Rep John Shadegg on health care reform

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A funny thing happened on the way to the ACR Economic Update. For those not in the know, this afternoon's session by Maurine Dennis -- to be repeated again tomorrow at 2 p.m., which I'll definitely be attending so I can keep you all up to speed on their valuable intel -- was preempted by the arrival of surprise speaker Rep John Shadegg (R-Ariz), a longtime advocate for physicians and member of the House Committee on Energy and Commerce, who delivered an update on what's happening with health care reform. There had been rumors that Rep Shadegg might make an appearance, and I was so delighted at the opportunity to bring you all inside the session with me that I took down his speech to the assembled group as close to verbatim as I could. Depending on which side of the political divide you stand on, his remarks have an equal chance of inspiring you or enraging you. Either way, though, they represent a valuable inside look at the number-one policy issue facing America today. I also took notes on a few attendees' questions, as well as Shadegg's answers, all after the jump. “Why health care?” Shadegg asked. “Health care has been an interest of mine since I got into congress. Health care is where our nation is closest to embracing socialism, and I don’t want that to happen. I first said that ten years ago, and here we are, very close to the first step in that direction. “I know HR 3200 pretty darn well. I’ve read it multiple times flying back and forth to DC, and if you need to drift off to sleep after a long week, just pick up HR 3200. I think we have the best health care in the world. I think the problems with the delivery of health care are all created by government. If you look at what’s screwed up with health care in America, you’ll find that the government did it. If you don’t like your employer’s plan, buying your own plan is at least 30% more expensive. Making Americans buy health plans with after-tax dollars is outrageous. It just frustrates me. I personally believe the current structure goes a long way toward building barriers between patients and physicians. I think it’s not good to put employers and plans between patients and doctors. I don’t think it’s good that your industry has to come hat in hand to Washington year after year to try to influence a bunch of congressmen who don’t know squat about health care. “The good news is that there is substantial agreement in this nation on two of the three issues in health care. Republicans and Democrats both agree that you shouldn’t be denied coverage or told you can’t get coverage if you have a preexisting condition. Whether it’s through high risk pools, risk readjustment or other issues, I think America is ready to resolve this, and we shouldn’t be fighting about it. “The second issue is universal coverage. I argue a lot with my Republican friends that we are already supplying universal coverage because those without health insurance just go to the emergency room. “The third issue is how do we control costs. With the Baucus plan, the other side has given up on controlling costs altogether. The Republican school is we need to connect patients with their primary care physicians again, enable them to pick their plans and that will control costs. They won’t buy a plan they can’t afford. The Democrats’ answer is, if we put the government in charge, they’ll control costs. I don’t mean to be partisan, but that’s putting the same group responsible for Hurricane Katrina in charge of health care costs. That’s the way I see it. “Now let’s talk about the outrage. For those of you who spend a good part of your time interfacing with the government or supervising someone who does, the good news is, if this bill passes, there’s lots and lots and lots more of that to come. Mr. Baucus was extremely thrilled because the CBO [Congressional Budget Office] scored their bill and said only $829 billion, and it will cover more people. How many of you could make the financial side of whatever you do look really good to the people in charge by including ten years of revenue, but only seven years of expenditures? The taxes begin in 2010, but the expenditures begin in 2013. CBO scored from 2010 to 2030. I think it’s an outrage, and only in Washington would you get this kind of accounting. “That’s what the bill does. It says we’re going to save a whole bunch of money on Medicare by doing away with Medicare Advantage. Well, it might, but you’re going to have a lot of people angry. The rest of the money comes from them saying the SGR will never happen, and you’re all going to live without a cost of living adjustment for the next 10 years. The last one is kind of, I’ll try to talk about it as though it’s funny, but it’s not. It’s corruption, Washington-style. If you want Soviet-style, gulag politics running health care in America, then you’ll love this bill. It turns out that Senator Harry Reid is up for reelection this year. It turns out that they want to expand Medicaid to cover more people. It turns out states would have to match that. So guess what’s in the bill? Mr. Reid wrote an addition saying that in four states, including Nevada, the government will pick up all of the Medicaid costs. If you want your health care to be determined by how powerful your US senator is, then this bill is great. “In the Baucus bill, they’ve decided that we ought to tax gold-plated health care plans to pay for care for everyone else. I’m perfectly happy to pay for health care for those in our society who don’t have it, but I think it ought to be fair and equal. In this bill, here’s what they did. They wrote the bill to say that all gold-plated health plans in America will be taxed at the level of $2,200. But then Schindler worked with the senators to get that portion rewritten. So if you live in Kentucky, the tax kicks in at $2200, but if you live in New York, it’s $2500; in Connecticut, it’s $2600. So if you’re lucky enough to live in a state with a powerful senator, you pay less. Sounds like gulag-style politics running our government. The senator from Michigan Debbie Stabenow said, ‘I’ve got to keep my union workers happy,’ but she got an addition to subsidize only union plans in Michigan and New York. “Now you know how I feel about this bill, and I’ll be happy to answer your questions. An attendee asked, “Why are we throwing the baby out with the bathwater? Why are we taking a hatchet to a lot of good things that are working well? And the second thing is, why is Congress trying to cram something down America’s throat that it doesn’t want?” Shadegg answered, “In Washington, anyone who bases their life on the numbers CBO comes up with, you might as well read tea leaves. When Medicare was first created they allocated a budget for it. It turned out to be enough money to cover two states. On the uninsured, the number they cited kept creeping up over the years until it was eventually 50 million. But when you take out illegal immigrants, it’s closer to 30 million. Most people hear that number and they think there are 30 million Americans who’ve had no insurance for years. That’s absolutely wrong. The number is based on the number of people who were uninsured at any point in time in a 12-month span. The chronically uninsured? Who knows how many there are. “Covering everyone is a societal value. I think we’ve made our minds up about that. But I think it’s crazy to be throwing the baby out with the bathwater. One of the things I like to remind audiences of, you want to talk about health care, the one thing that scares most Americans is the big C. We beat the socks off the rest of the world on cancer. Our five-year survival rates are better than Canada, better than England, better than all of Europe.” Another attendee asked, “What’s being done on the insurers’ side of things?” “I’ll tell you what I think about insurers,” Shadegg answered. “I think the health insurance industry in America has got a fat hog, and we’re the victims. If you flick on the TV tonight, in the span of an hour and a half you’ll see five commercials for auto insurance saying they can make you a better deal, but you won’t see a single health care commercial make the same argument. They don’t have to sell to you and me. The health insurance industry does not have to sell to individuals by and large, and they like that. They like it so much that the big guys are onboard with this bill. They want the government to put a gun to the head of every single American saying now you’ve gotta buy their product. If we rewrote the law to say you could take your employer’s plan tax free or go buy your own plan tax free, and that will keep the competition going.” Finally, another attendee asked, “My question has to do with what is helpful for members of Congress to make decisions. Are surveys that organizations like the ACR do helpful to members of Congress?” “Obviously,” Shadegg said. “What influences an individual member of Congress on any important vote ranges from soup to nuts. There was an amendment in front of my committee on the issue of imaging utilization. The current team in Washington thinks imaging is overutilized. Some of us don’t agree with that. My answer to your question is facts are stubborn things. When you bring the facts to people like me or any other member of Congress, that makes a difference, but so do other factors. I guess my answer is facts help, but to the extent that medicine has become phenomenally intertwined with government, which to an extent it has. You can’t open your eyes in the medical field without asking the government for permission, and it’s going to get worse. Studies with hard facts make it more difficult to ignore the merits of your position. And therefore all the other things come into play. The other thing I would suggest is that personal contact really does matter. Do the string theory. Find somebody in your community who knows somebody who knows somebody who knows your congressman, and work that string. Find a way to have a personal conversation. Then you’re in their head, and they’re doing it with someone they know and respect.”