Horizon, Host: Ted Simons

July 22, 2009


Host: Ted Simons

Health Care Reform


  • A discussion about President Obama’s ideas for health care reform with Dr. Jonathan Weisbuch, a former director of the Maricopa County Department of Public Health, Dr. Jeffrey Singer, a surgeon and treasurer for Arizonans for Health Care Reform, and Dr. Michael Powers, a neurologist and former president of the Arizona Medical Association.
Guests:
  • Dr. Jonathan Weisbuch - former director, Maricopa County Department of Public Health
  • Dr. Jeffrey Singer - Surgeon and Treasurer, Arizonans for Health Care Reform
  • Dr. Michael Powers - Neurologist and Former President, Arizona Medical Association
Category: Medical/Health

View Transcript
Ted Simons:
Good evening, and welcome to "Horizon." I'm Ted Simons. President Barack Obama has made healthcare reform one of his most urgent priorities. He's called for a government-run health insurance plan that's affordable for everyone. Critics say it will cost too much and limit personal healthcare choice. This evening, the president spoke to the American public in an effort to gain support for his plan that's been struggling in congress.

Barack Obama:
This is not just about the 47 million Americans who don't have any health insurance at all. Reform is about every American who has ever feared they may lose their coverage if they become too sick or lose their job or change their job. It's about every small business that has been forced to lay off employees because it became too expensive and because the biggest driving force is the skyrocketing case of Medicare and Medicaid. Let me be clear, if we do not control these costs, we will not be able to control our deficit. If we do not reform healthcare, your premiums and out-of-pocket costs will continue to skyrocket. If we don't act, 14,000 Americans will continue to lose their health insurance every day. These are the consequences of Inaction. These are the facts of the debate we're having now.

Ted Simons:
Joining me are Dr. Jonathan Weisbuch, a former director of the Maricopa County Department of Public Health, Dr. Jeff Singer, a surgeon and treasurer for Arizonans for Healthcare Freedom, and Dr. Michael Powers, a neurologist and former president of the Arizona Medical Association. Thank you all for joining us on "Horizon."

Michael Powers:
It's a pleasure.

Ted Simons:
Let's start with the simple question: Is healthcare reform necessary?

Michael Powers:
Yes.

Ted Simons:
Yes? Explain.

Michael Powers:
People feel threatened by the cost. People feel threatened by the concern that they may not be able to access healthcare in the future. People feel threatened they cannot change jobs without losing their health insurance. People are threatened by the cost of medicine, which is escalating and I think they feel many threats and are very concerned.

Jeff Singer:
I've believed that the healthcare system in the country is in need of reform. It's a cost issue. That's the number one issue. Much greater than the rate of inflation in the general economy and health insurance premiums continue to go up and more and more people concerned about being able to buy health insurance. The plan being proposed takes the existing dysfunctional healthcare system, and basically expands it and puts layers of government bureaucracy and it's only going to continue to make healthcare costs continue to soar, except now we'll have government superimposed on the costs.

Ted Simons:
Is healthcare reform necessary?

Jonathan Weisbuch:
Absolutely. Ted, I've been working on healthcare reform all of my professional life. We didn't have Medicare when I was a student and happily that was passed. And all of the students that were going bankrupt, the elderly, no longer have to worry about that problem. We need do for the American people what the congress and Lyndon Johnson did for those of us 65, 35, 40 years ago. To pass a piece of legislation that will ensure everyone has healthcare. It doesn't have to do with cost. The issue is not cost. The issue is making our system guaranteeing that when people need access to care, they will have access to care. Without constraints, without barriers and whether you work or do you have insurance or do you have a family member who has insurance. None of that.

Jeff Singer:
There's not a single person in this country who doesn't know if they don't have insurance and they're sick, they can go to the emergency room and they have to treat them. And as a doctor on call, I know that very well. That's not the issue. The issue is people need to have access to more affordable health insurance. Because costs continue to go up. Those who want health insurance.

Ted Simons:
It sounds like the argument is whether or not healthcare is a right or a privilege. Is that what we're arguing about here?

Jonathan Weisbuch:
We're arguing about that, but Jeff is not correct. If everyone could go to the emergency rooms and get the care they needed, we wouldn't have 22,000 people dying every day in this -- every year in this country. That's 75 people a day. Because they're afraid that the cost of the care in the emergency room is going to bankrupt them. They put off the care. That number is well -- the institute of medicine has published that number along with other numbers.

Jeff Singer:
That's like how many jobs have been changed -- how many people --

Jonathan Weisbuch:
Let's not argue with the facts on this. People are denied healthcare in this country because they feel their economic situation and the fact they don't have insurance -- keeps them from going to the physicians and the emergency rooms and care providers who they need.

Ted Simons:
Hold on for just a second. We've heard two pretty different ideas over here. And what I want to know, how urgent is the need for change? We're hearing such a disparity there. It almost sounds as if you get one, you're going to lose the other. Is there a compromise in there?

Michael Powers:
Hopefully, there's a compromise. I think in fact, there's a pretty good consensus there's a need for change. The concern that I hear is the rate of change and the way it is being handled in Washington, HR3200, for example, is over 1,000 pages. I certainly have not read it. My sense is that the details change day to day and you try to find out what really is going to happen and it's suggested we just need to pass this and then we'll work out the details later with senate versions, etc., etc. I think there's a lot of concern we're rushing into something where we have a healthcare system that's amongst the best in the world when you can access it, and we're dealing with people who can't access it or are afraid they'll lose their access or cannot afford to access it and somehow we have to pull those pieces together and I think that has to be done in a thoughtful fashion. We have to be careful because the devil is always in the details and there's no doubt hidden landmines that could explode and make a dysfunctional system even more so.

Ted Simons:
Is it too much to go after cost, quality and access all at once? Is this something that should be approached piecemeal?

Jeff Singer:
Absolutely not.

Jonathan Weisbuch:
You need --

Ted Simons:
Hold on.

Jeff Singer:
I think that you can actually approach all three if we get away from this dysfunctional employer-based model. Today, out of every dollar spent on healthcare, 50% is spent by the government on either Medicare or Medicaid and 40% by employers and only 10 -- 10 cents of every dollar out of pocket by the patient and so we have a situation where -- can you imagine if groceries were handled this way? If we had our employers buy our groceries this way? But we have our employer buying our health insurance based on what's most cost effective for the employer and then go to the healthcare provider who is including the kitchen sink as a possible test or procedure because he knows that the person he's suggesting it to isn't going to be directly paying for it and the doctor isn't accountable and basically the doctor and patient are spending somebody else's money and that's the problem.

Ted Simons:
The employer model, is that the problem?

Jonathan Weisbuch:
That is the problem. Jeff and I agree that the system is broken, the employer model doesn't work and that the system needs to be changed radically. I think that's -- he said all of those things. Where we disagree is how that model should be proposed and functioning. My conception is like so many other things in our society -- public schools, public utilities and public transportation -- we have public everything in this country. Public parks. Public education and so on. What we need to have is a public healthcare system so that everyone has the same level of care in a way that is consistent with their needs which is comprehensive, which is coordinated and which provides them the kind of help and support they, their family and society needs.

Jeff Singer:
We don't have that today in this country. The --

Jonathan Weisbuch:
That doesn't get to the problem again.

Jeff Singer:
The problem --

Jonathan Weisbuch:
The problem --

Jeff Singer:
The problem --

Jonathan Weisbuch:
Let me speak. What you have, Ted, can we do access, cost and quality all at the same time? My argument is if we were to pass something akin to health -- HR876. The Conyers' bill. Maybe a -- the access to care, and the maintenance of quality would take care of the cost issue because in every nation in this world, there are 27 of them that have a universal health system, not only is the quality better, access is 100% and the cost is half per capita.

Ted Simons:
Do you believe the --

Jeff Singer:
When you talk about any illness, heart disease mortality rates, the United States excels over all of the countries. We have a 20% better rate for prostate cancer than in other countries. So that’s not true.
Jonathan Weisbuch:
So that’s not true he’s right. It’s not true.

Jeff Singer:
So instead of the employer buying the insurance and the doctor and the patient are deciding how to spend that money, you have the government with taxpayer money being the one spending the money. Right now, Medicare that John talked about before, people like Medicare. They also liked Madoff until they found out he had no money and about a few years, the Medicaid trustees are telling us that --

Jonathan Weisbuch:
We're off the track.

Jeff Singer:
Benefits promised that Medicaid can't deliver.

Ted Simons:
What's happening right now with the private sector, does that make sense to you?

Michael Powers:
Yes, we talked about people in Europe getting excellent healthcare. Regularly we read in the paper that the people in Europe and other countries come to the United States for their difficult healthcare, assuming they can pay for it. I would point out they go to the Mayo Clinic, the Cleveland clinic. You never see them go to a V.A. Presumably they do a good job of basic care for basic jobs and by and large, if you're a veteran and sick, with a complicated thing, you get sent to a higher level program in the university, etc. My fear is that the V.A. is a good representative of the model that Dr. Weisbuch proposes and my sense is that the average person in the United States would not be happy to be forced in that single-payer system.

Ted Simons:
Does not the V.A. rise to a certain necessary level, if it's all --

Michael Powers:
The concern is that you draw a line, exactly as Dr. Singer said. You draw a line and this is the care you're going to provide and unfortunately, the concern people have is rather than that being the floor, it becomes the ceiling.

Ted Simons:
Why is that -- that seems to make sense. Why is it that the V.A. wouldn't go up as opposed to the Mayo go down?

Jonathan Weisbuch:
The V.A. is open to a group that has served the country and -- but the average person couldn't come in and go to the V.A. The V.A. does provide -- veterans are a lot sicker than the average person their age.

Jeff Singer:
The VA is pretty spotty.

Jonathan Weisbuch:
Let me speak.

Jeff Singer:
There's a big scandal.

Jonathan Weisbuch:
The scandals in the current public system, private system are equally great. The scandals where people have open heart surgery because they want the money. And they're equally large scandals. But the point is that under a system like Medicare, for example, Medicare says if you're over 65, you get the care you need. You can go to a hospital, the costs are paid for. If you're on part B, you have to pay 20% of the physician's costs but you know that up front. You're not going to be denied care. If you need to go to M.D. Anderson to get cancer care, there's nobody going to say it's not in the system.

Ted Simons:
What's wrong with Medicare?

Jeff Singer:
What's going on with Medicare now, it's popular -- again, the Madoff analogy -- up until the baby boomers started to come of age, when Medicare was established, people were living to their 70s and now more and more people are using Medicare.

Jonathan Weisbuch:
Only if Congress doesn’t improve--

Jeff Singer:
Each year, as a doctor who practices in Medicare, hospitals and providers -- decreases in reimbursements. There's another 20% decrease to take place at the end of this year.

Jonathan Weisbuch:
It was approved and the Bush administration to save --

Jeff Singer:
You have never practiced clinic medicine so--

Jonathan Weisbuch:
I have happened to have spent the last 30 years practicing public medicine, my patients with Maricopa County, 4 million people. That's a big --

Jonathan Weisbuch:
I can tell you that many of my colleagues are --

Jeff Singer:
I've been in the trenches.

Jonathan Weisbuch:
I'm telling you that Doctors are not seeing Medicare patients. They're having to wait weeks and months for appointments.

Ted Simons:
The president mentioned the Cleveland clinic and Mayo as models. Does it make sense as part of reform? Should we be seeing more of that kind of idea?

Michael Powers:
I think it's reasonable to be on the table. I personally favor a plurality of approaches. I would be nervous if that was mandated as the only approach. Mayo Clinic is able to attract a number of physicians who are very qualified, and I suspect are willing to accept a salary there for the privilege of doing teaching and research, rather than being in the business of medicine. The problem is the business of medicine is increasingly challenging these days. Dr. Singer said Medicare covers my overhead for seeing the patient with no additional gain for me. That's a concern in the current system.

Jeff Singer:
Wait until the rest of the baby boomers come on board.

Michael Powers:
The Mayo clinic system orders a lot of tests and sees difficult patients. I'm a neurologist. The bulk of my practice is seeing people with chronic diseases and the 20% of the chronically ill who have M.S. or A.L.S., these are people who by and large have bad luck and I think that's essential to point out. We often see people say we can hold down costs if we make people adopt healthy lifestyles. That's important, but the people I see didn't have an unhealthy lifestyle that gave them A.L.S. and Parkinson's, etc. It becomes -- as you look to the future and the potential for gene therapies and etc. I would -- I respectfully disagree with Dr. Weisbuch. I think cost is only going to become an escalating problem.

Jonathan Weisbuch:
Let me explain. First of all, every other country in the world that has down a single system, whether it's insurance-based like Switzerland, in providing 100% care, they have half the cost that we have per capita in this country. They must be doing something right. We're not sicker.

Jeff Singer:
They’re rationing--

Jonathan Weisbuch:
No they’re not rationing.

Jeff Singer:
In England you can’t dialysis.

Jonathan Weisbuch:
It happens to be one of the great myths that the advocates like Jeff would have you believe. Rationing is not having health insurance and not being able to go to a doctor. We ration healthcare to 47 million people. Sorry you can't get in because you don't have healthcare. If you're one of the people that has a chronic illness, can't buy health insurance.

Jeff Singer:
If you have health insurance and you have to wait six months to see a doctor.

Jonathan Weisbuch:
That's rationing.

Jeff Singer:
How long does it take to get your dermatologist -- The average wait to see a physician is 20 days.
I have that number for you. The average wait in Massachusetts where they passed universal care is 51 days.

Jonathan Weisbuch:
The reason that’s different is when Massachusetts passed their plan; they did not include a Medicaid type of program. They said was everybody has to buy private insurance, but they made no-- they didn’t expand the bill to primary care providers. Because if people are going to have health insurance the first place they want to go is to a primary care provider.

Jeff Singer:
Are you going to force--

Jonathan Weisbuch:
They’re easy. It’s very easy. You just say to medical students if you go into primary care, the system will pay you more than you are going to get. The reason that people are not going into primary care-- 6% of American graduates last year went into primary care. Why because they can’t make the kind of money doing a cognitive skill that you as an orthopedist can make.

Jeff Singer:
And that's because Medicare is barely paying primary care providers.

Jonathan Weisbuch:
I’m talking about—

Jeff Singer:
You're talking about -- [inaudible]

Jonathan Weisbuch:
85% of the people are paid out of the private insurance system which is not paying.

Jeff Singer:
Your system, nurse practitioners --

Jonathan Weisbuch:
Not true.

Ted Simons:
Let me ask a question here. Considering the dichotomy there. And you too, as well. Can healthcare reform and capitalism -- I mean, are they inherently at odds with other? The incentive for this, the profit motive, we can't get doctors to do that.

Jonathan Weisbuch:
Ted --

Ted Simons:
Hold on. Can this work together? Can this work? Or do you have to make this a public option?

Michael Powers:
Certainly, they can work together. How long would it take someone to see me? If they've gone blind, a new event, I'm going to see them. I'll fit them in tomorrow morning. Am I going to be pleased with the thought that I'm paid extra other than what I would be paid in salary if I do the extra work? That's probably subliminally there. I think some of the most creative things we see in the healthcare system are probably driven by the capitalist model. Some of the worst are driven by the capitalist model. The entrepreneurial way to sell people things they don't need, the direct to market that the pharmaceuticals are doing on television all the time, that's entrepreneurial and doesn't do service to the patient.

Ted Simons:
How do you bridge that?

Jeff Singer:
They put clothing on our backs and put us in homes. Seems like markets are able to deliver much better than any other system. Very vital needs. We don't have a market in healthcare. That's the problem. The market requires direct interaction. But in this system, we have a third party intervening and I would argue the reason we have our healthcare problem now is because we have a hybrid. Sort of a half market -- half Soviet system. We've got a tremendous amount of command and control. 50% of every dollar is government -- Regulations for Medicare and Medicaid and then health insurance regulations and meanwhile, the doctor and patient are the two who are out of the loop.

Jonathan Weisbuch:
First we hear that Medicare is as bad as Madoff. Now we hear we have a Soviet system. Wait a minute. The capitalist system is what we have in this system and it's probably made this country great. However, there have been lots of studies about the medical care system with regard to the marketplace. It does not work. If you go to the tenets of the market system, there's no knowledge on the part of the patients. They don't know what they need. There's an array of things. I can give you references.
Jeff Singer:
I don’t know much about cars, but I am able to buy a car.

Jonathan Weisbuch:
Hang on Jeff. The issue is simple. We go to professionals because we trust them to do what the Hippocratic Oath they took will do. And that is to put their patients first. And to do no harm. Now, if you put your patients first, you don't discharge from a hospital just because they can't pay. If you put your patient first, you don't send them to somebody who's going to do open heart surgery they don't need.

Ted Simons:
Are you a doctor who has patients if you don't have the incentive to go into the profession?

Jonathan Weisbuch:
I'm sorry, if?

Ted Simons:
If you don't have the capitalistic incentive to get into the profession.

Jonathan Weisbuch:
The profession is not driven by people who go into this to make a buck. They go to Harvard business school to do that. Maybe others. People go into medicine because they're interested in caring and using an intellectual scientific approach to solve problems.

Ted Simons:
Will the incentive be there?

Jeff Singer:
No, it will not. Because people are humans whether you're a doctor or a clergyman or farmer. People basically want to do.

Jonathan Weisbuch:
People go into the priesthood, they go into nursing or medicine, they go into many professions because it's a caring, giving, charitable, Christian thing to do.

Ted Simons:
And with that in mind, we're going to have to stop it right there and maybe continue the discussion another time. Great conversation. Thank you all for joining us tonight on "Horizon." Tomorrow on "Horizon" -- Join me for a conversation with Governor Jan Brewer. Hear what she has to say about the special session, a temporary tax increase, and some of the bills she's signed and vetoed. That's Thursday at 7:00 on "Horizon." That's it for now. I'm Ted Simons. Thank you for joining us. You have a great evening.

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