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Contact Us Fall 2000; Volume 1, Number 1
Features: Election 2000

Interview with Sarah Bianchi, Deputy Issues Director to the Gore Campaign
Interview conducted by Clay Ackerly
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HHPR: What is your position in the Gore campaign?

SB: I am the Deputy Issues Director.

HHPR: Do you have any advisors to help you out? How is your system structured?

SB: We have lots of different advisors both inside the campaign and outside the campaign. On health care, we rely on advice from lots of experts from around the country, from Laura Tyson to Ken Thorpe, and others that are sort of outsiders. Then, there are different people who work on health care here, both from the policy side and the communications side. It's not a formalized structure. It's just a lot of people we've been working with for a long time.

HHPR: How did you get interested in health care? How did you get tapped for this position in health care?

SB: I had worked in a number of different health care positions in the government, at the Office of Management and Budget, and at the President's Domestic Policy Council. I moved over to work for Gore at the end of '98. So, I've done it for awhile. Then, earlier this year, I began working full-time for the campaign.

Three Most Important Issues
HHPR: What do you consider to be the three most important health policy issues facing the country today in both your mind and the Vice President's mind?

SB: Well, there are a lot of issues out there. First, the challenges facing our seniors: With the retirement of the Baby Boomers, it's important to assure that Medicare is strong for the future. That includes making sure both that the program continues to provide quality care and that it is improved to add a pharmaceutical benefit. This is an extremely important challenge in making sure that we are ready for the Baby Boomers' retirement.

Then, clearly, the problem of the uninsured is a very important issue. Too many Americans in this country are uninsured, and Gore has what we think is a really good plan. It's ambitious. It would be the largest health care coverage expansion since the Medicare program was enacted. It's $146 billion, but it is a step-by-step approach to get toward universal coverage, acknowledging that the country is not now ready to take one big giant step. However, we can go step-by-step and improve the confidence in the health care system and in our ability to help people find affordable coverage. It has the goal of getting there, so it expands access to health insurance to all children and their parents. It makes it easier for small businesses to provide coverage. These are a number of important steps.

Then, I think that there is the importance of assuring that health insurance coverage is worth the paper its written on, and that we have a quality health care system. With the completion of the human genome project, we're making enormous strides in the kind of health care we can provide. That is important. We should support that work and medical research in general. But we should make sure that Americans have access to quality health care, and that includes patient protections. With more people moving into managed care, we need to make sure there are adequate protections. We believe that managed care, when managed well, can provide quality care and sometimes more preventative care. However, we need to make sure people have protections, such as access to specialists, access to emergency room care, and privacy. These are the kind of challenges that will continue to be important as we move ahead.

Main Differences With Bush
HHPR: Where do you see the Vice President and Governor Bush differing in their views? Can you point out one or two major areas where they differ?

SB: There are huge differences. In fact, it's an area where they have their biggest differences. Certainly, one area is their records on health issues. Gore has been working on health care issues for his whole career, from everything from the organ transplant system to strengthening Medicare, to expanding coverage. Today, he has what we think is an ambitious agenda. Governor Bush's own advisors have acknowledged that he has given only a couple of speeches in his career. Moreover, when the CHIP program, the Children's Health Insurance Program, was passed, he was slow to take it up in Texas and pushed for a less generous expansion. Many in the state legislature wanted only 150% of poverty rather than 200%, and they erected some significant barriers that prevented children from signing up for coverage in Texas, such as requiring Medicaid kids to have face-to-face interviews before they were eligible to be enrolled. They were the kind of barriers that are significant in terms of preventing low-income families from signing up. So, there is certainly a difference in record and a huge difference in approach.

Position on Medicare
HHPR: What is the Vice President's position on Medicare reform?

SB: Medicare is a great example of the differences between the Vice President and the Governor. When Gore and Clinton took office, the Medicare program was scheduled to go broke in 1999. Because of changes we made, as well as the good economy, it is now strong through 2025, but there are important challenges left. With the Baby Boomers retiring, the Medicare population is expected to double from 40 million to 80 million over the next three decades. Gore believes that we ought to use this time of prosperity to prepare and save for tomorrow. He proposed taking Medicare off budget and putting it in a lock box, so that if the Medicare program is creating surpluses, we don't count thm as part of the budget surplus and spend them on tax cuts or other spending. Rather, we should save that money for Medicare and debt reduction for the future. Lots of Democrats and Republicans have endorsed this kind of idea. Governor Bush has not.

Gore has also been talking for a couple of years now about the need to provide a prescription drug benefit that is affordable and accessible to all Medicare beneficiaries. If you were designing the Medicare program today, you would never design it without a drug benefit, as they did in 1965. With more seniors and more progress in the health care system in terms of research and the available medications, we ought to make sure our seniors have access to these kinds of drugs. Gore has gone around the country and met people who tell him stories about cutting pills in half or skipping drugs and telling their doctor they donŐt need the pain medication because they can't afford it. That is unthinkable in this country and is not part of the guarantee, not consistent with the fundamental commitment and guarantee that Medicare should be. Therefore, Gore has invested $253 billion in the drug benefit that is a part of Medicare and is both affordable and accessible to all beneficiaries.

Governor Bush has yet to put out a plan, although he does now say he is going to put out one tomorrow. So, we are still waiting, but the kind of approach he has endorsed is run by private insurance companies who themselves say that they wouldn't provide an affordable benefit to the sicker population. Thus, Bush's program is going to leave out millions of people and leave millions without coverage. [Editor's Note: This interview was conducted just before Governor Bush announced his MediCARxES plan in early September 2000.]

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