Reform, it's still debatable

The 450 people who attended the Colorado Health Foundation's sold-out 30th annual state health symposium were an interesting mix to say the least, but you know what you're getting into when the opening night's “entertainment” is a debate on whether the Patient Protection and Affordable Care Act should be repealed and it actually turns out to be a fun event.

“This will not be a shout fest,” said moderator Anne Warhover, the foundation's president and CEO. “It will be entertaining but, hopefully, the debaters will use facts to make their points—what a refreshing idea.”

The debaters, all apparently well-known to the local audience, consisted of Jon Caldara, president of the Independence Institute; Len Nichols (whom Warhover introduced as “the infamous Dr. Rev. Len Nichols”), director of the Center for Health Policy Research and Ethics at George Mason University; journalist T.R. Reid (whom everyone called “Tom”); and Grace-Marie Turner, founder and president of the Galen Institute.

Three agreed with the debate's resolve that the reform law should be repealed. Caldara said so because “Obamacare is unsustainable.” Turner said market solutions were needed to solve the problem of the uninsured; and Reid argued that universal coverage was needed and the Affordable Care Act “didn't get us there.”

Only Nichols argued against repeal, saying that it offered an efficient way to cover the uninsured.

Before the debate, the audience voted electronically on whether they agreed or disagreed with whether the reform law should be repealed and with which debater's position they most agreed. Voting results would be revealed after the debate, and Warhover called on the audience to keep an open mind no matter how firmly committed they may be one way or another on the subject.

Turner began the debate by stating how “we absolutely need” healthcare reform and universal coverage, but—to get there—a properly functioning insurance industry that offers consumers affordable choices is necessary. She added that conservatives did a poor job of advancing this vision during the healthcare reform debate, and so now the nation is stuck with a law that will have many unintended consequences, such as employers dropping coverage for their workers. In closing, Turner noted that the current system's incentives are aligned in such a way that stakeholders spend their time trying to figure out “how to jump through Washington's hoops” rather than seeking a way to provide affordable healthcare and affordable health insurance.

Reid began by saying a rich, equitable and ethical democracy ought to provide healthcare insurance for all that need it, and he summed up his argument with a statement suitable for bumper stickers: “If France could do it, the USA could do it.” Reid noted that the Affordable Care Act is headed toward the U.S. Supreme Court where five conservative justices will jump at the chance to shoot it down, which he added would be the best thing that could happen because it will liberate politicians to develop a new plan to achieve true universal coverage.

Caldara, who describes his Golden, Colo.-based organization as “Colorado's free-market think tank,” began with an old joke about the French Army before acknowledging that he already knew he would lose the debate but that didn't discourage him because “Somehow I'm the guy who keeps rooting for the Washington Generals over the Harlem Globetrotters.” He went on to compare and contrast auto and health insurance before noting that “a beautiful thing happens when people spend their own money, they spend it more wisely.”

Nichols began by acknowledging that Caldara's jokes had scored with the audience. “You know you're in trouble when the libertarian is that funny,” Nichols said before explaining his position that the country needs to build on what's good in the Patient Protection and Affordable Care Act and amend it where necessary. Most importantly, he said the reform law created the tools to move toward a system that rewards value over volume. Nichols also received applause when he questioned the current Congress's ability to write replacement legislation and, after referencing the debt ceiling debate, he asked “Does that give you confidence in Washington's ability to hold an adult conversation about anything?”

The debaters then asked each other a quick series of questions, and Turner defended her position by noting that creativity is needed but the healthcare system's problems are not going to be solved by the reform law that she compared to a “Rube Goldberg contraption.”

Caldara said that government has a role in enforcing contracts, leading a military and providing a safety net. Providing basic healthcare, however, is not one of those roles and he bolstered his argument by noting how many Canadians come to the U.S. to get medical treatment because of long waiting times in their own country.

Reid countered that argument by telling the story of a 58-year-old man who needed knee-replacement surgery but couldn't afford it until he became eligible for Medicare. “He has a seven-year wait,” Reid said.

In closing, Nichols said discussions about healthcare reform have become so toxic that “You can't talk about this stuff in our country without making half the population mad and the other half scared,” so starting over is unrealistic. “This is it, sport fans,” he concluded.

The audience was quizzed to see which debater they were most surprised to find themselves agreeing with. The vote went Reid, 33%; Nichols, 21%, Caldara, 16%; Turner, 14% and the rest a mixture of undecided, and all or none of the above.

Then the vote came on whether the audience agreed or disagreed with the debate's resolve that the reform law needed to be repealed. The pre-debate total was revealed to show a 21-79 split in the audience between those who agreed and disagreed that repeal was necessary. A few seconds later, the post-debate totals were shown to be exactly the same.

“What happened to all those open minds?” Warhover asked.

A little more open-mindedness was shown in the pre- and post-debate totals revealing which debater the audience said they most agreed with. Although Turner had only a small minority of the audience in agreement with her, she changed the most people's minds. Before the debate, only 3% of the audience agreed with her; but afterward, 9% did for a six-point swing. The biggest drop was for Caldara. Before the debate, 10% of the audience agreed with him. Afterward, only 2% did.

Reid registered a three-point gain, going from 13% to 16% in agreement with him. While the overwhelming percentage of the audience was in agreement with Nichols, he lost a few members along the way, going from 74% of the audience in agreement down to 72%.

Tough crowd. Even if it was a like-minded one.