In my column today, I noted that I had interviewed Elizabeth Warren, the Democratic candidate for the U.S. Senate in Massachusetts. In the course of the interview, Warren offered what I thought were particularly interesting thoughts about the Affordable Care Act, and also about the role of her religious faith in her public engagement. I share a partial transcript of the interview here.
I was struck by her comments on the Affordable Care Act because she is arguing that Democrats have been reluctant to claim and defend the act as a major achievement, and that this is a mistake. Warren believes (and I happen to agree) that the law is not only a substantial accomplishment, but also provides a foundation for further improvements in the American health care system. For too long, many of those who supported and voted for the act have been reluctant to talk about it. This is changing in the campaign because faced with Republican promises to repeal the act, Democrats have discovered that reminding voters of what they would lose if the disappeared is good politics. And for the long run, it is good policy to make the case for expanding on and improving the law rather than scrapping it. I share her energetic answer because she is a rarity among Democrats in offering a comprehensive argument for the law and its possibilities.
As for her religious commitments, few among either her supporters or her detractors know how important these have been to Warren, and how they shape her political approach. (I suppose I should confess that since my own political views have been greatly influenced by the passage she cites from the New Testament, I am happy to hear what she had to say.)
The full passage from the Kings James version of Matthew 25:40, which she quotes in part, reads: “Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.” The part she paraphrases later, from Matthew 25:35-36, reads: “For I was ahungered, and ye gave me meat: I was thirsty, and ye gave me drink: I was a stranger, and ye took me in: naked, and ye clothed me: I was sick, and ye visited me: I was in prison, and ye came unto me.”
This is a verbatim transcript drawn from an interview conducted in Boston at the Omni Parker House coffee shop on Tuesday afternoon. Thanks to Ross Tilchin for transcribing the interview
Warren on the Affordable Care Act
So, I’ve got to tell you, on the Affordable Care, to me, this was a huge and great place to engage in direct, hand-to-hand combat with the Republicans. I want to do it at three levels because that’s how I think about this.
The first one is that after years, decades, of trying to deal with health care in the United States, finally a bill passed the House, passed the Senate, was signed into law by the President of the United States, and passed constitutional muster with the United States Supreme Court. Done.
It’s time to move forward. To concentrate on making the bill better in some places, and in reducing costs of health care overall, but not to go back to Washington to spend years more fighting over this issue. And that’s why it’s one of these reminders…[that] the Republicans are the party of “no.” The Affordable Care Act is a place to see that in neon lights. They not only say “no” during the debate process, trying to get something passed. They say no after the law has been passed. . . . Come on! We’re supposed to, after the law passes, come together, work together, and make it better. And if the Republicans have an idea that costs could be saved over here, or there’s a piece over there that can be handled more effectively, let’s hear it! Let’s all work together to make this work for the American people. That would be what we would have expected, right, a long time ago, a different kind of Washington. But instead, here they are, continuing to bang heads.
Part two: The Affordable Care Act has been under-explained by the Democrats. . . . . [M]any people think of it as only about insurance coverage, and yes, for the 30 million people who will have insurance coverage that didn’t have it before, this is a life-changing event. But there’s so much more here. And I’ll just go through a few of my favorites that I like to talk about all the time when I’m out on the stump. Young people will be able to stay on their parents insurance until they’re 26. People who develop cancer and other conditions that are expensive to treat won’t bump into lifetime caps and get thrown off their policies just when they need it most. Seniors will get better help on paying for prescription drugs. . . .
So that’s the second slice. There are just a lot of good pieces in it. No discrimination against women, including pregnancy, preventive healthcare services, so there are a whole lot of pieces to it. But people, as they begin to see those, as they begin to see that the Republicans are threatening to repeal it all, the support grows for the Affordable Care Act.
The whole business is in the structure, that people have gotten checks back from the insurance companies that have overcharged. So you got this whole set of, the coverage now shifts. That’s part two. . . .
Remember, the area that I worked in at this time, medical bankruptcy, was a big part of the early work that I did, and continuing work that I did along with my co-authors at the Harvard Medical School. And a big part of what we found was that simply having health insurance wasn’t enough to protect families from medical bankruptcy. The combination of co-pays and uncovered services and lifetime caps left many middle class families exposed when a serious illness hit. . . .
Part three, and this is what is really exciting about the Affordable Care Act… [L]ong term, it speaks about whether or not we can think as a country about our long term interests where we’re headed. On health care, we’ve got to change the health care cost curve. It cannot continue to rise until we are a nation of people who are administering health care services to each other and producing nothing else, we can’t do that. If you look at those projections you just say, at the end of the day, we’ll all be healthcare workers, healthcare providers, or patients. And we can’t do that. We can’t survive as a country.
So the question becomes what’s it going to take to bring health care costs under control? And now, on each one of these, it’s back to this vision of America going forward — how to bring those costs under control. The Republicans have a vision for bringing costs under control: Get private insurance companies in there, compete with each other, and somehow that’s going to bring costs under control. There’s not only no empirical evidence to support that, most of the evidence goes the other way. The insurance companies make large profits that don’t go to healthcare services. People make the comparison of what does it cost to administer the Medicare system versus the estimates of what it costs to administer a private health insurance. And there are some reasons those comparisons are not perfectly apt, but there’s a lot that’s going on here in this huge difference.
So, that’s the Republican position. Just leave it to the free market, somehow that’s going to fix it. And frankly, that’s what we’ve been doing and it hasn’t fixed it. It’s gotten worse and worse and costs are going up and up.
The vision in the Affordable Care Act is brilliant. It starts with the assumption that this isn’t going to happen with a single magic bullet. It’s going to be a series of changes, a thousand changes, ten thousand changes, maybe a hundred thousand changes, but here’s how they’re going to come: they’re aiming in a forward direction. Better outcomes for lower costs.
So here at Children’s Hospital in Massachusetts in the spring, we announced a study [of] . . . children who were asthmatic, and [it] had been serious enough that they had been hospitalized in preceding twelve months and had some number of visits to the emergency room. So these are pretty severely asthmatic kids. And they changed the treatment protocol. They had an idea of how to do better by these children so they changed the treatment protocol. They moved up the treatment to much earlier, so they did good things like home visits, and they would look around the apartment and say, get rid of this, add this, and they bought HEPA vacuum cleaners for these families, and they discovered that for every dollar spent early they saved a dollar forty six over the course of the year in treating these children.
Here’s the cool part. How did they end up saving so much money? By doing the right things at the beginning when the kids were healthier. So there were many fewer hospitalizations. Many fewer trips to the emergency room. Here’s the key to it...More kids who are playing outside. More kids who are able to join a sports team. More kids who are able to live normal lives, or lives that are closer to normal.
And so that’s the sweet spot. Do the gold standard studies, . . . figure out what the best treatment protocols are to give better outcomes at lower...costs, and that becomes the best practices approach throughout the country. Just think about what that could be. Start with asthma, think about diabetes across this country. Think about the opportunities for improvement here -- a healthier American people who spend less money on health care. And that’s the direction this is going.
And by the way, the pieces fit together. This is why, for example, I keep reading how the parts [about] preventive healthcare services, how mammograms are covered now, it goes to exactly this point. Why weren’t insurance companies doing this before? Because there’s a very high rate of people switching [from insurance company to insurance company]. And they would look at it and say, ‘If I can’t guarantee I’m going to be the beneficiary, then I’m not going to do it.’ The alternative, and this is one of those places where it’s possible for the government to step in and say, ‘Wait a minute. Everybody’s going to provide it because one of you will be the beneficiary.’ So now everyone provides mammograms and cervical cancer screenings, and the whole system now benefits. It helps bring down costs.
On Religious Faith and Public Life
Methodists believe in action. And that’s a part of goodness — a part of worship of God is to act.
I grew up in a Methodist church and I was a Sunday school teacher when we lived back in Texas. When I was making the decision whether to get into this Senate race, one of the important touch points for me was to read my bible. And it’s Matthew 25:40, you know the passage? For me, that passage is the heart of what I believe. Because what it says is “Inasmuch as ye have done it unto one of these the least of these my bretheren. ...” (I still use the King James version, it’s beautiful).
It says three things: it says there is God in...the hungry, the poor, the stranger, there is God in each of us. Because. Remember, it says “you did it unto me.” And that’s saying God was in, God is in, the poor, the thirsty, the stranger.
But then part two is he never asks the question of going to heaven and hell, what your intent was, the question was: Did you act? And those who gave meat to the hungry, those who gave water to the thirsty, those who welcomed the stranger in, were the ones that God welcomed to heaven. ... It stresses the importance of community, because it says, in fact, it’s about action and it’s about action together.
And that’s how I read Matthew 25:40. And it’s why I’m in this race.