Salud Carbajal, One of the Problem Solvers, Part 2

Published: September 20, 2017

By Jim Lichtman
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Senate Republicans are making yet another attempt at repealing The Affordable Care Act, this time, under the guise of the Graham-Cassidy bill which would impose stringent cuts to Medicaid.

“Eleven governors, including five Republicans,” The New York Times writes (Sept. 20), “urged the Senate to reject a new push to dismantle The Affordable Care Act.”

Republicans are using the same strategy Congressman Salud Carbajal talked about in Monday’s commentary: the current bill has not been scored by the CBO; there have been no substantive hearings; and Senate Republicans rejected proposals by Democrats for bipartisan support. It is, in fact, yet another piece of legislation that is being rushed to a vote by the end of next week.

I continue my conversation with California Congressman Carbajal regarding health care and his participation in the Problem Solvers Caucus, a group of Republicans and Democrats committed to finding bipartisan solutions.

Last week, Vermont Senator Bernie Sanders began pushing his plan for a single payer system, “Medicare for all.” I discussed this single payer idea with Carbajal.

Lichtman: I recently read economist Robert Frank’s commentary about how a single payer system could work.

Frank writes, “Total costs are lower under single-payer systems for several reasons. One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers. Single payer systems also spend virtually nothing on competitive advertising, which can account for more than 15 percent of total expenses for private insurers.”

Why don’t we hear more about this?

Carbajal:  I think it’s something we can move towards. I tend to agree with a lot of the arguments that are being made. But what they won’t tell you is that the single payer bill that we’re considering right now, is not Medicare as you and I know it and as Frank talks about.

Right now, Medicare has a public component that’s overwhelming the framework of it. It also has a private component which is what makes the system work so well. The single payer that is being proposed is all government run, and in order to get there, there are some conversations we need to have.

We need to score it [through the Congressional Budget Office], just as the Republican majority score their proposal, so that we understand the actual cost of it.

Has there ever been a CBO score on the single payer bill?

To date [July 29], this particular bill hasn’t had a score. But that’s a good question.

The bill being put forward is all government run. Frank is right, there would be savings from no advertising. That’s why one of things that we need now before we get to such a single payer is a public option, which is step number one, to show how we can make either Medicare work better as an alternative to everyone, or to the rest of the exchange options that exist. It would also abolish the American Indian Health Act, and the V.A. system, because you can’t have two systems. So, we have to work our way through that.

Quite frankly, this repeal wasn’t even about making a better health care system. It was about an ideological issue where the Republicans said, “We said that we’re going to take this back. Let’s just undo it, period.”

I think to be able to fight that and at the same time, try to explain what single payer does or doesn’t do, detracts from Republicans being accountable to the proposal they’re trying to push forward. That’s why it wasn’t right for many Democrats to come on board.

I’m open to single payer. I think it has potential, but again, moving beyond the concept, we have to work together to look at all the details of what it means and what it doesn’t mean.

Have you discussed this in Problem Solvers?

Republicans in Problem Solvers see this as socialized medicine, and they’re not willing to go there.

What do they say?

Well, right now we’re just looking at whether we agree on the current system that exists.

And what do you agree on?

Most important is keeping the individual mandate. We think that the individual mandate is what makes this whole system work. Several Republicans want to get rid of it. We’re trying to negotiate to keep it in, but maybe we should raise the level of employees that require companies to buy insurance.

The employer mandate created two-million new residents that now have insurance that didn’t have insurance before. That’s very important. So, we are appealing to Republicans and say, “Hey, don’t get rid of it, but if you want to modify it from 50 to 250, or 500 employees, let’s explore that. But let’s keep it in.”

This is what’s so frustrating to many Americans — the endless wrangling over different components. There’s a faction for this component, a faction for another, and it turns out to be an endless negotiation concerning who gets what without giving away something else. This is why the simplicity of  a single payer system is appealing.

If I want to drive a car, I’m required, by law, to buy car insurance. There are statistics that take into account my age, location, my ticket or accident incidence; and then I pay X.

And that’s the individual mandate. I will tell you that Republicans are for insurance. From what I observe, their argument is that government isn’t providing the insurance. It’s the private sector that’s providing the options.

So, how do the Problem Solvers strip away the partisan aspects and deal with the issues themselves?

That’s what we’re starting to do. We’re a fledgling group. We’re struggling to do that. We were a little late in doing this, because, initially we thought that might be too big of an issue for us to start our short wins, and then we saw this failing [of the “skinny repeal” of The Affordable Care Act], and thought, it might be an opportunity for us to strip away all the B.S., all the partisanship.

We agree on the problem, and we agree on some basic solutions and we’re working our way through those.

I will share with you [the Problem Solvers] initial guiding compromise framework of what those issues are after Monday, and then I’d love to continue the conversation.

I hate to sound cynical, but how do you know that there aren’t some moles in this caucus who might try to undermine the bipartisanship process?

I’m sure there might be one or two. But unless you resign the caucus, you’re included in whatever we come up with. So, if you remain in the group and we reach agreement on something, you are tied with the rest of us to whatever proposal we come up with.

There’s nothing to say that anyone can’t vote against it on the floor, but from our position, if 75 percent of the members agree, you are part of it.

Friday’s Conclusion: how do you remain true to your guiding principles and avoid extreme partisanship?


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