Interview with Sarah Bianchi, Deputy Issues Director to the Gore Campaign (cont.)
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HHPR: I believe your plan says that it will take over eight years to phase in. Why did you decide to do that, and what are you going to do to protect seniors today? SB: Well, first of all, in the very first year seniors would get half of their coverage paid for up to $2,000 of their cost, and they would get the $4,000 catastrophic benefit, with low-income seniors getting the full protection. So, even in the first year, it's a strong benefit and far better than most seniors have today. We did phase it in to make it affordable, and to make sure it's working right, but even in the first year it provides seniors far more protections than are currently available to them.

HHPR: A few more questions about Medicare: You said that Medicare is projected to be solvent until 2025. Has Gore proposed anything to increase the long-term solvency of Medicare?

SB: He has proposed taking Medicare off-budget and putting it into a "lock-box," so that all the surpluses go towards strengthening the program. That plan is projected to strengthen the program until at least 2030.

HHPR: The Lewin Group recently came out with a study about HCFA and Medicare and how the latest technologies take 15 months to about 5 years to get into the hands of seniors while they are available today to most people in private insurance plans. What is your reaction to the study?

SB: I haven't heard about the study, but I think it's an important issue. I think that we ought to look at how efficiently run the program is. One of the things Gore has proposed relates to preventive benefits. It is sort of the same situation when we get a new technology (like colorectal cancer screening) that we know is incredibly effective and will impact the elderly. We don't enact the program quick enough, even though we know it can save lives and has the potential to save costs, as well.

Gore has proposed what we call a "fast-track hurdle" for prevention. If there is a benefit that appears cost-effective, the Secretary would appoint a group of scientists and medical experts to make the determination that it is cost-effective and also an effective prevention technique. Then, Congress would have 90 days to vote up or down on it. If they don't vote at all, it would automatically become part of the Medicare program. That's an effort to make Medicare more responsive to some of the changes that we've seen in health and technology and biomedical research. Gore certainly would be open to looking at other issues, as well.

HHPR: Why limit these plans to preventive medicine?

SB: I think we were trying to do something that would be cost-effective. You don't want to have too many changes, but I think the Vice President would be open to looking at other parts of the program, as well. You always have to evaluate these technologies in terms of the affordability of the program and whether they're good for the program. However, if there are technologies that would improve health, then we certainly ought to look at quicker ways to make HCFA look at them.

Medicare+Choice
HHPR: What is the Vice President's view of Medicare+Choice - where it has succeeded and where it has failed, and why?

SB: Well, I think his views are that choice is a good thing, and giving seniors more choices in the program has been a good thing. We ought to have options for people. He acknowledges some of the instabilities in the Medicare+Choice program. Actually, one of the things his drug benefit proposal would do is finally to reimburse managed care for the benefits of their providing prescription drugs. This would help stabilize the market to some degree. He also acknowledges, though, that managed care for Medicare is never going to be universally available. It may never be available in some rural areas and other places; you need to have a strong fee-for-service program there. He was concerned about a number of the premium support ideas that were designed to encourage more people into managed care, to force people into managed care, because it would have the impact of making traditional premiums higher. He thinks that we need to have a strong fee-for-service program, but that we need to work to stabilize managed care and give beneficiaries choice where it makes sense.

Technology and Costs
HHPR: Many economists believe that technology is the main historical driver of increased health care costs. Do you have faith that modern technology might actually bring down costs?

SB: Al Gore is a big fan of the potential that technology can bring, and if you think of the progress we've made in this century, it is significant in terms of everything from penicillin to critical technology. He believes that with the completion of the genome project and enhancements in technology, there is potential for lower costs, because one of the things that new technologies are going to be able to do is to help us diagnose and detect things earlier. One of the things he has focused a lot on is cancer. The potential in cancer is that you are going to be able to treat it far more significantly with technology and diagnose it much earlier when it's much more treatable. So, I think there are potential cost savings. Obviously, there will continue to be technologies that are developed that will be expensive. But I think that it can cut both ways. Government Encouraging Personal Responsibility

HHPR: Many health problems can be helped or prevented by simple lifestyle changes. Do you think there is a role for the government to encourage personal responsibility?

SB: I think that the government needs to get out information about good health and good prevention. I think that schools and communities ought to be doing more to encourage healthy lifestyles, to get the message out about good eating habits and good exercise habits. The Gores have practiced that in their own lifestyles and are very committed to healthy diet and exercise. There is a responsibility of the government to help make sure people have the information about what science and research show again and again. Much of it is preventable, and we all have a responsibility through schools and communities and senior centers to help people to adopt a healthy lifestyle.

Health Care as a Right
HHPR: Do you believe, or does the Vice President believe, that access to health care is a right?

SB: Gore believes that everybody in this country ought to have access to affordable health care coverage. That ought to be our goal. That is his goal. He believes, based on what he has learned with his vast experience in public service, that the best way to get there is to move step-by-step, aggressively and ambitiously, while improving the confidence of Americans that we can effectively expand coverage in a way that meets a balanced budget and in a way that is efficient and targeted. He believes that we should all work to the day when every single American has access to affordable coverage.

Areas of Agreement
HHPR: Are there any major policy issues on which the Vice President and the Governor agree?

SB: Well, I noted that the Governor praised Gore when he put out his mental health agenda. But, I don't really know whether he would endorse it.

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