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Our previous coverage:

Live at Senator Claire McCaskill’s health care town hall in Kansas City

A healthcare town hall done right

Senator Claire McCaskill (D): health care town hall in Kansas City – press conference, part 1

….Question: Wouldn’t this battle be a lot easier if you guys would fix the problems with Medicare and Medicaid, the, the fraud and the over expenses and the, the new drug bill? Same thing. Wouldn’t this battle be a lot easier if you fixed the problems that are right before you before you took on something totally new?

Senator Claire McCaskill: Well, this is not totally new. I mean this has been, I’ve said in some of the meetings, it didn’t come up in this one, I can’t remember a political campaign when there weren’t TV ads saying we’re gonna fix health care. And the irony is that even though politicians have been campaigning to fix health care for the last twenty or thirty years nothing’s happened. The status quo has continued. We’re workin’ on bringing to justice the people who commit fraud in the Medicare program. In fact there’s been great improvements made in that because of the ability of us to do better investigations through computers and data matches and those kinds of things. But we’re not gonna fix the health care costs for the Medicare program if we don’t fix the rising health care costs for all of health care ’cause they are interrelated. You can’t fix the, the rising costs in, in the Medicare program and not have an impact across the board. I mean they, they are, they’re kind of interwoven. The hospitals in terms of what they’re charging and, and the doctors and what they’re charging for Medicare. And that’s part of the problem, is you got two or three or four different rates. So, we may end up, you know, who knows what we’ll end up with? We may end up with something very incremental. I don’t know. I can’t tell at this point how much support there’s gonna be [crosstalk]…

Question: Did, did you say today that you would not support use of reconciliation for a, a bill in the Senate?

Senator McCaskill: I said that I didn’t think it was a good idea. I haven’t ruled it out [crosstalk]…

Question: That was [laughter][crosstalk]…

Senator McCaskill: I haven’t ruled it out because [crosstalk]…

Question: What’s the difference? [laughter]

Senator McCaskill: Well the difference is [crosstalk]…

Question: It’s a good id…bad idea, but you’d vote for it?

Senator McCaskill: Well I don’t think it’s a good idea because it’s very limited what we can do with reconciliation. It’s a very arcane rule.

Question: Right.

Senator McCaskill: And it only relates to the pay fors. It only relates to the budget part of the equation [crosstalk].

Question: Apparently there’s a memo that’s out there that suggests that health care could be done this way. At least the leadership believes that.

Senator McCaskill: Well the, the chairman of the Budget Committee doesn’t. And that’s where reconciliation happens, it’s through the budget process.

Question: Right.

Senator McCaskill: And so, you know, we can’t do some of the things in term, especially the market reforms, the consumer protections [crosstalk]…

Question: But you could do that in a [crosstalk] separate bill [crosstalk]…

Senator McCaskill: They don’t lend themselves [crosstalk]…

Question: I’m just saying [crosstalk]…

Senator McCaskill: …to reconciliation [crosstalk].

Question:…whether you were ruling out reconciliation at all.

Senator McCaskill: I, I don’t want to take it off the table because I if I think we take it completely off the table it removes an incentive to compromise by some of my friends that are Republicans. I mean what we’re trying to do is to get people here to come together and participate. This shouldn’t be about the Republican Party’s success is the failure of health care reform. And [crosstalk]…

Question:  But you do hear a lot, Senator, a lot more Democrats saying we gotta go this alone. You heard that today from some of these people [crosstalk].

Senator McCaskill: Yeah. Oh, yeah. No, I, I get that.

Question:  Senator [crosstalk]…

Senator McCaskill: I hope it doesn’t come to that. I don’t want to go it alone. I want a bipartisan bill.

Question: Since this was a listening forum did you hear anything that surprised you from anyone today or throughout your tour? Anything?

Senator McCaskill: No, I mean I’m hearing many of the same questions. I mean there’s a lot of misinformation out there about, you know, what’s in the bill, what isn’t in the bill. A lot of distrust about government being further involved in people’s  health care. So, no, there wasn’t anything that I heard today at this particular forum that, there, there’s some common themes that are coming up. There are people that are frustrated that want, feel like that Barrack Obama won the election and the Democrats control Congress. Get it done already. And then there’s other people who feel very strongly that Congress needs to back away and do absolutely nothing. And everything in between.

Question: …What has to be in a bill and what, are there drop dead points on either side of it that you will or would not vote for health care reform [inaudible]? What do you have to have in it? What do you not want to have in it? What is it besides [crosstalk]…

Senator McCaskill:  I’m not gonna vote [crosstalk]…

Question: …anything. It mean [garbled][crosstalk]…

Senator McCaskill:  I will not for a bill that’s not deficit neutral. I will not for a bill that’s not paid for. We’re not gonna do anything about health care costs if we continue just to drive up the costs to the government. We’ve got a huge deficit problem that we’ve got to get serious about. So I won’t vote for bill if it’s, if it’s not deficit neutral.

Question: But you’d vote for a bill [crosstalk]…

Question: Does it have to have [crosstalk]…

Question: …tax increases then?

Senator McCaskill: I would vote for a bill [crosstalk]…

Question: Most of the bills out there have tax increases [crosstalk] to make it deficit neutral.

Senator McCaskill: It would depend on which ta.., what, what taxes [crosstalk] and fees there are.

Question: So then you wouldn’t rule out a tax increase?

Senator McCaskill: I’m not gonna rule out, for example, I think the Finance Committee is probably gonna come with a tax on, a premium tax on insurance companies for the gold plated plans. I would not rule that out [crosstalk].

Question: So, so some people are gonna have to pay taxes on their health benefits? [crosstalk] If [garbled] [crosstalk]

Senator McCaskill:  No, no [crosstalk] The insurance companies would have to pay a premium tax. What premiums they received for those plans they would have to pay a tax on those.

Question: You, you don’t think they’d pass that on to the consumers?

Senator McCaskill:  They might. [laugh from questioner] But we’re only talkin’ about on the gold plated plans. It’s maybe one or two percent of the plans out there.

Question: How ’bout cutting Medicare by two hundred and fift
y billion dollars?

Senator McCaskill:  Well, but that’s not cutting the benefits. That would be the Medicare Advantage programs and the Medicare Part D [crosstalk]…

Question: You don’t think they’d pass that on to patients?

Senator McCaskill: …and I’m on board. Oh, well, no. Because Medicare Advantage, we just need to, that program is a ridiculous waste of public money. Ridiculous. I mean we are supplementing the profits of these insurance companies and the government’s got no bargain for it. And neither have the people on Medicare Advantage. And that’s three hundred billion a year right there.

Question: …Out in the rural areas of, of Missouri when you’re talking to these folks who [inaudible] generally against the idea of increasing any kind of state plan, there’s a huge shortage, right, of medical providers? And these people, in small town America you don’t have the access to health care that [garbled] there’s not enough doctors, there’s not enough nurses, there’s just nothing out there. So that you can have, you can be insured from here to kingdom come, it doesn’t really matter. There’s no, no one to provide that care. You increase, put another forty-five million, fifty million people on, on the insurance rolls, do we have the medical staff available to treat all Americans at the same le.., at, give, provide the level of care that we want to provide and what do we do about that if we don’t?

Senator McCaskill: Well, I, you know, I hope that we shift some of the personnel out of emergency rooms into primary care physicians. That would be great. ‘Cause there’s a lot of primary care medicine that’s being practiced in emergency rooms right now.

Question: GPs are, I mean you’ve had a slight increase last year for the first time in fifteen twenty years [crosstalk], right?

Senator McCaskill: I think, I think that’s something will have to happen.

Question: But GPs are way down. How do we, how to encourage people to go, I mean the, these people, these people are leaving school with a hundred and fifty thousand dollars in debt. How do you, do you, do you eliminate medical school costs for people going in to it?

Senator McCaskill: Well, I, I think, you know, we’ve got our plate full right now trying to figure out how we incentivize more visits to, for preventative care, more general practitioner visits, certainly rural health care is a huge part of the problem in terms of access. The costs are even more overbearing for them [crosstalk]…

Question: Interesting.

Senator McCaskill: …than people in the urban areas. And there is, you know, that’s one thing about the Senate, is you’ve got equal representation, very rural communities and very populous communities and that’s why you usually see bills look a lot different in the Senate, ’cause rural interests generally have a pretty big voice in the Senate because of the way [crosstalk] it’s designed.

Question: With, I mean, if you look at Greece. Greece has a surplus of doctors right now. And Greek doctors make about a quarter what American doctors make. What’s, what’s wrong in the equation here? Why don’t we, why do we have people not going into medical school at the rate that we need to provide for the increase in population we’ve got?  Whereas other nations have surpluses of [inaudible], I mean [crosstalk]…

Senator McCaskill: I don’t know.

Question:…Germany has a surplus of doctors. Greece has a surplus of doctors. Italy has a surplus of doctors.

Senator McCaskill: I don’t know. I don’t know what the answer is to that. I don’t know why people, probably because it’s very expensive and it takes a long time. But, it, this is all about hopefully encouraging more people to get into that kind of medicine. I, I don’t [crosstalk]…

Question: But we don’t, is it, none of it, none of the [inaudible] makes any, it doesn’t amount, make any difference, right, as far as the health care of Americans doesn’t increase if we don’t increase the level of, the amount of care we can provide? Especially if we had more people [crosstalk] [inaudible]…

Senator McCaskill: Well, I mean, just, just let me just say this, too, that, you know, we have a, there’s a vast discrepancy between the number of providers per capita in some parts of the country and others. And I think you may see some equalization of that if you start reimbursing, incentivize for good outcomes as opposed for process and procedure. I mean you have, what, you know, a gajillion doctors per person in Florida and you have very few doctors per person in many other areas of the country. So I think you’ve, you know, hopefully you’ll see some kind of shift there in terms of geography and have a more equal distribution across the country. Hopefully. Anybody else?

Question: With regards to public option co-op, at what, kind of , was there ever a point when you were fully for not considering co-op as opposed to now, what is that process been like and are you one way or the other?

Senator McCaskill: Well, I , I , I’m open to considering a co-op, but, you know, the disadvantage we have right now, that’s why it’s important that we’re out here listening, is we don’t know what it’s gonna look like. You know, I’m glad that we didn’t try to rush the finance bill out the door before we left. On the other hand, it would’ve been helpful if we had more information about what they’re proposing to do as it relates to a co-op as opposed to a public option. And, and I don’t think we’ll know until probably October whether or not there’s enough support for a public option versus a co-op.

Question: Think you’ll get a bill this year?

Senator McCaskill: I think we will. It may be incremental, it may not be as much as most people wanted, but I think we’ll get a bill this year.

Question: Following up on the provider question, any plans to get the AMA out of their gatekeeper role, because that’s why we’re short of providers. Because they have controlled who gets into medical school, how many medical schools operate. I spent my first career, before I was a thorn in your side, I was a health care provider, I retired from Research, so.

Senator McCaskill: You know, I don’t know [crosstalk] that’s the…

Question: I’ve watched [crosstalk], I’ve watched it happen.

Senator McCaskill: Yeah. Well, I need to look at that more. I haven’t looked at what the AMA’s role is right now and what, what, I’m thinking about the bill and where in the bill it would impact that, the HELP bill, But, I, I need to look at it and I will. You’re, you’re Blue Girl, aren’t you?

Question: Um, hmm.

Senator McCaskill: I knew it. [Blue Girl laughter] Okay…

Question: What do you think’s made this such an emotional debate.

Senator McCaskill: I think it’s a combination of things. I think we’ve done a lot of big bold things in a very short period of time. We have an economy that was in freefall. And all of a sudden it was TARP, it was stimulus, it was omnibus, it was budget. It felt like a lot of things happening at once, a, a new President. You know, I think that some people who very much didn’t want Barrack Obama to be President began to see this as a vehicle to express some of that. Their opposition to his presidency and, and it just kind of crystallized. And health care’s really important to people. And there’s a fear of the unknown. And I think the man’s point that we haven’t done a very good job of explaining the various proposals and what’s out there. This notion of growing the bill in Congress, that’s good in terms of reaching some kind of consensus. It’s bad in terms of there being a vacuum that misinformation can fill. And I think that vacuum got filled pretty quickly with a lot of misinformation and now we’re kind of trying to wade our way through all that.

Staffer: If we have one more question.

Senator McCaskill: One more. No more? Great, I’m done! [crosstalk] Oh. It’s been a long day.

Staffer: One more.

[laughter]

Question: Sorry. My question has to do with what results have you seen from your town halls? Have you been seeing, have you been able to change peoples’ minds or are people remain polarized with their views?

Senator McCaskill: Well, I’m resigned to several things in Missouri, and that is, it’s usually gonna be a third, a third, and a third. It’s gonna be  a third of the people who feel very strongly about many of the policies and beliefs of the Republican party. A third that feel very strongly in many of the policies and beliefs of the Democratic party. And a third that is open, that wants to hear and, and learn and they’re willing to, to vote either way. I see that on this bill. I think the loudest noises have been made by the opposition so far. But, just because you’re loudest doesn’t mean that you’re the majority and it doesn’t mean you’re right. I think it’s important to, to step back and make sure everybody gets good information. And I think, as I said out there, I think the vast majority of Missourians want to see some kind of reform. Thank you guys very much…