Voices of Power: Secretary of Health and Human Services, Kathleen Sebelius

Secretary of Health and Human Services Kathleen Sebelius talks about abortion and her painful rift with the Catholic Church in her home state of Kansas. Video by Jennifer Crandall and John Johnston.
Worldwide Reporting LLP
Tuesday, September 15, 2009; 12:00 AM

Welcome, Kathleen Sebelius, Secretary of the Department of Health and Human Services. Thanks for joining us today.

SECRETARY SEBELIUS: Sure, glad to be with you.

MS. ROMANO: So, President Obama has delivered an impassioned plea for healthcare reform. How do you all go about selling it now in the next few weeks?

SECRETARY SEBELIUS: Well, I think Congress is poised to act. Four of the five Committees have completed their work, are ready to take a bill to the Floor of the House and the Senate. The final Committee, the Senate Finance Committee, has said they will move next week. So, we have never been at this place before. It is more action than this topic has seen in 70 years, and I think Congress is--the majority of Congress is ready to take up the President's call and pass health reform this year and get a bill to his desk that he can sign.

MS. ROMANO: You are from the middle of the country, the Heartland. Your dad was the Governor of Ohio, where you grew up.

You were the Governor of Kansas.

What are people afraid of in this plan?

SECRETARY SEBELIUS: Well, I think the status quo is always a little easier to sell than whatever might be in the future, and certainly there has been a lot of misinformation intentionally circulated trying to scare people about the future.

What I think the President did when he addressed Congress, what members of Congress themselves have done is to clarify what is in the plan and what isn't that--for Americans who have coverage, they can keep it, they keep their doctor, costs will come down, but there is some safety and security by changing the rules for insurance companies who can now pick and choose who gets coverage, can dump people out of the market if they get sick, can raise rates so that it is unaffordable.

MS. ROMANO: Why do you have to be bipartisan? It's time for action, why not just go with it?

SECRETARY SEBELIUS: Well, I think we are reaching that position that the President will work with anybody who wants to move ahead, but what he said pretty clearly to the members of Congress, if you have a good idea, if you want to help improve the bill, come on in¿..But if your only intention is to stop action, is to cling to the status quo, is to support the special interests who right now are doing just fine but don't really want a change, then we'll move right by you, hoping that there'll be Republican votes.

What we know is that there are Republican ideas that will be incorporated into the health reform bill. I am hoping that some of the Republican members of Congress will step up and actually vote for the package.

MS. ROMANO: Is reconciliation still an option on the table?

SECRETARY SEBELIUS: Well, I think it is a legislative tool that allows the majority to move forward, and that if that's really, at the end of the day, where Congress finds itself, they have not taken any of the tools off the table. I think action this year is the priority.

MS. ROMANO: Do you see a possibility of doing this without raising taxes?


MS. ROMANO: You do?

SECRETARY SEBELIUS: Yeah, I absolutely do. I think that there won't be a general tax increase and the President is firm on his commitment that no one who makes $250,000 or less will pay any additional taxes. So, I definitely think that that's part of the plan.

I mean, what we do right now, Lois, is, in America, we spend twice as much as any country on earth on healthcare. We live sicker and die younger than any developed nation. So, we have a lot of money in the system that is not really paying for outcomes that improve the lives of all Americans, and part of the change we need is really to look at higher quality care for everybody at a lower cost. It takes place in the Mayo Clinic and in Geisinger and in the Kaiser plans and with Intermountain Healthcare, but day in and day out it doesn't occur with most Americans, and that is part of the system that has to change.

MS. ROMANO: You are pro-choice.


MS. ROMANO: Do you think that the federal government should do some federal funding of abortions, personally?

SECRETARY SEBELIUS: Well, the President has made it pretty clear that Congress and the new health insurance plan will not provide federal funds for abortions.

MS. ROMANO: Well, I know that. I was asking you what you thought.

SECRETARY SEBELIUS: I am the Secretary of Health and Human Services, and I will support the President's proposal moving forward.

MS. ROMANO: You are also a pro-choice Catholic, and I was reading some stories out of your home state recently where one of the bishops took an action. Can you tell us a little bit about that?

SECRETARY SEBELIUS: Well, the Archbishop in the Kansas City area did not approve of my conduct as a public official and asked that I not present myself for communion.

MS. ROMANO: What did you think about that?

SECRETARY SEBELIUS: Well, it was one of the most painful things I have ever experienced in my life, and I am a firm believer in the separation of church and state, and I feel that my actions as a parishioner are different than my actions as a public official and that the people who elected me in Kansas had a right to expect me to uphold their rights and their beliefs even if they did not have the same religious beliefs that I had. And that's what I did: I took an oath of office and I have taken an oath of office in this job and will uphold the law.

MS. ROMANO: Do you continue to take communion?

SECRETARY SEBELIUS: I really would prefer not to discuss with you¿That's really a personal--thank you.

MS. ROMANO: Okay. Let's turn to swine flu.

SECRETARY SEBELIUS: Swine flu. Let's talk about swine flu. It's H1N1.

MS. ROMANO: You got some good news today about the vaccine.

SECRETARY SEBELIUS: We did. The research has--the clinical trials have shown that the vaccine is effective in a single dose and effective within ten days, and that's very, very good news. We had assumed that, for adults, they would need two doses and that it might take three weeks between doses, and then another couple of weeks before the immunity was fully realized and this means that, starting in mid-October, when we have a vaccine available, we should have adults immunized a lot faster than we had feared. We were thinking Thanksgiving might be the worry window and it may be a lot sooner than that.

We don't have the children's clinical data yet. This applies probably to kids nine years old and up. We are still waiting for the next ten days to get the rest of the data for younger children.

MS. ROMANO: So, I understand from a source at NIH that, in mid-October--that you you'll initially have 75 million doses and then 10 million--

SECRETARY SEBELIUS: We have somewhere under, we think, 40 to 50 million doses, perhaps, by mid-October.

But those numbers even are not certain but that's probably the ceiling, by mid-October.


SECRETARY SEBELIUS: We'll have plenty of vaccine as we move along, yeah.

MS. ROMANO: Who will be getting the first batch? The most vulnerable?

SECRETARY SEBELIUS: Well, the committee on vaccinations has recommended priority populations, and they include pregnant women, caregivers of infants under six months, because babies are not recommended to get the vaccine, so protecting the vaccines by getting the caregivers vaccinated, healthcare workers who will be on the front lines are in the priority population; children ages 6 months to 24 years who have been really kind of targeted with this flu, particularly those young Americans with underlying health conditions, any kind of neuromuscular disorder, asthma, diabetes; and older Americans who have those kind of underlying health conditions. About 160 million people, about half the population fall into those priority groups.

MS. ROMANO: I didn't know that.

Now, some of the reports are saying that about half the population could be infected--I mean, that's a pretty broad estimate. What are your worst fears?

SECRETARY SEBELIUS: Well, the fear is that, until we get the vaccine and until people have immunity, we could have a lot of illness. So, we have to take steps right now to really prepare for that for possible hospital surge, looking at additional capacity, but doing everything we can to mitigate the transmission¿keeping sick children home, keeping sick adults home, kind of that social isolation really does work, and that's the strategy we have to put in place in a widespread fashion until we get enough vaccine that people really can be fully immunized against the spread of the flu.

MS. ROMANO: And have you gotten your shots yet?

SECRETARY SEBELIUS: Well, I got my seasonal flu shot today.


SECRETARY SEBELIUS: And we want to remind people that seasonal flu vaccine is available right now. So, that's a really good idea. H1N1 vaccine is not available yet, and I'm not in a priority population. So, I will get a vaccine--

MS. ROMANO: Not in the pilot, either?

SECRETARY SEBELIUS: No, no, no. I am not in the clinical trials. So, eventually, I'll get one, but that won't be available until mid-October.

0:16:51 MS. ROMANO: Now, I had a question for Secretary Napolitano, and she told me to ask you, and that was, why aren't the shots mandatory?

SECRETARY SEBELIUS: Well, I think that most vaccination programs in this country have been voluntary. There are a limited number really dealing with vaccinations that children need to have before they enter school which have dealt with diseases which are pretty much eliminated in the United States, but we've never made seasonal flu vaccine mandatory even to healthcare workers. We don't have other flu vaccines mandatory, so this is really presenting itself a lot like seasonal flu.

0:17:33 We hope that people take it seriously because nobody has immunity to this new strain and people can get very sick. People get very sick with seasonal flu. We have 200,000 hospitalizations every year. 36,000 people die. So, it is a serious disease and vaccination is a great blockade against the disease.

I was really stunned to find out that healthcare workers only take advantage of seasonal flu about 40 percent of the time.

During the President's speech, he openly tasked you with the job of pursuing medical malpractice reform. Where do you start?

MS. ROMANO: Well, actually, the Department has had legislative authority since 1999 to run the kind of demonstration programs that the President mentioned in his speech, to test some opportunities to lower the rate of defensive medicine to see if there are some strategies that avoid some of the most costly litigation. They've just never used it. No President has asked for it to be done before.

So, we have a team together right now. We are looking at how we put together at the President's request some pilot projects and have states apply for funding to test some strategies and see what really works. There are states who have various kinds of screening panels in place, various kinds of review opportunities in place, the so-called "sorry works" program where there is an opportunity for a doctor and an injured patient to actually meet together and try to resolve the situation before litigation is filed. So, we're looking at those kind of models that were outlined in the House version of the reform bill and seeing how quickly we could put some RFPs together to get out to the states. We have the authority to do just that.

MS. ROMANO: So, we got a question from Twitter on this, and it is Mary Katherine [ph.], and she wrote, "How will the Secretary reconcile her new role in exploring reform with her history of working for the trial lawyers?"

SECRETARY SEBELIUS: Well, I think I am just the person to do it, because I think I understand the system of litigation very well. I understand that we want to, as the President has always said, compensate injured victims, but the defensive medicine is not helpful to the overall cost of the system. The best opportunity is to raise the quality of care and to lower medical errors. And so, there are lots of strategies that we can put in place.

MS. ROMANO: Do you think it's realistic given the vast support the trial lawyers have given the Democratic Party over the years? I mean, will they buy into this?

SECRETARY SEBELIUS: Well, I think that the opportunity to have faster compensation for injured victims is one that most lawyers that I know support, and I think the opportunity to work together to lower medical errors and produce higher quality medicine is actually something that everybody supports. So, I think there's a lot of opportunity here to figure out some strategies that actually work and see where we can go to improve the quality of medicine, and that's really how the President framed it. That's what our statutory authority calls on us to do.

MS. ROMANO: Okay. Well, great. Thank you very much for joining us.

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