July 1, 2009 -- ABC News Medical Editor Dr. Timothy Johnson sat down with former Speaker of the House Newt Gingrich June 25, 2009, to discuss health care reform. The following are excerpts from the interview.
On Public vs. Private Sector in Health Care
GINGRICH: In the case of health care, if I have to choose between my doctor and a government bureaucrat, I have zero doubt which one I want. And I think that it's very important that we not allow a bureaucracy to get set up. ...
JOHNSON: But you right now, you say that you don't want the government between you and your doctor. But right now many people have the private insurance office between them and their doctor. They're arguing constantly with their insurance company about what they'll cover, what they'll pay for.
GINGRICH: Right. And in that setting, if you don't like your current insurance company, you can change insurance companies. But if you ended up with a single national health system, you wouldn't be able to change bureaucrats. And if you look at the experience in France or Canada or Great Britain, if you look at the waiting lines in Canada, where, despite three years of effort, they've not been able to shorten the waiting lines, because in fact the system doesn't work.
JOHNSON: Now, the president says, and he said last night, again, what he wants is a system or a field where there's level playing opportunity, the same rules and regulations would apply to the public option as to the private insurance companies, and then they can really compete on a level playing field. You don't think that...
GINGRICH: I guarantee you the language they draft for the public plan will give it huge advantages over the private sector or it won't work.
GINGRICH: Because it won't work. And what they will do is rig the game. I mean, anybody who's watched this Congress, I mean, look what they did with Chrysler, with the 55 percent of it to the union.
I mean, anybody who's watched this Congress who believes that this Congress is going to design a fair, neutral playing field I think would be totally out of touch with reality. I think it's disingenuous on the president's part and it wouldn't work.
JOHNSON: And when the president says to the private companies, you had 30 years to prove that you can do it well and they haven't...
GINGRICH: They have it done well. And the fact is, overall, 71 percent of Americans are relatively satisfied with the health insurance.
JOHNSON: But we have 46 million uninsured.
GINGRICH: Right. And we have -- you know, that means you also have 260 million insured.
JOHNSON: Oh, no, I'm...
GINGRICH: So let's start with, OK, what have the insurance companies not done? They've not done, covered people who are unemployed.
JOHNSON: Or who have pre-existing conditions.
GINGRICH: And the 46 million, by the way, includes illegal aliens.
JOHNSON: But it's a significant number no matter how you look at it.
GINGRICH: It's a significant number. OK? The question is, are there ways to solve that that don't require creating a government monopoly? And I think there are a lot of ways.
On Primary Care and Student Loans
JOHNSON: People have a terrible time finding primary care doctors. We -- in Massachusetts now, we've got waiting lines for the initial doctor you want to see that can go up to a year. So we have problems at certain levels in this country right now. Maybe not so much with specialists, but as you know, obviously, primary care is really essential to good health care reform.
GINGRICH: That's right.
JOHNSON: And we have terrible waits for primary care doctors.
GINGRICH: Well, at the Center for Health Transformation, we're frankly working on a project to shift the payment patterns to dramatically expand the number of primary care physicians. Part of what has happened is because we've gone to a model where young people are borrowing so much money to get through medical school, that they look for the highest-paying specialty in order to pay off their student loans.And one of the things I heard the president say that I think is a very good idea is to actually have a program that if you're willing to become a primary care physician, we would forgive a large part of your loan...
JOHNSON: Loan forgiveness program.
GINGRICH: ... because you would induce a generation who don't particularly want to become specialists, but who do need to find a way economically to pay back their loans.
JOHNSON: What about doing what some other countries are doing, which is even pay for tuition, so you come out with no debt and the same effect?
GINGRICH: I think in both nursing and in medical school, we should be seriously looking at government scholarship programs that maximize getting the number of people we need into health care.
JOHNSON: Let me get back to the government insurance program. If you and others are so opposed to government insurance, per se, why don't you want to repeal Medicare, for example? That's a government insurance program, obviously.
GINGRICH: Well, what we did do is we've created more choices in Medicare to give people a wider range of opportunity, and there you have an effort on the part of the left even to eliminate the choices. Medicare is a good example. You know, the government already runs about 48 percent of all spending on health care. Now, if the government is so clever about reforming health care, they could create models in the 48 percent they already have. Instead, the effort is to get the other 52 percent. And if you go out and you talk to hospitals, for example, if the whole country were reimbursed at the rate of the Medi-Cal program, which is California Medicaid, virtually every hospital in the country would collapse.
On Government Regulation
JOHNSON: And I think you're outlining the kind of thinking that so many of us agree with. The question is, how do we get there to have that spread like a virus, in a sense, inside the health care system? And many would say that it's pretty hard to have happen without the government providing some guidance.And let me give you another example, if you think there's any analogous thinking here.When I get on an airplane, as you do all the time, whether it's a small airport in Peoria or Logan Airport in Boston, I'm very reassured to know that the FAA exists, that pilots are required to be trained in a very standard way...
JOHNSON: ... and re-certified every six months, that those planes are being examined very carefully. In other words, I'm happy to have the government involved in kind of providing a certain basic standard for safety, which, of course, is missing in medicine, which is one reason we have about 100,000 medical deaths in this country every year.
Isn't there a role for government in regulation, in setting standards, in making sure that certain basic criteria are met?
GINGRICH: Sure. Look, I'm a Theodore Roosevelt Republican. I think there are a lot of roles for government to set the rules but not to run the system ... If we could pass -- as part of this health reform, if we could pass a bill that said if you, as a doctor, follow the established best practices, and you have an electronic health record that proves you followed the established best health practices, then you have a safe harbor for malpractice suits and you're not going to be subject to the kind of horrendous attacks that trial lawyers levy on doctors.
Now, there would be a win-win for the country. The doctor would be participating in best practices, they would be recorded electronically. The doctor, in return, would be protected from trial lawyers. The country would pay less for litigation and it would pay less for bad outcomes.
JOHNSON: So, is it fair for me to say you're not opposed to a strong role for government, you just don't want government insurance, per se?
GINGRICH: I don't want the government to be the primary operator of the health system. I don't want the government to try to run things. I don't think the government runs things very well.
I'd like the government to set standards, to set goals, to incentivize the right behavior. All those are positive steps the government can take.
On Taxing Employer Benefits
JOHNSON: Do you think we should tax employer health benefits as income to help pay for this?
JOHNSON: So you disagree with John McCain and some others on that?
GINGRICH: Yes. And I see no rational reason to go out and punish people who have worked hard and who have a good health plan and say, why don't we attack your health plan because we've decided you have too much health insurance.
JOHNSON: Except people who are self-employed do have to pay taxes.
GINGRICH: But what I would do there is I think everybody ought to have the same tax advantage. So everybody ought to have the same access to being able to buy health insurance, except if you're very poor. I think you need a tax credit rather than a tax deduction.
On Passing Health Care Reform
JOHNSON: What's your sense, as a politician, about what's going to happen by the end of this year? I mean, regardless of your own biases or interests, what do you honestly think is going to happen?
GINGRICH: I think the odds are reasonably good they can get something through. And I think that the president faces a very big decision, whether he wants to move to the left and have a Waxman/Rangel big government bill, which I think may not be able to get through the Senate, or whether he really wants to have a genuinely bipartisan approach. And I don't think it's clear yet which way they'll go.
JOHNSON: You really don't? You think it's still a wide open question?
JOHNSON: You don't think that within the White House and the administration, they've already pretty much made up their mind?
GINGRICH: I'm not convinced of that at this stage. I mean, I think if they thought they could get away with it, they'd go with a very left wing bill. But I'm not sure -- if you look at, for example, the most recent poll that showed 58 percent of the country now wants to cut spending even if it lengthens the recession, I mean, that's a level of concern about spending that begins to bring a pressure to bear on Capitol Hill that's different than it was three months ago.