Bill Clinton on Health Care Reform
Dr. Sanjay Gupta and former Pres. Bill Clinton
CNN, Larry King Live
March 11, 2009
http://transcripts.cnn.com/TRANSCRIPTS/0903/11/lkl.01.html
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GUPTA: All right. Let’s drill down specifically on something you said earlier. When it comes to sort of creating these silos of health care reform — you have sort of single payers and more governmental involvement on one send — one end, free market involvement solely on the other end. Single payer never has really caught traction politically. Is it politically unpalatable or is it a bad idea?
CLINTON: Well, I think it’s more politically unpalatable than it is a bad idea, because single payer is not socialized medicine. Canada has a single payer system and a private health care provider system. Our single payer systems are Medicare and Medicaid.
GUPTA: Sure.
CLINTON: And Medicare is quite popular.
The good thing about single payer is the administrative costs are quite low. We probably waste $200 billion a year between the insurance administrative costs, the doctors and other health care providers’ administrative costs and employers’ administrative costs in health care that we would not waste if we had any other country’s system.
On the other hand, if you look at the experience of Germany, France, Japan — that don’t have pure single payer systems, they have more mixed systems — their costs are actually slightly lower overall than Canada’s. So there’s something to be said for having a mixed system if you can get the administrative costs down, because then the systems have enough competition in them to try to restrain costs and it’s not all up to the political bodies.
In Canada, because it’s all financed through the government, it’s more difficult sometimes for the politicians to say no than for just the regular management of the health care system to cut the costs.
So I think you can have a mixed system. If you look at the French system, which scores very high on every international measure…
GUPTA: Yes.
CLINTON: …it’s mostly publicly financed, but there’s enough private in there that there’s some tension that’s creative and positive.
GUPTA: Do you think there is a degradation quality of care with a single payer system?
Is that a concern?
Should that be a concern?
CLINTON: Well there’s no evidence of that in Canada that I’m aware of, except for excessive delays, which they always try to come to grips with. The British, you know, do have a completely government- run system, but they allow people who can afford it to get outside the system. And they’ve also started running hospitals almost like charter schools in America, that is, they have these trust hospitals that perform very well and therefore they’re given more control over setting their priorities, specializing and cutting delays.
There are all kinds of different ways to do it. But first, you do have to cover everybody. And then you have to stop people from gaming the system. There’s a lot of gaming going on now in the American system so that we spend more than anybody else and get loss for it.
I think that once you get the universal coverage, I think the health insurers then could play a more positive role than they do now, which is often involved in — you know, they make a lot of money through saying no and sort of the inordinate paperwork burdens that are put on doctors and hospitals and other providers.
GUPTA: What is it about the insurance industry that you just brought up?
They tried to scuttle the health care reform plan of ‘93. Now they’re saying we also believe in universal health care.
A politically tactile question, I guess, are you buying it?
Do you think they’re being honest?
CLINTON: I think some of them really do want it. Yes. If you look at their new organization, the person who heads it came out of a progressive background and favored, as a philosophical matter, coverage.
Secondly, I think they now understand that, in terms of the health of America and the well-being of our economy, we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.
I mean look at all the healthcare problems. The child obesity problem, which is my obsession, is the most glaring manifestation of a system that treats sick people and doesn’t keep people well. And that’s one where, I think, by the way, we can get broad bipartisan support on trying to — to do more on wellness. And that will save money.
I think the insurance industry realizes that they — a lot of the smarter ones realize that they could kill the goose that ate the golden egg here, that America can no longer go on spending more money and getting less for it and having all this money go to them and that they can make a lot of money and do well by making us healthier at a more affordable price.