Candidates’ Rx: Senator Bob Graham

JIM LEHRER:

Now, another of our conversations with the Democratic presidential candidates about health care. Margaret Warner has tonight's.

MARGARET WARNER:

Senator Bob Graham of Florida is advocating what he calls an incremental approach to getting health coverage to nation's 41 million uninsured. He would expand government programs like the Children's Health Insurance Program, or CHIP, to guarantee health coverage for all children; offer an affordable buy-in to Medicare for those nearing 65 who have lost coverage from their employers; and expand Medicaid to cover more of the so-called working poor, whose employers don't provide coverage and who cannot afford to buy it on their own. Senator Graham joins us now from Capitol Hill.

Welcome, Senator.

SEN. BOB GRAHAM:

Thank you, Margaret.

MARGARET WARNER:

How many of the nation's 41 million-plus uninsured would get coverage if you combined all three of your proposals?

SEN. BOB GRAHAM:

Two-thirds of the currently 41 million Americans who are without health insurance would be covered under these three proposals.

MARGARET WARNER:

So, do you not… then you do not consider this less ambitious than the plans of some of your rivals, Senator Kerry, Howard Dean, or Dick Gephardt?

SEN. BOB GRAHAM:

No, it is approximately the same number of people that they would propose to cover in their plans. I think it is pragmatic. If there's a lesson that was learned from the efforts of two very able and persuasive people, Bill and Hillary Clinton, to get comprehensive health care through ten years ago, it is that the health care system is so complicated and there are so many people who have a stake in the status quo that it's very difficult to do in one giant step. I believe it's pragmatic to do it step by step, focusing on three groups for whom there are already programs in place and who have very special medical needs: children, the working poor, and the early retiree.

MARGARET WARNER:

All right. Let's take the children and the working poor, the CHIP program and Medicaid. As you know, the states in particular are already facing huge budget pressures on these programs. How would you pay for them? Are you talking about the federal government assuming all the additional cost?

SEN. BOB GRAHAM:

No, I'm not. I think that this should be a shared responsibility, and that sharing should include the federal government, state governments, the individual beneficiary, and in the case of the working poor the employer of the individual beneficiary. The estimate is that this will cost the federal government between $70 billion and $90 billion a year when it is fully implemented.

MARGARET WARNER:

So you are roughly… your cost is also roughly the same, say, as Senator Kerry's or Howard Dean's?

SEN. BOB GRAHAM:

Yes. We would propose to provide to all children who do not have access to other forms of health care insurance coverage through the Children's Health Insurance Program. We would propose to extend Medicaid up into the working poor with a buy-in that is a partial participation by the beneficiary, the amount of that depending on the income of the working poor. And then at the early retiree stage, it would be in the opposite direction, as Medicare reaches back to provide access to its services to the early retiree, again, on a co-payment basis.

MARGARET WARNER:

Now, again, many of your rivals are suggesting or saying that to pay for their plans they would roll back the Bush tax cuts, both of 2001 and 2003. Would you do that? If not, how would you pay for this?

SEN. BOB GRAHAM:

That's the place I would start. I would not roll back benefits which are already in place, but I would freeze those parts of the 2001 and 2003 tax plans that have yet to go into effect.

MARGARET WARNER:

Your plan– at least as I read it, and it's not, as I'm sure you admit, very detailed– but I didn't see a lot about trying to beef up also the existing employer-provided health coverage, as again several of your opponents do by, say, offering tax credits to get more employers to offer it. Do you have anything there for getting employers just to do more?

SEN. BOB GRAHAM:

That would be part of the working poor plan. We would encourage employers to be a participant with the beneficiary in partial financing of the working poor plan. I want to say that our plan is not just focused on access. We also have proposals as it relates to enhancing the quality of health care and the patient outcomes, controlling cost of health care, dealing with the special needs of the elderly, and rebuilding our public health service, which as we have just learned through this recent SARS epidemic is a critical part of our health safety net.

MARGARET WARNER:

What would do you about controlling costs?

SEN. BOB GRAHAM:

In terms of cost to the system at large, these are some of the things that I would do. I would establish what I call the land rent college system for health care. This would provide that there would be not only research and development of applicable new technologies, but also an outreach system so that we can accelerate the pace at which those new technologies are adopted. I would also look to things like accepting the fact that for older Americans it's no longer just a single issue of retirement and then death; it is an aging process. And we need to reform our system so that we are providing the appropriate care at the appropriate process or period in that process of aging, with one goal is to keep people as independent and active as possible as long as possible.

MARGARET WARNER:

Some of your rivals who have issued more detailed plans have actually submitted them through what they call scoring or vetting or analysis of the cost and how many would be covered by an independent firm or analyst. Are you going to do the same?

SEN. BOB GRAHAM:

Yes, and we have. The number– 70 to 90 billion per year when fully implemented and the two-thirds of the 41 million covered– are the results of submitting our plan to experts in health economics, and this is what they have given us as their assessment of what it would cost, how many it would cover.

MARGARET WARNER:

Finally an issue that you were very active in last year, which is prescription drug coverage for seniors. President Bush is pushing to say he wants a bill on his desk by July 4. The Senate, as you know, is wrestling with now considering a plan to offer at least partial drug coverage for seniors. What's your feeling about that overall approach?

SEN. BOB GRAHAM:

First, it is extremely important that we do provide a prescription drug benefit for Medicare. The reason is that Medicare today is a sickness program. If you're sick enough to go to the doctor in the hospital, Medicare will pay a substantial amount of your cost. What Medicare doesn't do very well is to help keep you out of the doctor's office and out of the hospital by providing the kind of preventive care and early intervention. Now, once you make that transition, it is obligatory that you provide a prescription drug benefit since prescription drugs are an increasingly central part of any preventive regime. I, therefore, strongly support the objective. I have some serious problems with a specific plan, primarily because for the 86 percent or 87 percent of Medicare eligibles who are in the traditional fee-for-service plan, it would require that they get their prescription drugs through a private insurance policy rather than through traditional Medicare. There's no other group of Americans who get their prescription drugs in that manner. We're about to go into a vast social experiment with 39 million older and, in many cases, frail and vulnerable Americans.

MARGARET WARNER:

Senator Bob Graham, thanks so much.

SEN. BOB GRAHAM:

Thank you.