Carol Moseley Braun

Remarks at the Iowa Health Care Policy Forum - Aug. 14, 2003

Carol Moseley Braun
August 14, 2003— Des Moines, Iowa
Iowa Health Care Policy Forum
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Iowa Governor Tom Vilsack moderated a forum at Drake University in which Democratic presidential candidates individually spoke about the state of the health care system and their plans to improve the nation's health care. Candidates also answered questions from the audience. Moseley Braun's remarks begin at 1:32:35 in the C-SPAN video.

MOSELEY BRAUN: Thank you very much, Governor Vilsack, and to Drake University President David Maxwell, Dr. Hansen and Dr. Boxer. Thank you so much for organizing this forum, and thanks to all of you for taking time out to come out and hear the candidates for the Democratic nomination speak about health care.

I'm delighted to have this chance talk about this issue, because I believe that I offer a different perspective on health care reform, one that gives us a win-win-win solution to this national dilemma, in ways that will invigorate our economy, eliminate insurance, insecurity, reduce human suffering and anxiety, and redirect resources in ways that will give us a comprehensive system of universal coverage for quality care.

Before I do that, however, I'd like to take a moment and give you a sense of who I am and talk about how it was that I came to this issue. My mother was a medical technician and she worked in a hospital in the days when the women in the room all were quiet whenever the doctor walked in. (Laughter.) You all remember that. And, in fact, she had impressed upon me to go and pursue a career in medical care. When I passed out—I was a candy striper, and when I passed out in the emergency room they sent me to medical records—(laughter)—and that was it.

But I went on to law school at University of Chicago. And then, in my first job out of law school, as an assistant United States attorney, I had occasion to—my first big case was defending Jimmy Carter's attempt at health care reform. You may recall he came up with the HSAs and tried to restructure the way our health care system worked. And I was lucky enough as a baby lawyer to have a chance to try that case that the AMA filed against the Carter health plan. We lost, as you all are no doubt aware. But that was my first real introduction to health care policy, and it has been a factor in my career ever since.

Following my time in the assistant U.S. Attorney's office, I married and started a family, and I was home, being a homemaker, when my neighbors got me engaged in a local environmental effort to save the bobolinks in Jackson Park. We were protesting the removal of the bobolinks' habitat. (Laughter.) We lost again. (Laughter.)

But what came out of it was an offer by some of my neighbors who had seen me working on that community cause to get involved in electoral politics. And when I first started to talk about it, I said, Oh, no, I don't know anything—I'm not a politician, I don't know anything about this. And they said, Oh, no, you should run. And then another group came to see me and said, No, you shouldn't run for state representative, because you haven't got a chance to win—the blacks won't vote for you, because you're not part of the Chicago machine, the whites won't vote for you because you're black, and nobody is going to vote for you because you're a woman. (Laughter.) That was all I needed to hear, and that was the beginning of a political career. (Applause. Cheers.)

So I went on to serve in the Illinois General Assembly as state representative, and in that capacity had occasion once again to get involved with health care legislation at the state level. And among the things that I had occasion to do, and you never know in life what comes back around again—but the present speaker of the House, Denny Hastert, and I were co-sponsors on the first PPO legislation that the country had. And of course that was still part of my evolution in this whole process of health care reform.

Following my time in the legislature—and I served for a while as assistant majority leader—I served as Cook County recorder of deeds. Now, that was the one job that I didn't have a health care issue to deal with exactly, other than negotiating with SEIU, which I understand is represented in this room a little bit. (Laughter.) But—in the executive position health care wasn't as much of a concern, because our county government did have coverage for all of the employees of that office.

And then I went on to the United States Senate. And of course over the years health care just became more and more and more of a dilemma and a problem for the American people, particularly as our job market began to change and evolve.

Following my time in the Senate—oh, and I had occasion in the Senate to serve—I was the first woman in history to serve on the Senate Finance Committee, and of course we went through the trauma really of the Clinton health care reform effort. And with all of the pros and the cons—and I don't want to take all the time talking about that effort. But it was an effort. It was an effort that was directed at least in the direction of trying to provide universal coverage. It didn't get there for a variety of reasons, but frankly I think everybody should applaud the fact that the effort was made and the undertaking was attempted to try to fix this huge problem.

Following my time as a United States senator, I had occasion to become—I was confirmed by the Senate to become ambassador to New Zealand and Samoa, and I call that time my time as ambassador to paradise. One of the aspects of being ambassador to paradise is that New Zealand had a single-payer system. So I had an opportunity to see a single-payer system at work, and to observe how as a practical matter it actually happens. So, if anything, I have gone full circle with this issue, and I have come to the conclusion that the only real solution to this problem lies not in continuing to tinker with a broken industry, but rather to acknowledge that the structure of the industry is flawed, that we cannot fix it at this point, and we need to have a single-payer, universal health care coverage in order to provide quality health care to the American people. (Applause.)

Now, let me suggest—because this issue can be so complicated—that if anything, one of the traps, one of the dangers in it, is that you can get caught up looking at the trees and miss the forest. So if you take a step back and look at the forest in this issue, the question becomes, Is there any rational reason why payment for our health care system is tied to our employment? The answer to that is there really isn't.

And so if we were to step back and to look at what is it we are trying to do here, it is not health care that needs to be reformed; we have the best health care in the world. We know as a nation how to provide for health care. What we don't have is a rational system for paying for it. The Japanese, the Germans, the Italians, the French—all of these nations manage to provide health care to their citizens for less than the 15 percent, almost 14 percent, of GDP that it costs here in the United States. Ask yourself: Are Americans that much sicker than people in the rest of the industrialized world? Or perhaps maybe the answer is there's just a problem with the way that we pay for it.

I submit to you that examples of such a single-payer system actually abound, and we should look to those examples as a way of fixing this broken industry.

Right now the national government has a program of health coverage for federal employees, the FEHBP. I'm sure you've heard a lot about it. But the Federal Employees Health Benefits Program is for all intents and purposes a single-payer system. And under that system all sorts of health care—from mental health to dental health to vision health—all of these things get covered in a comprehensive system that winds up costing less than the private insurance system that we have. Right now we have, if you think about it, two separate tranches with different divisions. We've got a private system and a public system.

The public system is Medicare, Medicaid, CHIPS—that is a whole bunch of acronyms for all the different specialty programs for health care, for special diseases and the like, all under here under a public system.

On the other side we have a private system, and that private system depends on everything from where you live to where you work to whether or not you're full-time, part-time or whatever. But there's different iterations. And the insurance companies make contracts to run that private system.

The result of the changes in our work force is that we now have 41 and counting million Americans with no coverage, particularly young people, not to mention the cost of all the outlier groups that just don't fit into a category. There is something very strange when members of the middle class can't access health care as well as someone who receives public assistance. And that is really the reality. We have a system that puts people—(applause)—

And so if you'd step back from the trees and look at this forest for a moment, what becomes really clear is that we are not talking about health care reform; what we are talking about is health industry reform or health insurance reform. Because the health care part of the equation is not what's broken. It is the way we pay for it.

With a single-payer system we would eliminate the leeching away of resources and money that could go—that right now is going into paperwork on the one hand and profit on the other, and could very well go into providing additions to care, particularly in regards to prevention and in regards to other kinds of outliers that would have the effect of improving the health status of the American people as opposed to just dealing with sickness care at the end of the line. And the old expression about closing the barn door before the horse is out—it makes much more sense to focus in on providing wellness and providing people opportunities to access care in a reasonable way, on the front end of the process, than trying to do interventions in an emergency room in the most expensive setting possible. (Applause.)

And so I have been challenged. We are getting our campaign started. I look forward to putting out the requisite papers. I haven't put out a paper yet. But I have embraced a single-payer system, and again a single-payer system not dependent on employment, but rather in which the payment shifts to the income tax as a base. Now, is that a shift? Yes, it is. It is not a tax increase, but it would call for a tax shift.

Shifting off of the payroll tax onto the income tax would have the effect of eliminating the unfair, the disparate impact on working people that the current system has. Right now 80 percent of the American people pay more in payroll taxes than they do in income taxes. And because the way it's structured, the payroll tax impacts disproportionately on working people, so that, you know Michael—I don't mean to pick on Michael Jordan, but Michael Jordan pays a smaller percentage of his salary for health care than someone who goes to work on a farm every day or goes to work in a mill every day. There's something wrong with that. We can make the system progressive in the way that we pay for it by shifting it off of the payroll tax base onto an income tax base. And I believe that in the course of it we will still wind up saving money, and have a more progressive system in which health care gets paid for in a more rational way, and out of that rationality we will have the savings and we will have the capacity-building that will allow us to provide for a quality system of health care that is accessible to everyone.

And that—and this is my last point—the signs are going up here—but the last point that I think is very, very important—and a system that also respects and builds on the relationship between patients and providers. You know, there is that old—it's not a joke anymore, because it's kind of sad, but there was an old joke about that organized medicine spent so much effort running from the embrace of socialized medicine that they ran into the clutches of the venture capitalists. (Laughter.)

The truth is—the truth is that doctors and nurses and providers of care should be the people making the decisions about how that care would be delivered as opposed to some bureaucrat sitting nowadays somewhere offshore somewhere, not even here—someone making a decision on behalf of an insurance company's bottom lines. DRGs were never meant to exclude care, but that's exactly where it's gone. That's exactly what happens. And the result is we are a sicker nation, and we pay more for our health care than any other industrialized country in the world.

We can do better. We have the capacity to create a single-payer system in this country, that frankly in my opinion is more creative and more innovative and more comprehensive even than some of the systems that have gone before.

You know, we heard the horror stories about the lines in England and Canada and even in New Zealand. It doesn't have to be that way. With a market as large as ours, with the capacity as deep as ours, I have every confidence that the American people are innovative and creative enough to come up with reform of the payment system for health care in ways that will preserve our values around what health care should do. And those values include providing the best quality care to everyone without regard to means, and making certain that physicians and providers are in a position to make decisions that they are best able and capable to make, and that we eliminate the human suffering and the insecurity and the job block and all the horrors you've heard about by finally settling on the notion that rationality in the way that we pay for something that is as personal as health care ought to be our first priority.

Thank you all very much for this opportunity. (Applause.)

(Moseley Braun moves to sit on stage with Vilsack.)

VILSACK: Welcome.

MOSELEY BRAUN: Thank you, governor.

VILSACK: Ambassador, you have focused your remarks on a single-payer system, and I am wondering if you might take a few minutes to elaborate just a bit on how such a system would address the equity issue in relationship to the access to health care between urban and rural centers. This is a state, as I said earlier, that has many, many small communities, and they are challenged every day to have access to health care providers that can provide immediate help. How do you envision a single-payer system as you have outlined addressing that issue?

MOSELEY BRAUN: Largely because such a system would not be so focused on the profit motive—it wouldn't be so profit driven. You wouldn't have physicians and providers neglecting rural areas, because they couldn't make the economies of scale that they can make in the urban centers. I mean, that's largely part of the problem. Doctors and providers have to perform where they can make the money, because the insurance companies are setting their prices, actually if you think about it. And so if you begin to have a more rational basis for the payment system, I believe that will serve the interests not only of rural health but health care—access to health care in inner-city and other neglected and marginalized communities around the country. So I think therein lies part of that answer.

Carter tried to fix the problem with what he called the HSAs; that is, to have areas in which people would essentially organize the provision of services across the board within that area. And all the HSAs had a critical mix of both rural and urban, tertiary, secondary, primary care and the like. But that kind of planning can and should take place I think on a local basis, because everybody knows their own area. They know without having somebody in Washington looking at a map and not understanding that the line on the map was really a mountain, and we don't get from one side to the other, that people on the ground can make those decisions best in my opinion, but with the support of knowing that the payment for health care will be commensurate with the need for that care to be delivered.

VILSACK: We have just a few seconds left. Please address if you would your views about the single-payer system as it relates to mental health and substance abuse coverage, and where that fits into your plan.

MOSELEY BRAUN: Actually I ran into a little of that in New Zealand, because they had an issue with smoking among Maori people, who are the indigenous people, and everything from smoking to alcoholism—well, they actually treated smoking and alcoholism both like mental health problems, which I thought was kind of interesting—(laughter)—but those issues were covered. And as a result, the minister of health was able, at the time I was there, was very focused on trying to reduce Maori smoking and so a full-court press effort was being made in that regard. So, yes, mental health is just like—you know, if you break your arm there's an avenue to get it treated. If you have depression, those avenues are not as available. And there's something wrong with that, because mental health in my opinion is as much a physical ailment as breaking your arm, as something that is identifiable and observable.

VILSACK: Well, there are obviously too many questions and not enough minutes. (Laughter.) Ladies and gentlemen, please join me in thanking the ambassador. (Applause.)

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