Is "trigger" a victory?
Paul Jay speaks to Anthony Wright of Health Access California at the Tides Foundation’s Momentum conference in San Francisco. Wright says that even if a public option is included in the health reform bill, its supporters will continue to fight for it to lay the foundations for a strong health care system. He says it is important to change "the way [private] insurers work, and challenge them, to see if they can even operate in a model where they’re competing on cost and quality, rather than finding healthy people and avoiding sick people." He goes on to say that, "Even if the public option is included, it will be up to us to guarantee that it is as strong as possible, that it is as robust as possible moving forward. This effort will not end when a bill is signed."
PAUL JAY, SENIOR EDITOR, TRNN: Welcome back to The Real News Network. We’re in San Francisco at the Tides Foundation Momentum Conference. And we’re joined again by Anthony Wright, and he’s the executive director of Health Access California. Thanks for joining us again.
ANTHONY WRIGHT, EXEC. DIRECTOR, HEALTH ACCESS CALIFORNIA: Thank you.
JAY: So we left off the first part of the interview essentially with the question: if we wind up with—and there’s a lot of drumbeats that this is where this is all headed, to a regulated insurance industry, with the public option as a kind of a threat, a trigger, that if the insurance industry resists the regulation or aren’t capable for one reason or another of meeting certain standards, then it triggers a public option. Can this be called a victory?
WRIGHT: Well, let me back up for a second and say that, you know, the devil is always in the details. It’s—you know, a public health insurance option always was in the question of what was—.
JAY: So give us your litmus test. Like, for this to be called a real step—incremental, yes?
JAY: No one’s expecting a revolutionary transformation of health care. If a serious incremental change, what is your litmus test that this is going to have to meet?
WRIGHT: I think a couple of things. One is that it expands health-care coverage for a lot of people who can’t have it. And, I mean, you can’t dismiss putting major expansions of Medicaid so that low-income people who needed coverage, major subsidies to middle-income people so that they can have coverage, that’s the—that would be a major victory in and of itself, setting a standard for employers to provide health coverage to their workers.
JAY: That means the subsidy, right? Part one.
JAY: What is the level of subsidy?
WRIGHT: What are the level of subsidies? So that people can get quality coverage at a price that they can afford, based on a percentage of their income.
JAY: Okay. Let me—just going to ask you a question one by one, here.
JAY: We know that there’s been a big debate—although to hear this debate you’ve got to watch the business press or you’ve got to watch television shows directed at the business viewership.
JAY: And everybody’s talking about what’s coming with entitlement programs. Then, when the—to pay off this coming deficit, who’s going to pay? And the conversation’s not all that much about raising taxes for the wealthy. There’s a lot of talk about cuts in entitlement programs. So is there some fear that if there’s not a public option and it’s about subsidizing the buying of private insurance, and then you get into this deficit crisis, that this is going to be one of these soft areas where [inaudible]
WRIGHT: Well, some of this is expansion of public programs like Medicaid. So I don’t think that it’s that. And, I mean, let’s be clear: if we don’t reform the health-care system, you’re right, the health-care costs will go out, will skyrocket, and will skyrocket for public programs, as well as private. Not that public programs do a worse job. In fact, they do a better job than private insurance in providing coverage to a large number of people. It just is is that they’re able to provide health coverage at significantly lower cost than private health coverage. But if the costs of health care as a base cost goes up, then everything goes up with it. So the problem is not a Medicaid problem; the problem is not a Medicare problem; the problem is a health-care problem. And that’s why we need to do this. What I think is important is—and the victory we need to—we need—are—are we going to have the tools in place to be able to make sure that people have the coverage they need and for us to be able to control costs in a consumer-friendly way? What are those tools? That means getting everybody in the system, because how can you do preventative care if people are not in the system to begin with? How can you do epidemiology? How can you do cost containment if you don’t even have a system in the first place? How can you [do] information technology, electronic health records, all these things, if you have this current patchwork system where there’s a fifth of the population that’s not even in the system to begin with? So I think that having these tools in place are really important. I think that changing the way that insurers work and challenging them to see if they can even operate on a model where they’re competing on cost and quality rather than, you know, finding healthy people and avoiding sick people, which is their current business model now—. They do not compete based on cost and quality right now; they compete based on risk selection, on taking premiums from healthy people and avoiding sick people.
JAY: And they’ve more or less agree. They’ve said in a regulated environment they would agree with these kinds of changes, right?
WRIGHT: Some have, and some are still opposed. The Anthem Blue Cross of California was adamantly opposed to an effort to reform the health system in California two years ago. Just last week they put out an e-mail to millions of their subscribers, opposing HR 3200, the bill in the House. So—.
JAY: Which is a bill that does—.
WRIGHT: Which is the main health-reform proposal in the House that would do the changes that we’re talking about, securing and stabilizing employer-based coverage and Medicaid and Medicare, while also reforming significantly the way that people buy coverage as individuals. We have an opportunity to make major changes here. The public health-insurance option is a really important piece of that, but it’s up to us to get it through the Senate and through the legislature. It’s not the president’s to give away; it’s not any politician’s to give away; it’s our advocacy through this. And even if it is included, it will take our continued advocacy to make sure it is as strong as possible, it is as robust as possible moving forward. This effort will not end when a bill is signed, whatever is included in it, and that’s, I think, an important piece here.
JAY: So if it turns out that we’re dealing with a trigger, if it meets these other tests, this is an achievement for this period, or no?
WRIGHT: You need to see the puzzle—.
JAY: Can these other pieces be real without—.
WRIGHT: Well, let me be honest with you. This was not a hypothetical discussion in California. We had a proposal that Governor Schwarzenegger negotiated with our Democratic assembly speaker that had a lot of these same components—an employer requirement, expansion of public programs, a regulated individual market, a form of a public auction (but a fairly weak one, to be honest), subsidies up to 400 percent. However—of poverty level—when the governor first proposed a scaled-down version of that effort, my and a lot of consumer and a lot of labor and a lot of other community organizations opposed it, and we opposed it for a year until we finally came to an agreement. And some groups supported it and some groups didn’t, because they all had different things that they were looking at, ’cause you have to look at the proposal as a whole. If there is a weaker public option, then you need stronger regulations. You really need both. The question is, you know, different groups have different constituencies and different thresholds. I do think there’s something about the issue of momentum, which is not just the title of this conference, but it’s about the fact that, you know, success breeds success. If we pass something in health care, that provides momentum for continued victories not only in health care but in other fields, whether in climate change or labor rights or other issues. If failure begets failure, that, you know, the last time we had a major health-reform debate and it failed, politicians ran from the room for several years before even wanting to discuss health care. And so I do think that there is a issue, which is if we can build foundations, we can do more. I would like to think that the public health-insurance option is a foundational piece of this. And that’s what we’re going to continue to fight for because it is so important. And we’re very happy to have the House of Representatives, led by Speaker Pelosi and other leaders, actually making that case that it is a fundamental piece that we should start with, rather than have something that’s added on or triggered on later.
JAY: Your reading of the house: will they pass a bill without a robust public option? A lot of them have said no.
WRIGHT: I think they’ll pass a bill with a public option, and then they will go into a conference committee to be negotiated with the Senate, whatever the Senate does or does not do. At the end of the day, again, the president can’t sign anything that doesn’t get on his desk. So we have an interest in trying to move forward. Even here in California, when Governor Schwarzenegger had his proposal that we had problems with, we were still for reform and we still had to maintain the very tricky balance of being for reform and moving the process forward, even if the product at the moment was not what we wanted it to be.
JAY: Is there any point in this where you say it’s actually gotten to a point where it’s better to have nothing? Or is anything incrementally better than the current situation?
WRIGHT: No. I mean, and that’s what I’m saying is that, again, speaking as somebody who’s—where this was not a hypothetical but this was real—. You know, we had a first-do-no-harm principle, which was we want to make sure that coverage is expanded to a lot of people. I can’t tell a lot of people who are uninsured now, oh, no, you have to wait, because we need to get this perfect. At the same time, I don’t want to put anybody in a worse position than they are in now. HR 3200, thankfully, I think, helps most people and meets that test with flying colors. But I think that if you were to have a test that said, you know, "Are you going to require people to take up coverage?" then you have to provide people the means of meeting that mandate in an affordable and accessible way. And that means that there needs to be enough subsidies so that people can afford the coverage that they’re getting. It also means that they need to have options, so they’re not just trapped, as in, you know, some states where they only have one or two options in their state’s insurance market.
JAY: Well, just very quickly, ’cause I want to go to one more segment, but very quickly on this, the Republican argument, one of the main arguments they’re giving is that you can solve the competition problem by dropping the state boundaries around insurance companies—let there be cross-state competition.
WRIGHT: Right, and that’s a disaster. The reason that’s a disaster is because that would mean that—it would be basically a way—it’s a code for allowing insurers to basically go to the state with the least regulation. We’ve seen this in other parts, where if everybody will go to Alabama or Delaware or to the place that has the least consumer protections whatsoever. And a Californian—how would a Californian get justice if they’re denied for preexisting—if they’re denied care, how does a Californian go to the Delaware Department of Insurance to get their justice in terms of bad behavior? The proposal is just a thinly veiled effort to try to deregulate the insurance industry even further from where it is now.
JAY: Well, that goes to the next segment of the interview, because, as you said in your talk at Momentum, and as I found interviewing people at these town halls that are against health-care reform, it’s not actually about health-care reform; it’s really about government. And let’s talk about that in the next segment of our interview.
JAY: Please join us for the next segment of this interview on The Real News Network.
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