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Iowa Sen. Tom Harkin (D-Cumming) on Health Care

posted on November 6, 2009

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Borg:It's the process. Target dates for legislation overhauling the nation's health care system are repeatedly extended. Among those leading the senate's process is Iowa’s democratic Senator Tom Harkin. A conversation with Senator Harkin on this edition of Iowa Press.

Funding for Iowa Press' was provided by Friends, the Iowa Public Television Foundation; the Iowa Bankers Association ... for personal, business, and commercial needs, Iowa banks help Iowans reach their financial goals. Iowa Community Foundations, an initiative of the Iowa Council of Foundations, connecting donors to the causes and communities they care about for good, for Iowa, forever. Details at iowacommunityfoundations.org.

On statewide Iowa Public Television, this is Friday, November 6 edition of Iowa Press. Here is Dean Borg.

Borg:Distilling ideas and crafting coalitions for overhauling the nation's health care system are detailed, arduous, and politically sensitive. Complicated is another word that comes to mind. However you describe it, the bottom line is that it takes time, and some polls are showing disappointment and impatience in some quarters. This is all familiar territory for Iowa’s democratic Senator Tom Harkin. Chairing the senate's health, education, and labor committee, he's in the congressional trenches on this one. But it's only one of the topics that we'll be talking with him about during the next half hour. Welcome back to Iowa Press.

Harkin:Dean, it's good to be back with you.

Borg:And across the table, Associated Press Senior Political Writer Mike Glover and Radio Iowa News Director Kay Henderson.

Glover:Senator, as Dean mentioned, you are in the midst of the senate debate over health care, chairing the health committee. Give us your predictions. We all hear this talk about congress dealing with health care. Will congress this session pass a health care reform bill that will be meaningful?

Harkin:Absolutely. Take it to the bank, Mike. We are going to pass a strong health -- well, first of all, the house it going to pass their bill this Saturday.

Henderson:This weekend.

Harkin:This weekend. Then the senate will take up this bill the week after next, and we will be on it nonstop until Christmas. Now, I had been predicting all year that we would have a bill on the president's desk by Christmas. Well, I think I’m off a little bit on that, honestly speaking.

Glover:So it will be after the first of the year?

Harkin:But we'll have a bill out of the senate before Christmas. We'll go to conference. I will be one of the conferees leading my committee. And we'll have a bill on president Obama’s desk before the end of January.

Glover:And there has been interminable delays, it seems. First there was going to be a bill by the August recess, and then there was going to be this latest deadline. In fact, every time this bill gets delayed, isn't it out there longer for people to shoot at?

Harkin:Well, there have been a lot of delays. I think a lot of that has to do with some of the republican intransigence the senate more than anything else. We finished our bill in the health committee by July 15. It took the finance committee until September, I think, to finally get theirs done. So there's been a lot of foot dragging on this, and I think a lot of it's purposeful. I mean just look what just happened recently. We have unemployment insurance that helps pay for people when they're unemployed for certain weeks of unemployment. We know how high the unemployment is. The unemployment insurance program ran out of money the end of September. We brought up a bill to extend it for fourteen weeks. Well, we couldn't get it on the floor. The republicans in the senate made us file cloture and get a vote on that, file another cloture, get a vote on that, file a cloture, get another vote on that. Then they made us even run out thirty hours of debate. It took us 28 days of foot dragging to get the extension of unemployed insurance through. And guess what, it passed 98-0. 98-0 and yet it took us 28 days!

Glover:Are republicans winning this debate over health care? They succeeded in knocking the public opposite out of the health care bill. They scared a lot of modern democrats. What's the politics of this bill?

Harkin:Well, wait a minute, the public option is going to be in the bill. It's in the house bill and it's in the senate bill. It's in the merged bill that Senator Reid is going to bring to the senate floor. We are going to have a very strong public option.

Glover:And what's the politics of it?

Harkin:Well, the politics are very clear. Almost 2-1 -- almost 2-1 the American people want a public option health insurance out there as a choice, not to force on anybody but to give them the choice to have that. There's many places in this country where you have one insurance company and out there, or maybe two at the most. Public option, we usually have a better choice. So the polls show about 2-1 the American people want that choice. Among democrats, 4-1. 4-1 among democrats public option. Among doctors -- they did a survey of doctors, dean. Among doctors in the United States, 3-1 they say we have to have a public option. That's what people are looking at. The American people want this.

Borg:And the public option, you are very, very certain that out of conference committee there will be a public option. You wouldn't compromise?

Harkin:There will be a public option. Now will it be exactly like the one that we passed in our bill? Well, the one that is in the merged bill now is a little bit different because it has a state opt out. Our bill that we report out of committee did not have it, so this bill now has it where if you're a state like Iowa, Missouri, or wherever, if you want to opt out -- if your governor and your legislature says, no, they don't want it, they can opt out. I don't have any problems with that. If the states want to opt out, let them.

Henderson:One component of the bill that's important to Iowa hospitals, doctors, and other health care providers is an amendment that would allow for changes in Medicare payments to those providers. Do you think that will wind up in the final version?

Harkin:Kay, are you talking --

Henderson:Medicare payments and changing the reimbursement rates for hospitals, doctors, and other health care providers.

Harkin:It's kind of two issues. One is that -- is what we call the SGR, that payment rate that goes to doctors that we have to fix every year. That will not be a part of the bill. We'll do that separately. The other thing is just the standard reimbursement rate to hospitals, because we're so low in Iowa and the upper Midwest, yet our quality is very high. Yes, both Congressman Braley and Senator Grassley -- Senator Grassley in the finance committee, Congressman Braley I think in the commerce committee in the house put in provisions that will address that. And since I will be a conferee -- so I’m sure Senator Grassley will too. I'm sure that we will keep that provision in there.

Glover:Give me a number. Will people notice this? What percentage of Americans will remain uncovered if this bill goes into law?

Harkin:Well, if our bill goes through, all of these statistics show that by 2019 -- it will take some time. By 2019 we will cover 96-percent of all Americans. Right now it's about 83 percent. So we'll go from 83-percent to 96-percent coverage.

Henderson:This past week the AARP and the AMA endorsed this bill. How does that change the political reality, if at all?

Harkin:Oh, I think it changes it quite a bit. For example, many of the republicans' arguments have been that, well, we're going to harm Medicare, we're going to take away Medicare things for people. Well, if AARP is endorsing it, I rather doubt that that argument is going to hold much water. The other thing that republicans are saying that want to stop this bill is that you're going to put a government bureaucrat in between the doctor and the patient. If that were true, I doubt that the American medical association would be endorsing this bill.

Glover:What's different this year than 1994? I mean why is this apparently going to happen this year and it was blown up in 1994? What politics changed? Groups changed? What happened?

Harkin:Well, I was there for that too. I remember that very well, Mike. It's just gotten so much worse. In that time -- if you think back to 1994, we did not have the business community in America on our -- lobbying for health reform. We didn't even have labor unions arguing for health reform. They had their plans and they were fine. So we didn't have the kind of critical mass in 1994 that we have now. But for -- but for the health insurance industry, just about everybody else says we've got to get this done.

Borg:Health care legislation is centered in the congress right now. But centered in the white house another big question that probably will be coming the other direction to congress, and that is what to do about Afghanistan and increasing the troop level there. If you were advising the president right now, what would you say?

Harkin:Can we stay on health care? I understand that issue. Well, look, I’ll -- it's obviously part of my responsibilities, yes. Look, here's sort of my kind of bottom line on Afghanistan. I'll be the first to admit I’m not an expert in this area. I've been there. I've been to Pakistan a number of times. My bottom line is, number one, we can't stay there forever. Number two, we can't shoulder the burden by ourselves. Number three, it's the kind of situation that I don't think lends itself to a, quote, military solution. It's got to be both a little bit of military and a little bit of political solution to it.

Borg:It sounds to me like there's reticence about sending more troops.

Harkin:On my part, yes, there is. Again, I want to see more of a plan. It doesn't have to be public. I mean we're top secret clearance. I can get all these briefings and stuff if they don't want to make it public. They've got some way that they want to do things, how we're going to reach an end goal. What is the end goal: how do we get there? What happens afterward? I'd like to know that. I don't see that out there right now. Any really -- what's the end goal, how do we get there, when are we going to get there, and what's the aftermath, I’d like to see that before I’d support sending any more troops.

Glover:And your role in the senate has changed somewhat significantly, and you were chair of the senate agriculture committee. You have moved away from there to become chair to Senator Kennedy’s place as chair of the health committee. How do you answer to Iowa farmers that you've chosen health over agriculture?

Harkin:Well, I think health is pretty important to our farmers too. As a matter of fact, Mike, I’ll say this: under our health care reform, the biggest winners -- the biggest winners are small business and the self-employed. And what are farmers? Either small business or they're self-employed. I'll tell you this is a big win for them. But look, I’m still on the agriculture committee. I've been on the ag committee 35 years. I'm now second in ranking. I'm no longer chairman but I’m still on the ag committee, and I will be very heavily involved in it. But I also have my say that what eased my deliberations on which committee to take was the fact that we have a great Secretary of Agriculture in Tom Vilsack.

Glover:Was it a tough choice?

Harkin:It was a choice I had to think about. But, look, education is important. We're going to be redoing the elementary and secondary education, no child left behind next year. That's going to be a great challenge. Health care, for crying out loud, not just passing the health care bill but implementing it over the next few years and making sure it's implemented right and little tweaks and changes.

Henderson:The 'l' in help is labor. Will you pass card check before the year is done?

Harkin:Which year?

Glover:This term.

Harkin:We will pass a labor bill that will make it easier for people to organize themselves in the union, that will make it tougher on employers to fire people or crack down on people who want to form a union, and it will make it easier for employees to get what we call a first contract after they've organized. I've been working on this for the better part of this year, not all the time but having my meetings. I think we have a pretty good agreement put together that I hope to get 60 votes. I can't do anything unless we get 60 votes. And I hope to bring it out. Well, I was hoping to get it done this year -- calendar year, but it looks like -- more like next year.

Glover:One of the issues you will be dealing with is a cap and trade system to deal with climate change. That's not hugely popular in rural parts of the country. Where are you on that? And give me your prediction of where it's going to end up.

Harkin:Well, first of all, the cap and trade bill that basically we have in front of us -- well, it's still in committee but as it's been drafted, when I was still chairman of the agriculture committee, I asked Secretary Vilsack and the department to tell us how does this impact agriculture. And they did a big study on it, and I think the secretary testified on this in July, if I’m not mistaken, when I was still chairman. And their analysis is that in the upper Midwest, farmers have a net benefit from the cap and trade bill. We will actually be able to pay farmers money for sequestration, for example, for certain cropping practices and things like that. So actually for agriculture, it could be a big plus.

Glover:Do you have a sales job to do there?

Harkin:Say what now?

Glover:Do you have a sales job to do with farmers because there does seem to be some unrest out in rural America?

Harkin:Well, see, farmers are right to be concerned about prices of fertilizer, for example, and things like that. But as you know, we have -- under our new farm bill, we have instituted practices that will pay farmers to use less fertilizer. Well, I should say use it in a better way. Quite frankly -- and I’ll say this very frankly -- we don't use fertilizer in the best way we know how to. I mean just take a look at your rivers and your streams and things like that. With better -- with better conservation practices, using satellite GPS, we know -- and with soil samples, we know how to apply fertilizer much better and in a more -- in a way that we don't get all that runoff. So in many ways, I think our farm bill is going to allow farmers to use less fertilizer, get the same production yield, and they'll then be able to get payments.

Henderson:Farmers who are part of the pork industry feel that as if the rug has been slipped out from underneath them. With the federal government in any way help the pork industry?

Harkin:First of all, I want to congratulate Tom Vilsack -- I already did, by the way -- for what he did in China. He went to China and he worked very hard at this. I know this was a tough negotiation, but he got China to reopen their doors both for pork products and live swine. So that is a big deal for us in Iowa and a big deal for the country. So he did a very good job there. So I’m hopeful that over the next year or so that we'll start to get out of this hole we're in, in terms of the price of pork in this country. And we will continue to look -- as the ag committee and stuff, we'll continue to look at what more can we do, school lunch programs, things like that, where we can do purchases.

Borg:But there are other nations that are still blocking exports of American pork.

Harkin:Yeah.

Borg:Do you think that Tom Vilsack should be also doing the same magic that he did in China in those other nations? Have you had that conversation with him?

Harkin:Oh, sure, we talked about that. The other countries don't -- well, they don't amount to a lot, but everything helps, you know. So he's going to use the agreement that he got with China and start going to these other countries because a lot of these smaller countries kind of look to the big ones like China. And if China does something, they say, well, there must be something to it. Well, we've broken that down. They now know that there is no cover under the WTO at all, the world trade organization, for them to exclude pork from the United States.

Glover:It wouldn't be an official Iowa Press' show if we didn't spend a little bit of time talking about politics. So I’d like to get your assessment of things political, if you could. I'd like for you to assess the climate for next year in the midterm election. History would say that the first midterm of a democratic president is a pretty good year for republicans. But the economy seems to be first and foremost on the minds of almost everyone. That tends to help democrats. Talk to me about the climate of next year as we head into these mid terms.

Harkin:This is one area where, Mike, I always say that -- that's why I want to focus on the jobs issue, on economic recovery, because this is one area where policies have to take precedence over politics. And the good policies will lead to good politics, and that's why I think we've really got to focus on this jobs issue. The report came out, as you know, just --

Borg:Friday.

Harkin:Friday on the unemployment. It shows it about 9 to 10.1 percent. But the real unemployment in this country is really about 20 percent. About one out of five people are really unemployed or grossly underemployed, so we've got to start focusing on that.

Borg:Does that argue for a second stimulus program?

Harkin:It might, but perhaps a different kind of stimulus program than the first one we had.

Borg:How?

Harkin:Well, focusing more on longer term types of employment jobs. What I mean by that is maybe moving up the highway bill. We're talking about moving up the reauthorization of the highway bill, which would come normally in 2011, moving up early next year. Congressman Oberstar, who is the head of that in the house, has been talking about moving that up, getting that money out there right away. And the second thing would be to invest -- what I’ve talked about in building the smart grid in this country that al gore has been talking about for so long. We've got to build a new transmission system for electricity in this country from coast to coast, border to border. And then we've got to incorporate within that smart grid, by which we can control the usages of electricity and things like that. That's a lot of money and a long period of time. But once you get done with that, then you're in a new technology that will provide a lot of jobs for a lot of people in this country.

Glover:Iif the economy is driving everything, where is your take of where the economy is? It seems there are a lot of mixed signals out there. As you mentioned, unemployment has now gone past 10 percent. There are some other indicators that indicate things may at least not be getting any worse. What's your take on where the economy stands right now?

Harkin:Well, where I think we are is I really do think we've hit bottom. We may bounce around there for a little bit. But I think there are a lot of good indications that things are starting to come back. I hate to say this again. But the single best thing we can do as a country, as a congress, as the president, is pass health reform and get it done right now. Why do I say that? As I said earlier, the biggest winners are small business. Small businesses are the ones that create the jobs in this country. Sixty-five percent of all new jobs are created by small business. But when you've got somebody that's got a great idea and they want to go out and start a new small business and innovative and create things and they've got a child with a preexisting condition, you can't do it. So right now the health care system works against creativity. It works against entrepreneurship. It works against small businesses. We take that off the table, you're going to see small businesses start to grow and prosper and hire people in this country.

Henderson:Let's talk about one job, that of the president. What's your assessment of President Obama’s tenure in office?

Harkin:Well, I think for a first year, ooof, it's been an incredible year.

Henderson:There are people in your party who are not happy with him. They're upset with the way he's handled this health care debate.

Harkin:Well, I’m not. I think he's taken the right approach. I said that before earlier this year, that rather than the White House coming in heavy handed, like happened in 1994, let congress deal with it and let us do our job. There's a time for the white house to get involved. That's now and they are getting involved now. And the end game, when we go to conference and work it out, we'll work it out with the White House. That's the proper place for it.

Glover:There's another issue of next year, and that's called a race for who will be the governor of Iowa. Some say that's the top elected job in the state. You have a democrat, Chet Culver. He's almost certain to run for reelection. There's a pretty good field of republicans lining up to run against him. Give me your assessment where that races stands. Iowa hasn't defeated a sitting governor since 1962. Is this one in trouble?

Harkin:I don't think so. I mean, look, we've got a tough economy out there, and we've had some tough times in Iowa with the disaster, with the floods last year that hit. But Governor Culver has showed his mettle. He made some tough decisions. I mean, you know, and he made -- he made it determined -- when he cut that 10-percent budget, I mean that's a tough decision, Mike, and he did it. But when you look at the record of what Governor Culver has achieved in this state -- in the Hawkeye program, you know, the children's program, next year because of what he's done, we will be number one in the nation in the percentage of kids covered by health care in Iowa. Now, that's a pretty good record to run on. He did the power fund, which we had $190 million of private money into renewable energy here in Iowa. When he started as governor, 5 percent of the kids in this state had access to preschool. Next year 90 percent. I'm telling you that is a great record to run on. I would also close by this just saying that, you know, I know Governor Culver and I know him well and I’ve watched him. He is smart, he's got the long view, and he's looking to the future. And that's what that next election will be about, the future.

Henderson:You also know Senator Chuck Grassley, the republican senator from Iowa. He's up for reelection next year, indicating he will seek reelection. There is a trio of democrats who have emerged to challenge him. How would you assess their chances?

Harkin:Well, you know, chances are always good for anybody who is willing to work hard and raise the amount of money and highlight the issues that people care about. I don't get involved in that race. Senator Grassley has never gotten involved in my reelections, and I don't get involved in his. And I think that's the way it ought to be, just for senate comity. But I would say that next year is going to be a very exciting year, and I would think the challengers probably would have a pretty good chance next year.

Henderson:Do you sense anti-incumbent sentiment among the electorate?

Harkin:I’m probably glad I’m not up next year. Say again, I’m sorry.

Henderson:Do you sense an anti-incumbent sentiment among the electorate?

Harkin:Well, I think there's -- I think the electorate is just unsettled right now. And they're upset because of the jobs issue and the economy. And even those, dean, that aren't unemployed -- and I’ve heard a lot of this where people are being told, well, I don't know about your job, so far so good, but you might be thinking about next year. There's a lot of people concerned about this. That's why we've got to -- we've got to be about putting more jobs out there.

Glover:Is this now a democratic state? There are about 105,000 more democrats than republicans. You have a democratic governor. Democrats have solid control over both chambers of the state legislature? Is this now a democratic state?

Harkin:I wouldn't say so, no. One thing I’ve always said about the Iowa electorate, they're smart and they're going to take their time and they're going to look at these issues. But I will say this: my party has done a darn good job in the last several years of information, registration, active participation. Michael Kiernan is doing a great job as our party chair in the state of Iowa. He's young and he's in looking to the future. So I think my party has done a darn good job of reaching out and bringing in people and making the tent bigger rather than smaller.

Glover:And not to get too personal, but you will turn 70 years old later this month. You just won reelection to a fifth term in the United States Senate. What's your intention about staying in the senate? Will we see you run again? This is Iowa. It's never too early --

Harkin:I know that's true in Iowa. Look, God has been good to me. My health -- I couldn't ask for better health. I'm in great health condition. And contrary to what my political opposition says, I think my mental facilities are still pretty good. But I’ve got a good job. I've just taken over the chairmanship of this very big committee and trying to fill Senator Kennedy’s position. It's going to be a tough one, but there's a lot of things coming up that I want to focus on. I'll think about that a few years down the pike, if you don't mind.

Borg:I’m curious about conversations that may go on around your dinner table. Your wife, Ruth, is on the state board of regents.

Harkin:Right.

Borg:The state board of regents now is considering almost a 6-percent increase in tuition for the state. I know that you've always been a champion of access. How do you -- you may not advise Ruth Harkin as a member of the board of regents, but what's your feel on that?

Harkin:Whew! How come you want to get me in trouble with Ruth? Come on, Dean, give me a break. I think you should have her on here and ask her that. Look, families are hurting right now all over the state of Iowa. And it seems to me to start raising tuition on these families, I mean they're scrimping and saving every penny they've got right now to try to get their kids through school. I probably shouldn't get into this too much because that's her deal and not mine. But you're right, I have a sensitivity towards families who are really struggling to get their kids through school. And to whack them with something else, that kind of bothers me.

Glover:And you mentioned the governor's 10-percent spending cut. He says they're going to solve the budget problems with some spending cuts without tax increases. Is he right?

Harkin:Well, I -- I’m not all that familiar with the state budget and everything like that.

Glover:If it's the wrong time to raise tuition, is it the wrong time to raise taxes?

Harkin:You don't want to raise taxes in a recession. You just don't. It's just not a good thing to do. You know, you've got to look at places where you can tighten your belt. Don't tell me that we can't tighten our belt in a few places in this state where it really won't hurt a lot, but everybody has got to give a little bit. I just say don't -- don't pick on poor families and families that are struggling right now, you see.

Borg:Thank you very much for spending time with us today. I'm sorry that we're out of time.

Harkin:I enjoyed it, Dean. Thank you very much.

Borg:On our next edition of Iowa Press, we'll be talking with Iowa’s first district Congressman Bruce Braley. He's in his second term representing the eastern Iowa district and facing reelection a year from now. You'll see Congressman Braley at the usual Iowa Press airtimes, 7:30 Friday night and 11:30 Sunday morning. A reminder too that you can use the internet now for contacting our Iowa Press staff. The e-mail address is iowapress@iptv.org. We'd really like to hear from you. I'm Dean Borg. Thanks for joining us today.

Archive editions of Iowa Press can be accessed on the World Wide Web. Audio and video streaming is available, as are transcripts, at www.iptv.org.

Funding for Iowa Press was provided by Friends, the Iowa Public Television Foundation; the Iowa Bankers Association ... for personal, business, and commercial needs, Iowa banks help Iowans reach their financial goals. Iowa Community Foundations, an initiative of the Iowa Council of Foundations, connecting donors to the causes and communities they care about for good, for Iowa, forever. Details at iowacommunityfoundations.org.


Tags: Congress Democrats health health care health care reform Iowa politics reform