May 6, 2017

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Ideas Behind Health Care Policy Ignite Passions

Senate Minority Leader Chuck Schumer, joined by fellow congressional Democrats on Jan. 4, brands what Republicans are trying to do when it comes to health care as “Make America Sick Again.”

Evan Vucci/AP

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Evan Vucci/AP

Debates about health care are complicated, and it’s easy to get overwhelmed when complicated things like premiums, block grants, state waivers, Medicaid and Medicare are the main topics.

But what are the ideas driving this debate? And why do debates get so heated when we’re talking about something so technical?

To get some clarity about this topic, Michael Cannon, director of health policy studies at the libertarian Cato Institute, and Dr. Kavita Patel of the centrist Brookings Institution and a practicing primary care internist at Johns Hopkins Medicine spoke to Michel Martin on Weekend All Things Considered.

Interview highlights have been edited for clarity and length.


Interview Highlights

On health care as a human right vs. free market arguments

Cannon: It’s not like we have one side that wants people to have health care and one side that doesn’t want people to have health care. But the free market approach to this problem says, “Actually, a lot of the things that the government is doing to provide health care to people are preventing people from accessing health care.” Because what markets do is they identify and they disseminate innovations that fill in the cracks in our health care sector so fewer people fall through — innovations that make health care better and more affordable — and when the government gets involved it causes those cracks to widen.

Patel: I think one of the ideas that’s really at tension here is actually whether we believe health care is a human right. So you have people — I put myself in that category, a lot of physicians do as well — we think everyone should have access to health care. Now, there’s a lot of details to that. What does that mean? Who pays for it? But we feel very strongly, and many do in this country, that there are basic rights that people are entitled to, and access to health care is a right that all people in this country deserve.

On the American Health Care Act that just passed the House

Cannon: I don’t take positions on legislation, but Republicans have traditionally neglected health care as an issue. It’s just not a Republican issue, and as a result they haven’t been able to articulate why it is that their own principles would deliver better health care. What they’ve done here is, they’ve just tried to pass something that they can say is repeal, even if it doesn’t repeal the Affordable Care Act. And in the process, they may actually be making the Affordable Care Act worse and setting themselves up for a lot of electoral defeats in 2018, which would then, I think, cause the pendulum to swing back in the direction of the Affordable Care Act or maybe even a single-payer system.

Patel: I’m definitely opposed to the legislation. We will not see premiums come down for everyone. In fact, we know that premiums will go up for people who are older or have chronic conditions. This isn’t even repealing the Affordable Care Act. This is actually worse than what care was before.

On why politicians argue about health care so much

Patel: I think health care just touches on something that’s so personal to everyone, and then this sense of, “You’re taking away my hard-earned money and giving it to someone who doesn’t care about their health, and that’s wrong.” That’s tapping into something that’s really basal.

Cannon: Health care is a very emotional issue because we rely on health care at the most vulnerable points in our life — and that’s not just when we’re sick, it’s when a loved one is sick or a child is sick. If it appears that someone is trying to take health care away from you or from someone you love, you get a really strong fight-or-flight response from people. And usually it’s a fight response.

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The 'Oracle of Omaha' Condemns Republican Health Care Bill At Berkshire Meeting

Berkshire Hathaway Chairman and CEO Warren Buffett visits the exhibit floor in Omaha, Neb., Saturday, where company subsidiaries display their products during the annual shareholders meeting.

Nati Harnik/AP

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Nati Harnik/AP

Billionaire investor Warren Buffett fielded questions at the annual shareholders meeting for his company Berkshire Hathaway. He offered thoughts and insights on everything from Republicans voting to repeal Obamacare, to the Wells Fargo scandal, to how artificial intelligence and technology might reshape America. Here are some highlights:

Repealing Obamacare Is “A Huge Tax Cut For Guys Like Me”

When asked about the bill Republicans in Congress just voted to pass to repeal and replace Obamacare, Buffett signaled his distaste for a tax cut provision. Obamacare pays for health care for Americans in part by taxing wealthier people. The Republican bill scraps that tax on the wealthy.

And Buffett has apparently done the math here. If the Republican bill had been law last year, he said, “my federal taxes would have gone down 17 percent last year, so it’s a huge tax cut for guys like me.”

“That is in the law that was passed a couple days ago,” he added. “Anybody with $250,000 a year of adjusted gross income and a lot of investment income is going to have a huge tax cut.”

In the past, Buffett has bristled at tax policy that he sees as favoring the wealthy — famously saying it’s not fair that he pays taxes at a lower rate than his secretary.

The Medical Cost “Tapeworm”

Buffett said at the meeting that health care costs have become a bigger issue for American businesses than taxes.

He said if you go back to about 1960, corporate taxes were about 4 percent of GDP and now they’re about 2 percent of GDP. At that time, healthcare was 5 percent of GDP and now it’s 17 percent of GDP. “So when American business talks about taxes strangling our competitiveness,” he said, “they’re talking about something that as a percentage of GDP has gone down from 4 to 2.” Meanwhile, medical costs have exploded. “So medical costs are the tapeworm of American economic competitiveness,” he said.

He argued against the tax system crippling competitiveness “or anything of the sort.” He also noted that other developed countries appear to have found better ways to contain medical costs.

Wells Fargo’s “Big Mistake” In Its Banking Scandal
Wells Fargo had a sales structure that clearly led employees to do bad things, according to Buffet. “But the main problem was that they didn’t act when they learned about it,” he said. “It’s bad enough having a bad system, but they didn’t act.”]

Former Wells Fargo workers have told NPR that they called the bank’s ethics line and the bank did nothing. Buffett’s company ethics line is actively used by workers, he says, so he’s sure that Wells Fargo got reports of wrongdoing. He said it’s true that an ounce of prevention is worth a pound of cure, but “a pound of cure promptly applied is worth a ton of cure that’s delayed. Problems don’t go away.”

Wells Fargo responded to Buffett’s remarks before the end of the day’s meeting, saying in a statement that the bank has taken “decisive action to fix the problems.” Wells Fargo also said it’s created a new “Office of Ethics, Oversight and Integrity to centralize the handling of internal investigations, complaints oversight, and sales practices oversight.”

Why Geckos Don’t Like Driverless Cars
In response to a question about the impact of driverless cars, trucks and trains, Buffett said they’d not only be a threat to trucking and railroad businesses, but the insurance industry too.

“If driverless cars became pervasive, it would only be because they were safer and that would mean that the overall economic cost of auto-related losses had gone down and that would drive down the premium income of Geico,” Buffet said referring to the auto insurance company owned by Berkshire.

“Autonomous vehicles widespread would hurt us.” But, he added, “I think they may be a long way off.”

Life Lessons

When asked about reflections and lessons learned in his long life, Warren Buffett referenced Charlie Munger, the 93-year-old vice chairman of Berkshire Hathaway, who says, “All I want to know is where I’m going to die so I’ll never go there.”

But on a more serious note, Buffett says he’s gotten a lot of joy in life out of teaching other people things. So, he said, if people remembered him as being a good teacher, he would be OK with that.

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Always Dreaming Wins The 143rd Kentucky Derby

Jockey John Velazquez sprays the winning connections with champagne as he celebrates his victory aboard Always Dreaming in the 143rd running of The Kentucky Derby at Churchill Downs on Saturday.
  • Jockey John Velazquez sprays the winning connections with champagne as he celebrates his victory aboard Always Dreaming in the 143rd running of The Kentucky Derby at Churchill Downs on Saturday.

    Matt Sayles/Invision for G.H. MUMM Champagne

  • John Velazquez rides Always Dreaming to victory.

    John Velazquez rides Always Dreaming to victory.

    Morry Gash/AP

  • John Velazquez pulled through the slop Always Dreaming to win his second Derby, following his 2011 victory riding Animal Kingdom.

    John Velazquez pulled through the slop Always Dreaming to win his second Derby, following his 2011 victory riding Animal Kingdom.

    John Minchillo/AP

  • Jockeys walk through the paddock in a race before the 143rd running of the Kentucky Derby horse race at Churchill Downs Saturday.

    Jockeys walk through the paddock in a race before the 143rd running of the Kentucky Derby horse race at Churchill Downs Saturday.

    John Minchillo/AP

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The skies cleared just in time for Derby fans to trade out their ponchos for flamboyant hats when the jockeys assumed their posts. But intermittent rains posed a muddy challenge for the 20-horse field at Churchill Downs racetrack on Saturday.

In the end though, Always Dreaming, ridden by jockey John Velazquez, was able to pull ahead of Lookin at Lucky in the slop, to win the 143rd Kentucky Derby. The Battle of Midway finished third.

The win lands the thoroughbred’s owners a $1,635,800 first-place prize from a $2 million total purse. It’s the second Derby victory for both trainer Todd Pletcher, who won with Super Saver in 2010, and for Velazquez, who won atop Animal Kingdom in 2011.

Starting from the No. 5 post position and favored at 9-2 odds, Always Dreaming broke from the pack near the far turn. The 3-year-old colt finished by a clean two and three-quarters lengths ahead of long shot Lookin At Lee, who drew the unlucky first post. In 2010, his sire, Lookin at Lucky, hadn’t been so fortunate, and was pinned to the rail, finishing sixth that day.

Always Dreaming will have to defeat enormous odds in the next couple of races to snatch the coveted Triple Crown. Next stop is the Preakness Stakes, on May 20, before the final Belmont Stakes run on June 10. In the long history of horse racing — the Derby is America’s “oldest continuously held sporting event” — only 12 horses have been able to pull off the feat. Just in 2015, American Pharoah became the most recent Triple Crown champion.

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