KHN's Mary Agnes Carey talks to former Senate Majority Leader Bill Frist about the "super committee's" chance at tamping down the nation's debt. Frist says the panel has a chance to lower the debt and Medicare spending growth because the American public understands the stakes this time — the American Dream.
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Related coverage: FAQ: Debt Deal 'Super' Committee's Impact On Health Spending Explained (Carey and Galewitz, 8/3)
MARY AGNES CAREY: Good day. I’m Mary Agnes Carey, and this is Health On The Hill. Congress is preparing for a hectic fall where a 12-member panel will debate ways to cut federal spending. Medicare and Medicaid are expected to play a key role. Over the next few weeks, we’ll be talking with former members of similar panels, who have considered sweeping changes to entitlements. With me today is former Senate Majority Leader Bill Frist, who participated in a Medicare commission in the late 1990s and in the creation of the Medicare prescription drug program. Among the many hats he wears now is as a member of the Kaiser Family Foundation’s board of trustees. Thanks Sen. Frist for joining us.
SEN. BILL FRIST: Mary Agnes, great to be with you again.
MARY AGNES CAREY: The debt deal has created a “super committee” of 12 lawmakers. They’re going to try to get compromise on spending cuts and revenue increases. There have been many of these commissions before -- you certainly served on one of them -- that have had similar recommendations, but Congressed hasn’t followed them. What do you think the panel’s going to be able to reach agreement on? And will they be able to reach an agreement?
SEN. BILL FRIST: I’m back in Nashville now, as you know, and one of the advantages -- like many of your viewers -- is that you’re on the outside and you’re looking at Washington saying: What in the world is going on there?
MARY AGNES CAREY: A lot of people are saying that.
SEN. BILL FRIST: Everybody, everybody.
MARY AGNES CAREY: Everybody, absolutely.
SEN. BILL FRIST: But people back at home understand, I really think for the first time -- compared to almost 15 years ago when I was on the Medicare commission -- that the greatness of America, our standing in the world, the quality of life we live, the American dream does depend on how we handle this debt. And that depends on how we handle entitlements. And the entitlements, this is what’s important for everybody to understand, is that the entitlement that matters the most when you look out 20 years, 30 years, in terms of increased spending is health, is Medicare, is Medicaid.
It’s hard to deal with -- Congress has shown that it hasn’t been able to effectively deal with it. But I think they’ve got a shot this time, because the American people get it. The greatness of America depends on debt, depends on entitlements, and that depends on mainly, mainly, Medicare, Medicaid, how we handle that. I think the American people are primed to pay attention to the debate, to support what recommendations come out -- debate it hotly -- but support it this time around, take it off the political table, and say: Now is the time to do it. And part of it is because of the chaos here in Washington; they’re ready.
MARY AGNES CAREY: What about this automatic trigger that kicks in if they don’t get an agreement? Does that create additional pressure for this committee to act?
SEN. BILL FRIST: It does, it does. And I think there have been several efforts. The administration made one through the IPAB, Independent Payment Advisory Board. Somebody besides the 535 people -- 435 in Congress and 100 Senators -- somebody has to take a leadership position on making recommendations -- take some of the political heat -- make the recommendations and have them support it. So, I think the IPAB may or may not be successful. I think 535 people all throwing in their favorite programs and how to cut and how to restrain is not going to be effective. So this intermediate ground this time around has a shot. We saw it work very well with the base realignment closing after the Cold War, closing down the bases. Up or down vote. Can’t amend. Can’t play politics with it. That’s the model we’re following. We don’t know if it’s going to be successful, but I think this time around, it does have a shot.
MARY AGNES CAREY: But if it’s not successful, and you go to this automatic sequester the cuts, is a 2 percent cut in Medicare, while it’s supposed to hit the providers, not the beneficiaries, what does that mean to the program? Will beneficiaries be hurt if they cut Medicare 2 percent?
SEN. BILL FRIST: I think if the current program is not reformed at all -- we’re just squeezing, squeezing harder the doctors and the nurses and the facilities themselves without any change -- ultimately the recipients will be hurt in a way. And I think, if those cuts are being made -- which may or may not be unreasonable -- slowing the growth, we call them cuts here in Washington, I think they can be made, but it means we’re going to have to change the system, not just keep the system as it is. Because that, in effect, I think, is cutting beyond the bone to the point that it would hurt recipients themselves. But that’s if the BRAC proposal does not work, so that’s really a hypothetical. I think we need to make what Congress and the president have come up with work, and we all need to get behind it at this point.
MARY AGNES CAREY: You say people are ready for change; voters might embrace this – what sort of Medicare changes are they ready for? Your panel, lots of commissions have talked about: Raise the eligibility age, create a premium support model. What will America sign onto?
SEN. BILL FRIST: Well, it’s interesting. I think that in the past we’ve put a bucket in there and we’ve put all of our favorite cuts or programs in there. The two things you’ve mentioned: Yes, I think American realizes that when all of these programs were designed, it was with an age of 60 and people were dying about age 60, and now they’re living to 75 and 80 years of age and the programs are still designed for 60. They get it today. They get it. And I think that will be one of the proposals. Very slowly – you know, a month, a year, 10 years, 15 years – but that’s not enough. Premium support, a model which is on the table, which is kind of demonized today – Paul Ryan put it out there and Republicans kind of have run from it and Democrats. Yet it is one of the specific recommendations that the very Medicare commission that I was on – now almost 15 years ago, a little over 10 years ago – recommended, and yet it ended up being tabled by the president, in essence. But it’s a new model – I’m not saying it’s necessarily the model itself – but that new way of thinking, I’m very hopeful, is something that these 12 will come up with. And not just trying to go with the same old cuts we’ve tried in the past.
MARY AGNES CAREY: What about Medicaid? What do you think is in store for changes in Medicaid?
SEN. BILL FRIST: I don’t think very much. I think in the past, there’s been a reconfiguring of formulas themselves: How much the government is responsible for; how much states are responsible for. I think Americans understand – especially in these tough times – that the program which looks at the most vulnerable in society is one that we can’t cut too far. So I think, I predict – I don’t know, I’m on the outside, I’m not in government right now – but I predict that most of the focus is going to be on Medicare. If you look at the projections over the next 25 to 75 years, it is not Social Security that has the increase in spending, and it’s really not Medicaid, but the projections are in Medicare itself, and that’s where I expect the policymakers – or the 12, or the committee – and the American people to put most of the focus. And the good thing is, you don’t have to hurt the beneficiaries, you don’t have to hurt the recipients – and I would argue they need to be protected today. But you can’t over-promise and you can’t basically say: we’re going to get a lot for nothing in the years ahead. And that’s something that we have all – Democrat and Republican – done in the past.
MARY AGNES CAREY: I’d like to close with a question You mentioned in your remarks earlier: A lot of Americans are looking at Washington, what’s happened this summer, and saying, “What is wrong with that place?” How would you answer that question?
SEN. BILL FRIST: It has gotten increasingly polarized, and everybody says it’s you, it’s you, it’s the media, it’s having to raise money. I think the American people are fed up, and I know that they’re fed up. And I think through media like this, and new media – social media, the internet – that the American people will be able to respond more directly. You won’t have to rely on special interest making the case. And therefore, I’m very hopeful that this sort of liberal or conservative or Democrat or Republican – that at the end of the day people say it’s okay to be that way, but we need to have civil debate in-between the two. It’s demanded by the American people, and because of the Internet and the Facebook and the social media and cable, I think that that is going to bubble up and cause change that Washington doesn’t yet see.
MARY AGNES CAREY: Well, we’ll see if that plays out as you envision. Thank you so much, Sen. Bill Frist.
SEN. BILL FRIST: Thank you, great to be with you.