P.O. Box 409095
Chicago, IL 60640
Length: 8 minutes, 33 seconds
Interviewer: Neil McLaughlin
Interviewee: Chip Kahn
[00:00:00.00] OK. Were talking with Chip Kahn of the Federation of American Hospitals, and I wanted to ask you about healthcare reform. The Federation has made its own proposal in this regard. There are numerous proposals out there. What do you foresee for the future of this?
[00:00:23.18] Chip Khan: Well, I think were at a new period that may be equivalent to 1992, to the extent that there is a real groundswell out in America about healthcare coverage and about covering all Americans. If we look at any poll today, a poll that we took a few weeks ago prior to the announcement of our plan, there is tremendous support today for a real healthcare reform that would include covering all Americans.
And if you look at the funny side of it, theres a Clinton running for president. Theres a Bush in the White House. There are a lot of, of factors that are, the number of the uninsured has been going up. All those factors are the same. So, Im very optimistic that were beginning a national conversation about healthcare coverage and, you know, one would hope that something could happen in the near term, in this year or next year, regarding covering all Americans. But realistically, I think this is a conversation thatll extend over the next two years and that in 2009, that well have a real opportunity to again address this issue thats important to so many Americans.
[00:01:38.14] Neil McLaughlin: During the previous healthcare to date that you referred to in 92, there was some worrying amongst the various interest groups. Do you think well see less of that this time around? Or will there be more cooperation, do you think?
[00:01:55.09] Chip Kahn: At the end of the day on any kind of social change that says, that would be as big as a national program to (ensure) everyone coverage, youve got to have all the major players either rowing together in one direction, or at least all only a bit dissatisfied by the outcome. Or all equally a bit dissatisfied and everybody feeling that at least the right thing was done.
And so I think its gonna take real leadership from a new White House with the right kind of combination in Congress that seek compromise; and where everyone listens to everyone else. I mean, if were gonna have a private/public partnership in healthcare coverage, which we have today.
Lets be frank. We have public programs, Medicare, Medicaid and the Childrens Health Insurance Program. We have 42%, 45% of all healthcare spending for delivery covered by government in one form or another, a number thats growing. On the private side, we have private coverage. I mean, everyones gonna have to work together to come up with a plan thats gonna cover the gap for the 47 million, 46 million uninsured.
And I think its the kind of thing where its gonna have to be a little bit of public program, hopefully the preservation of a private insurance market place and private coverage. But thats gonna have to be subsidized because most of the uninsured are low income. Or at least lower moderate income.
[00:03:33.18] Neil McLaughlin: Going to another subject, specialty and physician on hospitals. Recently theres been some action against a couple of such hospitals that were prominent in debates on Capitol Hill. How do you see this issue playing out over the next year or so?
[00:03:52.07] Chip Kahn: Well clearly, youre correct, Neil. There have been some incidents recently that make one pause about specialty hospitals. At the end of the day this is a complex issue. But Im not confident that the last Congress or even CMS has given it the kind of attention (to) give or set the policy direction that we should have and that Im ... I see in the new Congress that recently was elected and came into office, and particularly with the leadership in the Senate, two Sens. (Chuck) Grassley and (Max) Baucus, as well as in the House, Congressman (Charles) Rangel and Congressman (Pete) Stark. They seem to understand the issues that the specialty hospitals position with physician referral and ownership raise. And I think that well see the possibility for some legislation here. Up to this point, the administration and the last Congress, I think, let us down on this issue and didnt face the facts of the problems that these institutions, from a public policy standpoint, confront us with.
[00:05:06.20] Neil McLaughlin: And one last question on physician payments. There is, Congress has sort of left this issue unresolved for a couple of years now. Physicians are complaining about Medicare payments and the hits that they may have to take in the future. And our magazine did a story about how hospitals are worried about how this may affect them. Again, what do you foresee happening and not happening?
[00:05:39.21] Chip Kahn: Well, first let me say some of the problems in the system that come from physician ownership and referral problems that come from on-call, a lot of these problems come back to the fact that Medicare is not paying physicians sufficiently. And its even doing worse because of the way the formulas work. Its threatening their payments every year with real reductions. And I think its reprehensible. I think its obviously turned out, whatever the initial intentions for the policy, the policies arent working.
No policy of payment for any professional would be designed, was designed, with this kind of result in mind, but the result is there; and so action is needed. And dealing with it on a yearly basis, as Congress has been doing for the last few years, is putting the physicians through Chinese water torture frankly. And I think something needs to be done to fix the physician payment system. They ought to get fair increases and fair rates. And whether itsand I think thats true throughout Medicarewhether its free-care hospitals, long-term-care hospitals, skilled-nursing facilities, rehab hospitals, physicians, home health agencies.
Medicare is purchasing services and theres an expectation that all of us are gonna provide the kind of service that seniors expect and deserve; and theres no free lunch here. And for Medicare, in the various cases, to treat it as such, I think is at least problematic. At worst a serious issue that public policymakers have to face up to.
Now, fixing the physician problem, because of the way the federal government does its budgeting and because of its artificial budget baselines costs money. But to think of any federal policy having the effect of the one the formula does on physicians is, is sort of absurd or unreasonable on its face. So I think Congress just ought to bite the bullet and figure out a way to refine this process so that physicians get a fair increase annually and get a fair rate. And I think itll make the whole healthcare system work better. I think all of us in the healthcare system ought to get paid for the delivery of, the fair delivery of services. And when you dont get paid, it means youre not, youre not available or you have to find the funds elsewhere to cover the services for seniors. And Medicare ought to pay its fair share. Thats the bottom line here.
[00:08:31.16] Neil McLaughlin: Thank you very much, Chip.