Proper role of government at heart of healthcare debate

By LINDA P. CAMPBELL

lcampbell@star-telegram.com

The Democrats’ ambitious attempts to quickly undertake broad-ranging changes in the nation’s healthcare system don’t bother former Health and Human Services Secretary Michael Leavitt so much.

After a political party wins an election, he said, "they are genetically required to overreach."

Voters gave them "a ticket to charge the hill, and there’s no reason for anybody to expect them to stop" unless they meet resistance.

But his Republican Party has been "both anemic and ineffective on this issue," he said. So the pushback has come from Americans who are "intuitively feeling uncomfortable" with some of the Democrats’ proposed changes.

And that doesn’t bother him so much, either, even if it’s been peppered with hostility and distortions.

"I think we are having what we call in this democracy a reasoned debate," Leavitt said during an engaging lesson Friday on politics and government at the National Conference of Editorial Writers convention in Salt Lake City.

"Doing things politically that are this complicated is doing surgery with a very blunt instrument," he said. "There’s going to be a lot of misinformation and a lot of misspent emotion."

What does bother Leavitt about the healthcare debate is the elephant in the room, so to speak. Not the Republicans grumping about being ignored, but what he considers an inadequate focus on how it will all get paid for long-term.

"We can’t just continue to print money," he said.

"I support every American having an affordable insurance policy, and I think we can get there in three to four years," Leavitt said.

But as the discussion stands now, he said, "the young and healthy very clearly are going to pay, and those older and unhealthy are going to benefit."

Leavitt brings the kind of insight to the healthcare debate that comes from having been a governor (Utah) and a cabinet member (HHS 2005-09). He can talk governing philosophy as well as practical reality, what he’d like to see and what obstacles he’s already encountered.

"Healthcare is an opportunity to talk about what is the role of government in our lives," he said.

"Government has to be involved here. These problems cannot be resolved without strong action by government."

The first question is whether government should run things, as it does with providing national security, or should organize things, as it does in regulating the nation’s food supply. Then comes the question of payment, whether through rate-setting, taxing or other methods.

For healthcare, Leavitt would prefer that government organize an effective market then use a strong hand to punish abuse and provide subsidies where the market doesn’t meet needs. He pointed to Medicare’s prescription drug benefit as an example of government organizing the market and letting people choose the plan they want.

But he also pointed to Medicare as a system filled with waste caused by lack of coordination and a payment system that rewards quantity instead of quality.

"I ran the biggest healthcare system in the world. I had my hands on that wheel," he said. "What I learned was a lot of other people had their hands on that wheel and it was very, very hard to turn."

Leavitt said Congress let HHS start a demonstration project to save Medicare money by requiring competitive bids to sell durable medical equipment, such as wheelchairs, through the program. The project, which involved 10 products in 10 cities, saved an average of 26 percent, Leavitt said, with some products as much as 43 percent cheaper. Congress put the program on hold anyway.

"These were free-market capitalist members of Congress responding to businessmen" in their districts who disliked the impact on their companies, he said.

"I went with a plan to save $158 billion, and I was essentially politically stoned."

Despite these kinds of experiences that left him skeptical about the ability of the political branches to resolve "35,000-foot policy issues," Leavitt suggested that the problem with fixing the healthcare system isn’t too little political will but too much.

"Everyone’s unholstering their political will and aiming it at each other," he said.

If only more of them were talking as thoughtfully as Leavitt.

Linda P. Campbell is a Star-Telegram editorial writer. 817-390-7867.

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