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Science and Health:
Transcript: Bill Moyers Interviews Julie Rovner
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Julie Rovner

MOYERS: That was Julie Rovner reporting from Maine. Here she is now in the studio with me. You've heard her many times as NPR's health policy correspondent, and many of us know her as an expert on health care in her own right. She's the author of the book HEALTH CARE POLITICS AND POLICY A TO Z. Thanks for joining me tonight.

ROVNER: Nice to be here.

MOYERS: What's your...what do you learn from your reporting about why are health care costs rising so fast?

ROVNER: Well, there's a lot of things in health care that are very complicated. This isn't one of them. It's pretty simple.

We're getting older as a society and older people consume more health care. And we're developing more things that we can do. I mean, everyone says what a great system the United States...or, what great health care we have in the United States.

And we can do...not only can we do wonderful things, but we can do wonderful things that are safer. And that's important to the health cost equation, because as things get safer and so the risk benefit goes down, there's more of a benefit and less of a risk, you can do more things and therefore it runs up the cost of health care.

MOYERS: But even with all of those choices, can't we do a better job of controlling the cost?

ROVNER: Well, certainly we've talked about it for years, for generations in fact. This is a recurrent theme in American social policy history. We've just never been able to resolve what it is that we want to do.

MOYERS: Right now the market rations health care. But that means millions of people cannot buy into the market. Can the system sustain itself when so many people are outside it?

ROVNER: Well, that's certainly the big question and that's a problem that we really haven't faced to this extent before.

MOYERS: These are then people with no voice, no representation?

ROVNER: Well, some of them do. A lot of these people though are struggling to live day to day. These are people with no health insurance and many of them with if not very low incomes low enough incomes that it's hard to keep food on the table. And really they work two, sometimes three jobs. They don't have a lot of time to be off lobbying their legislators to help them get health insurance.

MOYERS: Here's a true story I heard about just yesterday. A young woman turns up with ovarian cancer. She goes to the doctor. He says he won't take her because she doesn't have the right kind of coverage, and he doesn't want to take this on. So she has to go and find coverage. She gets it, but she gets lesser coverage. I mean, that happens a lot, doesn't it?

ROVNER: It does. I mean, there's certainly study after study that suggests that while the uninsured do get care, if you get run over by a bus in the middle of the street, you're going to get taken to a hospital, you're going to get taken care of.

But people who don't have insurance get less good care. They don't get as much preventive care, so that when they get sick things get found later when they're harder to cure.

They don't get the kind of continuous care that's better. They don't develop relationships with doctors that can help keep them healthy. So yes they get care but it's not optimal care by any means.

MOYERS: I don't know if your reporting has turned this up, the answer to this question, but every industrialized democracy in the West, and some developing countries, treat health care as a human right. We treat it as a function of the market. Why can't we move toward what so many others embrace?

ROVNER: I think because we've had this ongoing debate really over the last 50 years about which way to go. Everybody agrees that people should have health insurance, that people should be able to have access to health care, to good coverage.

But we can't resolve this, every other country managed to resolve this most of them years ago, some of them more recently. But there is this continuing standoff, a policy standoff in Washington, to some extent in the states, too, you've really got people dug in on whether to get the government more out of health care or whether to get the government more into health care.

MOYERS: You mentioned earlier that some 10 or 12 years ago there was a great outrage over health care, in fact, it influenced the outcome of the '92 election, in one sense, Bill Clinton was elected because he exploited that issue and said he was going to do something about it. What's happened to that outrage in the last 10 years?

ROVNER: Well, I think the outrage has gone away. What really happened was in about 1989, 1990, really before Bill Clinton even came to this issue, we saw the same kind of skyrocketing health costs that we're seeing right now. And what happened was that companies moved to managed care to try to get a handle on cost.

And I think the combination of managed care and the threat of universal health coverage helped dampen that health care inflation for several years. Then what happened is that health care inflation has started to come back in the mid to late 1990s.

At that point we were in a booming economy with a tight labor market. And for most people who had insurance, their employers shielded them from those increases. They needed to be able to get workers. So they said, it's going up 10 percent a year, we're going to swallow that. You're not going to feel it.

I think that's just now beginning to change as the economy is doing not quite so well. We're seeing more of these costs being passed on to workers. We're starting to see strikes again over health benefits. It's sort of back to where we were 10 or 11 or 12 years ago.

People are starting to feel the pain of these increasing health costs. And what's going to happen as the costs go up as we've seen in Maine, employers are going to just to have...have to stop offering insurance at all.

MOYERS: Do you see in your reporting the evidence of the great consequences of the inequalities in health care?

ROVNER: Yes, I think there's...what I'm starting to see is evidence that the system is starting to break down again. As I say, I think most people don't feel it yet. They're not feeling it in their pocketbooks, they're not feeling it to a great extent when they try to go to the doctor or to the hospital.

But the level of complaints from the health care providers, from the people who actually give the care, is getting louder once again. It's sort of ominously coming over the ridge.

MOYERS: How does it play out, this inequality? Who gets really hurt?

ROVNER: Well, I think obviously the people who don't have insurance. The people who have insurance that's not very good, and there are a lot of people who have insurance that just isn't very generous or doesn't cover very much...

People who need care, and this growing gap between what we can do and what we can afford to do, even on a personal level. If you need something that costs $20,000, or $30,000, or $40,000, for the average American, if your insurance isn't going to cover it, that's just unreachable.

MOYERS: I mean, some of those families in Maine, how do they afford $1,000 a month, $800 a month?

ROVNER: Well, they're giving up everything else.

MOYERS: Thank you, Julie Rovner, for your reporting from Maine, and for being here tonight.

ROVNER: Thank you.

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