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Language: english
Created: Wed May 14 14:37:45 2008

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Transcript provided by Health08.org, a free service of the Kaiser
Family Foundation 1
(Tip: Click on the binocular icon to search this document)

Viewpoints: The Health Care Debate
Families USA Executive Director Ron Pollack
Kaiser Family Foundation
May 15, 2008

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Health08.org makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded
material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.
Viewpoints: The Health Care Debate 2
Kaiser Family Foundation
5/15/08

[START RECORDING]

JACKIE JUDD: Ron Pollack of Families USA thanks for

joining us on Health08.org.

RON POLLACK: Well, thank you, Jackie, for inviting me.

JACKIE JUDD: I know the organization has a very, very

broad agenda, particularly when it comes to health care issues,

but what would you say is the single most pressing issue facing

the country when it comes to health care?

RON POLLACK: Well, I think the issue of conscience is

the issue of how many people cannot afford to get health care

coverage and are uninsured or underinsured. I think if you ask

the American public, the American public generally would say

the costs of health care is what concerns them the most. So, I

think those two issues need to be wedded together, obviously

related to one another. And so dealing with costs and dealing

with access, I think are the most critical thing that we need

to do.

JACKIE JUDD: Why do you call it an issue of

conscience?

RON POLLACK: Well, here we have the richest country in

the history of the planet, and yet we have got 47 million

Americans who are uninsured. That is more than the aggregate

population of almost half the states in the United States, at

least populous states, of course. And so, it is extraordinary

to think that in the United States, where the costs of health
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Health08.org makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded
material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.
Viewpoints: The Health Care Debate 3
Kaiser Family Foundation
5/15/08

care are far higher than any other country in the world, and

yet we have such a large proportion of our population who

cannot gain access to coverage. I think it is a matter of

conscience that we actually are a magnet for people who wealthy

in other countries to come here to get high-quality care, and

yet people in this country cannot get basic care. And that is

something I think we need to get changed very quickly.

JACKIE JUDD: And so you identify access and cost as

the big issues. They are the biggest issues, the most

complicated ones. Give me a sense of priorities when it comes

to Families USA. What do you tackle first and how do you

tackle it?

RON POLLACK: I think they are interrelated and I think

you have to deal with both of them simultaneously. That does

not mean you get everything done all at once. I do not think

we are going to get everything done all at once. But we have

got to make some significant incremental progress in both of

those areas. If we do not deal with access, then I think we

are going to see the numbers just continue to rise with more

and more people priced out of health care, unable to get basic

care. If we do not deal with cost, it obviously is going to

have an impact on how many people are uninsured and

underinsured. So, I think these two matters are clearly

intertwined.

JACKIE JUDD: Early last year Families announced with a

number of other organizations health coverage coalition for the

uninsured, some strange bedfellows. A year and a half later

where does that coalition stand and is it the framework for a

prescription to deal with cost and access?

RON POLLACK: Well, that effort was an effort that

focused only on an incremental solution on coverage. We came

up with a proposal that was, I think, in many ways, historic

because you never had groups like this agree on something,

particularly of such significance. But it was only focused on

an incremental improvement on coverage. There is yet another

group, many of the same organizations that were part of that

first effort are coming back together over the course of this

year to try to see whether we can create a dialogue so that the

cooperation that has been missing with each iteration of health

care reform, whether we can achieve that cooperation.

You know, every time healthcare reform has been on the

agenda, one or more major interest groups spent a fortune in

opposition to health care reform, and I think that we need to

try to get those key stakeholders together and see whether, for

the first time, we actually can reach an agreement so that if a

president comes into office in 2009, with a congress, and they

are both eager to try to do something significant with health

care reform, that this time we succeed rather than fail, and

that has to start by dealing with the key interest groups, the
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Health08.org makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded
material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.
Viewpoints: The Health Care Debate 5
Kaiser Family Foundation
5/15/08

key stakeholders, so that hopefully we have a consensus about a

direction of where to go, and that is not an easy thing to

achieve.

JACKIE JUDD: Right, it is actually the strategy that

was used about 20, 22 years ago when congress was debating

nursing home reform. All of the parties that sometimes were

loggerheads actually sat at the same table, and there was

legislation as a result of it. Who has to be at that table?

How many of those organizations have given a commitment that

they will be at the table?

RON POLLACK: Well, we have already had plenty of

preliminary conversations, and I would say every major interest

group that has been a key stakeholder in the health care system

is prepared to sit at the table, consumer groups, business,

labor, the medical profession, hospitals, pharma. So, the

various groups, many of whom were blockers and different

iteration of health care reform, are each determined to come

together to try and create a dialogue. And this is not easy.

What we did the last time and will do again this time

is we actually hired conflict managers to shepherd us through

this process, people who do not necessarily have a background

in health care, but who are smart and thoughtful and

experienced in creating a good dynamic so you can engage each

other in a productive way. We found it very helpful on this

first iteration. I think it will work again or at least be

very helpful in this next effort.

JACKIE JUDD: Well, what happens in that situation?

Does the conflict advisor say, "You need to leave your hard and

fast principles at the door."? Or, "Come to the table with

your principles but be ready to be flexible."? What is the

advice?

RON POLLACK: Well, one of the things you learn when

you do conflict management courses--and I have taken a conflict

management course at Harvard and learned a great deal from

this--is that you have to separate interest from position, and

often we get stuck on position. Take, for example, an actress.

An actress says, "I want a huge dressing room. I want flowers

all over the place," et cetera. Her position is she wants this

big dressing room and the flowers. Her interest is she wants

to be acknowledged. She wants people to understand how

important she is.

Well, maybe you could work something out that serves

her interest that also serves the interest of the producer of

the play or whatever. And trying to get groups to get off of

position and really drill down on interest and then try to find

ways that the positions can be combined together to match those

interests, that is really the process that you try to work

with. And what is also very important and it is, I think,

critical to the success of an effort like this, is you have got
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Health08.org makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded
material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.
Viewpoints: The Health Care Debate 7
Kaiser Family Foundation
5/15/08

groups in the room who have always been on opposite sides of

issues, and when you get together and you have a really good

dialogue, you create trust. That does not mean you have

changed your positions or your interests all of the sudden are

the same, but once you create a trust, then the dialogue

actually can be a whole lot more productive.

JACKIE JUDD: And so for Families USA, that means

coming to the table not with a specific proposal such as single

payer or a mixture of private and public, or price controls, or

this or that; it means coming to the table with what?

RON POLLACK: Well, we have our preference in terms of

an approach to health care.

JACKIE JUDD: Which is?

RON POLLACK: Well, our view is that if we are going to

get anything done, there is going to have to be a mixture of

public and private sector initiatives. That is the real gulf

that exists between conservatives and liberals, between

republicans and democrats, and often the special interest

groups versus those that have traditionally been supportive of

health care reform. And I think that we have to find a virtue

out of everyone's second favorite choice. Each of us comes

into this process saying, "Here is out top priority proposal."

And, in the past, if our top priority proposal did not

get adopted, we either walked away from the table or we opposed

what is left on the table, and another way of saying that was
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Health08.org makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded
material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.
Viewpoints: The Health Care Debate 8
Kaiser Family Foundation
5/15/08

all of our second favorite choices was the status quo, and we

have to find a virtue out of a second favorite choice that is

not exactly what we came to the table with in terms of our

first choice, but something that actually is substantively

sound and politically achievable.

JACKIE JUDD: You have been at this for so many years

now. What are the chances that what you have just described

might happen this time? Is the environment any different than

it has been?

RON POLLACK: Well, I am a congenital optimist, so I

think something can happen; I think something will happen. But

there have to be certain preconditions for something to happen.

First, the President elect has really got to make health reform

a top priority, and it means sequencing is very important. In

1993, 1994, even though President Clinton cared deeply about

health care reform, there were several things that came before

that. There was NAFTA, there was balancing the budget, and

there was the debate about gays in the military; and by the

time he gave his speech on health care in September of '93 and

issued his proposal in November of '93, much of his political

capital had been expended.

So, this has got to happen early on, I believe, to be

successful. Then, I think it improves also an aura of

inevitability, which, I think, actually existed at the very

beginning of 1993. If you remember the history of 1993, you
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Health08.org makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded
material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.
Viewpoints: The Health Care Debate 9
Kaiser Family Foundation
5/15/08

had republican senators led by Senators Dole and Chafee, who

were prepared with a majority of republicans and United States

senate, to try to work something out with the President. It

was a bare majority. As time went on, that majority moved

away, and finally the Republican Party said, "It is best not to

give this President a victory," and they wound up being strong

opponents. So, I think timing is critically essential.

JACKIE JUDD: And is it not only that it happened early

on in an administration but that it happened quickly, that the

process, beginning to end, happened quickly?

RON POLLACK: Yes, and the process needs to move

quickly, and that does not mean that comprehensive health care

reform happens all at once. Sometimes we have experienced that

efforts at health care reform tried to bite off more than could

be chewed, but there has to be a significant initiative, that

the President has got to push hard early on, and congress has

got to develop the mechanisms for getting it considered

quickly. Remember, there are lots of different committees in

congress that have a piece of the action, and they guard their

jurisdiction with great tenacity. So, there has got to be a

process to move that along in a fairly swift but deliberative

manner.

JACKIE JUDD: A final question: Give your hopes and

aspirations, does it discourage you that there are some

politicians, lawmakers on Capital Hill, already seeming to tamp
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Health08.org makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded
material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.
Viewpoints: The Health Care Debate 10
Kaiser Family Foundation
5/15/08

down expectations about what can be done because of the

economy?

RON POLLACK: Well, I have read some of the quotes by a

few members on Capital Hill, and obviously it is disappointing

to read that, but I think that is where presidential leadership

comes in, and the leadership in both houses of congress has got

to be clear that this has got to be a top priority. So, I

still think that we have got a pretty good chance of doing

something significant in 2009. Obviously it will depend on the

elections; obviously it will depend on will the president elect

make this an early top priority.

If that happens, I think the conditions are right.

Business wants it; governors across the country want it. I

think the key stakeholders are now trying to find ways to work

together rather than be recalcitrant. So, I am more optimistic

than I have ever been about this being a possible time we will

get it done.

JACKIE JUDD: We will check back with you in 2009.

RON POLLACK: Alright.

JACKIE JUDD: Thank you, Ron Pollack of Families USA.

RON POLLACK: Thank you.

JACKIE JUDD: Appreciate it.

[END RECORDING]