We the People; Health care reform on trial

Oh. Good evening I'm Dave Iverson and I'm Katie side. Tonight the Wisconsin State Journal wy CTV Wisconsin Public Radio and Wisconsin Public Television joined together for a unique broadcast. Please stay tuned for We The People. Health care reform on trial. I. Think there is no better phrase that. I have. I once said. Anything. That's not fair that. They go. That route that you never know. On the. Tape.

We have many many families that were covered. By health care for their disabled children. And. Right. Their families with money their family through work and they cannot buy health care for their children. Or. With. Funding for We The People. The sponsored health care reform on trial. Has been provided. By Miller Brewing Company Wisconsin Education Association Council representing sixty eight thousand education employees throughout the sponsor. Additional funding has been provided by. The response and power and Life Foundation. Striving to meet the needs of. Wisconsin Manufacturers. Are presenting. To. Us.

Good evening everyone. Tonight we're going to put more of the health care plans now before Congress on trial. Two congressmen a state senator and an economist will testify before a citizen jury here in our studio. Our jurors will then consider the evidence and report their verdict at the end of the hour. To make sure the citizen jury we gathered here tonight reflects our state as a whole. We first conducted a survey of three hundred forty seven Wisconsin residents. We found out in that survey that about 10 percent of those surveyed have no health insurance at all that there is support for universal health care coverage in our state but little consensus on how to pay for it. So then we asked a group of 60 individuals from all across our states who reflect our state demographics to volunteer for jury duty. For the past two hours our jury pool 60 was briefed on health care issues discussed the key proposals and prepared questions for tonight's program. We then drew a

lot to select our final 8 member jury with a cross check for balance and diversity and our jury has joined us now in the studio along with the rest of our program participants and here to preside over our healthcare trial is Dane County Circuit Court Judge Mark Frankel. Judge thank you. Members of the jury. Jury trials have historically been used as a means to resolve complex public disputes. We hope this novel approach tonight will shed some light on this important public policy debate as jury members will have the opportunity to take written notes and to ask questions of our four presenters. They are Congressman Tom Barrett of Milwaukee who supports President Clinton's health care plan. Congressman Scott Kluger of Madison who favors the so-called Kuiper plan. State Senator Chuck qual of Madison who supports the single payer option. And Michele Davis an economist who advocates a market based plan. First we've prepared some background information on the Clinton plan.

A number of key features including a call for universal health care coverage by the year 1998. A uniform benefit package insurance reform and large health alliances or buying cooperatives. The money to pay for the plan comes from a higher tax on tobacco savings from cuts in Medicare and Medicaid through the year 2000 and required employer contributions. The Clinton plan also places tough controls on health care costs. Here to argue on behalf of the president's plan is Milwaukee Congressman Tom Barrett. Congressman Baird will have two minutes to make a presentation and then we'll take questions from our citizens juries. Congressman there. Thank you very much thank you for inviting me here tonight as we begin our debate on health care reform. It's important to recognize the strengths of the current system. We're fortunate the United States because we have the best health care in the world. We have the best health care technology. We have the best doctors nurses therapists. As a group we have the best people providing health care for Americans. But there are

serious problems in the delivery of our health care. And those problems come in the area of cost and availability. Everyone in this room knows that there's a problem with cost and health care in the United States. Over the last 10 to 15 years health care costs have skyrocketed. The president's plan addresses this problem by building on the strength of our current system and by giving purchasers more power to band together as a group to drive down the cost of insurance. That's a positive step in the right direction in terms of availability. Most Americans think that the people who don't have insurance in our society are the people on welfare. Well that's simply not true because if people on welfare actually have AFDC providing the Medicaid the real problem comes with the working poor that people in our society who are trying to support their families who are trying to stay off welfare and are doing so by taking low wage low benefit jobs we should be doing everything we can to help those people

stay off welfare. Again the president's plan works off the strength of our current system and goes with the employer based system that we currently has and works towards universal coverage through that system. As we debate health care reform we should be throwing the baby out with the bathwater. But we also should not miss the opportunity to reform the best health system in the world and make it the best health care delivery system. Thank you. Thank you Congressman. And now I'll ask if there are any questions from our jury. Ladies and gentlemen of the jury do we have any questions for Congressman Barry Yes Mr. Swanson. I'm a retired educator and three fourths of my insurance is paid by supplemental insurance is paid for by my former employers. What would happen to that insurance in the president's plan. With all decisions in general and point out that the Medicare system essentially remains intact under the present system. You probably add from your statement or your question by a medic gap insurance policy right now and you could continue to

purchase Medigap insurance under the president's plan. The other issue for older people and what I hear most when I talk to my constituents is a problem with prescription drugs and the president's plan really provides help for people to buy prescription drugs by having additional payment of 11 to 12 dollars a month on Medicare so older people can can purchase those. But basically for older people the changes will not be as significant for as for some other age groups. Thank you. Other questions for Marjorie. Yes Mr. Wagner standards standard benefits package be determined. Well that would be determined by going through the different states probably a lot of it would be done on the national level. And bear in mind as we develop this legislation there will be many amendments to it. But I think you will see a basic plan coming out of Washington frankly. But the possibility for variations on the state level so that you have flexibility in the different states. You may want to have a different plan for a highly urbanized state like Delaware for example and a different plan at least some of variation for a more rural state

like Montana and he specifics on what might be covered. Not at this point. And again as we move through the legislative process a lot of that will be played out there are some specifics for example there are some mental health coverage reproductive rights are mentioned in there. Both of those frankly will be quite controversial issues. But but there is there is a listing of the wide range of options but it doesn't get terribly specific in the current bill as Harper is so you know how much flexibility for the states in his plan. Again bear in mind that we're working through the legislative system right now and what the states would be allowed to do this is under the president's plan right now is that they would set up the alliances within the state and the number of alliances which within this state would vary in part on the number of people who live in the state for instance they would have to have alliances. Again that will be an issue that will be very controversial because what we're talking about is whether employers or individuals have to purchase through an alliance or whether they can voluntarily purchase

outside the alliance. But there are complex. Well. If you look at the type of program that set there the purpose of that program is to allow individuals to have greater market strength. And the real problem we have right now and it hits small business people probably the hardest is they have no market power. If you're a large employer you can go in and you can really dicker for a price. But if you have five 10 15 employees you basically are left with a take it or leave it type proposal. And under the current system it's the small businesses who are really getting massacred is what we're going to question. Yes but currently paying calls for an estimated increase in federal bureaucrats of 55000 employees. What do you say to convince me that that's not going to increase red tape. That's not going to increase paperwork and that's going to make. Personal level doctor to patient closes one of the things that's happening right now against the legislative process is we're looking at the level of bureaucracy. It's my goal and the goal of most people who support President Clinton's plan to minimize the DeMarco to

minimize the bureaucracy that we have right now. But bear in mind that the current system is just replete with red tape. If you look at most actuarial studies you'll see that probably 20 up to 25 percent of our current system is administration so we can cut back and make savings through having changes in the delivery of our health care system. I one quick question is. What would President Clinton's plan do to ensure my freedom of choice as to what kind of a provider I would be able to go to what i bet is probably the area where the president's plan I think is the strongest of any of the plans that are before Congress today. When you go to a chiropractor I could go to one. Yes you could do that and also what it would do it would preserve your right to choose your own physician. And that's extremely important and that will be written that way says there is no person would like to purchase through a fee for service physician they would do so. It would be 20 percent more than the basic plan which would be primarily an HMO type plan. And then there would be a lesser plan. So if a person didn't want to have as much coverage they could go

that route as well. But it's a choice. The choice is very crucial and crucial to pay more for choice. You would pay more for choice just as you do under the current system. I don't want to indicate that our time is up I want to thank you very much for your presentation. Thank you very much. Now move on to another plan being proposed in Congress. It is the managed competition plan sometimes known as the cooper plant. Here are some of the key points of the managed competition plan supported by about 60 House Democrats and Republicans so far. The plan does not guarantee universal coverage but aims to provide access to the health care system by offering affordable coverage for all. It calls for insurance reform in purchasing pools to keep down the price of coverage. A national commission would determine a standard benefits package that all insurers would have to offer the money to pay for the program comes from cuts and changes in the Medicare and Medicaid systems and limits would limit also the deduction employers can take for providing health care benefits that would raise an additional 79 billion a

feature of this plan is that the market determines the price of health benefits there would not be price controls there now to present the managed competition plan to our citizen jury is Madison Congressman Scott Klute. Congressman thanks Dave. There's one point I want to make to you early on about the Kuiper plan that differs from the Clinton plan in the operative word here is restraint. And I think all of us who have been involved in the Kuiper build up to this point and again it's the only bipartisan bill right now in front of Congress. Understand that we have an obligation in the federal government to intervene and fix the market when the market's broken. But the major difference between the Kuiper approach and the Clinton approach or the cooper approach in the single player plan you're going to hear more about in a minute is that once we change the ground rules and really fix the problems then the government gets out of the way. In a couple of points on how we do that. First of all by establishing large pools very similar to the president's plan we're able to do a number of things. As Tom Barrett just told you as Sam Walton made a fortune doing when you buy in volume you get a better deal. So by

creating large pools we do a couple of things. We help the 85 percent of Americans who don't have insurance coverage right now who work for small businesses or self-employed get insurance coverage. By creating large pools you can eliminate the problem of employer lack where people are afraid to leave jobs because they're afraid they'll lose their health insurance. To the degree that you end up with larger pools you save a great deal of money in terms of efficiencies in terms of eliminating duplication in insurance companies. Now where do we differ significantly from where the president is. First of all the Kuiper bill does not have an employer mandate for a couple of reasons. First of all I think an employer mandate would absolutely devastate the small business economy in the United States. The tell every grocery store every corner hardware store that they have to provide insurance or else. I think in many cases the else means they go out of business. Secondly why for years in fact almost 20 years has had an employer mandate and if you look at the number of uninsured in Hawaii in the last quarter of 93 was about 7 percent which is almost the same rate of an insurance hearing with folks who are uninsured here in Wisconsin. And what

we do instead is to turn around directly and to provide vouchers to folks who are the working poor to buy insurance. We have very definitive ways to do that. It's not unspecified Medicare and Medicaid cuts in the president's plan. And again the operative word here is fiscal restraint. All right thank you Congressman let me turn to our jury now and see what questions we have. Mr. Nichols How would your plan address a few issues like an insurability in preexisting conditions. Almost all the plans actually I think to a large degree figured out a way to deal with risk adjustments. And so if you have three employees who work for you and one of them has had bypass surgery in today's insurance market you can't find insurance for your employees. But if you take those three people and fold them into another larger group of a million or a million and a half and what's called community based ratings you've essentially evened out the risk for everybody and that means in those large pools you'll be able to essentially eliminate the kind of problems we have right now. And whether it's the Clinton bill or the cooper bill or a number of variations everybody thinks portability is actually one of the easiest problems to solve.

Yes. Mr. Forrest Yes but the Clinton plan to lower the stakes to make their individual choices such as single payer or other ways now what is your plan. Have a new provision for individual choices of states we give states some latitude because I think everybody assumes it's going to take a decade or more for whatever plan we passed to phase in. We don't have a single payer option. In contrast to the president's plan because we're not convinced that the government running the system is in the long run the solution we want to see. We really think the problem right now in the small insurance market is the fact that the market's so badly fragmented with pools of 3 and 4 and 5 and single employees for instance farmers who can't get insurance that if we redefine the market and really allow large groups of health insurance providers to bid for large groups of consumers you will centrally put competition back in the market. And that's the way to solve it not through government regulation. Others are questions yes was just one of them. I'm a retired educator and I've seen hundreds of children whose families

didn't pay for health care. Sometimes they could afford it. Often they couldn't. What will happen to these children if their family says we can't afford to supplement your stuff. If your help is fine but we can't pay for the rest of it is there any provision for these children. Well again one of the things that our plan does is to dramatically shift the amount of money we spend in U.S. health care system towards more primary care and more preventive care. And we do that for a number of ways for example by requiring medical schools to graduate more primary care physicians and specialists will give vouchers directly to families of the working poor to help them get insurance coverage. But one of the things you should listen to tonight in this debate about who has insurance and doesn't have insurance of the people right now in the United States who don't have insurance. About 15 percent of them make more than $50000 a year. You're never going to reach them unless you have an individual mandate rather than an employer mandate. There's another big chunk of folks again with you look at who doesn't have insurance with any kind of sophistication and it's young people between the ages of 20 18 to 28 frankly because it's a safe bet when you're 21 you assume you're going to live forever. And if it's $300

a month in your pocket or $300 a month for insurance many times the lap for the cash. So whatever system we put into place unless it's got an individual mandate you're not necessarily going to reach everybody. But we think the Kuiper bill is tilted towards primary care tilted towards preventive care and frankly tilted the services for children. Yes Miss Carver How is your plan financed. You did mention it would not be cuts in Medicare and Medicaid. There are some cuts but not to the level the president has suggested. One of the great On cap tax breaks right now for large corporations is the fact that anything you want I want to pay for health insurance for employees is 100 percent deductible. If you and I decide that our employees should spend two weeks a year in Switzerland in the health care spa we can deduct 100 percent of the cost. But some poor farmer out in party Ville can only deduct 25 percent of the cost of their health insurance. That's nuts. And so what we want to do is plug a longstanding tax loophole. Right now the federal government for example has caps on the amount of money you can deduct for chauffeurs for jets for limousine service for executive dining

rooms. But there's absolutely no restraint whatsoever on the amount of money you can spend on health care. And one of the major drivers in the Kuiper bill is to try to force folks into standardized benefit packages and to try to provide incentives to get people in the lower cost plans. If you and I still decide we want to send our employees to Switzerland fine that's our right. But we no longer have the tax deductibility to pay for that or if we decide it's better to buy a more sensible plan that means you give more money to your employees in forms of raises or you and I keep the money anyway the federal government to get the tax dollars in the end. We have a very brief question for Marjorie in the back. Ms Weber I was wondering you mentioned the standard benefits package what if my father has worked hard all of his life and has some money set away what if he decides to go outside of the standard benefits package. Does your plan penalize him in any way market will he be able to take care of himself if he has the money to do that. Briefly the one thing we do that's different than the president's plan. Much of what the president wants to do in terms of benefit packages is defined legislatively. We in Congress are going to do that. I think that's a huge

mistake. Instead what the Kuiper bill is allows the president to appoint a panel of consumers and health care experts and they define the benefit package and then Congress has got to vote it up or vote it down. And we always give consumers the option to go outside the system. We may just not allow corporations to take all the tax breaks they get today. All right thank you Congressman. Appreciate it. Next up is the so-called single payer or Canadian style plan. And here are the key points about the single payer plan now supported by about 90 Democrats in the House of Representatives. It calls for universal coverage by the year 1995. It includes a uniform benefits package determined by Congress and includes long term care. The plan requires that government taxes pay for all health insurance. The money comes from a 2.1 percent income tax on all individual income. Employers would pay a payroll tax of four or eight point four percent depending on the company size and average wage. Additional money would come from taxes on handgun sales and tobacco and the states would pay 15 percent of the program's overall

cost. One feature of this plan is that it would allow individuals to pick their own doctors without financial penalty. And here to argue on behalf of the single payer plan is State Senator Chuck Weil of Madison. Thank you. A single payer plan I think this is a very confusing debate let's focus on three issues. First issue is do you get the choice of your provider and so you've asked about that under single payer there's absolutely no restriction. You can choose whichever doctor nurse hospital or other provider that you want to choose. That's very important to people. Not all of the plans allow that. And as Congressman Bair pointed out it would cost more under the Clinton plan it will also cost more with the plan that was outlined the Kuiper plan with Congressman clu freedom of choice. If your freedom of choice under single payer. Secondly cost containment. What will happen with cost containment. Obviously we're going to have to pay for the system. There is no free lunch. But the cost can be reduced if we have good cost containment. It's not just my position but the Congressional Budget Office a nonpartisan entity. They reviewed all of these plans so that single

payer does the best job in terms of cost and in fact by a pretty good margin. Why because we squeeze the administrative fat out of the system. It was Congressman Baer pointed out nearly 25 percent of every dollar that we spent 25 cents out of every box is used to pay for administrative costs. That's all the paper shuffling that goes on around our country. A doctor in mineral or a hospital administrator in mineral told me they had eight people for 72 hospital beds. We're all paying the cost of those paper shufflers who have to deal with the insurance issues. Single payer squeezes out that administrative fat and reduces it dramatically. Does the best job of cost containment. We can also negotiate with providers and make sure we get fair rates. The final thing is universal coverage. Remember coverage not access. We all have access to buy a Rolls Royce. We can afford it. Will we cover all of our citizens. That's the question. Only two plans here tonight do that. President Clinton's plan and the single payer plan not everyone else does it. And remember in Wisconsin out of the five hundred thousand people who do not have health insurance coverage 80 percent of those people either work

or they're in working families. These are the people not on welfare. They have coverage on AFDC not wealthy citizens or legislators who have coverage who have health care coverage. These are working citizens in our state. Children and parents who work and don't get coverage. This plan will cover them. That's the way we should go. Right. Thank you Senator. Let me turn to our jury and see if we have any questions. Yes in the front row Mr. Merkel's sender question is if the CBO has come out and said that this contains best cost containment and almost 20 percent of the house is signed and sponsored. WHY ISn't SINGLE PAYER more part of the public debate. Well I was up in Wassa listening to Hillary Clinton talk about why they didn't go a single pair she cited two reasons. She said One was that they wanted to build on the existing system and I like that I agree with Congressman Baer that we do have excellent health care in the country. But you also cited the other reason I think that's the reason she said politics. They were afraid that they couldn't get it through. Remember we're spending 15 percent of our gross domestic product on health care.

That means there are a lot of special interests out there whose ox would get gored and single payer. To be honest under single payer insurance companies are eliminated and we might contract with them to do some work. But obviously that would shrink substantially. They will fight tooth and nail not to have single payer considered. Unfortunately I'm afraid politics play a large role. Good question. Next question you asked was a butler. Well actually it's going to cost a lot of money no matter what plan we go with. We're already spending a trillion dollars in our country on health care. If we do nothing it will cost us two trillion dollars in this country by the end of the decade. The good thing about single payer is that it gets us to where almost every other industrialized nation in the world is and that is covering all of our citizens. And it does the best job of cost containment so that two trillion dollar price tag will be substantially reduced. And the good news is even though it will cost us less we will have all of our citizens covered. Mr Wegg What can you say to convince us that a government run

program will honestly cost less than free market. Well I think that's probably the hardest thing. I think one thing you can do is you can look at Canada which has a single payer system. Canada has some waiting list problems but that's really not because of the system because they don't put quite enough money into the system. In Canada they started out with a lot of different plans. Saskatchewan started with single payer. Eventually it spread to all of the other provinces. Why. Because they found it was the best plan for their country. So I think that we at least ought to have an opportunity to try it on Wisconsin. That's why I'm the author of Single payer in the state of Wisconsin. Right in the back room is Harper. We have 500000 uninsured in this state. Could the single payer with with the money it saves on administration take care of those five hundred thousand people. Well the good news is for Wisconsin we have only 500000 which is about 10 percent of our population. That's much lower than the national levels. And in fact our analysis

shows that we might even save a little bit of money versus what we're paying out for health care now even with covering everyone under single payer why. Again we squeeze out all that administrative fat. And by doing that we can put those dollars into taking care of our citizens. I'd much rather have a nurse or a doctor seen a patient than to see a lot of paperwork down in the bowels of the hospital and frankly so would the hospital administrator and so with the doctor and the nurse. These things are the questions we asked Mr. Swanson. You said the tax was 2.1 percent. Is that in addition to the present Medicare tax. This is the plan at the national level and I believe that that is a situation where they will substitute that tax for the Medicare tax but I'm not sure at the national level what their plan is. I do know they continue the employer mandate. But remember when you talk about small businesses even in single payer that's proposed at the national level they have a reduced level of payment for for small businesses and then a very modest amount of money that will all have to

pay. And let's face it we all have to contribute something in order to make the system more right. Yes MS Beiler will your plan be available to anyone with a preexisting condition. That's one of the great things about single payer. Everybody is covered. No one can keep you out for any reason if you have a problem there. You can't be kept out when you move from one job to another you cannot be denied health insurance. It covers every citizen without regard to their health condition without regard to anything else that might befall them. No one loses their health care. Health Security is absolute under single payer. Right one brief question to enter. Would health insurance companies have any role in this plan. Well one of the things I've proposed at the state level is instead of having the state run the program which is scary to many people why don't we consider contracting the running of single payer out to private entities and get the advantage of having the private sector efficiency run the program. I'd rather not see a great new state bureaucracy or national bureaucracy. And it's also a way of preventing a lot of those health insurance company employees from losing their jobs and they already do. You know

this type of work anyway. I think that might be the ideal mix because I think the only thing that really scares people about single payer is a huge bureaucracy of new government employees. I think we could avoid that and still do the job. Thank you very much Senator. Thank you. Now we're going to hear about a market oriented approach that requires less government involvement. Finally we're going to hear about something that's called the Consumer choice Health Security Act is favored by some Republicans in Congress. And the key player points of the plan look like this. It creates so-called medical savings accounts that are roughly akin to IRAs. These individual accounts would be used by families in any way they choose to buy insurance and to pay for medical care directly. The money for the accounts would come from the funds that employers normally spend on insurance closing tax loopholes and Medicare and Medicaid savings. Now one key feature of this plan is that it's up to each family to use the medical savings account as they see fit. Michelle Davis who's an economist with the

Citizens for a Sound Economy in Washington D.C. will present the plan. Is Davis thank you. All the plans we've heard about here tonight so far would put a bureaucrat between you and your doctor. It might be an HMO gate keeper or it might be a government bureaucrat but they will be in target deciding whether or not you can see a doctor whether or not the can the treatment you want is medically necessary and whether or not the country's already spent too much to be able to take care of you. They call that cost containment. I call that rationing. It's a consumer choice health care plan fixes the problems in the current health care system without forcing us to turn over our basic medical decisions to government bureaucrats. We will fix the system by putting consumers U and I in charge of our own health care spending. Right now we don't have we don't have any control over our own health insurance. Almost everyone of us who has health insurance has whatever plan our employer chose for us. We we take that or we take nothing we want and that's because we get as Congress include explained we get a tax deduction for health

insurance only if we get it through our employer. We need to change that so that we get tax breaks no matter where we buy our health insurance. That way we can go out and get an insurance package that suits each of our individual needs and then it's portable it belongs to you. When you buy your own health insurance you take it with you. If you leave a job it can't be canceled. If you get sick. And we also encourage people to put money into medical savings accounts where they can pay directly for health care services. And and we end the same time we have a tax credit system to make to make health insurance more affordable to all Americans. The only way we can control costs in the health care system without denying people access to the highest quality medical care in the world and that we have today is by putting you and I in charge of making our own purchasing decisions. You and I deciding what health care is cost effective what health care is not necessary so that we can we can spend our money so that we get what we need without putting money into wasteful government run system.

Thank you Mr. Davis and let's turn to our jury to see what questions they have for you. Yes in the back Mr. Swanson at the present time the insurance companies exert enormous control over what happens to you. Are you suggesting that I will somehow be able to find an insurance company that will pay my doctor whatever the doctor says I need. The beauty of this system. Right now we have about fifteen hundred insurance companies and under all these plans including mine and all the other three there'd be fewer. I mean that there's no question that that's a big a huge sector of the economy that's kind of gone out of control. But under under the beauty of this plan is that most people once you have these medical savings accounts you would just buy a tax deductible health insurance policy that covers major medical expenses something they have a thousand dollar deductible or something like that. The premiums for a plan like that are about a thousand dollars or eleven hundred dollars. So the money that you're saving by going from the premiums you have now to a plan like that you put that in a medical savings account and then you don't have to worry if the insurance company lets you go to the doctor. I can go and get well baby care. You can go

to a chiropractor or a dentist or whatever. You don't have to worry about some standard benefits package defined in Washington. That's got to be one size fits all. We can go we can make our own decisions and pay and we pay it right out of the account. No one else is going to look over your shoulder and approve it but we're. Going to. Have a savings account. The tax credit system in the in the consumer choice plan basically would be refundable to people at low income so that if you have a year if you're a low income family of a lot of medical expenses you'd actually be getting a cash or voucher transfer from the government to make your health insurance more affordable. So the way the current system is structured the tax incentives we have now the more money you're making the better off that the bigger tax break you get. That doesn't make a lot of sense that's not what we're trying to accomplish in the health care system. Our system would would target the tax breaks to the people who spend the greatest portion of their income on health care. And if you're at a low a low income and you would actually get cash to palpate help you pay your bills.

Q Finally how would you know. That when we basically have a Medicaid system right now that that is supposed to be reaching a lot of those people and that will be transferred over into the into this new system of Medicaid don't cover everything. You're right and I think that's the exactly why we should. That's a perfect example of why we don't want a government run system that's supposed to be reaching everybody and it's not government have your Social Security number and they know where you are. So how are you going to know to for those people. You have to at some point in the system you've got to rely on individuals to want to take care of themselves and their families. That's true under all these plans even under a single payer system. You can't make someone go to the doctor. You got it at some point we've got to encourage individual responsibility. And this plan gives people the greatest makes and the easiest for people to do that because the health insurance is more affordable and you can buy it like you buy car insurance. There's no middleman involved. Or the drug procedures. Along with the question that was asked first. Why do we need

insurance companies. Couldn't we just do the savings plan or the help. I have Medicare and nobody's in between me and my doctor I do not have a gatekeeper. It seems to me one plan should should be Medicare for everybody. What would we want that would be easy to put into. Operation The fact of the Medicare system is actually the cost the Medicare system are going up faster than the cost of the wreckage of the private sector health care system we have now. So if you're if your goal is cost control that's certainly not going to work. But we also have to look at the fact that Medicare right now also cost shifts onto privately paying consumers. The average in the hospital is an average of about $900 every time it treats a Medicare patient. And that $900 ends up in all of our bills because the government isn't covering the cost of the system. So not only would that system be underfunded but it wouldn't it would be a disaster for Medicare patients as well because suddenly no one else

in the rest of the system would be able to pick up those costs for you. You also talk about Medicare. That's right. Snow White and the plan is financed by taking the tax breaks we have now and just restructuring them so that they reach the right the reach to families who have the highest medical care costs and really need to help a lot of these plans to target money to employers and target money to the single payer plan that provides free care for the whole system. That's a recipe for exploding costs because we're not targeting assistance exactly where it's needed we're hoping that this this assistance trickles down to the right people. Under our plan you're reaching out to exactly the people who need your help and that way it's an efficient system of making sure that we can all get quality health care. Thank you very much Bruce Davis. Ladies and gentlemen of the jury now that you've heard descriptions of the various plans that are being discussed in Congress we now turn to that part of the proceedings where each of our presenters gets one last attempt to persuade persuade us the jury to vote for their particular plan. We'll do the

closing arguments in reverse order from the testimony you've heard. So we'll begin again with Ms Davis or economist Miss Davis one of the important facts for you all to consider as you think about health care reform is that the government already pays almost 50 percent of all medical costs today and that is I mean the source of the problem as much as anything else in the system we've got a broad system of bureaucracies if we've got government making things supposedly free and that when we think things are free we go take advantage of them. If someone offered me a free lunch I'd be there every day. But if I have to pay for it I think twice about going out to eat. And that's why the medical savings account concept will make us all cost conscious consumers. So we act like real consumers in the health care market and make smart decisions about our own health care instead of turning those decisions over to a government bureaucrat in Washington. Thank you Mr. Davis. Next up is Senator Chuck Chua who will again address the single payer plan.

Well let's talk about again the three essentials of the plans that were presented tonight only to provide universal coverage. The president's plan presented by Tom Barrett and the plan that I have talked about single payer on that basis I would urge you to reject the other two plans because we do need to cover all of our citizens. Well one of the few nations in the world industrialized nations in the world that doesn't. We ought to do it and our society will not be the same in 10 or 20 years if we don't the next thing you might want to consider is freedom of choice. Congressman Baird indicated that to get that under the president's plan it will cost you something more so on freedom of choice single payer. Does a better job but perhaps the final and most convincing reason to vote for single payer is that it does the best job of cost containment in the final analysis. We're going to have to pay for health care somehow since single payer does the best job and it's again not just my opinion. The Congressional Budget Office looked at this nonpartisan basis and that's how it's done. I would urge you that on that basis along with universal coverage and freedom of choice

that we should adopt the single payer plan. Thank you. Thank you Senator. Next we'll turn to Congressman Scott who will again present his closing argument for the managed competition plan that's just Frankel. This is an article not from any right wing publication but it's from The Washington Post and this says Ontario hospitals say with holiday shutdowns here in Ontario home to one third of all Canadians and bastion of socialized medicine this Christmas time is no time to get six sick rather hospitals in the provinces are closing many of their beds for two to three weeks over the holidays to achieve a severe government imposed spending reduction. A single payer system and a government run system via necessity with global caps will always lead to shortages and rationing. France some years ago when it did a study of medical care in that country discovered that if you provided every medical service to everybody available at any time in their lifetime they needed it. It would be six times the gross national product. Ladies and gentlemen of the jury we have a 200 billion dollar deficit in this country. Back to the first word I told you tonight when I began my arguments for the Kuiper plan restraint

in the long run. It's my belief that medical care is a matter of personal responsibility. It's not a time in our country to create a new personal entitle program. Let the government intervene to fix the market and then keep the government out of health care. Finally Congressman Barrett will present a closing argument for the Clinton plan Congressman Barrett. Thank you. Now you see why it's so easy to get an opportunity to hear everybody and see why it's difficult to reach a consensus in Washington on this issue. But I think we should look at our goals again. I think there's something wrong when you have a society where people who are working for a living are actually given an incentive to go on welfare in order to get insurance. I think it's wrong for us to have 37 million people in this country without health insurance and we can address that issue through the president's plan. I think it's also wrong that half of the growth in our deficit over the next four years is in health care spending. The president's plan truly goes after that problem by trying to keep down the cost of health

care. It's a plan that can pass. It's a plan that should pass and it's a plan that will pass. If the American people recognize that strength. Thank you very much. Thank you Congressman and thank you to all of our presenters allays and gentlemen that concludes all the evidence you're going to hear tonight. Now your task is to decide which of these plans you prefer. We don't expect any easy answers or perfect solutions to the problems presented. It is your job to apply your best judgment personal values and common sense in assessing the respective merits of each of the plans described here tonight. You should consider carefully the arguments made by each of the presenters as well as their responses to your questions. After you have heard and discussed the views of your fellow jurors we ask that you attempt to reach a consensus as to the best overall plan presented. If you are unable to reach a consensus please give us a tally of your votes for the various plans your designated for person will be asked to report the results of your deliberations. Good luck to you in your deliberations we appreciate your efforts.

And as our jury begins to file out they'll head to our deliberation room which is just down the hallway. Katie sayas going to follow along with them. And then in just a few moments we'll check in with them and see how they will come to terms with this obviously very difficult task again our jury was drawn by lot tonight from a larger group which represents we think the state of Wisconsin. Now just a few moments we're going to hear how our jury is doing whether or not they're all still standing and making able to come to some kind of consensus on this. In the meantime what we're going to do is continue our larger discussion out here in our studio audience for the rest of our audience that's been patiently waiting to have a chance to ask questions of our four presenters Is there anybody here who'd like to ask it sounds like a lot of people already. OK go ahead. Your question please stand up. Johnston from Oakland Wisconsin and my question goes to the heart of cost containment and politics and health care. As a business person I'm

finding that I'm working for the federal government the state government and the health insurance companies. I see no economic or market reason for health insurance companies. Scott clewed Would you please tell me why we have health insurance companies. Well if you go back to the 1930s health insurance companies were actually created by doctors because folks could not afford the cost of surgery and so that's where the whole fee for service program began and it's grown up over the years. In that situation I think insurance companies in the future and in the long run other both the plans that President Clinton has suggested or the Kuiper plan both of which have their roots in some work done by a group of physicians and health care analysts who for years met in Jackson Hole Wyoming so sometimes you hear it referred to as the Jackson Hole plan. I think that in the long run what insurance companies really become is almost what Chuck koala suggested which are professional administrative agencies and so I think rather than having the government for all practical purposes run the operation of the system. I still think there's a role for private health insurance companies to minister the cost. I mean let me put this in very practical terms. You've got a package that's got to get

to Atlanta tomorrow. You're going to send it through the U.S. Post Office. You're going to send it through Federal Express. And I think in the long run all of us in this country have a bias towards a mix of public and private and I think there's still room for private insurance companies. But there's going to be a vast consolidation in the insurance industry 10 years from now under just about any plan will not look the same as it does today. All right we have another question here and as we're getting ready for this next question if the four of you would like to come forward and take positions up here on the four steps that'll bring you a little closer to our audience so we don't feel like we're shouting across this great chasm so go ahead and take a position here. We have a question in front but I have place I. Was in who was a question for Senator quality that I had for a congressman. OK. Sorry go ahead. Yeah. OK. Or you are on their way here. They

really do. Oh are you in Gary. We have it. It's OK if I might stop you there so that we can get an answer to your question. QUESTION Congressman Kluge about the need for community support. I think probably particularly for people with disabilities. Well two thoughts. One thing frankly that the Kuiper bill was not very good on early on when it was first draft it was really long term care. And I think that involves a whole range of service from seniors who need hospice care to people who need a visiting nurse or some other kind of association we've actually gone back now and try to figure out a way to actually steal some of the ideas from the Clinton plan which I really think did have the best ideas on long term care.

There's also more money that shifted again into primary care and more money into community clinics. So I think to some degree that waiting period that you see for this gentleman's case will disappear. All right one congressman there in just a moment response that we need to check in with our jury and see are you doing plea because the president's plan I think does do a good job my community. Karen again the theme is it builds off the strength of the current system and frankly it's building up the strength of the current Wisconsin system. The community options program by giving additional dollars so people can remain in their homes and not have to go into expensive nursing home settings. All right. We want to fold the senator a qual and Michele Davis into our larger conversation here in just a moment but right now what we want to do is listen in on our jury deliberating in the other room so let's see how they're doing with sorting out these four plants. How much medical care is really costing us. And that's my concern with the single payer plan. You have no clue if a broken arm costs $10 a hundred dollars a thousand dollars. It doesn't matter that people need to be aware how much it costs or that they think twice before they go for something that I need to be with you I would go for that myself.

Their individual choice because you would save the money because there are many rights but they didn't see that out there that you might think that's the basis of the plan that would be a market for the other system it would work good for a percentage of the people I don't know what percentage it would be. But then they have some tax tax funded support for people who can't afford it right. Choice programs for the most part it seems like they are all ready to go ahead and ignore that plan. They just feel like there's no chance of that pass. One of the initial concerns when we first came in was universal coverage. Someone mentioned that is there really a need for universal coverage that really it's a matter of personal responsibility and personal choice to have health care and health insurance and someone else mentioned that we really end up paying for everyone's coverage anyway so in a way we do have universal coverage even if it's not a plan that spells it out in that way. One thing that they wish that they had brought up earlier to the presenter's was

preventive care. No one got a chance to ask about preventive care now they kind of wish they had a chance to do that. Let me tell you real quickly about this jury. We have four men and four women. One person has no insurance. The other seven do have insurance the age range is 23 to 73 and the task before them is to not find the plan that is best for them personally but for the plan that they think is best for the nation. They have just a few more minutes to deliberate before they do decide on a plan and what to try to reach a consensus. Let's listen in a little bit more and see what else they have to say. This week the Coopers plans on the front line and we never got around to asking what about something like oh I didn't go round here and Arizona and the other half you know what happens. I mean we didn't get the result of you know but you know you have a problem. That's the sort of liberal I mean when I joined in the studio to see what questions folks have their day from what we heard of.

All right we'll see if we can pick up on a few questions that weren't asked I heard someone wanting to ask about preventative care don't know if that's your question but stand up please and direct your question if you would to Senator quality Senator kuala. I'm not known as a kook or you know an extremist but I would have an absolute flip over paying for abortions with the single payer plan or the Clinton plan I'm not sure about the managed care plan if that would that would be included. But whether you call it a premium that we have to pay or just regular tax means we have to pay. I cannot morally stand that all right let's get what we get. Back to me why don't we get a response on that point in terms of how these plans fare on the question of reproductive choice from each of you Senator go ahead first please. The single payer plan under the proposal would pay for Reproductive Choice.

Obviously in any plan that you have out there you can always eliminate that if you want to. I'm really disappointed frankly that this issue has to even be part of the debate. To be honest most plans have paid for that type of coverage for years and years and years. And it's it's not something that I think is essential to the health care debate. For those people who feel strongly about it I can say this that if that is at the core of whether or not you support a plan any of the plans can provide for not covering that service or provide or covering that service it's not critical to one or the other plan. Michele Davis Jonah comment on that I would say that actually our plan does avoid that whole issue because we the government does not dictate to you what coverage kind of health insurance coverage you have to buy. You can pay for those kind of services out of your medical savings account if that's your choice. If you don't want if you are morally against as some type of medical services including abortion or whatever other services you don't want you don't have to pay for those. That's the advantage that one of the great advantages of this plan is it does not politicize the choice of health insurance benefits

because it does not have to mandate some one size fits all packages frankly on this issue as well please from each of the congressman. The Cooper bill is actually silent on the point because again remember what we do is to set up a national group of consumers and medical experts to try to define it. But both the Clinton plan and the cooper plan quite frankly have a prejudice in them towards managed care. And as you fold in citizens for example who are now under Medicaid and people who work for Rayovac or Oscar Myers and medicine all into the same plan. I'm not sure how you take Abortion and Reproductive rights away from women who already enjoyment or private insurance. It's a major problem. It's been a huge fight here in Madison. And I think by the time we're done it's going to be a huge fight in Washington. The president's plan does include coverage for Reproductive Rights. So it's up to the individual to choose a policy that they want to purchase. I think that you can address the issue by having plans out there that the individual chooses not the employer or the employer spouse as to determine whether they want to have coverage in their plan. All right let's get another question here we our jury is going to be coming back I understand in just a moment. If you

were the jurors what would you like to ask what still needs to be sorted out I guess in your minds as you begin to deliberate Go ahead please stand if you would. My name is Jim from Kimberley. I'm a recovering alcoholic and we have about 400000 people in our state with an alcohol or some other type of drug problem. And about 100000 of those people receive treatment the way our system is set up today. We don't ask what a person needs. We just have a benefit limit that's very extensive and that's it no matter what they need. What type of coverage does your plans have for chemical addiction disease. And does any of your plans offer coverage for chemical addiction disease at an equal level as it does for other illnesses like lung cancer and heart disease. Thank you. Brief response please Senator Coleman go ahead. The single payer plan would cover a service as I was the chairman of the State Council on alcohol and other drug abuse I think that it's important that we have coverage that will actually save money with it. When you ask does it cover as much as cancer. I don't think that any plan that you're going to see out there is going to have unlimited coverage for services I think there will be some limits placed on that. But I

do think it's important that we have coverage and the plan does have coverage for those right to come back in. So will will pause here and let me go ahead and re-enter our courtroom here in the studio allow them to take their place so that we can hear what their verdict is. You can stay where you are and be face to face with the jury. Go ahead. We're still missing three jurors I imagine that they have made up their mind and are abandoning us. Go ahead please take a seat here. I'm impressed that you made it so quickly. The jury jury reached a consensus or a vote that you can report to us. We were ready to have a tally of how your jurors broke down in support of the various plans that were presented. Yes we have six of us voted for the single payer plan and one voted for the corporate plan and one for the back of the market.

Right. Well Mr. Forrest thank you very much for that report and thank you all very much for your service I think you've helped us quite a bit in sorting through some of the issues the jury asked. Some very excellent questions and I'll turn it back to David this point. All right just to review the vote as you heard it was six for single payer one for the cooper plan one for the consumer choice plan and no votes interesting Lee enough for the president's plan. I don't know quite what to make of that because although the president's plan Katie has been dipping a bit in the polls it certainly isn't down to zero. You know it was interesting we get an idea of why it's so difficult to choose a plan when it came time to vote. Our producer said can you reach a consensus. No there's no way we can reach a consensus. Interesting to note that six of the folks voted for single payer and one of those was the person who was uninsured. Right. All right. We've only begun to touch the subject obviously and we want to encourage you if you'd have more questions and you wanted to continue this dialogue tonight you'll have the opportunity to do that by

dialing into Wisconsin Public Radio. Jan Weller will conduct a one hour long call in program on this topic his guest will be Tom Barrett's predecessor former congressman and economist Jim Moody who will be on the air on the ideas network of Wisconsin Public Radio. So if you'd like to talk about this more you can dial a public radio and continue our dialogue. I'm Dave Iverson Thanks for joining us tonight. And I'm Katie. We the People. Wisconsin health came through on trial. Was a co-production in 1793 Wisconsin Public Radio Wisconsin Public Television and the Wisconsin State Journal. The. The. The.

The. For we the people who sponsored health care reform on trial. Has been provided.

By Miller Brewing Company Wisconsin Education Association Council representing sixteen thousand educational toys throughout this concert. Additional funding has been provided by. The Wisconsin power and Life Foundation. Striving to hand them in to communities. And Wisconsin Manufacturers and commerce. Representing. Distance and business.