CNN "State of the Union with Candy Crowley" - Transcript: ACA and Government Shutdown
Interview
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Joining me now, former Vermont governor and doctor, Howard Dean, and senator and doctor, John Barrasso of Wyoming. Let me start with the question I asked Brianna about the White House. You both have been in practice. What are your long term concerns if any about the implementation of the Affordable Care Act?
BARRASSO: Well, it's not going to be affordable. There's going to be sticker shock, number one. And number two, it's going to be harder for people to actually get what they wanted which is the care they need from a doctor they want at lower cost. The president made a couple of promises. One with the exchanges, and he said it would be cheaper than a cell phone bill.
And I don't expect a lot of people to be able to find something less than $71 a month on the exchanges. People are going to be paying more. And he said you can keep the doc -- if you have your doctor and you like your doctor, you can keep your doctor. We're seeing all across the country exchanges that trying to get the price down have had to exclude many doctors.
CROWLEY: Governor Dean, we are -- it really does seem to me, it depends on which state you're in, because this is very hard to keep track of, because in some states, some people are saying oh, mine will be much lower. And other states it appears to be much higher. Long term --
DEAN: Candy, the vast majority of states, in fact, the premiums are significantly lower including mine. I mean, really lower, like 40 percent in some cases. So, I would disagree with Senator Doctor Barrasso on that. Look, I think there are going to be some glitches. As you know, I wasn't a big supporter of this bill, but now, that we're at the day I'm looking forward to it. I really do think it's going to change things and it's changed (ph) in the private sector. These people are going to go on the exchanges and they're going to get private insurance. That's what this does. So, I don't buy this doctors aren't going to accept this.
Doctors always have trouble accepting, some doctors don't accept Medicare, but this is going to work. It's a sensible solution. There are going to be glitches. None of them, so far, are major. We'll see how this - the big one is the federal exchange. For all the folks who refuse, governors who refuse to become part of the -- their own estate exchange are now in a big 33-state federal exchange. And that's what they've got to do right and we'll have to see how it works, but I'm very optimistic. I think it's going to be good for the public. And I think when they see what this looks like, this debate that we're having, which is outrageous is going to look really stupid.
CROWLEY: Go ahead with the --
BARRASSO: I think the exchanges are being held together right now with duct tape and chicken wire. We're not sure what's --
(CROSSTALK)
BARRASSO: We see many states, even governors home state of Vermont has had problems. They're not going to be able to accept payments online. Oregon is backing down. Other states and the District of Columbia last week said, hey, we're not ready. Huge ability, I think, for fraud, for identity theft on the exchanges. The bottom line is, I think it's not just an issue of will doctors still see patient.
Patients are going to have a hard time finding a doctor to take care of them under these exchanges. In New Hampshire, where Howard was on Monday giving a speech, we know that there's an uproar, because - Blue Cross/Blue Shield is excluding 10 of the 28 hospitals in that state.
(CROSSTALK)
BARRASSO: And pediatricians aren't going to be able to take care of kids they've been taking care of.
DEAN: That does need to be fixed that that's the fault of New Hampshire state government, not the fault of Obamacare. Look, we're going to see, I don't think the sky is falling. We've been through much more. This is what they said about Medicare. The right wingers said this about Medicare. The sky was going to fall. Nothing was going to happen. It was going to be awful. And it's one of the most popular programs in the country.
CROWLEY: But you know, we are seeing what they call those with concierge (ph), doctors or are saying --
DEAN: That was long before this ever started.
CROWLEY: Exactly, but will we see more? And these are doctors who say forget insurance. If you can come and pay me, you know, write new check --
DEAN: The reason you're not going to see a lot of that is there's not much of a market for it. There are a couple of those in Vermont. There's more in New York and L.A. This is just -- look, this is what's going to happen. People are going to have a different system. The glitch in Vermont and D.C. is minimal, but you can sign up for health care. Now, it doesn't matter if you can pay for it today or November 1st, because it doesn't go into effect until January 1st. I look at this stuff inside out, because I look at it from a point of view of somebody who didn't like what they did in the beginning. I actually wanted Medicare, public option so we could sign up for something we knew what it was and understood it more easily. But we are where we are.
This is going to be a very positive thing for the public. And I think you saw the desperation in Cathy Morris' voice is about the fact that they realize that once this goes into effect, people are going to like it. And the right-wing, very conservative let's not spend another dime people, are going to be stuck supporting another entitlement, which is really --
BARRASSO: This law is unworkable. It's unpopular. It is unaffordable for us as a nation. It's hurting jobs. It's hurting the economy. And now, what I'm hearing and I was at a health fair in Wyoming yesterday, it is unfair. Someone said to me why is it that the president is going to give my boss a one-year delay? The bosses are getting a delay, but the workers are not. And we need a delay in the individual mandate.
CROWLEY: Hold that thought. We're going to come back with the two of you. And when we return, the Obamacare exchange is open Tuesday, but the question is, will patients sign up?
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CROWLEY: From theory to practice, Obamacare exchanges open for business Tuesday in a CNN iReport (INAUDIBLE) Virginia Beach weighs in.
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REP. JOHN BOEHNER, (R) HOUSE SPEAKER: Well, I think the election changes that. It's pretty clear that president was re-elected. Obamacare is the law of the land.
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CROWLEY: Really? That was not who we were expecting (ph). That was the speaker of the House, John Boehner, for sure. We will have more when Howard Dean and John Barrasso next.
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CROWLEY: I'm back with our two doctors, former Vermont governor, Howard Dean, and Wyoming senator, John Barrasso.
From a patient's point of view, clearly, if you don't have insurance now and you're going to be offered insurance that you can afford along with government subsidies to help you get it, you are better off. What does it do in terms of putting 40 million new people into the marketplace for doctors? And what does it do in temperature of patient choices from their point of view?
DEAN: Well, first of all, Candy, it doesn't put 40 million new people into the marketplace. Those people in the marketplace now --
CROWLEY: Takes them --
DEAN: It takes them out of the emergency room. It takes them out of getting really sick before they go get care. I think it helps. The people who are going to benefit this demographically are actually the people who are most opposed to it, over 55-year-old people who've been laid off and can't get hired because nobody will take their risk in their personal insurance tool. That's a problem.
So, those people are going to benefit disproportionately. The other people who are going to benefit which we haven't talked about, I think, this is an unintended consequence of the law is small businesses, because small businesses are going to dump their employees into the exchange. I think that's a good thing.
John McCain proposed it in his 2008 campaign to separate employment from health insurance. That's something the conservatives want to do for a long time until recently. And I think that's going to happen as a result of this bill.
BARRASSO: Howard just said small businesses are going to dump their employees who are currently paying for their health insurance. Dump them on to the exchange, dump them on to taxpayer subsidies. Now, think about that. The president said if you like what you have, you can keep it.
There are people all around the country who like the insurance that they have and can't keep it because as Howard said, they're going to get dumped into the exchanges. And the people that are going to pay the most are going to be most abused by this are the young people, those were going to be forced to pay more than they would base on their own risk to subsidize others.
(CROSSTALK)
DEAN: We disagree on this. I support community raiding. We've had (ph) it for 20 years in Vermont. We have a better insurance market than some states. So, you know, I know a lot about this, because we did it. A lot of Obamacare we did in 1992, and it's worked really well. Every child in my state is covered under the age of 18.
We have community rating. So, you can't charge 55-year-old more than 20 percent above what you charge 25-year-olds. I think that's a good model for medicine. That's what's coming out in Obamacare. Something like that. BARRASSO: And community ratings mean can you give no incentives to people who go to the gym, who watch what they eat, who take care of themselves, who do wellness programs. No benefit of that at all.
CROWLEY: They will cover --
DEAN: That's not really true.
CROWLEY: Insurance companies will be required to have healthy care benefits.
DEAN: Right. And that's the way they --
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CROWLEY: Can I -- go ahead, make your point.
DEAN: This is my life, right? So, the large companies and high end small businesses are not going to dump their people into the exchange. Low end businesses who struggle to pay for health insurance are going to want to do that. So, what you're going to see is a leveling of the playing field in small business community between those who can afford it and can't.
But those with highly paid and small businesses or large businesses, fortune 500 are not going to do this because they use health care benefits as an attraction to really attract the employees. So, I think the system is in the private sector. The benefit of that is that you're going to see the flexibility and the ingenuity of the private sector sculpt this thing in some ways that none of the people who voted for ever expected.
CROWLEY: As a final question in our last minute or so. Are we headed to, as some democrats hope, a single payer system and by that I mean government funded health care insurance?
BARRASSO: Well, that's what Harry Reid said in a discussion in Nevada on a television interview. He said there's going -- the Obama health care law is going to fail and we go to a single payer system which is like the system in Britain or Canada where the care is free, but the waits are very long. I've operated on people from Canada who have come down because they couldn't wait. They couldn't afford to wait for their free operation. And death rates from cancer are much higher in England and the United States because the care is delayed.
DEAN: Fifty million people in this country are already on a single payer. It's called Medicare. That is how the Canadian system works. Basically, the same way our Medicare does. Fifty million people Americans already are in a single --
CROWLEY: That's a huge --
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DEAN: It's a difference, but it works in America for people over 65. There's no reason it can't work for more people.
BARRASSO: In Canada, they say we're going to do this many total joints a year. Once it's over, and usually that's by Halloween, you get no more health care until the end of the year.
CROWLEY: Don't have a bad joint (INAUDIBLE) Canada.
(LAUGHTER)
CROWLEY: Sen. John Barrasso and Gov. Howard Dean, thanks for your perspective.
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