November 4, 2009
Host: Ted Simons
Health Care Reform
- A discussion on the latest Congressional efforts to pass health care reform with House Assistant Minority Leader, State Representative Kyrsten Sinema, a Democrat and one of 32 state lawmakers nationwide to serve on the White House Health Reform Task Force. And Tom Patterson, Chairman of the Goldwater Institute, a former state senator and a retired emergency room doctor.
- Kyrsten Sinema - State Representative
- Tom Patterson - Chairman,Goldwater Institute
Ted Simons: Congress continues to work on healthcare reform. The house has a 1900-page bill it hopes to bring to the floor for debate very soon. Another bill is being drafted in the senate. Both are an attempt to insure more Americans and control ever-increasing healthcare costs. To do that, Roger Hughes, executive director of St. Luke's health initiatives, says we'll have to change how we pay for healthcare.
Roger Hughes: We have a third party -- you know, system, that essentially is -- is a way of paying for healthcare. It's not health insurance at all. And it insulates the customer in this case from the true cost of that care. And somebody else, you know, allegedly is picking up that tab. It happens to be the American taxpayer, but somebody thinks it's the government or the employer that's providing this benefit. It encourages overconsumption, which in turn, encourages overproduction and that creates this vicious cycle of rising prices. What's coming out of Washington today is still wanting to hitch health insurance to an employer-based model and in my estimation, until we move way from that model and then begin to consider what I think are the other two main alternatives, either some type of a single payer system and that doesn't mean government-owned and operated, but something like Medicaid for all. Or some kind of system where health insurance and costs are in the form of individual vouchers and tax credits.
Ted Simons: Joining me to talk about healthcare reform -- Assistant house minority leader representative Kyrsten Sinema. She's a Phoenix democrat and one of 32 state legislators nationwide to serve on the White House healthcare reform taskforce. Also here is Tom Patterson, chairman of the Goldwater Institute. He's also a former state senator. He's a Republican and a retired emergency room doctor. Good to have you both on "Horizon."
Both: Good to be here.
Ted Simons: You heard Roger Hughes, let's go ahead and just dive right in. From what you just heard, does that make sense to you?
Kyrsten Sinema: Certainly. The first portion that Roger discussed concerning how costs escalate over time and that we have overproduction and overconsumption, absolutely. If you have an insurance plan or the ability to pay, you can get as much care as you want in America today.
Ted Simons: The idea of overconsumption is driving everything. Make sense?
Tom Patterson: Absolutely, Ted, it's true. There's no other industry in which a consumer goes to a provider and neither of them knows what the cost of the service to be provided might be and neither of them cares because they're not paying it. The patient, the consumer is not paying it, and so there's a constant pressure to overconsume and that has a lot to do with why we've got a system that's good in many respects but simply costs too much.
Ted Simons: We have the best medical professionals in the world and yet fewer people seem to be able to afford their care. Back to Roger Hughes. He gave two ideas. Single payer or voucher tax credits?
Tom Patterson: That's precisely the question that we're sitting on now as a nation. That's what this debate is really all about. We need a system in which government makes the calls and mandates and defines the fees or can we as Americans take healthcare back into our own hands and be the ones that with our doctors make the decisions, we're responsible for and accountable for the financial aspects as well as the outcomes of those decisions but we make them ourselves and that's the way we can wring costs out of the system, if that’s the way we want to go.
Kyrsten Sinema: Congress put neither of those two options on the table. What congress put on the table is a hybrid option that utilizes our existing system including many of its flaws of employer-based insurance and opens up a new exchange which actually is not new in Arizona. We have one. That provides new opportunities for consumers who don't have access to affordable care and it's more of a hybrid. It doesn't solve all of problems that we see now in terms of overconsumption and rising costs, but it does attempt to control them.
Ted Simons: I know the house talks about extending coverage to tens of millions of folks which is a major factor in the healthcare debate-- the house plan talks about extending coverage and can't deny coverage to pre-existing conditions. That's not so much a hybrid. That's what people are asking for. Can it be done and can we afford it?
Kyrsten Sinema: Think the most important part of any package on the hill is the prohibition against discriminating against people with preexisting health conditions. There are millions who don't have coverage or can't get full coverage because of preexisting health conditions. They often see care from emergency rooms and that's uncompensated that you and I are paying for. So the cost will decrease over the long run. The house bill will save $104 billion over the course of 10 years by providing true preventive and intervention care rather than catastrophic care. Saving costs over the long run.
Tom Patterson: Wait a second. That's not what the congressional budget analysts say. It costs more money than ever and here's the thing, Ted. We have all of these estimates going around. Obama started off, saying it is not going to cost anything. And people laughed and then it was $850 billion and then 1.05 and now we’re up to 1.5 trillion-- none of those numbers in reality mean that much. Nobody can estimate what this program would cost in 10 years. We do know this. It would be a lot more than anybody is estimating at this point. These programs always cost more than their estimated cost. Medicare costs seven times nor in 10 years than the original budget estimates and this is a horrendously expensive program, even according to the analysts and more than they're analyzing right now.
Ted Simons: Compare and contrast the expense of the program -- whatever expense prediction you want -- and what we'll wind up paying for healthcare if nothing substantial is done, or changed.
Tom Patterson: The nothing option is something that nobody I know of is advocating for. That's not out there -- to do nothing. The question is, are we better off having government deciding who gets what and trying to tamp down the utilization of medical care through -- if I may use the word, rationing -- or are we better off having patients and doctors making decisions with the dollars in their hands and be accountable for the decisions and trust them to make the right medically and financially accountable decisions.
Kyrsten Sinema: The cost of doing nothing will be astronomical. Premium costs have risen by 130% and are anticipated to increase next year alone by another 15%. That's not sustainable. What we do know is this: We have two plans in congress that will eventually merge and become one piece of legislation. But absent that, the alternative will be to do nothing. That's what congress has done over the last 60 years. When they’ve tried to do this in the past, they’ve been unable to enact reform. They have to do it now.
Ted Simons: As far as the Republican plan, and let's kind of go that direction, because there's a plan out there. It's a little nebulous as we speak now. But it does call for easing restrictions on the insurance industry, to expand coverage and sells insurance policies across state lines without submitting to the state regulations each individual regulation. Does that make sense to you?
Kyrsten Sinema: I think it depends. In general, allowing companies to engage in business across state lines makes sense. It’s the American way. The idea that you can engage in free enterprise wherever you are. It makes sense to have some general regulations to ensure you're protecting against fraud and hurting consumers and those are things that can be easily worked out. I think moving across state boundaries makes sense.
Tom Patterson: We sell all other lines of insurance across state lines and it works fine. There's no reason we couldn't open up the insurance market. What's at stake are insurance mandated and many, many insurance groups have gotten into state governments and influenced state legislators and I was there and know how it works. And Kyrsten does too. When you can sell across state lines, the mandates go away and because no one is going to buy insurance from a state with a lot of mandates and that saves up to 30-35% depending on what state you're comparing it to. It's a no-brainer.
Ted Simons: And yet the budget office says as many as a million people may not be able to get insurance if that particular avenue is taken. Do you agree with that?
Tom Patterson: No. That -- that is an analyst's way of looking at it, that is static and doesn't take into account the dynamic things that would happen. The problem with insurance is it's too expensive. If it wasn't so expensive, a lot of the other problems that flow from that would not be with us either. If we can save money -- and I know we could by selling insurance across state lines, it would increase access to insurance, not limit it.
Kyrsten Sinema: I think that's not the greatest weakness of the Republican legislation. There are some good aspects of the Republican bill. There are a couple of key flaws. It doesn't include the mandate for insurance companies to stop discriminating people with preexisting medical conditions. That’s one of the most pressing concerns. The other grave concern, it doesn't cover very many people. It's cheaper, but primarily because it doesn't cover as many people. It's not robust enough to address the needs of our country.
Ted Simons: What do you do with people with preexisting conditions?
Tom Patterson: Kyrsten's idea, which is a very common one, is to throw them in the insurance system and make those with medical insurance pay for them – it’s a big problem though. Think of this, you go to the doctor and I've got bad news. You've got cancer and AIDS and since you don't have insurance, you're in a heap of trouble. If you can, you're going to get on the phone to your insurance agency and say I need a policy right now. That's not insurance. That's a way to pay the bills. And in Massachusetts where they have this preexisting condition in their law, they found that insurance companies were selling policies for one week at a time. It sounds good, but it's more complicated and there are better ways -- you know, people have preexisting conditions and don't have insurance -- by the way, no insurance company should ever be allowed to terminate somebody's insurance because of a condition that comes up. That's the flip side of it. But if you have a preexisting condition, no insurance, we have to figure out some way of doing risk pools, tax credits, some combination. We have to take care of those people.
Kyrsten Sinema: The American people are already paying for it. We subsidize their costs and we’re for this through our taxes each day. What many people do with preexisting conditions is quit their jobs to become poor so they can qualify for Medicaid and then you and I are paying the bill. That's one of the worst ways to address it. The one thing Tom and I did agree on, is it is wrong to dump someone from their health insurance if they develop an illness or disease.
Ted Simons: I want to get back to Roger Hughes regarding the concept of mandatory health insurance. Here's what he had to say about that.
Roger Hughes: I think you can make a strong case for actually going to a true insurance model, where everybody is required to have catastrophic coverage just like you buy it on your house or on your car. And then for the people that can't provide that, that is publicly subsidized and then you take away first dollar coverage and then you allow people to provide various kinds of plans, depending on their resources and their ability and their interest on the private insurance market. Some people -- I mean, the only thing that everybody has to be in the system, but individuals can still choose from a variety of individualized plans on what they want to purchase.
Ted Simons: Very quickly, you've got to make sure everyone is covered and that includes preexisting conditions, or else the whole thing gets out of whack.
Roger Hughes: It has to be mandatory. Whether for a single payer system or some individualized plan it has to be mandatory.
Ted Simons: Does it have to be mandatory? Whatever we do, will everyone have to be in the boat or will it sink otherwise?
Tom Patterson: I think first we bring down the expenses. Make it realistically available to every American. Provide them the money for their medical insurance and health savings account if they need it. I’d like to stay away from the mandate; I don't think it's mandatory if we have a way it make insurance affordable to everybody.
Ted Simons: What do you think?
Kyrsten Sinema: Well, President Obama doesn't support the mandate until he got a concession from the insurance industry and they said, look, we'll stop discriminating, but in exchange for allowing the people in the big pools, we need a mandate and he agreed under those conditions and those two things work together if you have one more aspect, which is subsidies for individuals who can't afford it so they can have choices in the private which company works for them.
Ted Simons: In a word, Tort reform, is it necessary?
Kyrsten Sinema: Well, I would say, yes, and I'm an attorney. And the president is doing right, the reform pilot he's doing throughout the country and I want to see those succeed.
Ted Simons: Can you give me one?
Tom Patterson: Absolutely, don't tell me you're serious about cutting costs if you're not serious about tort reform. And these programs of the president are not serious reform.
Ted Simons: That's it. Our time is up.
Both: Thank you.
Luke AFB and the F-35
- Luke Air Force Base is a finalist to train pilots for the F-35 Joint Strike Fighter. Peoria Mayor Bob Barrett talks about what it will take to make Luke a home to the F-35, and what success would mean to his city and the State.
- Bob Barrett - Mayor of Peoria
Ted Simons: Good evening and welcome to "Horizon." I'm Ted Simons. Last week we learned that Luke Air Force Base is a finalist to train pilots to fly the F-35 joint strike fighter. That's considered a win for the base, the state, and the city of Peoria, which has been a leader in efforts to protect Luke from encroaching development and other threats to its future. Peoria mayor bob Barrett was in Washington D.C. this week meeting with members of congress and attending meetings at the pentagon. He's been looking for ways to help position Luke to win the F-35. Joining me now is Peoria mayor Bob Barrett who returned today from his trip to the nation's capital. Actually just a couple of hours ago, huh?
Bob Barrett: That's correct.
Ted Simons: Good to have you here.
Bob Barrett: Thank you for the invitation.
Ted Simons: What did you ask and who did you see and what did you hear?
Bob Barrett: We asked the big question we asked is what is Luke's position? Right now, the training bases have been reduced it a group of five and where do we fall in that group and when are they going to make that selection. That was the big one.
Ted Simons: What did you hear?
Bob Barrett: We heard next month they're going to begin the environmental impact statement. And they will also do some public hearings, called scoping. And the scoping and that's when the public needs to step forward and support Luke's air base. At that point in time, hopefully, Luke will remain on the list, hopefully in first place. And the next step will be to go through and do site selections and they'll come to the bases and they'll take a look at them and decide, you have enough runway, you have enough ramp space and gunnery range and the right flying weather and everything else. If Luke makes it to the first place, when they get to the installation, I think we've got it made.
Ted Simons: The biggest competition seems to be Florida. Talk to us about what Luke has that they may not.
Bob Barrett: The air force base in Florida was selected as the first recipient of the F-35. That was a couple of years ago when they were closing the bases. They had decided they were the one. They began to put aircraft in there and a nearby community began to sue the air force. At that point, the air force started looking for other sites and accelerated finding that second air force base. That’s what we’re trying to get now. We're better than them and we have total support across the valley and better weather and the gunnery range, if there's one thing that sets Luke apart from almost every other air force base, it's the range.
Ted Simons: There's a chance that Eglin could get the whole kit and kaboodle?
Bob Barrett: It's on the list.
Ted Simons: Does Luke need to show something to say you need that site out here? You mentioned the gunnery range. What else does Luke need to show?
Bob Barrett: Well, Luke needs to show several things, but in terms of being selected as a training base, we're currently the largest training base in the world for the F16's. So the physical property that Luke has we've got and the air force understands this. And the question is questions of encroachment, in other words, are you allowing homes to be built too close to the runways. And we're not doing that, attorney general Terry Goddard stepped up and filed suit against the county to stop encroachment. That was a very big plus. The second question was air quality and whether or not the air force was aware of the fact that we're a non-attainment area for the EPA in terms of air quality. I have explained this is PM-10, our problem here, which is dust particles in the air. The F-35 doesn't emit dust. We'll run the studies and send them back not air force. The third is popular support and in terms of popular support, what I tried to hammer home there, you have the entire congressional delegation signed a letter of endorsement for the F-35 for Luke Air Force Base. The governor has supported it and we've created Lukeforward.com, where the average person can go sign on. The east valley partnership, all the West valley cities support Luke, the east valley partnership joined. I introduced in the Arizona league of cities and towns, a resolution supporting the military in Arizona. It was unanimously approved by all 90 mayors across the state. So you've got unanimous support.
Ted Simons: And yet, you've got a west valley city that does have concerns and is neutral as we speak on this whole deal. El Mirage and the concern seems to be for the most part noise. Is that a viable concern?
Bob Barrett: Noise is always a viable concern. I don't want to downplay it and say it's not. However, the indications we got from those in the pentagon is that with the F-35, people are going to be surprised at how little difference there is between the F-15 and the F-35. When they set the noise contours in the valley for the air force base, the F-15 was what they had at that time. The F-16 is quieter than the 15. But when they got the 16, they did not reduce the noise contours. They left them on site. So the air force doesn't seem to be particularly concerned about the noise.
Ted Simons: True, but I know that some residents on the west valley are concerned. Have you heard from Peoria residents? We've heard -- we're going to find out when the tests are done. But the F-35 could be two times as loud as the F-16. Are you hearing from Peoria residents saying “I don’t know about this”?
Bob Barrett: The only ones that seemed to be complaining about this would be those in office, in El Mirage. The rest of the people seem to be content to wait until the air force releases noise studies. The Air Force taking the studies from Edwards air force base. Those studies began in 2008. The modeling will be done about the time they release the EIS, the preliminary EIS, in the spring.
Ted Simons: I know El Mirage is saying, everybody seems to like this. Let's get a F-35 to fly overhead and then we'll see how people feel. Will there be F-35s for people to take a listen to?
Bob Barrett: I would assume that eventually the air force will do that. When, I do not know.
Ted Simons: What about crash zones. Are they being expanded?
Bob Barrett: No, stays the same.
Ted Simons: So everything stays the same pretty much?
Bob Barrett: There might can a slight expansion of the noise, but they're not sure yet.
Ted Simons: How important is getting the F-35 training site at Luke? How important to the west valley, to Peoria in particular?
Bob Barrett: To the west valley, I think it's the economic survival of the west valley depends on Luke Air Force Base. You have a 2.3 million dollar recession proof economic engine out there. If you take that away, the west valley has no other major employer. West valley has nobody else that's out there that can replace that. And those who say let Luke go, they're foolish. Williams closed more than a decade ago and has not yet recovered. If you think Luke goes away, something will happen with that space, you're fooling yourself. Think of all the retirees in that area that will not have access to the PX and -- they'll move. And as for the city of Peoria, something like 50-60% of the workforce in Peoria is at Luke.
Ted Simons: What happens -- what happens to Peoria, in particular, but what happens out there if Luke doesn't get this training facility?
Bob Barrett: Well, three things could happen. Number one, they could -- right now the F-16 training squadron is going through for the Singapore Air force and the Air Force to Taiwan. When that sequence ends, personally, I think Luke will close. The other possibility, they could find an alternative mission for Luke. The UAVs, the predators. An UAV base. Personally, I don't think that will happen. If we miss on the 35, Luke will close in a decade.
Ted Simons: Thanks for joining us.
Bob Barrett: Appreciate it.