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Kill the Bill or Support Passage? A Debate on Healthcare Legislation Between Insurance Industry Critics

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The progressive community is split over the $871 billion healthcare reform bill that passed the Senate last week. Some have lambasted the Senate for removing language that would have created a government-run health insurance program to compete with private insurers. Others believe the Senate bill is the biggest expansion of federal healthcare guarantees since the enactment of Medicare and Medicaid over four decades ago and should be supported as a first step toward reform. We host a debate. [includes rush transcript]

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This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: We turn now to the health bill in Congress. Well, Congress might be in recess right now, but the debate over the final shape of the healthcare reform bill is far from over. The $871 billion Senate bill that passed last week still has to be reconciled with the House bill. Democrats are hoping to be able to present a final version for President Obama to sign by late January or early February.

Meanwhile, the progressive community is split about what to push for. Some have lambasted the Senate for removing language that would have created a government-run health insurance program to compete with private insurers. Others believe the Senate bill is the biggest expansion of federal healthcare guarantees since the enactment of Medicare and Medicaid over four decades ago and should be supported as a first step toward reform.

Well, today we’ll have a debate between two outspoken critics of the health insurance industry. Both support the overhaul of the nation’s healthcare system, but they disagree over whether or not to “kill the Senate bill.”

Jon Walker is a policy analyst at the website Firedoglake. He’s been closely tracking healthcare reform debates. He believes the Senate bill is deeply flawed and writes, quote, “This Senate bill is not a step forward for progressivism, it is a step backward. It is part of the transformation of all-important public social responsibilities into a privatized profit-making machine that lives off of government money won through a corrupt cycle of lobbying, campaign donations, and corporate giveaways.” He joins us from Washington, DC.

Wendell Potter is with us, a senior fellow on healthcare for the Center for Media and Democracy. For twenty years he was a former executive at CIGNA and Humana, health insurance industry’s — among the nation’s largest health insurers. Last year, he left his job as head of communications for CIGNA. Earlier this year, he testified on the health insurance industry at a Senate committee hearing. In an op-ed published in the Huffington Post last week,
Wendell Potter wrote, quote, “It is tempting to join the ‘Kill the bill’ folks, but it would amount to cutting off our noses to spite our faces.” Wendell Potter joins us now from Philadelphia.

We welcome you both to Democracy Now! Wendell Potter, let’s begin with you. Why are you in favor of the passage of this Senate bill? Why would you like to see this be the new healthcare reform in the United States?

WENDELL POTTER: Well, good morning, Amy, and good morning, Jon. And I’ll need to clear up a misunderstanding, because I am not, and never have written, that I am supporting this Senate bill. So I think we will have a discussion here this morning, but not a debate. I don’t really disagree with much of anything, if anything, that Jon has said or written.

What I wrote was that we need to be careful that we don’t cut off our noses to spite our faces and fail to get something to the President to sign that will help us improve the healthcare system in this country. And I said absolutely and explicitly that we need to now focus our attention on the House and see where we can improve the legislation that many — there are many things in the House bill that is significantly better than the Senate bill. There are some things actually in the Senate bill that might even be better than the House bill. So what will happen, obviously, is that we’ll have a conference committee, a committee of House leaders and Senate leaders that will meet to determine what the final bill will look like.

But I’ve never said that the Senate bill is what we should settle for or accept. In fact, I said at the very beginning of my post in the Huffington Post was that, you know, I’ve gone through all the stages of grief and loss, including anger, but I’m also a realist. I wrote that after the Senate had passed that bill. I can’t change what it did. You know, the saying is, you can accept the things that you cannot change and change the things that you can.

So what I’m going to be focusing on over the next several days and several weeks is to try to see if I can make an impact on the debate going forward and see if we can maybe collectively, working with other progressives, making sure the final bill is one that we can all be proud of or at least consider it to be a foundation that we can begin to build on.

AMY GOODMAN: Wendell Potter, if it doesn’t include a public option, as the House plan does, but the Senate doesn’t, would you be willing to support it? And what are the elements of that Senate bill that you still think are worth preserving and supporting?

WENDELL POTTER: In terms of the public option, I’ve been a strong proponent of the public option for a long time. And I’ve noted that back during the campaigns, President Obama, then-Senator Obama, and Senator Clinton and Senator Edwards all advocated for it. And it was pretty much created as a concept by someone I’ve gotten to know, Dr. Jacob Hacker, Hacker of Yale. It would be a fantastic thing for Americans to have that choice.

What happened along the way toward reform in both the House and the Senate is that the public option was weakened so much, even in the House, that it probably would have minimal effect right now. So that’s a disappointment, as well. So I can’t say that the legislation with the — even the House version of the Senate bill would be something that I would fall on my sword for. I just don’t think that it now is as effective as it was as I originally envisioned it, and certainly as Dr. Hacker did and as the President did.

But there are other elements of reform that really are important. We need to make sure that we’ve got an expansion of the Medicaid program, for example, to cover many millions of others, to increase the —- or change the poverty level, so that more people can be eligible for the federal program. We need to move forward on defining or making sure that health insurance companies are held more accountable and that they’re required to provide a lot more information than they currently do.

And I also noticed that Jon Walker wrote an excellent post a few days ago, sixteen things that he would do to improve the Senate bill. I don’t think I disagree with a single one of them. We need to take, again, what is in both versions of the bill, try to combine them to get the best possible bill that we can.

AMY GOODMAN: Jon Walker, your position? You’re part of the group that’s saying, “Kill the bill,” talking about the Senate bill. Why?

JON WALKER: Well, we are saying, “Kill the Senate bill.” We have endorsed the House bill. It is a dramatically better bill. The Senate bill is just full of failings.

One of the biggest is that it works on a state-by-state level, where states run the exchanges, states are responsible for enforcing the regulations. Most states have just failed when it comes to enforcing insurance regulations. Most state insurance commissioners, the ones that actually try to enforce insurance regulations, just don’t have a good track record, because they lack the money, the know-how and the power to go up against these large insurance companies. So, to think that we can somehow make these small state-based exchanges work as a mechanism for expanding coverage is just fanciful. I don’t see how it will work. I don’t see any data that would indicate to me that that is a smart foundation to build on.

And my fear is, what will happen is this program will end up like welfare or even like Medicaid did, where it was a small cutaway program for a small group of lower-income, less politically active people, that eventually didn’t get popular, didn’t get well implemented, and slowly got cut over the years as it went forward.

AMY GOODMAN: Jon Walker, what about the House bill do you think must be preserved in order for the conference bill to be passed?

JON WALKER: Well, the first thing is the public option. That is the first check on the insurance companies, having them compete against a public entity that’s set up to advance the public good.

Another thing that’s critical is it uses a national exchange with a national regulating function. Only the federal government has the power, the know-how, to really enforce regulation, especially in some states where, frankly, the local state insurance commissioner wouldn’t want to enforce the regulation because they’re too close to the insurance companies.

Another big important thing is the House expands Medicaid up to 150 percent of the federal poverty line, as opposed to 130 percent. Expanding coverage using public programs costs about 30 to 40 percent less than using private insurance companies. This bill will direct about a trillion dollars to the private insurance companies. And for literally $300 billion less, we could add the same level of coverage to people by using a Medicare— or Medicaid-like program to expand coverage.

AMY GOODMAN: Do you think if the bill is killed, Jon Walker, that it will do irreparable harm to the whole healthcare reform movement?

JON WALKER: I don’t think that they will ever let healthcare reform stop, and I think it’s a ridiculous myth that they need to pass this bill that requires these sixty votes in the Senate. If you look at how Bill Frist ran the Senate only a few years ago, he never seemed to allow sixty votes stop him from doing anything. He threatened to use the nuclear option. He used reconciliation in creative ways. He did all sorts of things. He took away committee chairs, or threatened to, of his members. So I don’t believe the Senate, this is the best they can do. I think this is the best they want —- they were willing to try to do, but I think if they were pushed, they can do dramatically better.

AMY GOODMAN: We’re going to come back to this discussion. We’re talking with Jon Walker of Firedoglake and Wendell Potter with the Center for Media and Democracy. We’re talking about the split in the progressive community whether it’s worth killing the bill to save it. This is Democracy Now! We’ll be back in a minute.


AMY GOODMAN: The whole debate in the progressive community around healthcare reform, whether to kill the bill. Jon Walker is with us, policy analyst, Firedoglake; Wendell Potter, senior fellow on healthcare for the Center for Media and Democracy.

Wendell Potter, though you say you share the criticisms of Jon Walker, you say, at all cost, there must be a bill on President Obama’s desk. Why?

WENDELL POTTER: Well, because we gamble too much by saying kill the bill. Jon is right. It’s not good that the Senate has allowed the filibuster to really be the most important rule that they have. I think we need to change that. In fact, I think one of the things that progressives need to focus on very quickly after this debate moves to its next phase is to focus on how we can change Congress. That’s very important. We will never be able to achieve the progressive changes we all know need to be made, until we can fix certain fundamental things about our system, not just the healthcare system. We need to address campaign finance reform and lobbying reform. And we need to force the Senate to look at its own rules. But the reality is, that’s what happened.

And my concern is that in the midterm elections that are coming up, the Senate may not even have a sixty-vote caucus, there may be less, and I don’t know when the day might come when we will have sixty members of the Democratic caucus. I suspect that the House will probably lose some Democratic members. If we look at history, the party in power typically loses seats during the midterms. So what will we do then? When can we look to see the next time the stars supposedly will be aligned? I’m just too concerned that it will be many, many, many years before that happens again. And we very possibly could have a change in the leadership of Congress, and even the White House, as we saw after the last time we did this failed, when the Clintons tried and failed to achieve healthcare reform. It’s been more than fifteen years now.

AMY GOODMAN: Jon Walker, what about that? What about this being in a very rare moment, even within the Obama administration and a Democratic majority, having the sixty?

JON WALKER: Well, I don’t believe that they will let nothing pass this time around. And I think if the progressives in the House hold firm to their commitment to the public option, either they will make this a better bill because they can’t get it passed with the progressives, or they’ll strong-arm members of the Senate or even use reconciliation to pass a better bill. They don’t need Ben -—

AMY GOODMAN: Explain what you mean by “reconciliation.”

JON WALKER: Oh, there’s a budget procedure called reconciliation that allows you to pass a bill with a simple majority in the Senate, because it can’t be filibustered. Now, there are some problems with it. Certain things which don’t affect the budget can be removed, if sixty members don’t vote to waive what’s known as the Byrd rule. But you can pass a bunch of great stuff — Medicaid expansion, public option, Medicare buy-in, a bunch of great things — through reconciliation with fifty votes. And if you can’t get people to waive the rules for some of the insurance regulations, you can do what we did with the Matthew Shepard hate crime law. It didn’t have sixty votes in the Senate, so they attached it to a defense appropriations bill, and that’s how they got it passed through Congress. I think we should not buy into this myth that they can’t do better than they have done with these sixty votes.

AMY GOODMAN: Jon Walker —-

JON WALKER: You don’t need a Senate where Joe Lieberman -— oh, sorry.

AMY GOODMAN: Well, let me ask you this question. As soon as the Senate bill was announced, the stocks soared for the insurance companies. Why is it that the Republicans are so opposed to this bill?

JON WALKER: Well, the Republicans realize that, as an opposition party, tearing down whoever you’re up against is the quickest route back to power. And this is the problem with the Senate. It used to be a place where people tried to get together, tried to find compromises and stuff. But they realize that modern politics, bringing down your opponent is the fastest way back to the top, and that will be the modus operandi probably moving forward for the next several decades in this country.

AMY GOODMAN: What do you feel needs to be done, Wendell Potter, when you talk about the kind of activism and lobbying that must be done right now? What are your plans? What coalitions are you a part of?

WENDELL POTTER: I’m not a part of any coalition, but I would advise all progressives to really focus on the House bill over the next few days, next few weeks, to encourage and, in fact, demand that House leaders stand firm on the legislation that they have passed already.

The reality is, of course, that if they do pass something without reconciliation, it will have to be something that can pass the Senate, or we will have failed to pass anything. The reconciliation may be a possibility, but I would certainly want to make sure that — what would have to be given up in the reconciliation process, because there are certain things that would not be able to be included in legislation through the reconciliation process. It is an option — it was an option all along that was considered, but we just need to make sure that — you know, I’m not going to say I would endorse that right now until I see exactly what would be included in reconciliation and what would have to be given up.

But I think that one of the things, for example, that needs to be changed, in my view, and Bob Herbert noted it in the New York Times this morning, is how some of the revenue is raised. The Senate bill would tax the so-called high-end or Cadillac plans, which I think is very bad policy for a lot of different reasons. And Herbert, he describes some of those reasons. The House would raise money through taxing the very richest among us, and I think that’s the way to go. So there are a lot of things that I would focus on if I were to be an adviser to progressive groups. And what I’ll be doing as I go forward, as a part of the Center for Media and Democracy and as a blogger, is focusing on that myself.

AMY GOODMAN: And Jon Walker, of the sixteen demands, sixteen ways to fix the Senate bill, can you carry on with what you feel needs to be done?

JON WALKER: Oh, yeah. I don’t think the bill does anything to hold the insurance companies honest. And what we’re doing is we’re creating a mandate. We’re going to use the IRS to force people to buy a product, which is frankly a bad product, poorly regulated and not really worth the value of purchasing it. And that is a huge step for the government to give to the insurance companies, and it has not demanded enough concessions in return from them to justify that.

I would prefer a much higher medical-loss ratio, written into the law a really strong enforcement mechanism, obviously some form of public competition against the insurance companies, either some type of public option or Medicare buy-in. I would obviously, like with Wendell Potter, want to see this excise tax removed or changed. It will cause millions of Americans with good insurance right now to have higher co-pays and higher deductibles and worse quality plans. There’s just a bunch of things in the bill that needs to be changed, including a tighter age band. They will allow insurance companies to charge older people three times as much as younger people. That is not true community ratings. There’s just all sorts of problems with the Senate bill and a dramatic number of changes that need to be made if we want to get an actual working healthcare system, as opposed to something that will just funnel lots and lots of money into a broken system that will make it even harder to repair next time.

AMY GOODMAN: Jon Walker, I want to thank you for being with us, policy analyst with Firedoglake, and Wendell Potter, senior fellow on healthcare for the Center for Media and Democracy.

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