More often than not, the former U.S. senator from Minnesota is tapped for his insight as chair of the National Institute of Health Policy at the University of St. Thomas and his perspective as a former chair of the Health Subcommittee of the Senate Finance Committee. In the 1980s and early 1990s, he authored or co-authored the majority of legislation dealing with Medicare and Medicaid, health insurance and other types of reforms, according to a bio from the Kaiser Family Foundation.
The censure rarely comes up in everyday conversations or encounters these days, Durenberger says, explaining that the passage of time has a way of putting political events into context. Even his toughest critics, he says, have “come to realize that that was a period of time in which a lot of people were getting nailed for what is not necessarily a reflection of who they really are as a person or as a political representative.”
An Internet search also will turn up the fact that Durenberger, a moderate Republican who served from 1978 to 1995, voted for President Obama in 2008. “It had nothing to do with health care,” he told me last week. “I’m more than a one-trick pony in my thinking when it comes to the presidency.”
Durenberger says his biggest disappointment in the 21st century’s health-care reform debate is “Republicans sitting on the sidelines” despite overtures by Democrats and the Obama administration in the beginning. A big surprise, he says, was that Democrats still fashioned some reform proposals that appeal to his Republican roots.
Interestingly, at Durenberger’s invitation, aides to key Democrats and Republicans in last year’s presidential election as well as figures in the 1993-94 Clinton reform effort came to Minnesota in April 2008 to develop “10 commandments” for presidential leadership in the next round of health-care reform. Some of the Obama administration’s tactics and talking points seem to echo the commandments.
This is the eighth in a series of MinnPost’s Q&A’s with thought leaders about their best hopes and worst fears for health-care reform. The interview has been edited for length and clarity.
MinnPost: No. 1 of your conference’s 10 Commandments for Presidential Leadership on Health-Care Reform [PDF] sounds identical to the Obama administration’s bottom line: “The status quo is unacceptable. Doing nothing is not an option.” How did these commandments come about, and how closely has the administration and/or Congress heeded your group’s list?
David Durenberger: My wife (Susan Foote) and I got the idea back at the end of 2007. Both of us had worked on health reform in 1993-94. …We thought that as health care becomes an issue in the presidential campaign, wouldn’t it be great to bring together [PDF] as many of the veterans from ’93-94 [Clinton health-care reform effort] as possible?
… The thing that was taken seriously in the beginning [of the current effort] and then began to fall apart was that the [health] industry needs to be in the room but not at the decision table. That one turned out to be absolutely critical because by the time we got to the town hall meetings and the death panels and all the rest … , the industry had made whatever alliances they could with the Democrats on the stuff they liked, and alliances with the Republicans on the stuff they didn’t like, and they leveraged them all the way through Christmas Eve. And they’re still there, pounding away in one way or another, and none of them are giving up a thing.
MP: I take it you’re somewhat disappointed by what’s happened?
DD: The answer is yes and no. Back in July (2009) I did a piece about why don’t you just drop it (reform) because by then I could see the handwriting was on the wall that we were going to start focusing on coverage and we wouldn’t have the money to pay for it. … The administration and the Democrats said we’ve been at this now since Teddy Roosevelt and if we quit now, we’ll never get back to it. … So, by October or something, I basically endorsed the effort to go to universal coverage.
I do believe there’s a huge amount of authority in the administration … to implement the changes. But it’s going to have to get implemented. So the issue is going to come back to does Obama wash his hands of this as of the day he signs the bill, or does he make health care — for at least the first four years — just as important as it was in the first year? He cannot switch gears and say, “Well, now I’m going to do immigration reform and tax reform and a bunch of things like that and I’m going to ignore this.”
If he doesn’t put the right people in place and give them the right authority, the political muscle behind it when he needs to … then nothing will happen because there’s a lot of stupid Republicans who believe that health-care reform is as simple as walking around with a catastrophic plan funded by a health savings account. And that’s sheer stupidity.
So, getting the Republicans on board, now that you’ve gotten over the universal coverage and how you’re going to pay for it, getting them on board, or some of them on board, on the issues surrounding value indexes, pay-for-performance, accountable care organizations, and all the rest of the stuff that’s in there, it’s going to be important.
MP: If you were still in Washington for today’s debate, what would you be doing to get Republicans involved in a constructive contribution to reform?
DD: You’d have to shame them.
MP: Does that work?
DD: Not today. It’s just a shame that we can’t combine universal coverage with cost containment in a Congress that is faced with deficits and the entitlement programs and all that sort of thing that we’re facing. All I can think of is the word shame. There’s no other word for it. …
It is so clear that the Republicans’ agenda has been driven by the Tea Party, or right-wing radio, Fox News, you name it, whatever you call that phenomenon that’s going on out there. … That really has been driving the agenda. How does (Minnesota Rep.) Michele Bachmann get to be as popular, as famous … as she is today? It’s not because of any contribution she’s made to health policy or education policy or tax policy or national security. … She’s made none. It’s her mouth, basically. It’s these outrageous statements that she makes and that’s what people are feeding off of today because they’re outraged at health care … they’re outraged at everything. The Republicans were smart enough to sense that a year ago and that is the fault of the Republican leadership, whatever that means.
MP: What kind of shaming statement could work?
DD: The basics of shaming are that 45-47 million Americans are still uninsured; that millions more Americans are underinsured; that the insurance system doesn’t work; that the health-care system can’t work if the insurance system isn’t working. Everybody is agreed about the entitlement programs, Republicans and Democrats alike.
You go through the list: generational equity, the high cost of health care and the big impact on employment, the big impact on the economy. What do we have to offer other than the health savings account and individual insurance plans? What do we have to offer as Republicans? …
The Democrats have offered us an opportunity to have some genuine private insurance competition. Let’s seize this. We have offered the Democrats an opportunity to change the tax code, which people have been trying to do for 50 years so that it doesn’t reward excess purchase of insurance by employment-based health insurance. We offered them the opportunity, the so-called McCain proposal, and the only thing that stood in way of that was the unions.
We say we’ll buy your insurance approach if you buy our tax approach. That’s one way of doing it. Those are the two big big-ticket items. I’d leave it at that just to illustrate the point that there was a very huge potential in the beginning for that kind of a tradeoff between Democrats and Republicans and that doesn’t get you into the death panels and it doesn’t get you into physician payment reform, which is always a challenge.
MP: What have been the biggest steps forward, the biggest disappointments and the biggest surprises in the reform debate?
DD: The biggest step forward is getting universal coverage. The biggest disappointment is the Republicans sitting on the sidelines because … it would have made a huge difference. It could have forced the hand of the Democrats when the unions objected to tax changes.
The big surprise is they (lawmakers) stuck in there until the end. That (Senate Majority Leader) Harry Reid managed to get a bill off the floor was a surprise, and (House Speaker Nancy) Pelosi is another surprise. She and George Miller (D-Calif.) and Steny Hoyer (D-Md.) did a masterful job of getting that bill through the House. …
When the Republicans did what they did, the surprise was that anything came out that a guy like me could actually look at and say, “It’s not a great bill. It’s not what I’d do. BUT there’s enough good stuff in there that if you get committed to this over the next 3½ years, you could make something more than just lemonade out of this.”
MP: How disappointed are you in your party?
DD: I’m deeply disappointed in many ways because they’ve become a Southern party, and that has a lot of serious implications for people that come from Minnesota. I’m disappointed in the fact that the governors didn’t speak out. … Now the attorney generals are suing for states’ rights.
I think when we get a look at the low-income and Medicaid part of this, we’re going to see a lot of money shifted from the North to the South and then guys like Tim Pawlenty are going to criticize the Democrats for passing this kind of a bill. But he was nowhere to be seen. … He didn’t get all the Republican governors revved up to make a positive contribution on how do we more evenly spread the cost of coverage as they expand the Medicaid program. They just stood there and ditched.
MP: What is your biggest personal regret about the 1993-1994 health-reform effort?
DD: I don’t have a personal one other than, if you ask me what do I think is regrettable about what happened, it’s that the Clinton administration and Mrs. Clinton came either too late, or not at all, to the realization that the Newt Gingrich-Billy Graham side of the Republican Party, which is now the dominant side of the party … that they were going to kill any effort by the Clintons at health-care reform … . The Clintons came too late to the realization that they had the ability to do a bipartisan compromise but that they’d have to give up on funding everything they wanted under universal coverage in order to get movement in that direction and movement in the direction of bringing down costs of health care as well. The fault was on both sides … . In the end, if Mrs. Clinton and the president and others had realized what they know now they would have cut a mainstream deal with our bipartisan group.
MP: How did you end up endorsing Obama for president? Did it have anything to do with the parties’ health-care policy platforms?
DD: I didn’t endorse Obama; I voted for him. I deliberately did not do a public endorsement of him because I’m still a Republican and if I had wanted to endorse, I’d leave my party and become an independent or something like that. But I voted for him because I thought he was the better of the two candidates. It had nothing to do with health care. I’m more than a one-trick pony in my thinking when it comes to the presidency.
MP: What are your best hopes and worst fears for health-care reform at this point?
DD: The hope is that all the language that comes out and gets signed by the president gets implemented. My fear is that it won’t. It’s about that simple. If this administration does what none has been able to do in the past, which is get universal coverage passed, then it better have the people in place, and the political nerve, to make sure that everything they have passed that will improve the quality and performance of the system is implemented.
The fear is that the Republicans will get strong enough in the next election that they can shoot down what is genuine progress toward systemic improvement in exchange for their ideological approach to insurance.
MP: You’re sounding more like a Democrat.
DD: Probably. My wife says I shouldn’t say I’m a Republican because I can’t find anyone in office today that I agree with. But that’s the way I was raised and I doubt I’m ever going to change.
Casey Selix, a news editor and staff writer for MinnPost[dot]com, can be reached at cselix[at]minnpost.com. Follow her on Twitter.