August 10, 2009

(h/t Heather)

It could have been "The Clash of the Titans," but Howard Dean was, as usual, a class act when he appeared this morning on This Week with Newt Gingrich to talk about health-care reform. If President Obama had put him in charge of selling the health reform effort, we probably wouldn't be having all these problems right now:

DEAN:I think putting $60 billion a year into the health insurance industry is insane. I really do.

And so you want a public option. Look, we've -- what the president wants to do is very straightforward. Sixty -- or roughly sixty -- fifty or sixty million Americans have what Newt has called socialized medicine or government-run health care. They're over -- over 65. They're Medicare. That's what Medicare is.

Now, what Obama is essentially saying is, "Let's give the choice of getting into a system like that or staying with what they have to the American people."

So if you're voting against having a public option, what you're voting against is something that 72 percent of Americans in two polls want, which is the choice. Most of them aren't going to sign up for the public option, but they think they should have the choice.

Why shouldn't they have the choice? Why should the health insurance companies have that choice?

STEPHANOPOULOS: What's the answer to that question?

GINGRICH: Well, first of all, the government option we're talking about -- let's look at where government runs the health system entirely. The Indian Health Service is a disaster. Medicaid is so corrupt and run so badly -- we just published a book at the Center for Health Transformation called "Stop Paying the Crooks," because our estimate is that government fraud between Medicare and Medicaid is between $70 billion and $120 billion a year.

Hey Newt, do you suppose - bear with me a minute here - do you think the Indian Health Service problems just might come from the deep and crippling cuts inflicted on them by people like you and your buddies? Nah, never mind.

STEPHANOPOULOS: Veterans care works pretty well.

GINGRICH: Veterans care is the one system that actually works reasonably well. But the others do not. I mean, Medicare is basically a private system with a government funding.

An amendment was offered in every committee to have the -- to have the members of Congress and their staff in any government option as a mandate. And if this is good enough for the American people, it's good enough for the politicians. In every committee, the Democrats voted no. Now, why is it they want to insist on a government-run system for -- for people other than the Congress, but the Congress and their staff would be exempt?

Second, it's not -- it's just, I think intellectually not honest to suggest that this is going to be a matter of choice. The way the bill in the House -- and we're talking about a specific bill -- the way the bill in the House would work, if your company didn't offer any insurance, they would pay an 8 percent tax on their personnel cost.

For most companies, that would be a net savings of 3 percent, 4 percent or 5 percent. One estimate by Lewin Associates (sic) is 131 million Americans will lose their private insurance and be pushed into a government plan.

STEPHANOPOULOS: Governor Dean, those arguments seem to have taken hold, at least in the Senate, where even Democrats say you're not...

DEAN: Look, let's be fair. Lewin Associates is owned by a health insurance company. So let's -- let's -- let's -- the CBO, which I think is a more reasonable organization, says 5 million or 10 million people are going to end up there.

STEPHANOPOULOS: Depends on the amount of subsidy...


DEAN: Second of all, what the speaker didn't tell you is, let's just suppose you get forced out of your employer-based system, which I think is unlikely, but let's suppose that you do. You've got a choice.

The government will pay your subsidy to either go into -- based on your income, either to go into the public option or a private option. Nobody is forcing you in to the public option.

Now, a third thing is that nobody talks about is this bill is terrific for small business, and the Blue Dogs made it a better bill, and I hope as it gets through, it gets even better.

Right now in the House bill, if you have a payroll, if you're a small business with a payroll of less than $500,000, you have no responsibility whatsoever to give your employees health insurance. That now becomes a subsidy based on your income, and then you can choose either a private or a public sector.


DEAN: This is -- this is choice. This is real choice.

STEPHANOPOULOS: That's in the House bills, but the Senate has made it pretty clear they're not going to include this public health insurance option, at least as contemplated in the House bill. The most they're going to get is co-ops...


DEAN: No, actually, the Senate Finance -- this has already passed four out of the five committees. The Senate Finance Committee has said that, not the Senate Health, Education, Labor and Pensions Committee.

STEPHANOPOULOS: Well, but you need 60 votes to get it through.

DEAN: We need 51 votes.

STEPHANOPOULOS: So you're saying...


GINGRICH: But if you want to see why the -- why a substantial number of Americans are very frightened, that's a good example. The Senate rules on passing reconciliation were clearly designed for budget items.

If we're now going to try to rewrite 17 percent of the economy, life and death for every American, by pretending that massive health reform is a reconciliation item and ramming it through with 51 votes, first of all, I don't think -- I think a lot of Senate Democrats (inaudible) I think the idea of stripping the Senate of its ability as a Senate to operate with some sense of discretion and ramming through something on this size will go down very badly with many senators, will go down very badly with much of the country.

But I -- I talked to Senator Grassley as -- as late as yesterday, and he made quite clear that he believes there will be no government plan and there will be no rationing in any bill that the Senate passesand that he would certainly not in any way support that. And I think Grassley's very key to Republicans.

STEPHANOPOULOS: Let me follow up. Senator Baucus, the Democratic chair of the Finance Committee, seems to agree on that, and he's produced a draft that gets to 95 percent coverage, 94 percent, 95 percent coverage without a public option. Why wouldn't that be good enough?

DEAN: Let me just say, A, there's no rationing in any of these bills, so we don't have to worry about that. Secondly, 95 percent coverage is good. That's terrific. The problem is, you can't afford it unless you have a public option. There's no cost control on that. Again...

STEPHANOPOULOS: He says it would come in under $1 trillion.

DEAN: Well, the House is at $60 billion a year, and the Senate would be at $100 billion a year. I don't think -- look, here's the problem with -- this is why I think the public option is so important.

The fundamental problem is that Medicare has gone up around 2 percent over the rate of inflation. That's bad. But the health care -- the private sector has gone up at two-and-a-half times the rate of inflation for 30 years.

Our economy is uncompetitive because we have an employer-based health care system. Now, I'm not advocating getting rid of an employer-based health care system, because a lot of employers like it and people in it like it. But I am advocating giving people the same choice that Congress has.

STEPHANOPOULOS: I want to get to -- really quickly, because I want to get to another issue here...

GINGRICH: Well, I just want to say, this is one of the great tragedies of how we've approached this, this year. Cost control doesn't work. I had a major hospital tell me last week they would literally go bankrupt under the House plan, because if you apply the kind of cost control without real health reform, it doesn't work.

At the Center for Health Transformation, we've outlined health reform after health reform that would save hundreds of billions of dollars, but it's fundamentally different than the way Washington thinks. And it's -- it's very frustrating to watch people -- when you say cost control, you're either ripping off the hospitals, you're ripping off the doctors, or you're ripping off somebody because cost control defined by the government means somebody gets...


DEAN: Wait a minute. You -- you -- not you personally -- but the Republicans have had times over the last -- since the last time we tried this, was 15 years, where you had the president, the House, and the Senate, and nothing happened.

GINGRICH: And they failed. I agree.

DEAN: So, OK, so we've got to do something.

GINGRICH: I'm not defending that.

DEAN: We think this will work.

STEPHANOPOULOS: One of the other claims being made about the bill -- and it's related to cost control -- is an -- and opponents are spreading the idea that the president's plan will encourage euthanasia.

Most recently, Sarah Palin, on her Facebook page yesterday -- I think it was Friday night actually -- said that, "The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."

Now, as you know, Mr. Speaker, the president called that outlandish. He said...

GINGRICH: But why -- why didn't you put up what Dr. Zeke Emanuel said? Because Dr. Zeke Emanuel, who's the chief adviser to the president and brother of the chief of staff, said in writing...

STEPHANOPOULOS: He's not the chief health care adviser. He's written three articles between 1996 and 2008 that include some of those phrases...


GINGRICH: ... standards.

STEPHANOPOULOS: Those phrases appear nowhere in the bill. The only thing...


STEPHANOPOULOS: ... but let me just explain what's in the bill and then get you to respond to that. The only thing in the bill is they would allow Medicare to pay for what they say is voluntary counseling on end-of-life issues.

GINGRICH: I think people are very concerned, when you start talking about cost controls, that a bureaucracy -- we don't -- you're asking us to trust the government. Now, I'm not talking about the Obama administration. I'm talking about the government. You're asking us to decide that we believe that the government is to be trusted.

We know people who have said routinely, well, you're going to have to make decisions. You're going to have to decide. Communal standards historically is a very dangerous concept.

STEPHANOPOULOS: It's not in the bill.

GINGRICH: But the bill's -- the bill's 1,000 pages of setting up mechanisms. It sets up 45 different agencies. It has all sorts of panels. You're asking us to trust turning power over to the government, when there clearly are people in America who believe in -- in establishing euthanasia, including selective standards.

DEAN: Well, look, this is something Newt and I agree on. I don't want somebody in between the doctor and the patient. I don't want the possibility of losing your health insurance. I don't want people setting standards or denying care. That's all what we have now under the private health insurance system. That's what happens.

Look, I've practiced -- I've practiced for 10 years. My wife is still practicing. Never once did I have a Medicare bureaucrat tell me what I could or couldn't do for a patient, but all the time we have bureaucrats from the insurance companies calling up and saying, "We're not going to cover this, and we're not going to pay for that, and we're denying coverage of that."

The system we have right now is broken. We need to fix it. I think giving the American people some choices about how to fix it makes sense.

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