Dover Post editors sat down with Sen. Tom Carper (D-Del.) Aug. 21 to discuss health care reform, ask some questions about where he stands on the issue, and what direction Congress should take when the legislative break is over. Carper serves on the 23-member finance committee, which oversees health care.


   Dover Post editors sat down with Sen. Tom Carper (D-Del.) Aug. 21 to discuss health care reform, ask some questions about where he stands on the issue, and what direction Congress should take when the legislative break is over. Carper serves on the 23-member finance committee, which oversees health care.

    In light of the onslaught of misinformation out there about health care reform, including “death panels,” single-payer systems and the like, Carper borrowed a famous line: “It ain’t so much what people don’t know that bothers me. It’s all the things they know for sure that just ain’t so.”

    “I think there’s a lot of misinformation on health care reform, some from the left, some from the right and some from the middle,” Carper said. “Among the things I know for sure is that we spend more money on health care than any other country on earth. About 16% of GDP on health care and that’s way more than anyone else. We are on our way to 20%, 25%. It’s unsustainable at 16%. We spend more money on health care but we don’t get greater results.

    “We’ve got about 14,000 people in America who will lose their health care coverage today. Fourteen thousand lost theirs yesterday. Fourteen thousand will lose theirs tomorrow, the next day and the next day.”

    Carper vehemently disagrees with anyone who thinks that the current health care system is fine, with 45 million people not covered by a health care plan.

    “I think this is one of the challenges of my generation.”

    Misinformation is not the central issue here, Carper said. They are distorted issues.

    The central issues, he said are to rein in ballooning of health care costs, extend health care to those who don’t have it and follow models that provide better outcomes with less money, like the Cleveland and Mayo clinics.

    “Unless we figure out how to provide good health care for less money, we’re doomed,” Carper said.

Model systems

    Hospitals like the Mayo Clinic, Cleveland Clinic, Intermountain Health and Kaiser Permanente work by focusing on providing primary care, prevention and wellness, and managing chronic diseases like diabetes and heart disease.

    “They all have moved away from fee for service. Doctors, nurses, etc., are all on salary,” Carper said.

    To illustrate this idea, he pointed to a cardiologist who used to have his own practice but now works on salary at the Cleveland Clinic. He said the doctor didn’t spend a lot of time counseling patients, just operating, and made a lot of money doing so. When he moved to the Cleveland Clinic, he spent more time helping people with their heart problems, and adjusting their lifestyles and medications because, whether he operated or not, he got paid the same.

    “It makes a big difference. It not only saves money but we have better outcomes,” he said.

Getting together: Purchasing pools

    Another model Carper likes in health care is the Federal Employee Health Benefit Plan, which essentially is a large purchasing pool of 8 million employees and retirees, something he would like to open up to small businesses in which to participate, but said Republicans don’t want to.

    Instead, the idea is to create something similar, a different purchasing pool in the form of “exchanges” or “marketplaces” — either a national one or several regional ones — to encourage health insurance providers to compete for the pool’s business.

    “If you say you have 10 million people in that pool, all of the major health insurance companies will want to be part of the plan and have all of their products out there,” Carper said. “The prices will be competitive.”

    Under the federal benefit plan, employees and retirees can select anywhere from inexpensive catastrophic coverage to “Chevrolet” and “Cadillac” plans. The average cost for a family is $12,000 and $5,000 for an individual. Plan beneficiaries pay 28% of the tab with taxpayers picking up the remaining 72%.

    Another cost-savings that exchanges would accomplish is driving down the administrative costs of plans, similar to the 3% administrative cost of the federal employees plan.

    “People are out there trying to buy plans for themselves or their families … the percentage of premium costs can be not 3% but 13%, they can be 23%, they can be 33%,” he said.

What about a public option?

    Carper said he doesn’t care if there is a public plan, just that there is competition and the insurance companies are kept honest — “That is the key.”

    He points to the Medicare prescription drug plan that came to life under President George W. Bush. Since Medicare never had a drug plan, a public option was created to “keep the private folks honest,” Carper said.

    The competition is “robust” and the fallback public plan has never been used.

    “In five years, the approval rate for the Medicare prescription drug plan is 85% to 90%. Every year it’s come in at or under budget,” Carper said. “The threat of a public option has helped to do that.”

    Carper also points to the VA program as a public option that works, but not to Medicare.

    “Medicare is a public option and honestly, it isn’t very good,” he said “… Medicare works, it’s just very expensive.”

From both sides

    Because Carper serves on the finance committee, he said he has an advantage over his fellow senators who may not know the intricacies of health care reform bills and may not be equipped to dispel the myths about the bills promulgating the United States.

    He should know this stuff, he said, because of the time spent in hearings, roundtables and briefings on the subject.

    Rumors about health care reform aren’t just coming from one side.

    “It comes from both sides,” Carper said. “For Sarah Palin to come out on her Twitter and say that these are ‘death panels,’ that is just rubbish … I’m all about how do we work together, how do we find common ground, how do we get Democrats and Republicans to, on a bipartisan basis, get stuff done.”

Speaking out against defensive medicine

    Carper’s frustrations with a “fee for service” system extend to defensive medicine, where doctors order more tests and images in order to protect themselves from potential malpractice suits.

    “What we have going on here is we have created a health care system — fee for service — where we incentivize doctors to provide more tests, more procedures, more xrays, more imaging,” he said. “We allow our doctors to own imaging centers, lab centers and so on. They refer those patients to those centers, they make more money.”

    While some past proposals to put caps on malpractice suits failed, the Senate Democrats want to take a look at states that are trying to reduce medical malpractice costs, and in turn, reduce defensive medicine.

    Delaware is a good example, he said.

    After substantial negotiation years ago with doctors, hospitals, lawyers and businesses, Delaware established a panel to review malpractice cases, which then either gives the potential plaintiff a green light or says the doctor didn’t do anything wrong. The lawsuit can proceed in either case, he said.

    “I was told by the state Chamber of Commerce that the incidents of lawsuits have been cut in half,” Carper said.