Joshua Archambault on Obamacare
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Mar 30, 2012|
Mr. Archambault is the progam manager of health care and at Pioneer Institute.
Transcript - will not be 100% accurate
I -- I was I was you know when you go down in front of the Supreme Court elect to seal the signs like to hear the argument see the folks that are camping out overnight today. Heard about a gentleman that had been camping out three days before the hearings in order to try to be one of the 400 or so who went inside you that's correct and first and did he get Indian -- he did he did the -- the other hottest ticket was tired they are paying 600 dollars for a line -- for so if you look at for some good money you're in the sentinel -- So the Supreme Court doing their share tomorrow and turning up on climate -- Huh. Hot or you lawyer are you coming from a policy perspective on this time coming from a policy perspective my background so worked on Beacon Hill have a master's in public policy so I'd like to say that I went back to school. Can get a lot of grief but I have one year less of debt that to payoff so you have a perspective a legal perspective -- -- sent out certainly from a policy in the legislative perspective understanding how to laws are written in how to get implemented in and looking at the economics of it may be a lawyer. Doesn't have quite all that robust way to look at it but that's where I'm coming from Josh we -- we're told -- in the. Presidential debates -- the tenth amendment to the power of the states can do this so Mitt Romney makes a very clear distinction we -- to Romney care Massachusetts any state can do whatever it wants because it has that power. Inherent in its in it in its foundational documents. But the federal government can't do this now the left seems to me to be a little scattered after the three days of hearings and maybe a little bit worried about you know things that are gonna happen now they're -- -- how are how to -- might break what's your take after three days and you -- Listening to the arguments back and forth as you bring -- healthcare knowledge to have to bear on this. Yeah I think congress exactly right really thrilling questions and very probing questions from justices on both the last in the right. I think the folks on the left actually have a legitimate reason to be concerned with the how strong arguments were I think that the government's. Lawyer who might have done them a little distrust descending -- to defend the individual mandate so. If I was a betting man I would say 7080% chance that the individual mandate does go down I do think they're not gonna repeal the entire lot into a -- leave the Medicaid. Expansion on because that has weakest argument against it. Average do you think that that this could certainly shake up the presidential race coming up. Well help me understand the weakness -- of the Medicaid argument so let's just stay with Massachusetts anytime anytime number of times over the -- A number he has -- signed up and expanded the Medicaid program and goes 5050 whatever the share is going to be. Now comes -- -- along comes Obama camp. And they force an expansion upon the states and say well we're gonna do this but if you don't go along with this new chapter in our relationship. Everything how she did. It is just went you know it's the whole let's take an program the -- -- not a -- -- -- stop funding our -- how is out of it how is that not. Coercive how I feel that this is a voluntary consensual. Mutual arrangement to one now -- yet in the living daylights pummeled bottoming. Why don't necessarily disagree with the I'm not sure that justices feel that way but you don't know what gives you that impression because the from the discussion I heard. They sounded as upset with that notion as they did with the rest of why do you think the folks justice Sotomayor and -- and -- the Medicaid expansion actually is a great deal for states away -- the four leftists are devout. Nobody expects any of them to consider any thing but that what ever came out of the Obama administration is is fine. It doing ordering you may be surprised an individual mandate justice Sotomayor. Is specifically ask some very probing questions than -- crystal plus I use me Josh credibility questions what do you think the chances are in a while those I'm liberal justices. Goes with the constitution over the Obama administration and a half. Meeting question I think there yes you know I I I think. You'd be surprised. The level of a decision making some of these folks have made on past cases that you think there's a chance one of them will go against obamacare while liberals I'm not gonna put money down on it but I do think that you know it allows them to look a little bit more fair if they uphold certain provisions. I think they -- -- something along the lines of we don't think that this is the best public policy we think congress should go back in and fix it. Any day they could leave themselves a rundown allow congress to go back -- -- mean find it unconstitutional. They could it I think I think we be surprised by writing. Heck I'm out of it differ -- much smarter and name know this stuff better. But I think these people are ideologues and that the four leftists on the court will remain leftist even though they can look at the constitution and no. Every aspect of the slots patently unconstitutional for what it does to the country. But then it did the only people were flexible. I think this is funny because I was -- and my mother the other day who only gets her information through liberal prisons and all of her friends are liberal former professors so. All of it comes from context and she says do you agree. That the the court that the justices who are on the -- called conservatives then they're totally inflexible and none of them would ever consider voting the wrong way out and and I said no it's a matter of fact the reason there's a conversation here is because they're two of the five conservatives who could vote the other way. The people or inflexible. Are the four liberals it's impossible that many of them would vote to. To throw out the slot but you disagrees. -- -- I could give us an example for example of one of the surprising question you got from some of my -- -- I think she just have followed the line of Iraq questioning that some of the conservative justices have a on the individual mandate I'm not saying that she will rule that way I think there's a possibility. If I -- one of the more left leaning judges I would put her in that camp. Now with that being said before the case started a lot of folks -- Justice Scalia and Roberts could -- potential swing -- along with -- -- definitely -- to -- based on previous rulings especially first only on -- marijuana case so -- I just think that you know while we see the questioning and we hear it and everybody speculates based on the line of reasoning -- -- actually comes time to write -- opinions and and vote who knows -- a little -- no you're right but most -- servers were shocked at the vehemence with which the conservative side. Came out and was who was peppering with questions in that original statement. That Justice Kennedy made it work he said you're you're you're talking about. Changing in traumatic substantial ways the relationship between the government in the individual citizen. And that kind of stuff and everybody didn't I think it did and it was encouraging to those of us that think the federal laws unconstitutional however later in that hearing and again this is somewhat. The difficulty of not having media being able to report real time is that later and that same day -- Justice Kennedy ask questions they gave some court observers some questions about whether he really felt like. He's gonna vote against into the drama and it ultimately I think he will. I think -- a vote to overturn it for a variety of reasons. But I just think we need to be careful listen to the whole argument or -- no question and -- trying to gases is falsely except for those I think who aren't. Who know the nuance of it enough to know that this feels different than usual in today's articles so we we learn in this is how would I know -- on the US at the Massachusetts -- JC. They will vote on this today. They vote on and then the reasoning the review standards are not yet so yeah they're going to be in and out of there now and we probably vote no because -- that he would never really leaks out in terms of what the result is but we are going to know I'm curious Josh. You mentioned Beacon Hill and public -- you know pop. Health care policy is gonna have been you you you world experience. Do you think Romney -- is constitutional. Under the Massachusetts constitution and -- you know sorrow if so. Or what revisions. Authorized. I actually think that there's no question it is constitutional given. -- -- police powers that are given to these states. Their action this actually has been tested there was a lawsuit against the department of revenue Massachusetts. Challenging the individual mandate and the penalty and they have got they ruled against individual that suit and simply said look the federal government has and -- is in the state government has this power. It's not an unreasonable. Fee or penalty which we have SaaS and therefore we will not overturn a result -- -- I heard Howard Dean talking yesterday and he was saying it's so stupid that they have this mandated in their because is no need for the mandate the rest along would be fine without the mandate. And I was confused by that he didn't explain. How that could be because we know that the idea of the mandate is to force people who don't want or need insurance from their perspective like young people college I never. I never have for a in my twenties I never had a health care policies in -- full time job which might have been -- low thirties forties like. -- Unemployed and unemployable pop pop pop pop up. -- Why it was I I just I don't yet how you could create the -- for not forcing everybody who doesn't use the system. To buy health care how do you pay for everybody having health care I think governor dean wants -- to work towards a single Payer system anyways and it's a public option. But does that argument make any sense because the president when he was campaigning against Hillary. Her plan had the mandate he has didn't he argued against it in was he got to pay for. It's a very good question I think governor dean here's trying to make. -- and I've bad it's a good situation out of a very bad one for him I think he wants to justify the rest a lot to go back and look at his earlier comments. When this debate was happening he was very much pushing for -- public option saying this is absolutely necessary to really get to them the direction we want to move in this country so. I'm not sure I agree with him I don't understand how to financing would work out unless they assess somebody else to take more money out of Medicare or something like that too harsh harsher. -- us from the pioneer institute a local think tank and he is the director of health care policy there. We're talking about health care and their new book yet pioneer the great experiment the states the feds in your health care. Stay tuned for more Thomas Todd WRKO. Good -- not WR. Yeah and Josh Josh -- -- is I guess he's been held he had good. At the pride every institute so you've done the book at the pioneer the great experiment the states -- beds and your health -- The purpose of the book the findings the conclusions what's going on good morning guys have a plan alive yes sure -- the -- actions before. Purposes the first one is three wanted to put one place what happened in Massachusetts what was discussed what was -- -- -- out -- implementation as one data and it's all about. Where we are now what is it actually look like who helped give us quickie on that are they did -- how do you think Romney -- worked out -- So first I wanna say it important anyways issue because Patrick care because Governor Patrick as they implement has been largely responsible for it's a week document in the book at least six or seven different ways in which the law has differed. Implementation from what was actually pastor what was the understanding OK estimated. That from just a high level take away it actually depends on who you war so if you're an individual purchase insurance you've benefited greatly from the reform your premiums have gone down. You're small business you actually happened benefited all that much after Prius mania gone up slightly because of the reform. If you were -- at large company you are impacted by the reform how about the stayed on a macro level terms of cost of has the you know some people say it's at a couple billion dollars to the state budget tells what the financial impact so -- From our -- understanding and pulling apart the budget data it looks like the status of out on par with where I thought it would be spending line is the big difference and take -- has been the federal government has filled the gap. They've become much more is the federal government giving -- slot that's a little hard to tell him we try to pull it apart in the book but now. Due to the stimulus money and all that sort of things if you wanna pull apart and what is. What portion as the federal government picked up you know we're looking at somewhere between. Guy you know couple billion dollars actually -- federal government has put into the reform because it's extra Medicaid money -- stimulus and on them because in the qualitative terms as opposed to quantitative because it's difficult to measure. We have been they have given us a lifeline -- a -- substantial financial crutches to make it look as if it works is at an overstatement eyes slightly only because -- -- stimulus gave Medicaid money to every state. So we need to put a little bit context dying you know -- in the national setting here that because -- downturn things that tend to have cost or is it not possible -- if you two did to pull the numbers apart and say how much more this is costing so it's much easier to tell you how much the state has paid and that's in the book like you're saying that's basically where they thought they're going to be. Paying for insurance or Medicaid currently says the state spending about 373 million dollars this past year on reform directly tied to expansions and reform. So I mean in the grand scheme of things by 2526. -- mean dollar budget that's on them myTouch ram but there was no we can't answer whether it's the mass of the state Massachusetts's. -- -- Beat substantially more like the couple billion you're talking about that's against number so we know we can say how much the state is paying it's a little bit harder to -- are much the federal government aid and that's about it because I don't respect gets out of the federal government Sox -- them money we were gonna have to start -- so that's where it's important -- know the answer is absolutely true we -- a from a very high level we just haven't been able -- -- -- as as deep as we want to. But just -- clinic and a second part of the book is we what we wanted to do for a number -- experts together including the dean of our medical scored a couple folks from DC to think about. How'd you reset the relationship between the states -- government health reform so we basically in essence lay out a blueprint of how you move forward here. And I think very timely given Supreme Court hearings and -- a lot does it. And you know repealed or struck down at some portion -- lay out a number of different policy proposals that we think the country shouldn't torts are well adapted so we. What's the best case just give us one planned. For health care. So we we compared to the last entitlement reform happen in the mid nineties which is welfare reform. The best way to go about doing major reform across the whole country's for the federal government to. Authorized waivers and courage waivers and sent out the policy goals that we wanted to reach so you -- back to doing it covers would be. You'd take the Medicaid money but you don't have to follow the Medicaid rules come up with your -- correct that we there's great accountability there just like -- health care we say here's our eventual goal going to more folks off Medicaid into private insurance. Yeah yeah oddities of the goals that we -- reached he's got great flexibility to get their the other one is doing with this pre existing condition issue came up multiple times during the federal debate. We look at the best estimates that's two to four million folks in our country. Have really only becomes an issue when you change jobs or you move states so we want to state based high risk pools to be able to get those folks are pretty -- you're saying roughly 1% of Americans have a pre existing -- going to be that few. So it's heated political debate here right so. -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- You're looking at some are about 4500 dollars per person so all you would have to do is do what they do and car insurance in Massachusetts which is say ever insurer has to take their fair share. Of these people lower cost you a lot of money you can tune him up even have that federal government paid for and that's or advocate for a -- if you do the estimates are looking somewhere between fifteen to twenty billion dollars a year they can pre existing. Condition issue. Price over ten years 150 to 200 billion dollars. As a much different stories and Democrats than a trillion plus a live their dream for twenty billion dollars before we get that Democrats don't want the thing for them yeah I -- and a half hot dogs not even hot hot hot. I wanna ask a question about emergency room utilization. One of the theories of Romney care obamacare is she we get all these people clog an opt in if they just at basic insurance that would not happen and yet the statistics the year of the show. That people keep showing up in the same number is still overwhelming emergency rooms in the most expensive way. Usually the most inappropriate place to get treated how come. That issue has not been solved by either Romney Kia. You know what will be a -- question I think this is an example -- academic theory meets reality. Everybody stop when the reform passed. This is game once -- insurance credit stop showing up to emergency room that has not happened. However there's a slight silver lining here which is the percent increase in visits to emergency room have plateaued the last few years so that's. Why would anybody think it emerges or restore 24. Why would you stop on -- 24 because somebody says you know use the supermarket. That's stupid well in theory typically have to pay more to show up to emergency room and you went to have to go to regular doctors hope it would be different amount you -- at issue here is we didn't fully understand how hard it is to change behavior lifestyles -- or even -- could be other reasons here and that's definitely needs more research but. Maybe folks -- just an emergency room -- their job schedule but can't simply make an appointment during the day because their work. People are under a lot of stress if you lower socioeconomic -- in -- more stress yet. And one more -- -- subway ride or what have you missed an hour work a couple of hours can be tough especially in down economy I think this is a broader discussion too and our state we moved a little bit in the direction allowing minute clinics. Think we need -- the legislature needs to move forward with a lot of different reforms to allow our health care system that much more flexible and accommodating -- I -- -- -- -- volatile time we -- -- all got our -- dog yeah -- -- to have you back and do more help yourself if your -- happy to do some good stuff John Harris -- a pioneer institute. They've got a book out called the great experiment the states the -- in your health care which basically he's just given us an overview. Is an outline of how to solve the health care problem in America coming up Jeff -- joins us for. His weekly visit from The Washington Times it's Thomas Todd WRKO.