Participants
- Richard Armey
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Richard Armey
Richard Armey is Chairman of FreedomWorks, an organization dedicated to lower taxes, less government, and more freedom. First elected to Congress representing Texas in 1984, Armey was later appointed ranking Republican on the Joint Economic Committee as well as the GOP Conference Chairman. He was the main author of the Contract with America, the legislative agenda that in 1994 propelled Republicans to take control of the House of Representatives for the first time in forty years. Armey served as House Majority Leader from 1995 to 2003. Since joining FreedomWorks in 2003, he has traveled to more than twenty states, rallying grassroots efforts, testifying before state and federal governments, and meeting with legislators. Armey’s books include Price Theory: A Policy-Welfare Approach (Prentice Hall, 1997) and The Flat Tax: A Citizen's Guide to the Facts on What It Will Do for You, Your Country, and Your Pocketbook (Ballantine Books, 1996). - Susan Dentzer
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Susan Dentzer
Susan Dentzer is an on-air correspondent with PBS’s The NewsHour with Jim Lehrer, where she leads a unit devoted to in-depth coverage of health care, health policy, and Social Security. Prior to joining the The NewsHour in 1998, she was chief economics correspondent and economics columnist for U.S. News & World Report, and was a senior writer covering business news at Newsweek. Dentzer has appeared on ABC’s Nightline, CNN, and PBS’s The McLaughlin Group. Chair of the advisory board of the California Health Benefits Review Committee, she is a member of the Council on Foreign Relations, and serves on the Board of Directors of the International Rescue Committee and the Board of Overseers of Dartmouth Medical School. Dentzer and her NewsHour unit have received multiple awards, including the 2005 Award for Excellence in Health Care Journalism from the Association of Health Care Journalists and the first-place Gracie Allen Award for Public Television News from American Women in Radio and Television. - JudyAnn Bigby, MD
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JudyAnn Bigby, MD
JudyAnn Bigby, MD is Secretary of Health and Human Services for the Commonwealth of Massachusetts, where she oversees seventeen state agencies. Chair of the Health Care Quality and Cost Council, one of her top priorities is ensuring that the state delivers high-quality services to Massachusetts residents. Bigby is the former Medical Director of Community Health Programs at Brigham & Women’s Hospital and an Associate Professor of Medicine at Harvard Medical School, as well as Director of the School’s Center of Excellence in Women’s Health. The editor of Cross-Cultural Medicine (American College of Physicians, 2001), she has published a number of studies and participated in conferences and forums across the country related to health care disparities and the needs of vulnerable populations. - Regina E. Herzlinger
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Regina E. Herzlinger
Regina E. Herzlinger is the Nancy R. McPherson Professor of Business Administration Chair at the Harvard Business School, where she was the first woman to be tenured and chaired. She is widely recognized for her innovative research in health care, and Money magazine has dubbed her the “Godmother" of consumer-driven health care. Modern Healthcare’s readers have selected Herzlinger as among the "100 Most Powerful People in Healthcare" each year since 2003, and Managed Healthcare named her one of health care’s top ten thinkers. Her research has been reported in numerous publications, including The Economist, the Wall Street Journal, and the Washington Post. Herzlinger’s books include Who Killed Health Care? (McGraw-Hill, 2007) and Consumer-Driven Health Care: Implications for Providers, Payers, and Policymakers (Jossey-Bass, 2004). She has twice been awarded the American College of Healthcare Executives’ Hamilton Book of the Year Award. - Richard A. Epstein
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Richard A. Epstein
Richard A. Epstein is the James Parker Hall Distinguished Service Professor of Law at the University of Chicago, where he has taught since 1972. He has also been the Peter and Kirstin Bedford Senior Fellow at the Hoover Institution since 2000. A director of the John M. Olin Program in Law and Economics, Epstein has also taught law at the University of Southern California, where he served as Interim Dean. He is a member of the American Academy of Arts and Sciences and a Senior Fellow of the Center for Clinical Medical Ethics at the University of Chicago Medical School. His books include Overdose: How Excessive Government Regulation Stifles Pharmaceutical Innovation (Yale University Press, 2006) and Mortal Peril: Our Inalienable Rights to Health Care (Addison-Wesley, 1997). Epstein has written numerous articles on various legal and interdisciplinary subjects, and has taught courses in health law and policy.
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VIDEOS Get Flash to see this player.
Introduction of Debaters(02:08)
Gov. Gerald L. Baliles, Director of the Miller Center of Public Affairs, describes the National Discussion and Debate Series and introduces moderator Susan Dentzer, health correspondent for The NewsHour with Jim Lehrer. Dentzer introduces the four participants in the fourth debate in the Miller Center's National Discussion and Debate Series. The event, held in Boston's historic Faneuil Hall on April 9, 2008, examined whether health care is a universal right and whether it is the obligation of government to secure that right. JudyAnn Bigby, MD, Secretary of Health and Human Services for the Commonwealth of Massachusetts, and Regina Herzlinger, Professor of Business Administration at Harvard Business School, spoke in favor of the resolution. Dick Armey, Chairman of FreedomWorks and former House Majority Leader, and Richard Epstein, Professor of Law at the University of Chicago Law School, argued against. Health Care Debate: Background Video(03:20)
This video, produced by MacNeil-Lehrer Productions, provides background information for the debate, surveying both the historical and recent debate over health care in the U.S.
JudyAnn Bigby, Opening Remarks(04:07)
Bigby opens the debate by asserting that every individual in America should have adequate health care. America has signed various international agreements assuring a minimum standard of health. If we do not guarantee coverage, it means we are a society where individuals will suffer and die if they cannot afford health insurance. The only alternative to health care as a right is health care as a privilege. The definition of rights in America has evolved throughout history, so guaranteeing health care as a right is not a major departure from our system. Government must guarantee health coverage, but this does not mean that government must run it as well. Because Massachusetts has required coverage, over 300,000 new people have health insurance. Dick Armey, Opening Remarks(04:17)
Armey begins by saying he is inspired by the Founders' belief in the right to life, liberty and the pursuit of happiness. Liberty is a gift from God and it is the duty of government to protect it. This sets us apart from the rest of the world. Within these rights, we have the freedom to choose our own health care without the government's intervention. One of the audacities of big government is Medicare because it assumed that individuals 65 and over can no longer purchase health care for themselves. Even though Medicare is optional, doctors and hospitals suffer punitive mandates when people opt out of coverage. Regina Herzlinger, Opening Remarks(02:57)
Herzlinger affirms Bigby's remarks and discusses the economic reasons why health care must be universal. She says health care is killing the American economy. The public and private sectors in America spend much more on health care, in percentage terms, than other industrialized nations. Insuring sick people is one way of reducing costs because at current costs sick people cannot afford proper coverage. We need a system of universal coverage where the well subsidize the sick. But the sick must have control over who they select as their provider and how much coverage they want for a price they can afford. The government should help people attain coverage, not run the system itself. Richard Epstein, Opening Remarks(04:15)
Epstein says government regulations in the health sector have caused employer-provided coverage to decline in recent years. He calls government the greatest enemy to providing health care to individuals because they often mandate things into plans (like good neonatal, alcohol, and mental health coverage) that the consumer does not want. Employers do not like these mandates, so they will eventually pull out of the system, leaving people to fend for themselves. You cannot balance the accounts for what the Pro team wants to do. The main question is this: can we do better by a system of competitive markets and liberalization or do we do better by having more regulation? His answer is to deregulate.
Rebuttal, Pro Team(02:41)
Herzlinger challenges the supposition in the Con team's arguments that government will take over health care and constrain our liberty if universal coverage is required. Universal coverage is really about government providing the funding so that the poor and the sick can participate in the health care system. The Swiss system, for example, achieves universal coverage yet is run entirely by the private market. Their costs are 40% lower than ours because they are constrained by private market mechanisms. Rebuttal, Con Team(03:00)
Armey responds that America is about the liberty of the individual, not the well-being of the collective. He agrees that provisions need to be made for those that cannot provide for themselves, but people have to be free to choose what coverage they want. If you're already covering millions of rich people in Medicare, how will you have enough money to take care of poor Americans? There is too much regulation, too much compulsion, and too many mandates to resist high inflation of health care costs.
Medicare an infringement on liberty?(02:34)
How is a voluntary program (Medicare) an infringement on liberty? Armey responds that it is an infringement because doctors and hospitals that accept patients over 65 without a Medicare card suffer punitive sanctions that make it prohibitive for them to take patients that opt out of Medicare. The government should provide for the poor, but it should leave those alone that can get health insurance for themselves. Why is health care different from food or shelter?(02:57)
Bigby says we should not tolerate people living without health care because it impacts the ability of individuals to become productive members of society. Health is a key factor that determines one's possibilities in life. We need high-quality health care for everyone. Are there limits to the right to health care?(01:43)
Herzlinger answers that this is ultimately a political question as to how much we're going to devote to health care. In a consumer-driven society, people decide for themselves how much they're going to spend and what level of coverage they're going to attain. There are two questions: one, do we want poor and sick people covered, and two, do we want the federal and state governments to run this system? Switzerland, for example, covers all citizens, but it is run through private providers. They spend 40% less on health care than the U.S. Do private systems conflict with consumer-driven systems?(02:23)
Epstein responds that it is politically impossible to achieve the kind of system that Herzlinger is calling for. He points out that Herzlinger and Bigby are actually in disagreement because Bigby's plan would not allow consumers to purchase low-coverage health plans. Finally, comparisons between Switzerland and the U.S. are not very helpful because the size, socioeconomic composition, and history of health policy are so different in Switzerland. The simplest and surest way to reform the American system is to reduce prices so people can reenter the market. What if charities fail to provide for the poor?(02:16)
In response to Epstein's call in his book for private charities to provide care for those that cannot afford it in the marketplace, he says that throughout American history mandates have reduced charitable services. So if health care was not mandated, we would see an increase in charitable health centers. There would be gaps, but it would be incorrect to think there are not even larger gaps already in the current system. Government has the responsibility to get out of the way and let people find coverage in the marketplace. Herzlinger responds to Epstein(01:19)
Herzlinger responds to Epstein's characterization of Switzerland as a bucolic and homogeneous country by saying that it has social problems of its own which make health policy difficult. They are very much like the U.S. They are also as regulated in the delivery of health care as the U.S., but the differences are that coverage is universal and consumer-driven. Should U.S. observe international agreements on health?(02:48)
Why should the U.S. not observe the Declaration of Human Rights on health policy? Armey says the U.S. has a better promise than the UN. America says we're going to set you free and protect your liberty, not control you as a ward of the state. Why should we lower ourselves to be in line with the rest of the world? The U.S. is the world's leader in health care discovery and research, and if we had less regulation in the health care sector it would excel. Bigby responds to Armey(02:49)
Bigby responds to Armey's comment about reducing ourselves the rest of the world by saying that America is exceptional, but we are not the leaders, as Armey contends, in health care or in health. We lag behind numerous industrialized countries in many major indicators, like disparity of coverage and infant mortality rate. There may be problems in the delivery of health care by the government, but let's fix those problems. Let us not deny that universal access to health care is important. Armey again asserts that government-run programs force entry and reduce liberty. Epstein on Medicare spending(03:21)
Epstein disagrees with Armey that the problem with Medicare is its reduction of liberty. Rather, he says the problem is that it is an enormous subsidy to everyone who enrolls, which is economically inefficient. Epstein also discusses the difference between health care and health outcomes. We spend large amounts of money on health care with little concern for outcomes. And when we tax to pay for health care, we take money from people that could be used for things that improve their quality of life and keep people healthier longer. Dentzer asks why government is such a large problem when much of America's health spending comes from the private sector, and Epstein says even though it is privately expended, it is still government directed. How would you privately cover the sick?(01:20)
How would you cover the sick? Epstein responds that the reason poor people cannot afford coverage right now is because of how the prices reached their current levels. The reason we have high costs is because of restrictive government regulations that cause prices to rise. Before we start on the redistribution side, we need to first look at the productivity side to reduce costs.
Epstein: Closing Remarks(02:03)
The only way the government can discharge the obligation to secure health care is through a system of taxation. When you try to cover the entire country, what you end up with is a bloated government health care sector that is required to manage the system. Instead of caring first for those that are sick, we should try first to figure out how to reduce costs and increase access to the market of health care so that people can climb into the system when they're well. This will never happen if you're talking about health care as a fundamental right. In the end, if you deregulate and open the free market to health care, you may find that access to health insurance for the poor may be easier than anticipated. Bigby: Closing Remarks(02:08)
The cost of health care is high because we pay for a lot of services that do not add a lot of value to the system or the health of individuals. If we redirect these resources, we have plenty of money to cover everyone in the U.S. and to provide the highest quality of care. The problem with competition is that much of the money spent on health care is taken out of the system and given to those who profit in this business. There are improvements to be made, but this does not mean that health care should not be a fundamental right for everyone.
Health care is a right(00:20)
The government should provide a means of obtaining affordable health care. Every citizen has a right to health care—the government providing a way to affordable coverage for those that do not have it, and those that have private insurance and are satisfied with it can keep it. National plan would harm quality, cost of medical care(00:44)
It is a right for all Americans to be able to afford health care, but they should have to work to earn it. Health care should be handled more by the private sector, so I do not support a national health care plan. A national plan would be detrimental to the quality and cost of medical care in the U.S. Health care not a right, but govt. should provide basic care(00:30)
There is not a fundamental right to access to health care, but there should be equal access to all Americans, regardless of race or class. People should continue to have the opportunity to purchase private health insurance, but the government should provide a basic minimum level of coverage for all Americans.
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