Rx for Change: Susan Dentzer of NewsHour Talks about Health Care in America

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In conjunction with the September 30, 2008 broadcast of Critical Condition, POV has partnered with NewsHour to learn more about health care in America, and what presidential candidates John McCain and Barack Obama are proposing for medical coverage.

Susan Dentzer, the editor of Health Affairs journal and the host of NewsHour‘s Rx for Change,
answered some of our questions about these complicated issues.

Watch Susan talk to health care experts and campaign officials as they debate the state of the American medical system and which presidential candidate may do more to improve care on Rx for Change, tonight on NewsHour, and also available for viewing on
NewsHour‘s website

POV: Susan, you’ve been covering health care for over 20 years at the NewsHour, U.S. News & World Report, Newsweek and currently as editor of Health Affairs journal. Do you feel like the sides in the health care debate have evolved at all over that time, or are we still essentially debating the same policies put forth during the early ’80s? Are there any new ideas?

Susan Dentzer: We are still debating one central question: Should all Americans have reliable access to health care, and if so, what is and what should be the role of the government in assuring that access? And as has been the case for decades, Americans differ greatly on many sides of that question.

Some of the basic ideas in health reform have indeed been circulating for decades. For example, the health reform plans that Senators Clinton, Obama and Edwards put forward during the current presidential election campaign are strikingly similar to one advanced by an earlier President: Richard M. Nixon! Some ideas have been tweaked to better reflect current realities, and certainly Senator McCain is the first presidential candidate to my knowledge to advance the notion of making employer contributions to health insurance taxable to workers at the federal level and then substituting for that a system of fixed tax credits.

That said, the basic questions in health reform are much the same as always: Do we want everybody to have access to care, and by that, do we mean universal health coverage or something close to that? How do we split up the responsibilities and costs of doing that? And beyond that, do we have a health care system designed to provide optimum care at lowest possible cost, and if not, how do we get there?

POV: In a debate held earlier this month at the California Commonwealth Club, surrogates from the McCain and Obama campaigns debated the best way to cover America’s uninsured. One point that came up in the debate was that in a recent Gallup poll, a majority of Americans (57%) said that they are satisfied with their health care plans and 83% rate the quality of their health care as excellent or good. These percentages have actually remained pretty stable over the past 6 years. If that’s the case, why is it such a hotly debated election year issue? How do you explain that disconnect?

Dentzer: Very frequently, answers that people give in polls depend on how the questions are asked. If you have a health insurance plan you are, by definition, better off than about 1 in 6 Americans, so of course it is likely that you are satisfied. However, even in that Gallup poll, apparently 2 out of 5 Americans who did have a health care plan weren’t satisfied with it, so that is hardly a totally positive verdict on the status quo.

Also, most Americans who do have access to health care do feel good about the care they receive. Many people like their own doctors and value their own hospitals. However, if you asked the question differently — do you think the U.S. health care system has major problems? — many more people would say yes, and other polls reflect that.

What the Gallup poll essentially tells you is that many people who do have access to health care are happy with the access they have and happy with their health care providers. This, we know. It’s why many health reform plans don’t try to tinker much with existing arrangements that make much of the population happy. These answers in the Gallup poll don’t speak to those who are disenfranchised by the current system, or who worry that the system disenfranchises others, and there is plenty of evidence from other polls to show that there is ample dissatisfaction on these scores.

POV: Last week, Health Affairs published critiques of the McCain and Obama health care plans and a paper that proposed a compromise plan combining features from the two plans. What has been the reaction from the campaigns to these analyses? Should Americans vote in November expecting the two candidates to follow their plans to the letter, or do you think there is room for some compromise?

Dentzer: Not surprisingly, the campaigns quarrel with the analyses of their candidate’s plan and endorse the criticisms of the other candidate’s plan. We have had quite a bit of back and forth about this on our Health Affairs blog.

The reality, of course, is that presidential candidates’ health reform plans are always at best a schematic rendition of what the candidates would really do if elected president. They frequently lack critical details that would need to be fleshed out if these plans were ever to move forward as legislative proposals. They are often structured to capture the enthusiasm of a party’s base of voters or to sound certain themes that are appealing to those voters. And they rarely take into account the actual political realities that would face a President once elected.

That is the case with the current candidates’ plans, and most people who have followed these issues for years find it difficult to believe that these plans, even in broad outline, could be enacted as proposed. If you layer on our current economic difficulties and the uncertainty about the impact on the federal budget, it’s a near certainty that these plans don’t really have legs, and would have to be modified substantially to have any chance of passage.

POV: Do you think Americans can really expect to see an overhaul of the health care system some time in the next four years?

Dentzer: I don’t know, but I hope so. The problems facing us are serious, and the challenges of correcting them only grow over time.

POV: Finally, if American voters want to understand this very complicated issue, where do you think is the best place to start? Where do you think the best coverage of this issue is being offered to help American voters feel confident that they are casting an informed vote in November?

Dentzer: I’d recommend consulting some of the excellent resources now available on the Web. There’s our journal, Health Affairs. There’s the wonderful material published by the Kaiser Family Foundation at both www.kff.org and www.health08.org. There are super sites also run by the Alliance for Health Reform, the Commonwealth Fund and the Robert Wood Johnson Foundation. The Center on Budget and Policy Priorities has excellent analyses from a liberal perspective, and the Heritage Foundation and American Enterprise Institute has very important contributions from a more right-leaning perspective. I believe nobody has a corner on the truth, and one can gain immeasurably by reading as widely as possible. Fortunately, there’s plenty of analysis and information out there for the person who wants to become a serious student of the tough issues we face.

Critical Condition airs on most PBS stations on Tuesday, September 30 at 9 PM. Schedules vary, so check your local listings.

Ruiyan Xu
Ruiyan Xu
Former POVer Ruiyan Xu worked on developing and producing materials for POV's website. Before coming to POV, she worked in the Interactive and Broadband department at Channel Thirteen/WNET. Ruiyan was born in Shanghai and graduated from Brown University with a B.A. in Modern Culture and Media.
  • Sandra Brown

    FOREIGNID: 17488
    I am a Canadian in Vancouver, Canada, and I have just finished watching the film “Critical Condition”. How can this be in the richest country on earth? You are going to have many comments re government-run health coverage, many of them negative. Each province in Canada runs its own health-care system. In Ontario, I believe it’s free. In British Columbia, a single person who is working pays $54.00 a month. This covers all doctors’ & specialist’s visit, hospital stays and whatever medical treatment you need, including operations. If you are low-income, it’s possible not only to have the premiums waived, but prescriptions are covered as well. In British Columbia, there are deductibles depending on your income. No income – no deductible.
    You can see any doctor or specialist you want. I’s a 70-year old woman who has many medical problems, some of them life-threatening. Thank God I didn’t have to worry about how to pay! At the moment I am being followed because there is evidence that I have metatastic disease, a precursor of cancer. I have had medical lab tests and a CT Scan. I will be having an MRI, and hopefully will find out what’s wrong. And money doesn’t have anything to do with what kind of treatment I get.
    If a country with only 33 million people can look after its citizen’s health, why can’t the mighty USA? There’s always money for wars and Wall Street bail-outs, isn’t there?

  • Richard Heckler

    FOREIGNID: 17489
    Again why the USA should have National Health Insurance? Number one because taxpayers/voters want this coverage. Number two it should not matter what the political parties and the insurance industry want.
    Number three special interest campaign money needs to removed from the equation. Assuming special interest money is not the leading force is not reality.
    National Health Insurance protects families and business at the same time. No more large chunks from the paycheck for health insurance that sometimes is not worth the paper it’s written on. Business will not be forced to shell out large amounts for employees. Yet all citizens will receive identical coverage. Why should healthcare be treated like some retail object on a shelf in the business district?
    Why National Health Insurance?
    • We’ll all receive identical healthcare
    • Provides extraordinary leverage against suppliers
    • Protects families and business alike from being gouged by the healthcare industry
    • Treatment for serious illness such as cancer will not be cut off because a patient has reached the point insurance companies will pay no more…happens everyday
    • 60% of healthcare insurance today is paid with tax dollars so why not 100% that covers all who need treatment.
    • Citizens will not be forced to lose all of their assets or file bankruptcy due to serious illness as does happen somewhere everyday as we speak
    • Eliminates healthcare dollars going into special interest campaign cookie jars
    • Eliminates healthcare dollars from financing golden parachutes
    • Veterans receive care immediately for whatever symptoms war has imposed on their physical or mental health. No more waiting on the Dept. of Defense
    • National Healthcare eliminates over 300 different policies thus eliminating tons of wasteful administrative costs. That money could be included towards 100% coverage. It is estimated todays administrative costs runs at 33%…that is a lot of dough.
    • Myth busters: http://www.pnhp.org/single_payer_resources/mythbusters_by_the_canadian_health_services_research_foundation.php
    Organizations endorsing Single-Payer include:
    * American Association of Community Psychiatrists
    * American Medical Women’s Association
    * American Medical Student’s Association
    * National Medical Association
    * American Nurses Association
    * American Public Health Association
    * Islamic Medical Association
    * Americans for Democratic Action
    * California Nurses Assocation/National Nurses Organizing Committee
    * Church Women United
    * Consumer Federation of America
    * Consumers Union
    * Just Health Care
    * National Association of Social Workers
    * National Council of Senior Citizens
    * National Family Farm Coalition
    * National Health Care for the Homeless Council
    * Neighbor to Neighbor
    * Older Women’s League
    * Screen Actor’s Guild
    * US Public Interest Research Group
    * United Steelworkers Union

    Thank You,
    Richard Heckler

  • Howard Emerson

    FOREIGNID: 17490
    I agree with Sandra Brown’s comment above. After seeing “Rx for Change” I am convinced that both Obama and McCain are wrong by relying completely on private insurance companies to provide services to our people. The fundamental problem with that is that the private companies main motivation is PROFIT not SERVICE. I also ask, why do we need a plan that is so complicated that only professional economists can understand it? Why not do something simple?
    We need universal government sponsored health care – period. Let’s just DO it. We already have the mechanism in Medicare and the Vertean’s Administration. All we need do is expand it to cover everybody.
    How will we pay for it? I don’t have all the answers, but I can think of a few. We could stop no-bid military contracts. We could stop bailing out corrupt companies. We could re-regulate insurance, housing, and energy industries to bring in more revenue and cut costs. Even just accounting for the billions of dollars that having uninsured citizens costs us as a nation would help pay for universal care.
    OK, I’ll say what nobody wants to hear – we could even all pay a little more in taxes. Personally, if I knew I was covered, and so was everybody else, the relief would be worth it. By the way – I have decent medical insurance – and medical bills.

  • Richard Heckler

    FOREIGNID: 17491
    Until Rep John Conyers and HR 676 are stting in on every discussion regarding future health care in the USA all discussion is rendered incomplete. Why? Because the voting taxpaying public is not being exposed to all of the choices. The voting taxpaying public is only hearing what the political parties and special interest money want us to hear.
    Thank You,
    Richard Heckler

  • Richard Heckler

    FOREIGNID: 17492
    Until Rep John Conyers and HR 676 are stting in on every discussion regarding future health care in the USA all discussion is rendered incomplete. Why? Because the voting taxpaying public is not being exposed to all of the choices. The voting taxpaying public is only hearing what the political parties and special interest money want us to hear.
    Thank You,
    Richard Heckler

  • Paula Ruffy

    FOREIGNID: 17493
    What a disgrace! We talk about being a country founded on values and common decency.
    With so many Americans either unemployed or under-employed, how does either candidate expect these uninsured citizens to pay for private health insurance coverage with a tax incentive? These men and women can’t even afford to pay for daycare and gasoline just to go to work at their jobs (with no healthcare). And since when should it be the responsibility of the business community small medium or Fortune 500 to pay for insuring Americans.
    Does anybody in Washington have any common sense?
    Privatized coverage paid for with tax dollars is NOT the answer.

  • Debra L. Jones

    FOREIGNID: 17494
    My daughter graduated from high school in 1999 and attended a vocational school, she was not eligible for health insurance on my plan. She discovered a lump but was told by a doctor that it did not look like cancer and not to worry about it. This past April she was diagnosed with Stage IV metastatic melanoma, there is no cure.
    Health care is a fundamental right to life anything less is a crime against humanity.

  • Patricia VanMaanen

    FOREIGNID: 17495
    This was yet another compelling show on the personal experiences of Americans without health insurance. However, it leaves one saddened for those featured and frustrated about the current system. Yet it offers no true solutions or any actions one can take to begin addressing the issue. Nor does it even provide any education one can take away to begin asking the critical questions necessary to change our system. I think we all know the health care system is not serving most Americans very well. Our efforts, should now be focused on solutions and tools to empower every American toward change, not further episodes belaboring the issues of the broken system.

  • Rogette Edkin,LPN

    FOREIGNID: 17496
    I get very discouraged when I watch shows concerning healthcare and find that the people that are in charge of this situation and that are able to make changes are high class people whom have probably been brought up with silver spoons. Get these people out. They have no clue what it is like to live day to day and paycheck to paycheck. Get them out of their suits, put them into some scrubs and come follow me for a day or two. They need to come on out and see the real world. They need to see the huge number of people whom cannot afford thier medications, they need to see the poor care that is given in nursing homes, they need to see the poor people that are in a medical crisis and cannot worry about thier medical condition because they have to worry more about how they are going to pay for the care they need. They do not have a clue, just talk. They don’t have to worry, they can go out for a fancy lunch/dinner after their stupid comments in an interview. And yes, I am talking about the heads of our government. Get some mid. class people into government, people whom actually live the real life, people whom actually “work” 40 hours a week, people whom have accumulated doctor bills. Our country is run by a bunch of over educated idiots. Real people grew up spending Saturday mornings splitting wood, harvesting gardens, ect.. not in a country club. As a nurse for 10 years, I have seen things that make me very angry. I have seen young pregnat teenagers get free full medical coverage, free food, and free assistance, but yet I have also seen mid. to elder aged people that do not take the medications they are suppost to because they cannot afford it, and these people work!!! The working class Americans are screwed. We make too much for assistance, but yet not enough to make ends meet. Something better be done to cover us without raping us of our money that we need to live off from. America would not run without us. We have the group of Americans that do not want to work, they just want to be taken care of, then we the the high class group of people whom want to work but it’s the cushy office type jobs that make them look better than someone else, then you have the real American whom puts in the hard 40 hours a week plus some. Take care of us medically, if not, then who’s going to do the hard work out there that needs to be done? It won’t be the guy in the suit and tie, a backache would probably kill him, he’d be done after one 8 hour shift. I’m only one of millions and my voice will not matter, but here goes nothing: ” I need some help here, it’s getting tuff to keep my head above water”. We need to get the over educated people out of office and get some people in with common sence. A good president would be one whom chooses not to spend millions of dollars to prove himself to be better than someone else, but one whom stays home with his family while working 40 hours a week and records home videos to prove himself to conserve on money, that would be a smart person, one whom right off the bat does not spend money stupidly. It’s moreless proving ” I have more money than you so I am better”. If it takes money to prove someones worth, than that person is probably worthless. If someone has the confidense enough of themselves to not need money to prove who and what they are, than that person is probably very wise. There is a big difference between being an intellagent person, or being a wise person. I thing wisdom needs to be looked at more. Thank you, Rogette Edkin, LPN

  • http://www.healthcareforallnow.org Bob Haiducek, Bob the Health and Health Care Advocate

    FOREIGNID: 17497
    Howard Emerson: how can we pay for it?
    Easy, because going to non-profit financing of health care actually saves our country money, including invdividuals and businesses, cities and counties and school boards.
    Take a look at the costs and savings.
    Although he may have only said it once or twice that I know of, don’t let Obama or anyone else tell you ever again that national health insurance will require a large increase in taxes. Anyone who says that is making a VERY misleading statement, because the web page shows that the savings overwhelm the increase in taxes. Why? Because we will no longer be paying for the for-profit health insurance premiums to over 1300 health insurance companies.
    Paula Ruffy: good for you on what you wrote about tax breaks! The tax breaks, such as the Health Savings Accounts, benefit the wealthy more than the poor! Even subsidies are horrible! More spending of our tax dollars to more government bureaucracy that won’t cover the for-profit health insurance premiums for a set of benefits that has LIMITS on how much is paid!

  • Denise Snyder

    FOREIGNID: 17498
    Look around. Everywhere are indications that our society is broken. It is time to create a better society. A society that embraces all people and mandates that everyone is entitled to clean air, clean water, healthy food, health care, education, and opportunities to give back to society and help make the world a better place- including having meaningful and safe work.
    We have seen the costs of not caring about our people- record numbers in jail, record numbers of suicides, record numbers addicted to drugs, alcohol, and/or tobacco, millions without jobs, homes, health care, and hope. When our actions as a society, make the unspoken statement that “We don’t care enough to provide life’s necessities to everyone”, can we as a society blame those who steal, murder, rape, etc? If we don’t care about them and create (or at least take steps towards) a society that gives a minimum standard of care and help to all, can we blame those who drop out, act out, or fight back? Do you want to live in a society where sick people roam the streets, infecting others because they can’t afford medical care and can’t get it for free? Does it bother you that our sick are dying because they can’t get medical care?
    Commit today to strive for a healthier, happier, kinder, gentler society. In all you do and see ask yourself, “Will this make our society better, does this action/policy show people we as a society care?” Require government officials to tackle the big issues, hold them accountable to creating a structure for a better society, one that matches our hopes and dreams.
    A great starting place is – Health Care for All. Now is the time, this is the place, we are the ones.