Former House Speaker Newt Gingrich Talks on Embracing True Health Information Technology Transformation in Healthcare Reform

BHC Features

11.12.2009 02:26 PM

Click here to listen to the BHC interview with Newt Gingrich.

By Robin Jay, BHC Editorial Director

Former House Speaker Newt Gingrich was the closing keynote speaker at the 5th Annual World Healthcare Innovation & Technology (WHIT) Congress in Washington D.C. on November 6. His opening statement to senior healthcare executives on the topic of Embracing True HIT Transformation in an Era of Real Health Reform started with a sobering note, “we need to start talking about the reform we’re going to need after the reform fails,” Gingrich said. Yet, within moments, the attending thought leaders were motivated – and often humored – by Gingrich’s dry wit as he delivered solutions to transform the current delivery system into a 21st Century Intelligent Health System.

“I think it’s very important to recognize that, whether you’re for the current bill or against the current bill, there is nothing going on in Congress that is going to fundamentally change the underlying system. What we’re doing now is fighting over financing and bureaucracy, but we’re not actually trying to think about the underlying core challenges of the American healthcare system. I think probably because it’s so complicated. But I think it’s partly because we don’t really have good models for thinking about really fundamental alternatives. If you said tomorrow morning, 'Let’s go to a single-payor system', you might or might not change access, and you might or might not change the immediate pattern of financing of the job, but you wouldn’t change the underlying behaviors.”

Transforming and revolutionizing the current healthcare system, Gingrich says, into one that will create an economic boom for Americans and lead people to live longer and better, while paying less for care, will require three major changes:

Move knowledge from scientific laboratories to physician offices and patients as soon as possible. Today on average, it can take 17 years for a new medical discovery to reach patients. “We need to turn knowledge into solutions at a much more rapid rate,” Gingrich said. “It will require the FDA to rethink the time and cost of the current approval system in order to get away from an overly risk-averse system that increases the likelihood that you will die before new treatment is approved.” Gingrich says key steps in this process will include information sharing of best practices through telemedicine and video conferencing.
Adopt top quality technology systems to reduce costs, and increase productivity and accuracy. “We should have electronic health records, electronic prescriptions and decision-support systems. The system should be run on an ‘after-pay’ system with computerized order-entry and bar coding for medications and supplies, automated medication dispensing, and a paperless, real-time system of medical health information. Hospitals need to charge real costs rather than complex cross-subsidies that no one understands.” According to the Agency for Health Research and Quality, the proper application of health information technology is estimated to save more than $100 billion annually.
Equip consumers with medical information so that they’ll have the opportunity, desire and responsibility to achieve the best health at the lowest cost. “Americans should get more choices of higher quality options at falling prices. Doctors, hospitals, medical technology and pharmaceutical companies should have both cost and quality information available online so people can make informed decisions. We should have individual health records for every American and require that providers, labs and hospitals,” Gingrich said.

Since retiring from Congress, Gingrich has worked extensively on healthcare issues, advocating for a transformation of the entire system. In 2003, he established the Center for Health Transformation, a collaboration of public and private sector leaders dedicated to the creation of a 21st Century Intelligent Health System that saves lives and money.

In his book, Winning the Future, Gingrich called for new models of compensation in the healthcare system. He said the current fee-for-service model encourages doctors “to do just enough to bring you back for another transaction. We need to use information systems to measure outcomes and use a compensation model that rewards providers for better outcomes.”

Gingrich noted the single largest reason for increasing healthcare costs is the third-party payor system that leads to frustration and fraud. Instead, a direct buy-seller system would motivate providers to satisfy patients, rather than the insurance companies, with quality, efficient care.

“We are very interested in getting to 100 percent coverage, with one opt-out: Libertarians who don’t want to buy health insurance would be able to post a bond. We think we should try for coverage on a universal basis. We're trying to design is a 300-million payer system, in which everybody is engaged, as apposed to a single-payer system in which the bureaucracy does it,” Gingrich continued. “Among the steps we would take is, one, we’d have litigation reform; two, we’d have very aggressive efforts on fraud, which we think can save betweew $50 and $90 billion a year; three, we would be for across-state selling of insurance, which would mean [competition for] the high insurance states. High insurance states are generally those that have sold out to virtually every interest group, and what you get is everything piled into the minimum health insurance bill that requires everything you personally didn’t want to pay for – and it’s imposed by law, which is why it’s so expensive. Then we would favor tax neutrality, where no matter whether you buy health insurance or your employer buys it, you’d get exactly the same tax break under either circumstance. Finally, we favor tax subsidies for the working poor so that people who have very low income jobs and people who are in very small businesses would have the opportunity to buy health insurance. Something like that package would enable you to move toward a 300-million payer system in which everyone would be in the insurance pool. You can have a must-carry issue. Where you get killed is if you have a must issue, but everyone who is young and healthy can avoid paying because they know the morning they get sick, they can buy healthcare insurance. And then you get into a downward spiral in which the system simply loses any financial capacity to deal with the risk.”

The Four-Box Model of Health Reform: Individual, Culture, Delivery System and Finances

“The core problem we have in this country now is cultural, it is not economic. It’s not political, except as an effect of the culture,” said Gingrich. Using this information is how Gingrich and the Center for Health Transformation put together a four-box model for health reform. The first box is the individual, because "unless you build a microsystem around the individual, which emphasizes the individual’s knowledge, the individual’s responsibility, the individual’s engagement, you can’t possibly manage a modern health system,” Gingrich said.

That brings us to box two of Gingrich's model: society and the culture. “Two of the largest problems are teenage obesity and type II diabetes, which is largely culturally acquired. Now, teenage diabetes and obesity are a result of a pretty straight function: too much food over a long time and too little exercise. If you really want to make a step toward an effective health system, require five-day-a-week physical education in grades K-12 and you will significantly improve obesity and diabetes,” Gingrich said. “If you want to be radical, which I would be, require that kids who live within a mile of school actually walk to school. I know it’s harsh. (Laughter). But generations were able to avoid juvenile diabetes because they walked all of the time. We are genetically designed to walk 12 to 15 miles a day, while eating relatively little animal fat and no processed sugar. We’ve replaced that genetic model with a new culturally developed model of laying on the couch or sitting at the computer while consuming as much fat and sugar as we possibly can. The side effect is obesity and diabetes. Diabetes is to the Information Age what tuberculosis was to an industrial town in 1820.”

So how do we shape the culture? Gingrich said one of the things in the health reform bill that he favors is requiring all the fast food chains to post the calories on what you’re buying. “I think it will change people’s behavior because they will be shocked at what they’re buying,” he said.

Box three of the Gingrich health reform model is the delivery system. Gingrich calls for a system with engaged individuals in a supportive culture and society. By definiton, the engaged individual would have a personal electronic health record and have personalized medicine, with early testing and early diagnosis. “You need to engage people to comply with early testing and early diagnosis, because otherwise you can’t get people to take advantage of it. You can’t get anyone to get a colonoscopy unless they’re volunteering. Even this Congress would not pass a mandatory colonoscopy (laughter).”

The fourth and final box is the finances. Gingrich believes consumers should share in the cost of care – even if it's a minimal amount – so that they'll value the care and utilize it carefully. “I was speaking to the Governor of Tennessee recently and he said the area in Memphis which has the lowest birth weight babies in all of Tennessee actually has a free clinic. But he said there are cultural implications that block young women from going to a clinic. This is one of the problems – that everyone thinks free care will solve everything. Expensive care may inhibit certain behaviors, but free care doesn’t guarantee them.”

The link between physical and mental health

Also a topic of discussion was integrated care with a focus on wellness and prevention. For example, The Center for Health Transformation promotes the strong link between physical health and mental health. Depression is the most common type of mental illness, affecting two out of 10 Americans, yet only a quarter of those diagnosed with the condition are treated for it. Gingrich has often said an intelligent health system needs to create incentives and education to help prevent avoidable mental illness and manage those that do develop.

Behavioral Health Central asked Gingrich his opinion on the solution of a patient-centered medical home, and whether the model to be tested by Medicare in 2010 might help transform the burdened system of care. Currently, Medicare provides coverage for the largest sector of chronically ill patients, yet focuses on an acute care, piece-meal reimbursement system without prevention or care coordination. “You have to remember that Medicare is just a big bill payment system,” Gingrich said. “Medicare is a 1965 law, with paper-based bureaucracy based on the price of medicine in 1965, when pharmaceuticals were not a big enough part of treatment. Which is why I was for Medicare Part D because today pharmaceuticals are a major part of care. It’s a bad system that would help you with kidney dialysis but wouldn’t help you manage diabetes. They’d be glad to give you open heart surgery, but they wouldn’t help you with your statins. It is bad medicine. So now we get to your point, and you’re right, if you have a paper-based, fee-for-service system, what you will get is lots of fee-for-service, lots of fraud. They had five pizza parlors in Miami certified by Medicare to be HIV transfusion centers.

“The medical home is a step in the right direction. But we also really need fundamental reform of CMS, which is an insular, parochial bureaucracy that is an engine for paying bills, nothing else. My wife plays the French horn in the Fairfax band. They recently played Stravinsky’s Ballet for Elephants, which was literally written for Ringling Brother’s circus elephants. Ringling had 23 elephants doing a ballet – and that’s what CMS is like when you try to get them to be thoughtful and agile and flexible. It’s like watching a Stravinsky elephant ballet, except without the training and without the tutus.” (laughter).

“I like the medical home model. And this is something we’re trying to challenge the Academy of American Family Practice to work on. If it is seen as an extended network model – that is, I’m not interested in creating a doctor-centric primary care system because I think that’s obsolete. But if you’ll show me a doctor whose also a diabetes educator, you show me a doctor who will use his nurses aggressively, you show me a doctor who is willing to have extended data flow through electronic, wireless indicators, then I’m interested in having that doctor be at the center of the flow of information, because I think if they get to know you, and if they see your history over time, you’ll have much better judgments [and outcomes.]

“Health costs are the largest sector of the economy – 18 percent,” Gingrich noted. “And for many businesses, it’s the fastest growing expense – one that impacts the ability to compete internationally. If we can revolutionize our healthcare system, we will live longer, healthier lives and spend less on care. I have worked on healthcare issues for many years and I know this future is possible.”

For more information about the Center for Health Transformation, go to www.healthtransformation.net. To listen to the BHC interiew with Mr. Gingrich, click on the media player at top. The full transcript of Mr. Gingrich's talk follows.

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Newt Gingrich: I think we’re at a fascinating point. The time has come, now that we’ve watched the Congress function for the last 10 months, when we need to start talking about the reform we’re going to need after the reform fails. I think it’s very important to recognize that, whether you’re for the current bill or against the current bill, there is nothing going on in Congress that is going to fundamentally change the underlying system. What we’re doing now is fighting over financing and bureaucracy, but we’re not actually trying to think about the underlying core challenges of the American healthcare system. I think probably because it’s so hard to do, that the news media just bounces off of it because it’s just too complicated.

But I think it’s partly because we don’t really have good models for thinking about really fundamental alternatives. So what we try to do, because health is the densest use of knowledge that humans have; we use more knowledge in the health system then any place else in human activity. It is also the largest single sector of the economy. It’s 18 percent.

It’s also filled with many strong cultural patterns. For example, the way surgeons think, as apposed to the way psychiatrists think, as apposed to the way hospital administrators think, you’ve got hugely dense patterns. And so if you’re a normal politician or you’re the staff of a normal politician, you just stare at this thicket and you go,”Oh it’s just too hard, but I can change the finances, because I can understand the finances sort of.” When we first talked about it in 1949 or since Theodore Roosevelt talked about it in 1912, we’ve had politicians who bounce off the idea of a national health system, which actually wouldn’t change the underlying dynamics. If you said tomorrow morning, “Let’s go to single-payor, you might or might not change access and you might or might not change the immediate pattern of financing of the job, but you wouldn’t change the underlying behaviors. If you look at the current financial crisis, for example in Germany, where they’re running out of money. In Britain, they just don’t provide the care, which is not going to work here. So in one of the ways, the easiest way to balance the health budget is to decide at an age that we should no longer give people care, and depending how fast you want to balance the budget you, just lower the age. [If you said] Nobody in America gets healthcare after 65, the health budget will be remarkably balanced. Or if you said, ‘I got a little notice this morning from somebody who’s very smart has worked in the health business for years; he’s making an immense amount of money in the health business, and one of his ideas is the last 12 months of life, you’ll only get hospice care. Now that does raise the question, ‘how sure are you that this is the beginning of the last 12 months?’ He’s very sincere, very smart, but that’s what he came up with as a solution.

Years ago, I saw somebody in the Reagan administration at the Office of the National Budget and he said, “You realize if people would die earlier, it would really help the Social Security trust fund.” And the first thing I said to him was, ‘never say that in public!’

So let me give you a couple of big ideas, and then I’m going to have a dialogue; we can talk about anything you want to. I’ve dealt with this stuff since 1974 when I first ran for Congress. As Speaker, I think I was the only Speaker in history who actually chaired the Medicare reform task force and brought together both Ways and Means and Energy in Congress to write the Medicare reform bill of 1996. When I left, Igave half my time to the national security and enhancement on healthcare. I founded the Center for Health Transformation. I wrote Saving Lives and Saving Money in 2002, largely as a guide for the Bush Administration. And Secretary Thompson said to me once, “I used to think I knew something about this stuff until I had 26-year-olds in the White House telling me to shut up. And then I realized there was something unbalanced about the whole system.”

So I want to give you some observations. The core problem we have in this country now is cultural, it is not economic. It’s not political, except as an effect of the culture. I really got into this when we were doing a movie on Pope John Paul II and his visit to Poland in 1979, which was the key breaking point from which the Soviet empire never recovered. And in the 10 year period after the Pope went to Poland, there was a huge struggle between the Polish people and the dictatorship. And one of the slogans the Polish people adopted was “2+2=4.” This was an attack on the regime. Part of it came from George Orwell, who in the book Nineteen Eighty-Four, as the torturer on behalf of the state, was saying to the innocent citizens who the state was torturing, “If we tell you 2+2=5, it equals 5. And if we tell you 2+2=3, it equals 3. And therefore, you should listen to us.”

Now, let me give you the American analogue of 2+2=4. I’m going to give you half of the equation and you’ll see where I’m taking this. If you can’t afford to buy a house, what’s the second half of the equation? How many of you agree, if you can’t afford to buy a house, don’t buy it? It’s a very simple model. I want you to think about this model. For 25 years, what we’ve said to people is, ‘If you can’t afford to buy a house, I will find a way to get you into a house you can’t afford to buy. I won’t look at your credit record. I’m going to allow you to have no down payment, and I’m going to allow you to have no payment on principal for three years, I’m going to allow you to pay a 1 percent interest rate for three years.’ And what we discovered was people tended to go bankrupt because they couldn’t afford to buy a house. Now, when one person has that happen to him, because the system has lied to him, it’s a family tragedy. When a million people have it happen, it’s a national financial crisis. But have you heard any politician in either party suggest that what happened to us the last three years say that? No, because that would be inappropriate.

Now let me apply it to health for a second. I had this conversation in a meeting this morning. Imagine that when Henry Ford invented mass-produced automobiles, we decided that would require that we build a federal department of automobile ownership. And since that people aren’t all that clever, that we invest the power in gas station managers. They became gatekeepers. And that everyone could have gasoline on a random basis, but since no one is very smart, we won’t put a gas gauge in the car, because we wouldn’t know what to do with it anyway. And everyone can randomly change their oil and the gas station manager will keep a record of when you last changed the oil at that particular gas station. But we wouldn’t have a signal or an oil light that would go on and become red because we’re too dumb to know what to do about it. So you ended up growing up where cars were totally dependent on gas station managers. And occasionally, we would run out of gas and we would tow you in at no cost, because after all, it’s not your fault, because you’re too dumb to know anything about filling up your tank anyway. And occasionally, somebody would make a mistake and they wouldn’t replace the oil and the engine would freeze up, but we’ll replace it for free because you’re too dumb to know any better.

I’ve just described the American Health System. And this is how I’ve put together the four-box model for health reform. And we’re interested in health reform, not healthcare reform. So in a four-box model, being a Reagoniter, I believe in simplicity, so we actually have four boxes, which is why it’s called the four-box model (laughter.) The first box is the individual, because unless you build a microsystem around the individual, which emphasizes the individual’s knowledge, the individual’s responsibility, the individual’s engagement, you can’t possibly manage a modern health system. Now why is that true? Because the biggest problems in the next generation, now that we’ve largely eliminated epidemics like cholera, the biggest challenge for the next generation is going to be chronic diseases. The number one characteristic of chronic diseases is that you’ve got to get the patient involved with management. So you say to me, ‘Well, we can take care of cardiovascular problems, just take statins and it’s fine.”

But what if the patient’s not compliant? You say, “Well, they’re really stupid; they’re going to have a heart attack.” That’s not the point. The point is, how do you engage the patient so that they’re compliant and don’t have a heart attack? “Well, there’s no point in telling then that because they’re too stupid to learn.” You’ve just defined a totally self-defeating system that is guaranteed to be grotesquely expensive.

The most common discussed general early problem, which is teenage obesity and type II diabetes, which is largely culturally acquired. Now, teenage diabetes and obesity is a result of a pretty straight function: too much food over a long time and too little exercise. Which gets me to box two, which is in our model, is the society and the culture. So everywhere I go, I tell people, if you really want to make a step toward a health system, require five-day-a-week physical education in K-12 grades and you will significantly improve your obesity and diabetes. Now, if you want to be radical, which I would be, require that kids who live within a mile of school actually walk to school. And I’m old fashioned enough that I would actually reinvent rain coats and boots and have them actually walk to school in one-inch snow. I know it’s harsh. (Laughter) I know it’s not of the age. But generations were able to avoid juvenile diabetes because they walked all of the time. We are genetically designed to walk 12 to 15 miles a day, while eating relatively little animal fat and no processed sugar. We’ve replaced that genetic model with a new culturally developed model of laying on the couch or sitting at the computer while consuming as much fat and sugar as we possibly can. And the side effect is diabetes. It’s a culturally acquired disease. Diabetes is to the Information Age what tuberculosis was to an industrial town in 1820.

So then you start getting into how do we shape the culture? One of the things that’s in the bill (health reform) that I think is legitimate, although there is a lot of fighting about it, is that I do think all the fast food chains aught to post the calories on what you’re buying. And I think it will change people’s behavior because they will be shocked at what they’re buying.

There was a very funny thing this morning with Howard Dean. He talked about Bloomberg in New York City. And one time when he walked into Starbucks to order his favorite breakfast, which was apparently some kind of giant chocolate milk thing with a raspberry scone. And he realized that those two items alone were 1200 calories, but that he could get a cappuccino with 10 calories. He said it has changed his breakfast for the worst ever since then because he really misses the giant chocolate drink and the raspberry scone. But he can’t intellectually justify it.

So if you think about it, you want the culture to reinforce the individual. Once you’ve centered the system on the health of the individual, with a central message that the healthier you are, the less expensive you are, the more energy and time you have to be engaged makes us a better competitor for Germany and Japan and China and India, which means we’ll be more economically successful. And then if we keep you healthy into your 80s – if you don’t have co-morbidities by the time you’re 80 – the odds are very high that you will die very late in life and very inexpensively.

My wife’s father died at home at 96 after driving his power lawn mower down to the Quick Stop to pick up a six pack of near-beer. He died very quietly one afternoon and had a great life. If you live into your 90s, it’s harder on Social Security, but it’s really cheap on Medicare. And so you actually make out for the better on the swap. So if you really want to balance the federal budget, part of what you do is try to optimize the number of people who live to be 100 without going to the hospital. Now that may sound impossible, but it’s really not. I saw a Blue Zone book, the shows the places where the people on average, live to be 100 more. And the argument of the author is that those who die before 90 is largely due to culture and that we’re actually genetically designed to live to 90 or more. There’s an estimate in Japan now that the average girl born this year will live to be over 100. And we have no mechanisms to deal with that.

Now, you bring it back to health. Now you think about the delivery system, which is the third box, you’re thinking about a system for an engaged individual in a supportive culture and society. And the engaged individual would by definition have a personal electronic health record and have personalized medicine, with early testing and early diagnosis. For all of you who believe in early testing and early diagnosis, you can’t get people to take advantage of this unless they are engaged. You can’t get anyone to get a colonoscopy unless they’re volunteering. Even this Congress would not pass a mandatory colonoscopy (laughter).

It’s a fundamentally different design.

I was speaking to the Governor of Tennessee recently and he said the area in Memphis which has the lowest birth weight babies in all of Tennessee actually has a free clinic. But that there are cultural implications that block young women from going to a clinic. This is one of the problems – that everyone thinks that free care will solve everything. Expensive care may inhibit certain behaviors, but free care doesn’t guarantee them. So how do they socially break through so that people feel comfortable coming to the clinic, which charges nothing, in order to have adequate prenatal care so that you’re not getting very premature babies, with a very low birth weight, who are very, very expensive? And that’s why I go back to the part about the engaged individual and the back to the culture, so that you’re defining a fundamentally different delivery system.

If you’re designing it for an engaged society, rather than the person who only shows up under the duress of such pain, that it’s passive care. The best place to see this by the way, is in dental care. We’re taught by a very young age that you have to brush your teeth. It’s driven into us so much that it’s habitual. It’s enforced by commercials for dental floss and tooth paste. And for those of you who don’t floss, you should, because the bacteria in gum disease is the exact same bacteria as in heart disease. Having a healthy mouth is actually a good indicator for preventing heart disease. We’ve engaged the participant in oral health, compared to most of the rest of health.

I’m frankly frustrated with both parties. The bill that passed the House will not pass the Senate. But there will be a bill that eventually passes the Senate, they (the House and Senate) will then go into conference. My judging is that there is an 80 percent chance they will get something done. They will then have a rosegarden signing and they will explain it was a great victory with an enormous impact. And then two or three weeks later, the next healthcare reform conference will occur. And people will start talking about, ‘well what do we do now?’

The bill that they are now talking about has an implementation time that is eight or nine years long. Now any of you that thinks that Congress is capable of sustaining the same pattern for that long, has clearly been asleep for most of that time. So my guess is that next year, you’ll see wide changes in the bill. A 1900-page bill in the House, which is by the way in an of itself grotesque, because no one can write a bill that long that’s intelligent. It’s not technically possible. And furthermore, the real bill is 2013 pages, but they didn’t put the rest of the pages in because the 1990 page bill currently doesn’t increase the deficit, which meets the President’s pledge, and the rest of the 13 pages of the bill pays off the doctors for Medicare $200 million and therefore, we would increase the deficit. So they want you to focus on the 1990 page bill that doesn’t increase the deficit and not notice the rest of it that would. And by the way, the $500 million they’re taking out of Medicare does not involve anything in Medicare (laughter.)

We need a fundamentally different bill that focuses on health and healthcare, it doesn’t start by focusing on finances, which is the fourth box in my model. That’s a sweeping overview to start our conversation.

BHC: Mr. Gingrich, I’d like to get your thoughts on the patient-centered medical home and the Medicare trial that will test in in 2010. It’s interesting to me that Medicare has the largest number of chronically ill patients, but has an acute care focus and virtually no preventive measures. Can you comment on whether you think the patient-centered medical home may help and what it would take to make it successful?

NG: Medicare is a 1965 law, with paper-based bureaucracy based on the price of medicine in 1965, when pharmaceuticals were not a big enough part of treatment. Which is why I was for Medicare Part D because today pharmaceuticals are a major part of care. It’s a bad system that would help you with kidney dialysis but wouldn’t help you manage diabetes. They’d be glad to give you open heart surgery, but they wouldn’t help you with your statins. It was bad medicine. So now we get to your point, and you’re right, if you have a paper-based, fee for service system, what you will get is lots of fee for service, lots of fraud (there’s between $70 and $100 billion a year in fraud – theft, stealing.) They had five pizza parlors in Miami certified by Medicare to be HIV transfusion centers. The medical home is a step in the right direction. We really need fundamental reform of CMS insular, parochial bureaucracy that is used to paying bills and nothing else. It is an engine for paying bills. It’s not designed to do anything else.

My wife plays in the Fairfax band, she plays the French horn. And they recently played Stravinsky’s Ballet for Elephants, which was literally written for Ringling Brother’s elephants. They had 23 elephants doing a ballet. That’s what CMS is like when you try to get them to be thoughtful and agile and flexible. It’s like watching a Stravinsky elephant ballet, except without the training and without the tutus.

I like the medical home model. If – and this is something we’re trying to challenge the Academy of American Family Practice to work on. If it is seen as an extended network model – that is, I’m not interested in creating a doctor-centric primary care system because I think that’s obsolete. But if you’ll show me a doctor whose also a diabetes educator, you show me a doctor who will use his nurses aggressively, you show me a doctor whose willing to have extended data flow through electronic, wireless indicators, then I’m interested in having that doctor be at the center of the flow of information because I think if they get to know you, and if they see your history over time, you’ll have much better judgments.

I’ve had relationships with a couple of doctors over a very long period of time. They know what not to worry about and what to worry about. Whereas, if I walked into a brand new stranger, me might or might not pick up on the nuances. We’re dealing with human beings.

We are very interested in getting to 100 percent coverage, with the one opt-out for Libertarians who don’t want to buy health insurance would be able to post a bond. We think we should try for coverage on a universal basis. But what we tried to design is a 300-million payer system, in which everybody is engaged, as apposed to a single-payer system in which the bureaucracy does it. Among the steps we would take is, one, we’d have litigation reform; two, we’d have very aggressive efforts on fraud, which we think can save betweew $50 and $90 billion a year; three, we would be for across-state selling of insurance, which would mean the high insurance states (those that have sold out to virtually every interest group, and what you get is everything piled into the minimum health insurance bill that requires everything you personally didn’t want to pay for – and it’s imposed by law, which is why it’s so expensive. New Jersey is one of my favorite cases. Maine is another one. And so if you allow people to buy across state lines, you can buy catastrophic coverage for not very much money, but it’s a catastrophic plan, it doesn’t cover everything else. Then we would favor tax neutrality, where no matter whether you buy it (health insurance) or your employer buys it, you’d get exactly the same tax break under either circumstance. Finally, we favor tax subsidies for the working poor so that people who have very low income jobs and people who are in very small businesses would have the opportunity to buy health insurance. Something like that package would enable you to move toward a 300-million payer system in which everyone would be in the insurance pool. You can have a must-carry issue. Where you get killed is if you have a must issue, but everyone who is young and healthy can avoid paying because they know the morning they get sick, they can buy healthcare insurance. And then you get into a downward spiral in which the system simply loses any financial capacity to deal with the risk.

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