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

Interview with Sally Canfield, Domestic Policy Advisor to the Bush Campaign
Interview conducted by Clay Ackerly
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HHPR: How did you get interested in health care?

SC: I was working as the Government Relations Representative for Caremark International out of their corporate headquarters in Chicago. That was during the height of the "Hillary Care" bill. It was a baptism by fire for both the company and for me. Ever since then, I've been really interested in the topic.

Then, I moved to D.C. and started working for a member of Congress, Mac Thornberry from Texas, who was a Freshman elected in 1995; I did his economic work: health, tax, social security and the budget. Then, six months later, I got a job with Jim McCrery, a member of the House Sub-Committee of Ways and Means that dealt with Medicare. So, it has been an evolving issue for me. Since I've gotten into it—from the business side as well as the government side—it has been one that has intrigued me and continues to intrigue me.

HHPR: What is your position in the Bush Campaign?

SC: I am a domestic policy advisor. I cover health, veterans' issues, Native Americans, agriculture and a few others. But, my primary portfolio is healthcare: Medicare, the uninsured, and long-term care issues - really, all the health care world entails.

HHPR: Are there additional resources at your disposal to help you? For example, I just read an article that mentioned John Goodman of the National Center for Policy Analysis as an advisor to Bush.

SC: Well, that's an interesting question. I view [the other Bush advisors] as an ad hoc group—people like Bill Roper, who was head of the Center for Disease Control (CDC) and Health Care Financing Administration (HCFA). He's a guy I talk to a lot. I also talk to former Hill people, as well as physicians and providers from across the country. As for some of the big names in the health care world, such as John Goodman, Debbie Steelman, and Gail Wilensky, they're people I turn to for advice depending on the issue. But, at the end of the day, it's really all me, unfortunately. It's a lot of work.

Three Most Important Issues
HHPR: What are the three most important health policy issues facing the country today in the Governor's mind?

SC: One critical issue is the aging of the Baby Boomers and how our existing government programs are going to cope with that. Long-term care is a sub-set of that issue and will prove to be very difficult as the Baby Boomers start to age. In fact, we're already facing the challenge of an aging population as the Baby Boomers start having to take care of their parents. We no longer live like my grandparents did, where you had several generations of people in one building or on the same block, where everyone took care of everyone else. Instead, you've got situations where families are spread across the United States. You're also dealing with natural aging issues: should Mom and Dad live at home? Do they need a nursing home? How do I pay for it? So, I think that the aging of Baby Boomers is going to prove to be a big issue - an enormous challenge - as we go forward, from both public health and financing perspectives.

I think a second important issue is the growing number of uninsured people. What are the causes? The solutions? It's something that has perplexed both Republicans and Democrats. It's also something that will continue to grow, because of financing as well as choice issues. For example, more and more younger folks, or even middle-aged people, take jobs that don't have benefits. Benefits are not a big issue in some cases. Take the kids at these dot-com companies. [Health insurance is] the last thing they're thinking about.

But for a viable insurance market to work, you have to have both the young and the old, the healthy and the sick, and there has to be a large enough pool so that costs can even out. If you don't have the younger component, you're going to have an insurance market that's out of whack. So, we have to deal with these issues in a rational way - one that doesnÕt involve a continued expansion of government programs. As we've seen overseas, you run into an enormous number of issues if there is too much government involvement.

Then, I think the third big issue is the direction of medical technology. I think that with the cracking of the human genome and mapping the genetic code, we're going to have a lot of ethical, financial, and public health issues.

Main Differences with Gore
HHPR: Where do you see the Governor and the Vice President differing the most in their views?

SC: I think it is this: I call Vice President Gore's plan, "Program Creep." It would expand the Children's Health Insurance Program, which is a federal block grant program established to help states cover uninsured children. You can call the Gore plan the devolution of the CHIP program, if you want. He's expanding the CHIP program to include parents. Half of the states in this country have chosen Medicaid expansion as their CHIP program. Gore has, in effect, just expanded Medicaid to cover the CHIP population.

He would also expand Medicare down to 55 year-olds. There are two problems with this approach: first, you have not helped the people in the center who must rely on the private sector; second, you are relying on public sector financing to be the panacea for health care problems. Governor Bush has a 180-degree opposite view. Governor Bush believes that weÕve got to re-engage the private sector constructively in this effort, and he also believes that we need to help those people who are above the poverty level, but who either do not qualify for, or cannot afford, adequate health care coverage. The Governor calls these people "between poverty and prosperity." We need to assist them in buying a private sector plan that is their own: a plan they can pick and can "own," if you will.

Position on Medicare
HHPR: How would the Governor reform Medicare?

SC: Medicare today is basically one big HMO - of the worst kind. For individuals, Medicare decides what will be covered and then doesn't let people go outside the system. For doctors, Medicare decides how much they will be paid, if it pays for the procedure at all.

Governor Bush believes that Medicare should be reformed to reflect the fact that the senior population is a diverse population, and one size does not fit all. He wants to reform the program so it's both financially stable and also structurally stable. He believes that we should look at a model like the Federal Employee's Health Benefit Program (FEHBP), where each person gets a menu of options. The government says, "this is the chunk of money you get this year. Some of the choices are subsidized fully by the government. If you like one of these, fine. However, you can also choose one where you have to dump in, say, fifty bucks more per month of your own." So, the Governor's plan is based on a model not of the government controlling the health care choices, but offering the ability for seniors to make the choice for themselves.

HHPR: I know that a lot of seniors don't want to make that choice. Some are happy with what they have, and some are afraid they won't make intelligent decisions.

SC: That's right, and that's why Medicare, in it's current form, would remain a choice. The current Medicare program would be on the menu of options. Under the Governor's plan, Medicare, in its current form, would submit a plan to what we call the Medicare Board, which would operate somewhat like the Office of Personnel Management does today for FEHBP. They look at the structure of each plan, whether or not it is financially stable, and whether or not it is offering the benefits it is supposed to be offering. So, the current Medicare plan would have to go through the same process as the rest of the health care plans would. For those seniors who want to keep their Medicare program, there's no problem. They can certainly stay in the present system.

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