by the candidates and you wait for the debates. You wait for Clinton to take after Bush on his tax credits and his deductibles and this mish-mash that doesn't add up to anything. When Clinton, which is of course what I want to see happen, then he will be committed, bonded to the American people for getting health care within the first two years and that is what lie has told me that he wants to do. It is exciting.
CHARLAYNE HUNTER-GAULT: Senator Wellstone do you think this is a winning issue for a candidate In the fall?
SENATOR WELLSTONE: I think it is, I mean, the Minnesota State Fair, Charlayne, half the state's population comes in two weeks, nobody has a lobbyist. Everybody counts as one and no more than one. And people talk about health care. The vast majority of people fall between the cracks. But, again, we can't make it symbolic -- I'm having more trouble -- we cannot make it symbolic. We're going to have to define it. We're going to have to be clear on how we're going to finance it and how we're going to deliver that care.
CHARLAYNE HUNTER-GAULT: But how are you going
to be clear on it? I mean, I hear all this unity and if really that's the spirit of the convention this week and I can appreciate that, but I'm having a little trouble understanding -- I mean, if you two have -- and you do have some with different plans, how is Clinton in the first 100 days say of his -- of even in the campaign going to sell an idea where these various ideas are still floating around within his own party.
SENATOR ROCKEFELLER: There are only two basic ideas that are floating around and they're not that far apart. Frankly, the major difference between Sen. Wellstone's proposal and my proposal is the matter of financing them. Right now you have Exxon, AT&T, General Motors, and a whole lot of other, you know, corporations, big and small, picking up the majority of the cost of health care in this country. Under Sen. Wellstone's plan, which is -- I much prefer it to the system that we have, which is imploding and which is in chaos. What you have to do is you have to put forward in enormous amount of taxpayers' money in order to realize the cost savings which. Indeed, a single payer plan does produce. I would rather take an America which is uncomfortable on this subject, make the adjustments that we can, make them radically, make them firmly, but get them done. Don't hold the American people hostage while you're trying to get the perfectly efficient system.
SENATOR WELLSTONE: And I think, Charlayne, what we've got to do is he real clear with
CHARLAYNE HUNTER-GAULT: Sen. Rockefeller, do you see yourself moving more in Sen. Wellstone's, into his plan with the government paying the bill?
SENATOR ROCKEFELLER: Charlayne, again I think that you're too worried about the differences between these two things. What is important is that the Democratic Party at every
level in the Congress is flat out focused on comprehensive health care reform. And the degree of movement that I have seen in the last four years within the Senate and within the House on the subject is absolutely extraordinary. Nobody was talking about health care reform four or five years ago, nobody, including the media. It's been a real revolution. I don't think the difference between our plans is as much as the difference between what we're talking about and what George Bush is talking about, which is basically pushing the problem aside.
CHARLAYNE HUNTER-GAULT: Well, how would you advise Clinton to campaign this fall on health care?
SENATOR ROCKEFELLER: People, people measure candidates, including Presidents, in my judgment, on the basis of the intensity of the way they talk about something, what is their sincerity, how passionate do they feel about it, can they feel from the soul of Bill Clinton his desire to make change, to get access out into the Mississippi Belt and to Appalachia, into rural Minnesota. They're going to feel that from Bill Clinton because this is at the top of his agenda.
CHARLAYNE HUNTER-GAULT: Sen. Wellstone.
SENATOR WELLSTONE: Well, I think that Jay is right, I mean, there has to be conviction.
CHARLAYNE HUNTER-GAULT: All right. Well, Sen. Wellstone and Sen. Rockefeller, I'll wait to see this resolution between the two of you. Thank you for joining us.
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