Interview with Sarah Bianchi, Deputy Issues Director to the Gore Campaign (cont.)
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Cost of Gore's Plan
HHPR: The Vice President has proposed several health care plans. Do you know how much all of them would cost?

SB: He has invested $338 billion in Medicare. That includes the prescription drug benefit, and it also includes some money to extend the Trust Fund. It also includes some money for health care providers. That is in addition to taking Medicare off-budget. On the coverage side, he has proposed $146 billion and then another $50 billion for long-term care, research, mental health, those kinds of things. So what does that add up to? $534 billion, plus taking Medicare off-budget.

Reaction to Failure of Bipartisan Reform Initiatives
HHPR: What is the Vice President's reaction to the failure of the Bipartisan Commission on Medicare to produce Medicare reform?

SB: Governor Bush has criticized us quite a bit for our failure to endorse those controversial structuring reforms. The Vice President is for bipartisan reform, and he has worked in a bipartisan way to strengthen Medicare for 26 years since he has been in office. However, he had a lot of concerns about those restructuring proposals, including the proposal to increase the age eligibility at a time when Americans aged 55 - 65 are the fastest growing group of uninsured. He doesnŐt think we should raise the eligibility age without good alternatives for most people to get affordable coverage. We need fewer uninsured people in this country, not more. He was concerned about the premium support idea that reimbursed average health plans and had the impact, according to our actuary, of raising traditional fee-for-service premiums up to 47%, thereby coercing some beneficiaries to be in managed care. He had concerns about that.

He wants managed care to be an option, but he doesn't want people to have to go in because we are raising traditional premiums. He was concerned about a drug benefit that was a low-income-only benefit, because we know that 50% of those without coverage are in the middle class, and he was concerned that there were no proposals to extend the life of the Trust Fund. After the Bipartisan Commission failed, the Administration did put out a policy. So we want to get Medicare reform, but we want to do it in ways that would strengthen the program.

HHPR: Does the Vice President not support any of the bipartisan bills as they stand today?

SB: There are bills that he supports. I mean Senator Graham's prescription drug bill has some Republicans on it. But he does not support the Breaux/Frist model or the Medicare Commission model.

Public System v. Private Market
HHPR: Does the Vice President have faith in the Government's ability to deliver health care adequately?

SB: His plan reflects his belief that in some places it is appropriate for the Government to be involved, and sometimes there are other ways to promote good health. When you have private insurance saying they are not going to provide a Medicare drug benefit, you have to take them at their word, and I think that the Vice President believes that through Medicare we can offer an affordable benefit. It is the same analogy as before we had Medicare. Only about 50% of seniors were insured at all because the private insurance market was not responding well to a population that was sick and unhealthy. In other areas, it needs to be state and federal governments working together, such as in the case of the Children's Health Insurance Program, and in still other areas, such as in his small business proposals, Vice President Gore would give tax incentives to help employers provide more affordable coverage. So, in certain places he thinks the federal government plays a very strong role, and in other areas it is more appropriate for other actors.

HHPR: What is the Vice President's view of the involvement of the private market in health care? Does he believe that the market alone can deliver health care?

SB: No, I don't think alone it can. I think that, particularly for sicker populations, it is very difficult.

HHPR: The Vice President is trying to expand the public system by both creating a children's benefit and extending Medicare to 55-year-olds, but he has not proposed any universal benefit at this time. Therefore, if he could ideally draw the line between where the private and public sectors' involvement meet, where would that line be?

SB: Well, I think it's hard to draw a straight line. For the low-income children, we know that most of their parents aren't offered private coverage. In fact, he has proposed extending the CHIP program to the parents of these children, which is actually a pretty large population. The reason is that we know that 85% of those people are uninsured today. They are obviously not getting affordable coverage through their employers. Therefore, a state and federal partnership for those low-income families probably is the best way to go.

Similarly, 55 and 65 year-olds tend to have pre-existing conditions, tend to get sicker, and then to get priced out quite high in the individual insurance market with premiums of up to $1,000 a month. So, allowing that population to buy into Medicare in a way that keeps Medicare strong gives them a more affordable premium and a way for a sicker population to get coverage.

For a healthier population, he thinks it is appropriate to provide market-based incentives. For instance, there are some things you can do to strengthen small businesses within the private insurance market. One of their problems is that they don't have the leverage to buy affordable coverage; they don't have ways to spread their risk. So, if you help them band together into voluntary purchasing coops and give them tax incentives to make premiums more affordable, then the private insurance market works quite well for that market.

So, Vice President Gore looks at each problem in a targeted way. He thinks that the private insurance system that we have today works quite well for a lot of people, but he wants to make sure that we don't propose it for the places where it's not going to work. I would argue that the Republican prescription drug benefit that gives seniors a small subsidy to go buy private prescription drug coverage, when the insurance companies themselves say there is no way they would offer it, is an empty promise. That's an example of where Gore thinks the private insurance market won't work, and, incidentally, the industry agrees.

HHPR: When Medicare was passed, a lot of people who were supporting the bill wanted universal coverage, but they thought it was not politically feasible at the time. So, they looked at the most politically viable sub-sector of the population, the elderly. You said earlier that the Vice President was hoping for universal coverage eventually, but that he is not proposing it now, because it is not politically feasible. If he could get any health plan he wanted enacted today, what kind of health plan would it be?

SB: That's a good question. That is something you would have to ask him. It is hard outside of the context of politics and the campaign to sort it out that way. I think that what he wants to do is to move as fast as we can within the context of what is politically realistic, what's feasible. That means being aggressive and ambitious. It means moving step-by-step as quickly as we can and improving confidence that we can, so that we can keep moving forward. But, in a world without politics, the steps would probably come even quicker.

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