Transcript of Klobuchar Call

Transcription by ReadyTalk

BLOGHER

Moderator: Nancy Watzman
September 21, 2009
1:00 pm CT

You can find Audio of the call here on BlogHer.com.

Operator: Welcome to the BlogHer Health Care Discussion conference call. During the presentation, all participants will be in a listen only mode. Afterwards, we will conduct a question and answer session. At that time, if you have a question, please press the 1 followed by the 4 on your telephone. If at any time during the conference you need to reach an operator, please press star 0.

As a reminder, this conference is being recorded, Monday, September 21, 2009.

I would now like to turn the conference over to Ms. Nancy Watzman of the Sunlight Foundation. Please go ahead ma’am.

Nancy Watzman: Hi, I’m Nancy Watzman and I work with the Sunlight Foundation. We were founded in 2006 and our mission is to use the revolutionary power of the Internet to make information about congress and the government more meaningfully accessible to citizens.

We believe that public meet on-line, and so this kind of call and the kind of work that you bloggers do at BlogHer is really important, we believe.

I would like to introduce Senator Amy Klobuchar, who is here to talk to us today, which is really exciting. She is a former prosecutor, mother of a 13-year-old and the first woman senator from Minnesota. She is the granddaughter of a miner and the daughter of a newspaperman and a teacher. And she got interested in health care policy from personal experience.

I read that she got kicked out of a hospital 24 hours after she gave birth to her daughter who was sick at the time. So she went to the legislature and helped pass one of the first state laws guaranteeing new moms a 48 hour hospital stay. So it’s a very personal issue for her. She has been speaking out about it, and she is here to talk to us today and answer questions.

Senator Klobuchar: Well thanks so much, Nancy, and it’s great to be on with everyone. Thank you for taking the time today to really focus on what is an incredibly important issue for our country.

As Nancy mentioned, I got interested in this, like so many of you may have done because of something that happened to me. And that was about 14 years ago when my daughter was born and she was very sick, she couldn’t swallow, they thought she had a tumor, then they thought she had some wide range of genetic problems, and she was in intensive care, because everything she swallowed came out her nose.

And it was back when they had a rule that moms could only stay for 24 hours. And I literally had given birth, been up around the clock in intensive care, and they kicked me out of the hospital. Then, she was in the hospital for a long, long time after that, but I ended up going to the legislature with other moms, and Minnesota became one of the first states in the country to guarantee new mothers and their new babies a 48 hour hospital stay.

And what I most remember from the legislative battle is when we showed up at the conference committee, there were a number of lobbyists there for the insurance industry who wanted to delay it. And they couldn’t come out and say it, but they were trying to delay the implementation of the bill by a year or two. And so I decided I would bring enough pregnant friends of mine so they would outnumber the insurance lobbyists 2:1 and when the legislatures on the conference committee asked, “Well when should this bill take effect?” All the pregnant women raised their hands and said, “Now” and that’s what happened.

So that was my first experience with this issue and the kind of determination you have to have to make changes to the system.

Since then, as a US Senator, I have received 18,000 letters and emails to our office about this. People like (Dawn) in Staples, Minnesota, who is struggling to afford the prescription drugs she needs to treat her MS. Or (Joan), a woman in Wilmar who was denied insurance for pre-existing condition and now struggles to afford any visit to the doctor’s office, even if it’s just for a simple checkup.

You know, we have a backpack company up in northern Minnesota that I visited about a month ago and they employed 15 people. And the guy that started it is now paying $24,000 dollars for his family of four, two kids and his wife, and he said if he would have known this when he started, he wouldn’t have been able to start the company.

So, that’s where we are. And I don’t think we can just put our head in the sand and do nothing.

And I’ve realized that over the month of August the project started with an incredibly heated debate. And people have strong emotions about this, which actually I can understand at 17% of our (current).

But what I noticed was by the end of the month of August, the questions from people were getting much more detailed as they started to focus on the real details. like, “Well, maybe, if we make some changes to make Medicare more efficient, I can use that money to pay for plugging the doughnut hole, to pay for my prescription drugs. Or how many employees, where you can get under this kind of benefit, it was really interesting to see.

And I know in my state, which has an incredibly high coverage rate, it's 92 to 93% of the people are covered. The major issue there is affordability. And people have realized that their insurance premiums in Minnesota have doubled since 2000, similar to the rest of the nation. And are projected to double again. Medicare is projected to go in the red by 2017.

So that is why I have found some consensus on really three things: First, the idea of stability, that I want to make sure that if your child gets sick, that your family doesn't lose their health care. That we do something about pre-existing conditions and the ability to keep your insurance.

Second, affordability. Making the health care system more efficient. Minnesota is something of a Mecca for that. We have high quality, lower cost care and we want to put incentives in the law to help other people in other states to get that same kind of care.

And the third piece of this is the ability to keep choosing your doctors and choosing the kind of plan that you want.

So that's where I've found some consensus. And I still am hopeful we'll be able to get something done here. It's just people can't wait.

The last thing I'd mention that is kind of the big elephant in the room when it comes to this issue, is eldercare. We're going to see a doubling of our senior population by the year 2030. This is a long-term care issue increasingly. People in my age group, who have young children and also aging parents are in what we call the "sandwich generation." Where we're taking care of our own kids, while we're taking care or trying to make sure our parents get the help that they need. And it's become more and more difficult. And I think that the long-term care system has to be revamped, so it makes it easier for services to be delivered to people's homes. This thing was set up 100 years ago before we had that situation.

We are so fortunate that our seniors are living longer and we want them to have the highest quality of life that they can. I introduced a bill for tax credits for home people who are providing eldercare to their relatives, to their parents. I also believe we need to make it easier for people to get long-term care insurance. And that's where the health care bill comes in. Because there are some initial steps we could take in this bill to work on long-term care.

Senator Kennedy's Class Act is included in the Dodd health bill, which basically says you can use pretax dollars to start paying for long-term care. I have a bill that Senator Wyden is introducing in the final committee markup, which makes it for more disclosures of what a long-term care insurance policy is, a one-page description. We have to start shifting some focus, going ahead on reforming and revamping our long-term care system, because no one has been doing it and it's a long time in passing to do it. And so that's why I'm hoping, in this health care reform, we can do some of that too. And I'd love to answer questions about that, in addition to getting your ideas and anything else that we can do.

One last thing I failed to mention was just the idea of prevention and making sure we have nutritious lunches and have kids do more exercise and get on a better road here. Because that's another piece of this and I'm on the Ag Committee, so I care a lot about that issue, as well.

With that, I would just love to answer your questions. My health expert (Rose Ballin) is on the phone, as well and so she can help out. It's something that she had some expertise in, so we both are on the line today. And I'm actually really excited about the possibilities of getting some health care reform done. It's a huge issue in my state, the home of the Mayo Clinic, we care a lot about it and people have been really involved in the debate and I'm glad all of you are involved as well. So I look forward to hearing your questions. Thank you.

Senator Klobuchar: Would you like to go straight to the questions and answers? So I know there's people waiting on the line, go right ahead.

Operator: Certainly. Ladies and gentlemen, if you would like to register a question, please press the 1, followed by the 4 on your telephone. You will hear a three tone prompt to acknowledge your request.

If your question has been answered and you'd like to withdraw your registration, please press the 1, followed by the 3.

If you are using a speakerphone, please lift your handset before entering your request.

One moment please for the first question.

Our first question comes from the line of K745, please proceed with your question.

(Audrey Holden): Hi, my name is (Audrey Holden) and I'm here in Maine. I think my biggest question is clarity. We are going through a mental and physical health care crisis here in our family. And we're at a point right now, because our deductibles are insane, they're close to $10,000 a year, we're being forced to choose between our home and continued health care. And if I cease health care, I will probably be admitted to a full-time care facility. I'd like to know how either of these plans, I've read through HR 3200 and the Baucus bill and there's just no clarity as to deductibles and things of that nature. And what this is really going to end up, you know, costing bottom line for people in my situation.

Senator Klobuchar: Okay, well thank you (Audrey) and I'm so sorry you're going through this hard time. And I also wish that we had appropriate clarity for you right now in these bills. But as you know, the legislative process is a difficult thing to watch, but this one has been very open, so that people are able to hear stories like yours and take those ideas and put them into action in the laws.

Right now, just to step back a little on the process and what's happening. There is the House bill that (Audrey) referred to HR 3200, which came through the committee in the House. And then there's also, Senator Dodd has a bill out of the health committee. And the way the Senate works, and that's in the Senate side. The way that Senate works, that committee can't do any of the finance pieces, but they can have health ideas, prevention ideas, different things that are in their bill.

Senator Baucus has just put forward a bill. That bill is not through the committee yet, as you've probably heard. And there are, I think, something like 500 amendments filed to that bill. That's the process that's starting right now.

And I would say that there is an acknowledgment that these high deductibles are a major problem for middle-class families. And that's why one of the things that the President has talked about and that is included in some of these deals, is a limit, a cap on some of the out-of-pocket expenses that you can pay. And that would get to some of the issues that you're talking about with the deductibles. And hopefully that could help you out. I don't know if you want to add to any of that.

One other thing that I would note from what you said about having to go to a facility is that we know that that is not always the best thing for families, or for taxpayers. That that can be very expensive and that in fact, one of the ones I was talking about was the long-term care with any kind of health care, the more we can look at the system in terms of cost efficiency and quality.

We often find it's best if people are able to stay home and work with a primary care provider and a team of doctors, or someone visiting home health care, something like that. But our system is set up in a way right now, which I'm sure (Audrey) has found, that makes it very difficult to do that.

Often times people are rewarded for volume and then rewarded for some of the more costly ways of handling things, as opposed to the higher quality and less expensive ways of handling things. And that's why there's so much disparity between different parts of the country and Maine is like Minnesota in that there is a bigger emphasis on quality and lower costs care. And so I appreciate that question and I think as the weeks go by here, there'll be more meat on the bone, when it comes to exactly what those out-of-pocket caps are.

Nancy Watzman: Senator, just to add to that question. I'm wondering, you spoke to the process and where these different bills are, at what stage. I'm just wondering whether you support getting all legislation that's proposed out in public online and available for at least 72 hours before Congress considers it? This is one of the things that we advocated...

((Crosstalk))

Nancy Watzman: ...people here care about.

Senator Klobuchar: I certainly do and in fact if you look on my website, for instance, the appropriations I make, I put those up there last year before there was any requirement to do so because my requests. You know, I put all my bills that I’m on and things like that. I've just found that transparency is incredibly important.

I mean people may not agree with everything that I do, I think it's important that they know what I'm doing. And so that we can have discussions about it, or they can e-mail or call our office, so I know what their views are. So I think it's very important, enough where I wasn't as concerned as some people that this whole thing didn't get wrapped up and just why, because I felt that...

((Crosstalk))

Nancy Watzman: Great.

Senator Klobuchar: ...the citizens of this country really had to have a say in this. And that members of Congress had to get up to speed on what all of these components were. While it may not have been pretty, that has been what's been going on and I think it's really important for a functioning democracy.

Nancy Watzman: That's great. I know we don't have much time, so on to the next caller.

Operator: Our next question comes from line K744, please proceed with your question.

Line K744, your line is now open, please proceed with your question.

Nancy Watzman: Maybe we should move on to the next one?

Operator: Our next one comes from the line K760, please proceed with your question.

(Melissa Small): Hi, my name is (Melissa Small) and I so appreciate you taking the time to talk to us about health care. It's very important to me, as I am living with a chronic illness, I have multiple sclerosis. And my husband and I have spent and depleted our savings, even with insurance for my medications, doctor bills, hospital stays, etcetera. My heart goes out to people that are not covered at all.

My question is, we as bloggers, I believe, have a unique position to share our stories. This has become such a partisan issue and I'm wondering what your advice for us laypeople is, to help spread the word that health care is necessary and a basic human right? So how as bloggers can we help you get this bill passed?

Senator Klobuchar: Well I think first of all, again, your story sounds like such a tough one. And the reason we're doing this is to help people like you and others; that this has become such a monumental issue and it's so difficult. And I think everyone knows it could strike them or their family at any moment, where if they don't have insurance that makes sense, it can basically ruin their lives and ruin their family's budget. And that's why this is so important.

One other thing before I get to your direct question about partisanship and getting the word out on this bill, is when you mentioned the escalating drug costs. And one thing I would really like to see in this bill is a negotiation of drug prices under Medicare part B. And while my guess is that you may not be under Medicare part B, that negotiation could influence drug prices for everyone. Because the government is the biggest purchaser and they're not allowed to negotiate drug prices with how that Medicare bill worked. And I really would like to see that changed. I think it could help us greatly.

I've had a lot of experiences in my state with drug companies that have been charging exorbitant rates. Not drug companies in Minnesota, elsewhere. And actually, the FTC is now investigating one of them, so something might happen in a major lawsuit.

The second thing I would say is that to get the word out, to just keep telling your own personal story. To, you know, go to meetings when your elected officials are there, if you can. And a lot of people who have kids say you do it over the Internet. And that's good. That's why I personally have done not only public events, but I've done tele-town halls and I've done e-mailing and other things, so that you give citizens another way to access it. Because not everyone can go to the gym.

I was at my state fair booth day after day after day because people would line up, hundreds of people because that was another way where people could access me. They'd either have their kids with them and do it in a different way. So I think getting the word out in whatever way you can, talking to neighbors and friends and people just down the street about it. And why you care about it and getting the truth out and learning all these facts is really important because there's a lot of misinformation out there on death panels and other things that is just plain wrong about these bills.

And I will say that the first impression that we go, I think that part of it is that there isn't a final bill yet and so that makes it confusing. But that doesn't mean that people can't start advocating for getting something done here.

Nancy Watzman: Excuse me, I know we have a very short time and more callers, so next question. Maybe we could be quick.

Operator: Our next question comes from the line of K744, please proceed with your question.

(Heather Barmore): Hi Senator Klobuchar, my name is (Heather Barmore) and I'm from New York. And this question kind of in the weeds and it has to deal with Senator Baucus’ bill. In it he, instead of putting in public option, you know, he put in co-ops, so each state would end up having a co-op system for health care. But he doesn't say what would happen if the co-ops weren't able to have the membership to stay sustainable.

And so I know that a lot of senators have said that, you know, either put in a public option or there should be a trigger in there, so that if these co-ops aren't sustainable, then a trigger would, you know, kind of be pulled to put in a public option. So I just wanted to know your opinion on that.

Senator Klobuchar: Okay, well I've been positive about the public option. I want to see something that pushes competition so we get some lower rates. Of course for me, that also means changing some of the Medicare incentives that we have, fair rates in that way, because right now, the incentives is not for high-quality, low-cost care. And I would like to see that go hand in hand.

The co-op proposed in Senator Baucus' bill, a lot of us are still looking at that, to make sure that that fulfills a purpose. But certainly one thing that is worth looking at as well is if it doesn't fulfill that purpose, that you then actually have some kind of a trigger. But I'm not endorsing that yet, until I see the actual numbers on how that will. Because our whole goal here, remember is to first have something for people to buy into. Like small businesses, they pay 20% more than big businesses. And second, having a competitive option, a competitive push to bring down the rates.

Nancy Watzman: Do we have time for one more question really quick?

Senator Klobuchar: Of course we do, yes. In fact I'm just going over to my daughter's school with my husband and I could probably take some in the car as we go. See this is the working mother...

((Crosstalk))

Senator Klobuchar: ...I'm just going to get with him in the car and you guys can keep asking a few more questions.

Nancy Watzman: Okay.

Operator: Our next question comes from the line of K748, please proceed with your question.

Line K748, your line is now open, please proceed with your question.

Nancy Watzman: I think we lost them.

Operator: Moving on to the next caller. Our next question comes from the line of K750, please proceed with your question.

(Karoli): Hi, this is (Karoli) and I'm in California. I'm one of these people that falls into the sandwich generation, with the aging parents on one side and the kids on the other. I'm self-employed and right now my health insurance is 50% of my earned income for our family and I'm 51. I'm not seeing anything in these bills that really kind of covers those of us who are in that 51 to 65 range, were not eligible for Medicare. How are these going to help us?

Senator Klobuchar: Okay, well what we are trying to do here, when I brought that issue up. Remember, this is not the long-term care bill. But I think that we need to start setting the table for the issue that you just raised. The actual long-term care bill will come in another piece of legislation that will follow health care reform. But here are some things we can do now.

For one thing, we can make it easier for people to stay in their homes and try to address some of the struggles that long-term care providers have. Mostly it's family members and mostly it's women. By providing some more financial incentives to make it easier for people to stay in their home.

The second thing that we can do, is to make it easier to start taking out long-term care insurance. Only 10% of people have long-term care insurance right now, but it's going to become a bigger and bigger part of the solution. And that's why Senator Kennedy, and I'm a cosponsor of it, had this Class bill, which Senator Dodd has included in the legislation, which basically says you can use pretax dollars to buy long-term care insurance.

And also the other thing that go hand-in-hand with this, is making it easier to understand what your long-term care insurance is about, by having a requirement that there's a one-page description. As well as making an appeal, another bill I have, an appeals process available where you don't have to hire a lawyer if your benefits are denied. So those are a few of the things.

The final thing was we just started giving some tax deductions to family members who are taking care of aging parents. I have just read the most heartbreaking stories of family members, especially people who have parents with Alzheimer’s. That they are giving up their jobs to take care of their parents, and they’re doing it because they love their parents.

But the situation at times like childcare in the 70’s, back when no one could deal with it, well elder care is like that now, in that we are seeing a doubling of our senior population and we just don’t have a good enough network, especially in the rural areas to take care of it.

So I can’t comment that the whole solution is going to be found in this health care reform, but if we can do some initial things and then start the discussion going for this next bill, I think it’s important. And this is women for the most part are very affected by this, so your continuing advocacy would be important.

((Crosstalk))

Nancy Watzman: I know we have two more calls, maybe we could go ahead...

((Crosstalk))

Senator Klobuchar: When we get to the school, I have to hang up.

Nancy Watzman: Okay. Well that’s fair. So if we could keep it brief then.

Operator: Our next question come from line K748. Please proceed with your question.

Woman: Hi, Senator. This is (Jaelithe Judy). I live in Missouri. And I was just was wondering if you could tell me a little more about your stance on the Baucus bill and the lack of a public option. I know someone already asked a question about this.

But as we all know in the state of Massachusetts, they passed universal health care reform under Governor Mitt Romney, and it’s been a largely successful plan. I think they’re down to something like 4% of people who are uninsured. But some of the people who are still uninsured are small business owners and independent contractors, who have not been able to afford the insurance costs in the private market, but make too much money to quality for help from a public insurance plan like Medicaid.

So I’m just wondering, you know, if we don’t have a public option, if we don’t have co-opts, what do you think we could do to help contain costs for consumers?

Senator Klobuchar: Well first of all, I would like to see one of those options, because I think you really hit the nail on the head. One of the things that some of these bills do is to expand coverage by having this mandate. But then there are people that get caught in an area where they can’t really afford care, and it does tend to be small businesses and self-employed, the very people we want to help. And what we’d like to do is allow them to leverage their numbers. Because they have large numbers, it’s just that they’re all spread out and they can’t combine in a way. And that’s the idea behind the public option and a co-opt plan. So I think it’s very important to have something like that included.

But your second question, and that would be the way we do it. In addition to that, there are ways that we can bring rates down. One of the things is if you start with Medicare, which is the biggest purchaser of health care services, it’s actually going to help the rest of the health care system to be more efficient.

My favorite number is the Mayo Clinic number, which is an independent study found that if the hospitals all over the country used the same protocol Mayo uses in the last four years of chronically ill patients lives, we would save 50 billion dollars in tax payer money every five years, and still have this very high quality care.

How do they do it? Well, first of all, they have more an integrated care system with a primary care doctor and a team working together of specialists.

Secondly, the culture of care puts the patient in the driver’s seat. So often times patients when they are told the risks of surgery or the benefits of one option over another, will choose a more conservative option, or they will try one surgery and not another. So giving the patients that information so they can make their own choice is key to the way Mayo does business.

The third piece of this is just the incentives that are put in place right now are not focused on quality outcome, they are based on value and volume. So you probably heard about parts of the country where they actually get more money, because they are ordering more and more and more tasks, as opposed to focusing on what’s the outcome for the patient. So that’s why we want to put this value index in that I’ve authored that Maria Cantwell from the State of Washington is co-sponsor of, and we are trying to get that through in this bill as well.

So those are just some examples. And there are a lot of other things, as well, that we can do to reduce hospital readmission rates, reduce infections in hospitals. It’s all over the board for the quality of care that people can get, yet we know the protocols that get us there. And we want to put it in place and we want to put the incentives in the law that actually create that quality care.

And I think people would be shocked to know that there is an inverse relationship where the most quality care usually comes with some of the lowest cost states and it is vice versa, the lowest quality care comes with some of the highest costs. And we want to make sure that we put incentives in the bill to get us higher quality care.

Nancy Watzman: Do you think you have time for one more question?

Senator Klobuchar: One more question, yeah.

Nancy Watzman: That would be great. Okay, last question.

Operator: And it comes from the line of K751. Please proceed with your question.

(Joanne Bamberger): Thank you, Senator. My name is (Joanne Bamberger). I live in Maryland. And one thing I’ve been reading about in terms of the pre-existing condition. Discussion recently is that there are eight states and the District of Columbia that insurance companies are permitted to not cover injuries as a result of domestic violence. And I was wondering, you know, sort of how the health care legislation is going to address those types of things, especially as they impact women’s health.

Senator Klobuchar: Well that just is outrageous to me when I heard that. And it’s something that I had not heard of in our state. And I, as a former prosecutor, I did that for eight years, I saw first-hand how women’s lives have been turned upside down, how they have been brutally abused. And to think that event, through no fault of their own, would be used to deny them health insurance coverages and sometimes even to their families, because you can’t purchase family coverage if one person has a pre-existing, I just found that the biggest travesty of everything I’ve heard so far.

So I’m very hopeful that this ban on pre-existing condition as a tool to say you can’t have insurance, will obviously also include that. Because it’s just another reason why women should care so much about this. Because if it’s pregnancy or if it’s domestic abuse, to try to say, well you’re pregnant and so we’re not going to give you health insurance for you and your baby. Or you have been a victim of domestic abuse and someone beat up you, that means you are a risk, so we’re not going to give you insurance. I think it’s outrageous.

And that’s why I’m so glad that the President has been leading with this pre-existing condition as one of the main reasons why we need reform, because it’s something that I hear about all the time all across the country.

Nancy Watzman: That’s great. Well thank you so much, Senator for taking extra time today on your way to the school.

Senator Klobuchar: Well thank you. Hopefully everything is good there, we’ll see...

((Crosstalk))

Nancy Watzman: ...what’s going on?

Senator Klobuchar: She’s doing well in her first year in high school, so I wasn’t able to - we had the Senate back in session on her first day, so I was going to walk around with her a little and have her show me around. So it should be good.

Nancy Watzman: Oh, that’s wonderful. Well, thank you so much, and we look forward to, you know, hearing more from you.

Senator Klobuchar: All right. Very good. Thank you very much.

Nancy Watzman: All right, bye-bye.

Operator: Ladies and gentlemen, that does conclude the conference call for today. We thank you for your participation and ask that you please disconnect your line.

END