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Thursday, August 27 at 10:30 a.m. ET

Rep. Jim Moran Defends the Public Option

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Greenspring Village Retirement Community residents express their thoughts and concerns over President Obama's health-care reform bill with Rep. Gerry Connolly (D-Va.). A group of residents protested outside. Video by Whitney Shefte and Jon Johnston; Edited by Pierre Kattar/The Washington Post
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Rep. Jim Moran (D-Va.)
U.S. Representative for Virginia's 8th District
Thursday, August 27, 2009; 10:30 AM

U.S. Rep. Jim Moran of Virginia's 8th District was online Thursday, August 27 at 10:30 a.m. ET to discuss health-care reform and his support of the public option.

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A transcript follows.

On Tuesday night, Moran defended Democratic efforts to reform health care along with physician and former Vermont governor Howard Dean. The two were confronted by hundreds of angry opponents.

Rep. Moran has been a U.S. congressman serving Northern Virginia since 1990. He was elected to his tenth term in the U.S. House of Representatives in November 2008. Moran is a senior member of the House Appropriations Committee, and is a co-founder of the Congressional Prevention Caucus, the Task Force on Sovereign Wealth Funds and the New Democrat Coalition.

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Rep. Jim Moran: Good morning. It's a sad day given the loss of Sen. Kennedy but I'm glad to have the opportunity to chat with Post.com readers. I look forward to the next hour of discussion.

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Arlington, Va.: Jim,

How can you promise that this health-care bill will not be the first step in the total socialization of health care? Medicare only started out modestly and now it is out of control. When has the US Government not sunk its roots into a program and expanded it drastically?

Thank you.

Rep. Jim Moran: Medicare has become very expensive, no question. But I don't know anyone in the Medicare program who would drop it or doesn't prefer it to private insurance. As expensive as Medicare is, its costs are growing at a significantly lower rate than private insurance and 97% of Medicare's dollars go into the actual provision of medical as opposed to about only 70% of private insurance premium revenue.

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Washington, D.C.: Since there is not a single health care reform bill under consideration, what do you think the final bill that gets voted on will eventually look like?

Rep. Jim Moran: There are basically two bills under consideration. The bills reported out by the Energy and Commerce, Ways and Means, and Education and Labor committees in the House and Senate are consistent and easily integrated. The second bill being developed by the Senate Finance Committee will represent a more conservative approach with regard to the provision of medical care and the financing of it. I suspect that Sen. Kennedy's passing may provide added impetus to produce a more robust bill, more representative of the universal mandate for coverage and quality that the more progressive set of bills contain.

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Arlington, Va.: In what real-world concrete example has the involvement of a government or quasi-government agency as a participating entity led to actual competition and a lowering of costs and not the development of a monopoly? If you cannot cite any examples, how do you know that such a lowering of costs will actually occur?

Rep. Jim Moran: Since the early 1990's there has been an effort to enable the private sector to compete with the federal govt in nearly every area of service provision. This has especially been the case within the Defense Department. There were more private contractors in Iraq than federal military and civilian personnel. And yet while there are some very conscientious military contractors that I am proud to work with, the firms like Halliburton, Black Water, Aegis and a number of others have charged the govt considerably more than the in-house cost of the same service and have been responsible for the most egregious abuses of America's values and principles.

No private insurance system would provide the care that is provided our wounded warriors through the VA system. Nor have we ever been able to protect our national land and recreation areas as well as the national park service has. There needs to be a balance between the public and private sectors in my opinion and the anti-govt vitriol that has accompanied this health care debate is less than constructive.

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Laytonsville, Md.: You have said you think taxing people who already have health insurance plans is a good way to fund health-care reform. Why should people who are satisfied with their health coverage pay for those who don't have it or refuse to get it?

Rep. Jim Moran: First of all, well over 80% of Americans will stick with the coverage they have under this plan. 98.8% of taxpayers will not pay any more taxes than they are currently paying.

But I think it is important to keep in mind that under the current system that pays for tests and services, rather than the actual health of the individual, every American pays on average more than twice the cost incurred in any other part of the world. And in terms of people who are currently uninsured, they are now getting care, but at the most expensive level -- at a hospital emergency room -- which generates a cost of uncompensated care spread to those whose services are insured that amounts to $1,100 per person each year. I find it pretty shocking that Americans pay more than twice as much as people in any other industrialized countries and yet we live shorter lives and experience a good deal more illness.

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Alexandria, Va.: Congressman- Do you have any estimates for the amount of money that the federal government already spends to compensate hospitals for care that is not reimbursed (care for the uninsured, Emergency Medicaid, denial of claims for insured patients, etc)?

Rep. Jim Moran: I do know that in my northern Virginia congressional district alone, we all pay more than $100 million for uncompensated care given to the uninsured. That amounts to over $1,000 per family that the hospitals etc pass on to those of us who are insured.

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Roanoke, Va.: To show how connected you are to your constituents, will you vote to have you and your fellow Congressmen participate in the proposed health-care reform? In other words, you will be in the same boat as we are. Also, why is it politically difficult to address tort reform?

Rep. Jim Moran: Members of Congress participate in the same federal employees health plan that is available to all federal employees. I pay several thousand dollars per year out of pocket for insurance, as do most Americans. The exchange that is included in legislation is modeled after the system that we have. It will provide a greater choice of insurance plans than most people today have available to them. And because of the increased competition the premiums will probably be lower and the annual rate of increase will be slower than is currently the case.

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Arlington, Va.: A couple of comments:

1. Keep up the great work Congressman Moran.

2. I'm a resident who is an independent contractor without insurance (in my 30s and healthy). If I'm going to be mandated to purchase my own coverage, I want a public option. Private health insurers worst excesses and abuses are in the individual market by a pretty long shot.

If people are mandated to buy their product, I expect the abuses are likely to get worse, rather than better. This is especially true if the GOP wins Congress or the presidency again. Odds are they'll keep the mandates, but drop, or simply fail to enforce the consumer protections.

A public option is more likely to keep both the industry and future GOP administrations honest.

Rep. Jim Moran: I agree.

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Ashburn, Va.: I've heard concern about physicians refusing to accept public insurance because it doesn't pay as well as private insurance. How would this health care bill try to avoid such an exodus?

Rep. Jim Moran: The bills under consideration do put a greater emphasis on general practitioners and somewhat less on specialists. There will always be, as there is in Canada, a substantial number of people who choose to pay more for private specialists. But most physicians will continue to accept Medicare reimbursement rates and will continue to participate in the private insurance plans currently available. The estimate is that even if a public option is available, two-thirds of employers and employees will choose to stick with the private system. The American Medical Association does not see this as a threat to the wherewithal of their physicians and has endorsed the legislation.

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Fairfax, Va.: Why isn't the case being made more forcefully that our current system of "unsocialized" medicine is more expensive than any country on earth? We spend more on health care as a percentage of GDP than anybody, including countries with so-called government-run medicine, yet all we hear from conservatives and moderates is that we can't afford reform. Who is making the case that we can't afford NOT to reform the system?

Rep. Jim Moran: You make a good point. In fact, while the U.S. spends by far the most, we are not getting the best health care by a long shot, ranking 24th out of the 30 industrial countries in life expectancy and 28th in infant mortality.

Incidentally, the insurance companies this year stated that they intend to increase their insurance premiums by an average of 10.5%. This at a time when there is virtually no inflation in the rest of the economy.

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Falls Church, Va.: Rep. Moran,

Reading a commentary yesterday in the paper by a General Practitioner, it seemed as though the low reimbursement costs to him from Medicare is what is driving a lot of them out of the business, and driving a lot of newer doctors away from Primary Care. Are there provisions in any of the bills that would provide a higher rate of return for Primary Care physicians, or provisions that would encourage people to go to their Primary Care doctors first, in order to help reduce costs to the system?

Are there any provisions that would allow the government-run option to negotiate costs, in order to get them reduced?

Are there any provisions that focus on preventative care over medical treatment after the fact?

Thanks for your time.

Rep. Jim Moran: Yes to all of your questions. There will be higher reimbursement for general practitioners as well as investment in their education and training costs. This is actually one area that should be of concern in the early years because of the inadequate number of general practitioners currently available. It is envisioned that general practitioners will play a larger role as the gatekeeper and quarterback of the health care delivery team.

Preventive care will be fully reimbursed and emphasized under the reform bills.

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Washington, D.C.: How much will the public option cost a family?

Rep. Jim Moran: The public option will probably cost less than existing insurance plans because most private insurance plans spend nearly 30% of their revenue on corporate profit, advertising and administrative fees. The public option will not have to charge for these expenses.

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Arlington, Va. : What should people have to pay for, regarding their health care? What are reasonable out-of-pocket costs for the public to pay for quality health care? If the government provides it, then we still end up paying for it through taxes, but I think some people just want to be able to walk into any clinic or hospital without ever having to personally pay anything out of their wallet.

Rep. Jim Moran: I do believe that everyone should contribute to the cost of their health care. But that means that there needs to be some mandate that requires everyone to have an insurance policy just as we require one to drive a car. In the rest of the industrialized world, people seem to pay about 6% for health care. If we can cap ours at approximately 6-10% we could save 100's of billions a year. I do think a combination of a universal mandate, a public option to spur competition where some insurance companies control the market and an emphasis on research of best practices may help us bring current costs down from a sixth of GDP to perhaps 12% for the next generation.

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Charles Town, W.V.: Why was negotiating drug prices taken off the table?

Rep. Jim Moran: A deal was purportedly made at the White House that drug companies would reduce the cost of prescription drugs to seniors under Medicare by approx. $1700 a year through narrowing the so-called doughnut hole that currently exists for expenses between $2,700 and $6,154. In return for this benefit to seniors, the White House allegedly agreed not to change the language that prohibits the govt from negotiating with the drug companies on behalf of the Medicare population.

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Arlington Va.: Will there be a mandate for coverage for all US citizens included in the bill? Don't we need to force everyone to buy insurance so that those of us who are paying for coverage will stop subsidizing those who choose to avoid paying for insurance?

Rep. Jim Moran: The answer is yes. Everyone who chooses not to enroll in health insurance will pay a penalty of 2.5% of salary. This is the only way we can enforce a universal mandate. There will be subsidies for people who cannot afford to pay for health insurance on their own.

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Arlington, Va.: How do you possibly expect that this plan will get paid for? Our debt is already in the trillions.

Rep. Jim Moran: The cost is of great concern. But an even greater concern is the cost of doing nothing. When we first contemplated a health insurance bill in 1993, the average cost per family was about $7,000. It is now $15,000. If we do nothing, it is projected to rise to $36,000 in ten years.

Let me mention again that the insurance companies have stated that they expect insurance premiums to rise by 10.5% this year.

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Rep. Jim Moran: Enjoyed the chat. I appreciate the insight and knowledge of all those who participated. To be continued...

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