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How to Sell Obama Care?
Aired October 23, 2013 - 18:28 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
(BEGIN VIDEO CLIP)
ANNOUNCER: Tonight on CROSSFIRE, he wants you to sign up for health insurance.
BARACK OBAMA, PRESIDENT OF THE UNITED STATES: That's why I'm asking you to be a part of Team Obama.
ANNOUNCER: But some people still aren't buying it.
REP. JOHN BOEHNER (R-OH), SPEAKER OF THE HOUSE: You've got the whole threat of Obama care continuing to hang over our economy like a wet blanket.
ANNOUNCER: On the left, Van Jones. On the right, Newt Gingrich. In the CROSSFIRE, Howard Dean, a doctor and former head of the Democratic Party, and Chris Chocola, a former congressman who's a critic of the president. What's the best strategy for selling Obama care? Is there a Plan B? Tonight on CROSSFIRE.
(END VIDEO CLIP)
VAN JONES, CO-HOST: Welcome to CROSSFIRE. I'm Van Jones on the left.
NEWT GINGRICH, CO-HOST: I'm Newt Gingrich on the right.
In the CROSSFIRE tonight, Howard Dean and Chris Chocola.
Today the head of just about every major health insurance company was summoned to the White House for a closed-door meeting with the president's closest advisers.
You know, we used to think that CEOs in the same industry plotting together could only mean bad things for competition and higher prices for the consumer. Now these meetings are actually organized and hosted in the White House. Welcome to government-run health care. The achievement has been to take the insurance bureaucrats who we're all mad at and to them the government bureaucrats so they can now both conspire against the individual.
Now, doesn't that bother you? Come on. A secret meeting in White House like this?
JONES: Look, I tell you, it's -- I'm all for transparency, but this is fairly low on my list of things to worry about today. I'm glad that the White House is meeting with these executives. I'm glad they're meeting with tech people. They're trying to solve the problem. If they weren't doing it, you'd be mad at them for not trying to solve the problem.
I'm glad we have some problem-solvers here to join this show. In the CROSSFIRE tonight, former Vermont governor and Democratic Party chairman Howard Dean, who is a medical doctor, and former Indiana Republican Congressman Chris Chocola, who is now president of the Club for Growth.
First to you, you know, Newt's all, like, upset. I am sure you actually are the glad the president is bringing in people to help on this thing. You weren't upset with the Bush administration when they met with oil executives. This is no big deal. You're proud of the president today?
CHRIS CHOCOLA, FORMER REPUBLICAN CONGRESSMAN: Absolutely.
JONES: Well, good.
CHOCOLA: I am. You know this isn't really an ideological argument. It's an argument about what government can and cannot do. And so I think there's a recognition that big government really can't implement this and roll out this Web site. And so they probably should have had this secret meeting a long time ago, and people would be in a better position to be able to get on the Web site, sign up and get what was promised to them.
So you know, government can do what the private sector can do. So they're going to bring the private sector in to try to help. And there's reasons for that. One is because government spends other people's money on other people. And so there's very little incentive to become efficient in spending that money.
And there's not much accountability to it, either. And the proof of that would be I don't think anyone ever went to the president and said, "You know, Mr. President, we might have a problem here before they flip the switch." And so Management 101 says manage to a result, not a time frame.
And so someone in the private sector would be a champion of this and say to the president, "You know what? The time frame is not going to work. It's better to be late and work, than..."
JONES: I love this -- this kind of wonderful mythology, almost theology that nothing ever goes wrong in the private sector. And they're only geniuses there and things only go wrong. I think, in fact, you've got people making mistakes on both sides.
But I wonder, back to you, Mr. Speaker, if you would admit and agree with me that they're not geniuses only in the private sector, not geniuses only in the public sector. You've got geniuses and people make mistakes on both sides.
GINGRICH: Look, I don't think it's purely a question of how smart individuals are, especially when systems are incentivized to do it. And I want to come back to this whole issue of privacy for a second. Back in 2003, Governor Dean, you were very concerned about Vice President Cheney having a variety of secret meetings. And I was struck today. This was supposedly a meeting about solving a technical problem, but they didn't invite in the vice presidents of information technology. They invited in the CEOs.
And I have to believe that, at one level, this is part of a general process of getting their stories straight, that has nothing to do with problem solving.
HOWARD DEAN, FORMER CHAIR, DEMOCRATIC PARTY: Well, as I recall, attending these meetings to know the names of the people who enter the meetings, so we're a little ahead of the game. This is somewhat transparent. It's just the subject matter.
Look, I -- I don't disagree with everything that Chris said, but I do disagree with the fundamental premise: government is running this. It's private sector -- it's a private sector. This is modeled after what Mitt Romney did in Massachusetts, and what Mitt Romney did in Massachusetts was pretty successful.
Was -- didn't control costs. We're going to have to deal with that later on. That can was kicked down the road. But 98.5 percent of our people have health insurance. The private sector simply didn't do that. They had 50 years to do it, and they didn't do it. So that's -- that's why there's a government role in here, even if it's just simply to make it easier to buy health insurance.
So I think we need to give this thing a chance. Did they screw up? Yes. Is that common in technological roll-outs? Absolutely yes.
When I was governor, I did the tax department. My rule for IT is it takes twice as long, it costs twice as much, and often, you have to do it twice to get it done. And that's true of electronic medical records or the tax department or any university records, whatever you do. The mistake, I think, that was made was not to have this bill passed, which I didn't support, but I do think it's going to work, because Mitt Romney showed us it could work.
The mistake they made was, if you're going to do this, you ought to use another private/public partnership, which is the way the armed forces does health care. The country -- the 36 states who didn't partake in their own exchange should have been divided up into four or five groups, and they should have bid this out four or five groups at a time, and they should have had different companies running each exchange. So you wouldn't have the whole thing go down at the one time. That's 101. And that is something that a private sector person should have thought of.
JONES: Well, I mean, I'd love to hear your response to that, especially because, you know, what I like about what the governor is saying is that these things are iterative. It does take a while.
You voted for Medicare Part D. That's the prescription drug benefit. And horrible roll-out. Twelve percent of the seniors said it was a good idea at the time. But you continued to work; you improved it. Obama care improved it even further. And now everybody loves it. Why can't we have that same process now?
CHOCOLA: Well, I think that the problem with the Web site -- I agree with the president, that Obama care is not just a Web site. It's a health-care program. And what the governor said is there is some involvement of the private sector, but it's 100 percent mandated by the federal government. So it's not the private sector and the free markets deciding what to offer and consumers freely deciding what to buy and the market working that way.
So I think this whole Web site debate is temporary. They'll figure it out. They'll get somebody in over time to figure it out. But the problem is, then you move on to the next problem. The right people aren't going to sign up. The actuarial tables aren't going to line up in a way that...
JONES: There could be a number of problems, but don't you agree -- I mean, you can't both say that it was great for the federal government to get involved with Medicare Part D, which you voted for, and then turn around and say it's horrible for the government to get involved in health care. You voted for an expansion of our health-care system, didn't you?
CHOCOLA: Yes. That was the biggest mistake I made. That's a whole other -- seriously. It was a big mistake I made...
JONES: Every senior watching this wants to thank you for that big mistake, sir.
CHOCOLA: But -- but you know, the bottom line is that that is, in large part, a privately-run plan. There are free market forces. It was designed by a Republican Congress. It was passed by a Republican Congress, House and Senate. And a president -- Republican president signed it. I'm not defending it, but it has exceeded the expectations, and for the -- and it's the only plan that I know of that actually is cheaper than CBO predicted that it would be.
DEAN: That's true. I mean, you know, I don't think we ought to be partisan about that. I think the Democrats were against Part D for partisan reasons. And it turned out to work well. So we ought to give you credit for that. I'm...
CHOCOLA: I'm not asking for credit.
DEAN: You ought to run for office. I'll endorse you. Then you'll be in trouble.
No, I do think this is example of -- there's a lot of posturing going on here, as there always is in Washington. It seems to be worse than most of us could ever remember, but there are some things that are going to work out well. I do think that Obama care is going to end up working out fairly well.
What we decided to do, as a country, which I didn't agree with the majority on this one, is to get to universal health care using the private sector. That's essentially what we've done. Now, it's not entirely the private sector, but it's mostly the private sector. I didn't agree with that, but that's what we're doing. I think we ought to make it work, and Mitt Romney showed us it does work in Massachusetts.
GINGRICH: But nationally, I think the current projection is that there will be at least 30 million uninsured...
GINGRICH: ... even under this system.
DEAN: Partly because Republican governor refuse to accept Medicaid. So that's part of that problem.
But yes, this is -- as I said, I did not support this bill when it came through. Interestingly enough, I agree with the Republicans on the individual mandate. I don't think it was necessary. And I think it was politically foolish.
But... so we are where we are...
GINGRICH: So what -- so where would you be -- let me just jump in with that. Because as you know, Senator Shaheen today...
GINGRICH: ... has come out and suggested that there ought to be some real flexibility built-in, that they ought to move back the penalties, for example, because you may actually be penalizing people who actually can't...
DEAN: I think it's too soon for that, Newt. I think -- it's not an unreasonable solution if we get down to January 15 or whatever the deadline is, and now people really can't obey the law, because the Web site is not ready. Then I think you can have -- Right now, you know, honestly, I looked at the list of people who are supporting that kind of thing. They're all in fairly difficult reelection, whether they're in the House or the Senate. I liked Jean Shaheen a lot. I mean, she was the governor across the river when I was -- part of my time as governor. But this is right now -- this is posturing. Let's wait and see. Let's give this another month. Let's let it roll out.
GINGRICH: Let me ask you one other question, Governor. If you had had a mistake this big, and you have 3 1/2 years to prepare it. Hundreds of millions of dollars. You roll the whole thing out on October 1 without a beta test. It crashes and burns pretty decisively. I mean, wouldn't you have held somebody accountable in the government?
DEAN: We don't know who is accountable. I certainly wouldn't fire Kathleen Sebelius if that's where you're going.
GINGRICH: Well, no, if not her, then who would you hold accountable?
DEAN: Well, I don't know. I mean, because we don't know who made these decisions. Clearly, two things happened.
First of all, the Republicans did put every roadblock they possibly could in the way of it, so the kind of tech stuff that needed to get done was not done on time. So that was part of it.
But the other part was this is -- this is really tough stuff. We don't do tech very well in this country in terms of the implementation. We're incredibly good at the innovation. But what happens is the nerds talk to the nerds, and they never actually talk to the users. So that -- that happens all the time.
JONES: Well, speaking of nerds talking to nerds, us good nerds around this table are going to have to keep talking after the break.
We've been talking about the problems for a good long time, but when we get back, I want to talk about some real solutions. We'll talk about that once we get back.
JONES: Welcome back. In the CROSSFIRE tonight, we've got Howard Dean and Chris Chocola.
Now listen, I don't know about you, but I am beyond frustrated tonight. I am frustrated that Democrats are in this defensive crouch over a crappy Web site. I'm frustrated that Republicans seem content to just sit back and throw rocks.
I think for most Americans, this whole thing is just ridiculous. America does not want politicians just saying defund Obama care, like the Republicans. They also don't want Democrats just saying defend Obama care. They want some leaders in both parties to come together to fix Obama care, to upgrade it.
In fact, right now we could already have a giant bipartisan upgrade Obama care coalition if anyone actually wanted to solve the problems. I hope we can talk about that tonight. So to you.
Look, I want to show you some headlines and then get your response on how we can fix a pretty big problem. Here's the headlines I -- you know, think you might have found looked familiar: "Health spending rises at blistering pace," "Rise in health care spending could force many more in the middle class into the ranks of the uninsured," "Health care plans are dwindling in the United States." These are headlines from 2006 and 2005. Before Obama was elected, before there was Obama care, before the shutdown, before the glitchy Web site, this system was in disarray.
Can you give us a solution that's not a "repeal the whole thing," because then we're just back in the same system that we know doesn't work? Is there any solution that you can lead us on?
CHOCOLA: Well, Speaker Gingrich has done a lot of work on health-care reform and transformation. To read his book would be part of the solution. But, you know, there's -- the principles of free-market capitalism apply to health care by reconnecting the owner of the health care with the user of the health care, is where you could start. Where people make rational decisions on how they consume health care, because today it's disconnected. And so the third-party payer system has perverted the system and people's view of how they should consume health care and how much it costs.
So there, you look for free-market solutions that reconnect that. Because as I say, when's the last time you took a rental car to the car wash? You don't.
DEAN: See, I disagree with that. I think that's one of the reasons where this impasse, was free market economics actually doesn't work in health care.
What Paul Ryan should have done, instead of transferring the risk of Medicare from the payer, which is the government, to the patient to get this free market supposedly thing, he should have transported it to the people who are making the decisions, which is the provider. And the way you do that is very simple. You end fee-for-service medicine.
Right now, in fact all -- the way free-market capitalism works in medicine is that we get paid to do as much stuff as we possibly can. The incentives in the system encourage us, physical -- physicians, to drive costs up as high as we possibly can, because that's how we get paid. If you paid us to keep people well, we would.
GINGRICH: Listen, currently, you have this triangular system, where I get care. You're the doctor; you give the care. And the insurance company will give the insurance money.
DEAN: We send the bill to Van. Right.
GINGRICH: So the insurance company resents both of us, OK?
GINGRICH: And the system is designed to be conflict-ridden.
I would argue going in the opposite direction, that in fact, if we had price and quality transparency. If I actually knew how much -- the difference in hospital prices. In fact the California personnel system just went down this road last year. And they now incentivize their workers to go to any of the least expensive hospitals. And the difference between -- to get a hip replacement in California can be like five times as much money, depending on which hospital you go.
DEAN: I think the incentive -- Those kinds of incentives I think are good. The fundamental problem is, though, the patients -- and doctors are the worst at this -- do not make good decisions in the heat of serious illness.
So HSAs, for example, Health Savings Accounts, work so this is something that conservatives wanted to put in, and they did. And they do work. But the problem is they save you 100 bucks for not going in an office visit that you really didn't need.
But the big money that needs to be saved is the $100,000 coronary -- coronary artery bias graft with rehab, $250,000. The way you do that is, instead of paying people, doctors and hospitals, to do more and more of that stuff and more MRIs and more cardiac caths, you pay them to keep the patient well. You basically give them a flat fee, this is what you get. You want to see the doctor 57 times...
JONES: What's wrong with that? You tell me what's wrong with that? When he talks, that makes perfectly good sense to me, but I bet you don't agree. What's wrong with that?
CHOCOLA: Well, we don't trust people to make good decisions for themselves, so we must put a system in place that protects them from themselves.
JONES: The individual piece.
CHOCOLA: And so whether it's your health care of anything else that you want to consume, you know -- I have great faith. I have a health savings account. I've had it for several years. I had Lasik surgery 14 years ago, and you can get it done cheaper today than when I paid for it.
So -- so you know, free markets work in, I think, every marketplace, including health care. But you know, I agree that people that truly need help should get help. There should be some safety net in place for people that need health care that can't get it otherwise. But for people that can provide for themselves, they trust them to make decisions. And...
DEAN: Historically they don't. I've taken care of doctors, Chris, and they make awful decision about their own health care. When I had my hip replaced a couple of years ago, I was telling the orthopedic nurses what to do. I don't know anything about orthopedics. It was -- it was the emotional place that I was in.
GINGRICH: That may be a characteristic of doctors.
DEAN: Doctors -- It's a characteristic of everybody. When you're under enormous emotional stress from a really serious illness, you actually don't make terribly good decisions. It's not like buying a Ford when you're not under emotional stress.
GINGRICH: Well, let's use your example, because it's too good. My mother-in-law, who's now 81, has had both hips replaced at Gunderson Lutheran Hospital in Lacrosse. She was a compliant patient. She knew she didn't know. Now, this is one of the great challenges with doctors.
DEAN: Yes. That's true.
DEAN: She actually knew she didn't know.
But let me give you an example. There's a terrific new start-up in California. I think it's called Paramus. A young woman dropped out of Stanford as a sophomore, found a method for doing nano-scale laboratories. So she's actually taking a drop of your blood. They can do 1,000 lab tests.
They just went online at a local drugstore and have posted all their prices. She has -- their company has said they can take 50 percent out of the cost of Medicare and Medicaid diagnostics.
Now, here's the challenge. No laboratory in America will post their prices. They're all trade secrets. All these medical technology companies that want a tax break, none of them will tell you their prices.
JONES: Let me just go back to you, Chris. You know, you have these kind of innovations. There are some moderate Democrats; there are some moderate Republicans. If we all got around the table and we came up with something, and then some good Republicans said, "We're going to stand together with part of this upgrade Obama care coalition," would you support that or would you primary them?
Because my concern is that there are people who might be able to agree, but then they get afraid that a good force like yours or a good strong part of the Tea Party movement might actually primary people with good ideas if they're bipartisan. Do you think -- should I be afraid of that or no?
CHOCOLA: Well, good ideas are a matter of your perspective. If it's upgrade Obama care, no, we would not support it. And we...
JONES: Even if it's these good ideas? Even if the upgrade Obama care coalition had resources like...
CHOCOLA: If the basis is Obama care, Obama care is fundamentally flawed. It's not...
JONES: So no, you won't allow any fix?
CHOCOLA: If it's government-run health care where people don't have individual choice of the type of health care they want or they don't want, then, no, we would not support it.
DEAN: Can I just say one thing? This business about individual choice and Obama care being taking it away is mostly hooey. We have more individual choice when you go on the exchange and pick one of three or -- you know, two or three or six, or eight, ten plans than you do right now in an employer-based system. Because right now your employer chooses what health care plan you are. Under Obama care, the individual gets to do that.
GINGRICH: But you don't have...
DEAN: A lot of the stuff that's in Obama care was proposed by John McCain in 2008. Which was to get rid of -- to break...
GINGRICH: In Florida, you just had 300,000 people get a letter that said, "Your plan ends as of January 1. You can pick one of these four. And by the way, we can't tell you the price, and we can't tell you the deductible."
JONES: I guess...
DEAN: Well, if the governor of Florida wanted to make this work, they would have a lot more choices.
CHOCOLA: But you're going to pay for a lot of things you probably don't even want. I mean, if people want certain services, certain mandates and policies, they should be able to get those. People that don't want them should not have to...
DEAN: Well, that gets us into a really interesting argument. Should I pay and my health insurance policy for pregnancy, which obviously is not possible? I think the answer is...
CHOCOLA: If you have a family coverage, yes. If you have a family coverage and there are women in the family, yes.
DEAN: So this is probably the fundamental ideological difference between us, I think, between this half of the table and the other half of the table. And that is I actually think it's in my best interests as an American to make sure that people get good prenatal care, whether they're related to me or not. So this is -- now we have this sort of how much community do we believe in? And that's what this is really about.
GINGRICH: You believe in coercive community.
DEAN: No, I don't. I believe in...
GINGRICH: You're saying, "I'm not going to give you a choice about helping your community. I want to take your money."
DEAN: But taxing is coercive, right?
DEAN: But we all do it. We may disagree on what we spend it on, but we all do it.
GINGRICH: OK. You all please stay with us. Next we "Ceasefire." Is there anything these two can agree on?
We also want you at home to weigh in on today's "Fireback" question: "Is it OK for the White House to host insurance executives behind closed doors?" Tweet yes or no using #CROSSFIRE. We'll have the results after the break.
GINGRICH: We are back with Howard Dean and Chris Chocola. Now, let's call a "Ceasefire." Is there anything we can agree on? Chris?
CHOCOLA: Well, I think we can agree on the fact that the Web site will get fixed eventually. We may not agree on what happens next. As I think the real problems begin once people actually start getting into this system. But I think they'll get it fixed, and this will be an old story at some point.
DEAN: I hope you're right, because the sooner it gets to be an old story and people get in and get their health care that's great.
I actually also think that we may not agree on exactly the date, but we probably agree that, if this goes on for a long time, this Web site problem, they are going to have to relax the mandates and the deadlines because it's obviously unfair. I think -- my personal belief is they're jumping the gun. But at some point you can't, by law, require people to do something they can't do.
GINGRICH: Chris, do you agree with that?
CHOCOLA: Yes. There's a certain bit of irony just to the debate that we just had that -- you know, over the delay, but we're probably going to have to have a delay regardless of what your ideology or is what your view of Obama care is for just practical problems here.
CHOCOLA: They're going to have to get solved.
GINGRICH: Do you think that there's a date at which it begins to be a real problem for the president?
DEAN: Yes. Politically, you mean?
DEAN: Yes. I think -- sometime March or April, if it's -- it would be a disaster, with the bad will that leads up to that, if it goes that long, would be hard to overcome.
But eventually, I truly believe, even though this wasn't my idea, that when this thing gets into effect, it's going to be a huge plus for the president. I really do believe that. Because there are a lot of people who are even in the Tea Party who are going to get health insurance a lot cheaper. But it can't go on like this.
JONES: Well, listen, I want to thank you both. You've been awesome. We've got to have you both back again.
Listen, for you at home, if you want to stay a part of this debate, you can go to Facebook or Twitter, and you can weigh in on our "Fireback" question: "Is it OK for the White House to host insurance executives behind closed doors?" Right now 33 percent of you say yes; 67 percent say no. So the debate will continue online at CNN.com/CROSSFIRE as well as on Facebook and Twitter.
From the left, I'm Van Jones.
GINGRICH: From the right, I'm Newt Gingrich.
Join us tomorrow for another edition of CROSSFIRE. "ERIN BURNETT OUTFRONT" starts now.