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LBBJ: Where do you stand on the Affordable Care Act? Do you agree with the law in its entirety?
Lownthal: I support it.
LBBJ: So there’s nothing you would like to change about it?
Lowenthal: I would like to see, as it unfolds, what the issues are, and I would be open to looking at it. But right now I support the Affordable Care Act. I have supported single payer in the past in California and would have liked to have seen even more. I think this is a major step forward . . . we are using a market-based approach to see if we can provide national insurance, national health coverage. There may be issues that we have not addressed yet. California has unique differences than Iowa. We’ll have to see how that plays out. . . . We have to see how the health exchanges work. We have to see how competition, how small businesses are able to purchase at low rates and can come together.
LBBJ: But there are businesses that are considering paying the penalty because that may be cheaper than their current group medical costs.
Lowenthal: We’re going to have to see. Right now I am so excited we are moving in this direction. But I think the most important thing will be to have oversight and understand how it’s working.
LBBJ: Do you agree that the penalty is a tax?
Lowenthal: I agree with the Supreme Court. I think that Chief Justice Roberts was courageous.
LBBJ: So it’s a tax, not a penalty?
Lowenthal: I agree with the standing of the Supreme Court that it is constitutionally allowable. What I agree with is not the definition, but that it is constitutionally appropriate for the nation to require the mandate. That’s really what it was, whether you call it a tax or a fee. The question really was whether the Congress and the president had the right to put a mandate on the private sector, and they said yes.
LBBJ: So an individual who does not have health insurance right now, let’s say they’re 30 years old and they’re very healthy. They probably would choose to pay the $695 penalty, or tax, for the first year, instead of having to pay a couple thousand dollars for insurance.
Lowenthal: That’s why we have obesity . . . people don’t understand the importance of preventative care and having health insurance at a young age. They don’t get it. They don’t understand that health is something that you can’t just start taking care of when you’re older.
LBBJ: You said earlier that you would support the Bowles-Simpson plan, however the plan does nothing to address Medicare. When the idea to cut funding to end-of-life support was raised as a means of addressing the unsustainable program, it was referred to as creating “death panels,” that sort of thing. Other ideas that have come about are possibly higher costs for individuals who smoke or who are obese because of their behavior – not caused by thyroid issues, for example. How should we address the issue of Medicare?
Lowenthal: Well, I think that the president has already begun to address the issue of Medicare, to looking at those kinds of efficiencies with the Affordable Care Act. Medicare can benefit from that and provide more services for less money. . . . Starting next year, seniors are going to get more services. They will get preventive care, which they couldn’t get some Medicare plans to fully pay.
LBBJ: We’re not talking about services. We’re talking about the sustainability of the program, funding and a long-term extension of the program.
Lowenthal: As President Clinton pointed out, the money that I’m talking about extends the program, keeps it economically viable . . . from 2016 to 2024. We have extended . . . Medicare by just looking within the program and altering where the services are and how much reimbursements are paid to hospitals and other kinds of reimbursements. We’ve now extended the program for eight years. I think there are more efficiencies in the program, and I think that’s really what we need to do, especially around the issues of pharmaceuticals and other cost drivers in the program.
LBBJ: Would you describe those eight years as a short-term or a long-term solution?
Lowenthal: It’s short-term. It’s the first step in reform. It begins to look at this as a comprehensive system . . . not having separate systems. We’re already seeing that in the states by trying to combine Medi-Cal and Medicare for seniors as much as possible; to have Medi-Medi, which will cut down costs instead of having duplicative services. I think that will be the outcome. We will run it much better, much more efficiently.
LBBJ: How do you think doctors are feeling about those kinds of changes?
Lowenthal: I think those who are in primary care are as excited as can be, and those who are specialists are worried.
LBBJ: Why would you say the specialists are worried?
Lowenthal: Because the money will be shifted more toward the primary care.
LBBJ: Cuts to public education continue, impacting after school programs and athletics. The U.S. is also faced with an obesity epidemic nationwide. What do you think needs to be done to address the health and fitness needs of Americans and our youth?
Lowenthal: I’d say that, first of all, we need to understand that all of us are responsible. Education has to play a major role. We have to shift incentives. I like the Kaiser [Permanente] model. Kaiser physicians are paid for keeping people well, not just for illness. You get additional [money] for the amount of prevention work, the number of people who take classes to take care of your health. I think that we need to shift our incentives toward wellness, toward reducing the risk of disease. You talked about obesity. It’s estimated that 30 percent of the folks who are obese, the next generation will be obese and will have diabetes. This all needs to be prevented. People need to be educated. I think there needs to be a far more shift toward prevention, far more incentives for physicians for keeping people well, payments for keeping people well as much as people being ill.
LBBJ: We understand that some businesses with more than 150 employees, as an example, are going to split their companies into three under three different names so they fall under the 50-employee threshold [as required by the Affordable Care Act].
Lowenthal: I think most businesses would like a stable workforce and would like to provide the healthcare. I don’t think businesses are evil. I think that they would like to provide it. I think that if we can get this under control, it is a tremendous selling point for businesses. We must begin to deal with prevention in this country. We are paying for all of this stuff. People are going to emergency rooms. They should be seen in a preventive office by a primary care physician.
LBBJ: So this is going to stop the emergency room impacts?
Lowenthal: You’re damn right. It’s going to slow it down.
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