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LBBJ: How should we address the issue of Medicare?
DeLong: Here’s what needs to happen in healthcare, in my opinion. First of all, we need to acknowledge that the system is going to blow up if we don’t fix it. If you can’t do that, there’s nowhere to go. We can’t have a conversation about death panels or end-of-life care if you don’t recognize that in the next 12 to 13 years, the system that we know is going to blow up due to under-funding. Then, I can’t have a conversation with you. If you start with that, and we can agree that it’s going to blow up and it needs to be fixed, now we can move forward. Your idea may be different than my idea, but at least we’re on the same page that we need to do something. That’s the difference between me and my opponent.
The next thing we’ve got to do, from both sides, is stop blaming the other party for whatever solution they come up with. You can’t say, “Well, you want death panels,” or “You want to push grandma off the cliff.” It’s both parties. I mean, look at the advertising. Read the statements made by both parties. It’s always the other party’s fault. Well, when you create that kind of environment, what happens? No one wants to do anything because if I attempt anything and you’re not going to work with me, then I have to be careful because whatever I do you are going to criticize the heck out of me. Candidly, if we’re going to get any meaningful reform, it’s not about who is the smartest to come up with the next idea. It’s how we get back from the edge and say, “I’m going to work with you on this. I might like some of your ideas, not all of them. You might like some of my ideas, but not all. But which ones can we compromise on? Out of the 10 things we’ve put forward, there are three that we agree on. Let’s go ahead and implement those three and we’ll continue talking about the other seven to see if we can’t find more common ground.” I think that change is far more important than coming up with a specific little fix here and a little fix there.
Although, I would like to think there are some things we can readily agree on. For example, tort reform. Clearly, frivolous lawsuits add a lot of cost to our healthcare system. I think pretty much everybody but the trial lawyers agree with that. So that’s not a Democrat issue or a Republican issue.
Now, how do we work together to put that reform in place? Maybe we can’t do five things at once because we can’t get that much agreement, but maybe that’s one we can start on and that will significantly reduce costs. Let’s look at expanding health savings accounts, just as when you work for a business, the business gets to write off its health insurance expense on its taxes.
Doesn’t it make sense if you’re an individual and you want to purchase health insurance that you could also write off your insurance expense? As an individual, why don’t you have the ability to write that off? Why can’t you pre-fund it through a healthcare savings account?
LBBJ: That has been an alternative proposed by Republicans, as well as offering tax credits to the self-insured. What do you think other alternatives might be to the Affordable Care Act, or Obamacare?
DeLong: Let me first tell you what I don’t think. I don’t think that the answer is to repeal. I hear a lot of people say that it’s terrible and awful and that we need to repeal it. I think it’s there. I think what we need to do is figure out a way to make it better. What do we want to have in healthcare? I think there are three things that we want: We want improved accessibility; we want to reduce the cost of healthcare – we need to get away from these double-digit increases year after year for personal and businesses and the government services they’re paying for; and the third thing we want is to maintain or improve our level of care. So when you look at the patient affordability act, you have to ask, “How does it do meeting these three things?” I think you can make an argument that it might improve access. . . . But how does it do on reducing cost? It fails. The nonpartisan congressional budget office suggests that it is going to add $1.8 trillion in costs to our healthcare system. You can’t add $1.8 trillion in costs and tell me that the cost is going to go down. The cost is going to go up dramatically, which then might have a negative impact on access. The people who could have purchased health insurance before now can’t purchase private insurance. They might have to go to a government program as a means, or maybe choose no coverage at all.
LBBJ: Census information was released on September 12 and organizations that are in support of the Affordable Care Act are saying that more young people are now covered through insurance because of . . .
DeLong: When you look at access, that’s another example of access where people can now cover their children up to the age of 26. I think that’s a good thing. I support that.
LBBJ: Pre-existing conditions?
DeLong: Absolutely. I support that you should not be able to discriminate based on pre-existing conditions. I think that’s a good part of the law.
LBBJ: Individual mandate?
DeLong: I’m not as thrilled with that. It does concern me that you are mandated, that you have to have health insurance. That doesn’t sit well with me.
LBBJ: Isn’t that the major sticking point?
DeLong: It’s one of them.
LBBJ: Isn’t that the key issue – being forced to buy something that you don’t have a choice in?
DeLong: That is the principle. But I don’t think that’s the biggest flaw. The biggest flaw is that it is going to make healthcare dramatically more expensive. And, as I talk to physicians, they are concerned that it is going to reduce the quality of care. What we really should care about is how the quality of the healthcare is going to be affected 10 years from now. That’s more important.
LBBJ: Why would the quality go down?
DeLong: Many physicians are concerned that as more of the funding comes from the government at a reduced rate, they are going to walk away from it. These are people who have spent their lives providing medical care to others, and I know a few of them who are at retirement age and could leave and be just fine. But they are hoping to continue to work, looking at this thing and saying, “Well, if I’m not going to get paid, I’m not going to work. I’m not going to work for $17 a patient.” We’re going to have fewer doctors.
Look at the people who go to medical school. How many hundreds of thousands of dollars are you willing to take on in debt to put yourself through medical school if there’s not an economic opportunity? You’re going to struggle just to repay your student debt, not to mention that your ability to earn is reduced. I’m very concerned. But, again, it’s not repeal. It’s about keeping the good things. We’ve talked about what some of those are. Let’s look at the things that might have negative, unintended consequences, and let’s fix those. I will tell you, the fix is not a Republican plan and it’s not a Democrat plan. The fix has got to be what both sides are willing to work together on, or this is not going to get fixed.
LBBJ: Have you looked at healthcare systems in other countries that are comparable, like Canada?
DeLong: It’s hard to compare because there are certain attributes and positive things in those systems, but then you hear that patients want to come to the United States to get an operation that might take eight months to get in Canada or a year in the U.K. that you can get here in two weeks. . . . So, I don’t see a panacea. I don’t see a system where I could say, “We need a system like theirs.” I think there are pluses and minuses.
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