Iowa Public Television


Former Rep. Richard Gephardt on Health Care Reform and the Economy

posted on November 20, 2009

Borg: Political hardball. Key votes just ahead in the U.S. Senate determining the shape and extent of changes in the nation’s health care system. Insight from a congressional battle veteran, former Missouri democratic Congressman and presidential candidate Richard Gephardt on this edition of Iowa Press.

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On statewide Iowa Public Television, this is the Friday, November 20th edition of Iowa Press. Here is Dean Borg.

Borg: Much has been done, but there’s still a ways to go. The House of Representatives has passed its version of health care overhaul. Senate leaders are trying to leverage their democratic majority in getting a bill to the floor for debate. It’s all familiar turf for Richard Gephardt, serving 14 terms in the House of Representatives, and during that time, leading the House democrats in both majority and minority status. Add to that a couple of runs at the democratic presidential nomination, winning the 1988 Iowa democratic caucus. A cornerstone of his political career, overhauling the nation’s health care system. The cornerstone is still in place, although tangentially. Today he’s involved with the Council for American Medical Innovation, seeking to enhance medical research and development. Mr. Gephardt, you have been a guest here many times, although in a different role this time, welcome back to Iowa Press.

Gephardt: Great to be here. You know the people across the table because they have covered you from time to time, Associated Press Senior Political Writer Mike Glover and Radio Iowa News Director Kay Henderson.

Congressman Gephardt, welcome back to Iowa. The first question ought to be, what brings you back to Iowa, why are you here?

Gephardt: We are here to have a meeting with the governor and leaders here in Iowa on the subject of medical innovation. Our counsel from American Medical Innovation brings together disease groups, universities, pharmaceutical companies, biotech companies, research foundations to try to advance the cause of medical innovation in America. And Iowa, having great research facilities is an important part of this discussion.

We are in the middle of a big debate in this country about health care, national health care, health care reform, how does this fit into that whole package?

Gephardt: If you are going to have a more efficient health care delivery system, which is what we all want, you have got to have more new answers to dread diseases like cancer, like Alzheimer’s, like Parkinson’s. And so, we believe that we can move faster to get more answers to those problems. If we can find those answers, we will save a lot of money and increase people’s help status.

What are you specifically seeking to fix?

Gephardt: We are going to come up with a three-point agenda. First, we are going to try to advance the cause of what we called transitional research. That is the research that comes after the NIH does their basic scientific research. We also believe we need FDA reform, regulatory reform so that we can meet up with the new science of personalized medicine which is a whole new area that came from the genome project. And finally we need better science education. We need to develop more young researchers and scientists here and the United States.

What you’re talking about is faster approval for pharmaceutical drugs?

Gephardt: It is not necessarily faster approval, we just think because of the genome project and personalized medicine that the testing regime has to be updated and modernized. To be more consistent with the new science that we have developed. To put it in a word, there are going to be less big blockbuster drugs, there will be more targeted drugs that will work on you and not other people who have your particular disease. And that means you have to have a different testing regime. I also think there needs to be more cooperation between the government in the pharmaceuticals and the biotech companies to come up with new answers.

We are speaking about pharmaceuticals, are we talking about mechanical devices likes scanners or surgical techniques?

Gephardt: Talking about all of it. What is the pay off?

Gephardt: The payoff is that you use all diseases to come up with ways to manage chronic diseases which would save billions of dollars, that you come up with answers like the polio vaccine was in the ‘50s, that you come up with new devices that allow you to diagnose disease much quicker and more accurately. And you come up with other mechanisms that will treat disease.

It sounds to me, and this is like arguing against motherhood, I understand, but the question I’m asking here is it sounds to me like adding an increased cost to the health care system. We just this past week had a big hoopla about women and mammographies. That became very political. Aren’t you getting into the same sort of difficulty here with advancing and costing more in the health care system?

Gephardt: Well, you have to step back and look at what the health care system is trying to do. It is trying to increase our life span with quality. And if you look at America over the last 50 or 100 years we have really done that. Life expectancy has been increased dramatically over what it was when I was a child, even 40 or 50 years ago. So that is a good thing. Secondly, as the doctors at Washington University in St. Louis, when we had a hearing on transplants a few years ago, because we thought we they were costing too much, one of the doctors said to me, the thing you are not looking at what people have, a bad heart or bad lungs or a bad liver, they don’t just die, they linger, they cost lots of money with hospitalization and medical procedures. If we can give them a new heart or a new set of lungs, they can go back to work and be productive citizens.

Congressman, since you have left office, you have become something of a Washington insider, you have done a lot of lobbying in Congress. And there are some that are critical of some of the clients you have represented. You have signed up pharm companies, some other clients, anti-labor clients. How do you respond to those criticisms?

Gephardt: First of all, the criticisms are not all accurate. I have been working in government relations, I have taken on clients to help them with their efforts. I don’t take on anyone who is anti-labor, I can tell you that. That is not accurate. But I try to get involved in the same kind of issues I was involved in when I was in Congress, health care reform. I am a big advocate of this bill working its way through Congress partly because when I was a leader I couldn’t get it done and I am excited now that maybe they can get it done. Global warming, I work for some of the energy companies, energy industry in St. Louis, Amerenue. They have problems complying, but they are for our climate change legislation so I am helping them to assert their beliefs, their issues, in that context.

Specifically, regarding your representation of Pharma, how do you defend representing that company?

Gephardt: I think having good pharmaceutical answers to big problems like Alzheimer’s and cancer is really what we need to do. The pharmaceutical companies aren’t right on every issue, but they are right on a lot of issues. The ones I have dealt with are really interested in innovation. They want to find answers faster for big disease problems, and I think that is a very positive thing.

Another flash point for some democrats is your representation of United Healthcare, how do you respond to democrats who are critical?

Gephardt: Any company has its critics. I think United Healthcare delivers really good service in many places in the country. No one is perfect, no one does everything right on every day, but the organization of health care is one of our greatest needs. Health care is an industry that claims 16% of GNP. And most observers believe if it can be organized better through companies like Kaiser, United Healthcare and others that is really a step in the right direction.

Put your thinking cap on for a second. Congress is in the middle of debating universal health care. Is it going to happen this year? You have been around Congress for a while.

Gephardt: I am optimistic it will, maybe early next year but I think during this period of time it will be done. In 1993, when I was a leader in the house, with the Clinton health care plan, I couldn’t get it out of committee so the house is now passing the bill, the senate is trying to pass a bill. If they can do that by the end of the year, I think they can get a conference together and come up with a bill. I think the president has done a really good job of staying out of Congress’ way, giving them general direction, not being highly specific and also getting some of the big stakeholders like the doctors, like the hospitals, like the pharmaceutical companies to be supporters at this time. Last time they were all against it.

You mentioned you were house leader when it did not pass. What ran through your mind when the house passed the bill late on a Saturday night? Did you have regrets?

Gephardt: No, no, I was elated. I called Speaker Pelosi and Sandy Heuer and Jim Kleiborn, the whip and congratulated them. I was thrilled that they were able to get this done. Being in that spot 20 years ago and seeing failure, I know how hard this is to do. Let me tell you, the leaders and the members who got this done did a magnificent job on the very tough set of issues.

And given that you believe it is good for all Americans in the long run, but looking at the benefit to the federal government and to the states, is there a disconnect there? Is it better for the federal government and not as good for the states that might evolve now in health care overhaul? Do you see a disconnect there at all?

Gephardt: I think it is good for both levels. I think it is good for the people, which is the most important aspect of this. The states are going to have added Medicaid burden, as a result of this bill, both the house and the senate versions call on the states for more Medicaid, the federal government makes a contribution to that as well. But in the end, it helps a lot of people that don’t have health insurance. If you are out there without health insurance and you get a big problem, it is really awful. Many times out here in Iowa I told the story of my son who had cancer when he was two. If we wouldn’t have had insurance, he wouldn’t have lived. He is 39 years old. I see him every day, so I know what this is about. Believe me, not having health insurance is not an option today.

It wouldn’t be an official Iowa Press show if we didn’t talk about politics. You’re not in elective politics right now, but you are democratic. Give me the heath of the Democratic Party. You had a good election last year but it seems as though the party has fallen on some, if not hard times, questioning times. Give me your take on the health of the party.

Gephardt: People want results, and I understand that. I think the democrats understand that. Right now, we are in a recession. We have over 10% unemployment. That is a big problem. And even though a lot of the problems started during the Bush administration, the public doesn’t care about that. I understand that. So they now look to the Obama administration, the democrats in Congress to solve these problems. I think democrats are doing a good job. I think health care is part of the economic problem, it is not the only thing, but it is part of it. If they get a good bill done, that will show forward progress, build confidence in the country. The democrats are moving in the right direction. The president has got a lot of top foreign problems that don’t have any good answers to be honest with you. But he is dealing with it, in a very thoughtful way, he is positive, he does not get ruffled. I like the way he is moving ahead every day and doing the job. And I think when we get to that 2010 collection, the democrats are going to do fine.

Does he have to come up with some kind of health care bill before the 2010 election to say, you elected me, you elected me to do something, and this is what I have done?

Gephardt: It would sure help. I don’t think that he wants to fail as we did in 1993. And I would argue to you that part of the reason we lost in the house and lost in the senate in 1994 was that everybody’s hopes built on and we didn’t get it done. So, we disappointed voters.

You don’t think part of the loss was because of the debate over health care that republicans were able to take a government taking over health care argument to voters and won in ’94 because of that?

Gephardt: I don’t think so. I think there were other issues involved and not saying that failure and health care was the only thing. We also passed a balanced budget, so we raised taxes for about 50% of the solution and we cut spending all of which was unpopular. We only passed it by one vote in the house on one vote in the senate. We had ads run against our candidate saying candidate X raised your gasoline tax, that was true, raised your tax on Social Security benefits, that was true. That hurt us along with the health care and a few other issues, the crime bill and guns. There were a number of factors but health care failure was part of it.

Dean mentioned earlier that you won the 1988 caucuses, you were here in 2003 and 2004 campaigning for president. In 2008 you endorsed Hillary Clinton. Many of her supporters have raised questions about the mechanics of the Iowa caucuses, having gone through the caucus process twice as a candidate and being a supporter of Hillary Clinton, do you see problems with the Iowa caucuses?

Gephardt: No, I don’t. I think the Iowa caucuses are efficiently run, honestly run. Everybody is afforded every opportunity to succeed here or fail, whatever happens. I think it is a great place to start. The people out here are very interested in politics, interested in issues. Every meeting I have been to out here the questions are really good, really hard. I think it is a great place to start. I think it is wonderful that in this great and diverse country, large country, we subject candidates who want to be president to retail politics in a place like Iowa where they have to show their metal and people here are good judges of character.

Since you were such a big supporter of the Iowa caucus, would you advise on what republicans and maybe even the national party, republican national party on keeping the caucuses in Iowa? What does Iowa have to do differently anything at all in order to retain that first in the nation status?

Gephardt: I don’t think there is anything different that has to happen.

There are a lot of people that want it changed.

Gephardt: There always has been and always will be. And there are critics of New Hampshire, Iowa, everything else. You never have a system that everybody happily agrees to bridge, but, there are other ways of adjusting the system so that other states can be part of the dialogue at an earlier date if they want to do that, there is room for that now. States moved around in the process now. They have over the last 20 years, so there is adequate opportunity and people really want to be involved in it. At the end of the day doing this takes a lot of time, and a lot of money.

President Barack Obama has been in office for about a year now. Give us your report card on him, as you have mentioned, he has faced pretty tough challenges overseas. What is the report card on Barack Obama and how has he done this first year, assuming I don’t expect a democrat to be overly critical, but give us an honest assessment?

Gephardt: I was for Hillary Clinton, I helped her out here in Iowa, I helped her everywhere I could. I am very impressed with Barack Obama. I think he is doing a really good job in a very tough time. Here is what I like about him. He is smart and that is terrific, but he is also positive, he is persistent, he doesn’t get rattled by criticism, which the president gets plenty of today and always have. And he goes out every day and tries to attack the problems that we face with the American people. He is doing a great job at foreign policy at a time when foreign policy is almost impossible to deal with. There are no really smart good answers on Iran, Afghanistan or Pakistan. These are tough problems so I really like the way he has done this in the first year. I worry that no one can deal with the magnitude of these problems and that we just get so critical of anybody who is president because they are not hitting a grand slam home run every day on every issue. I would like to get you to address what I see as an increasing problem in Washington, which is Washington is no longer a place where republicans and democrats can work together. It is increasingly hotly partisan where a lot of republicans in Congress right now are telling their fellow republicans, if you try to cut a deal to work something you with Obama, you’re toast, you’re history. No longer can republicans or democrats get along. How do you break through that impasse and give me your assessment.

Gephardt: You have to remember that politics is always a substitute for violence, don’t ever forget that. It really is. And so you can’t expect it to be easy, for compromise to come easily because people feel strongly, differently about issues. And this is not made up stuff. Secondly, I would say to you, we have 535 people in the room to make the decision. That is an enormous group of people They disagree on everything. There were days as a leader I didn’t think we could get anything done at corporate, we expect too much out of this mechanism. IT is too big to work efficiently and quickly. The last thing I would say is there is more partisanship today I believe than there was when I started in politics. A number of reasons for that, some of which I have given you. But, I do worry that increasingly, in both parties, I don’t want to say this is just in one party, you have more people coming to office who seem more interested in elections than solving problems. And that worries me. The only way to fix that is for the public to try to find candidates and elect people who are primarily there, they have to win the election, we all get that, but are primarily there and interested in solving problems.

Now that you are outside looking in do you sense an anti-incumbent mood among the electorate?

Gephardt: I think whenever the economy is bad and conditions are bad and the country, or in a state, people get unhappy with who is in office. It is kind of like I elected you to solve these problems, whether you are to blame for them or whether you have done a good or a bad job, you have not solved the problem. Results are all that counts. I think incumbents certainly and election a few weeks ago and Virginia, New Jersey, incumbents did not do well. And if this persists, I think incumbents will be in some trouble in the election.

One of the hot new buttons happening in American politics right now is Sarah Palin, she is on the cover of Newsweek, she has a new book out. What is your take on her? Is she an up and comer in the Republican Party or is it as some have suggested she is Barack Obama’s best friend because nominating her will be a sure way to re-elect him?

Gephardt: I don’t know the answer to all that. She is a very interesting and attractive candidate and obviously she is or the republicans would not have put her on the ticket understanding the complexity of the things that have to be addressed. I have no idea where she will go on the Republican Party and not even sure she will run again.

What is she doing for republicans or negatively right now?

Gephardt: There is a work group and the Republican Party that was very attracted to her and her political views. I think it is a minority of the Republican Party and a minority in the country. But, that is a sizeable group and they are always looking for leaders.

Is she the new party Barry Goldwater?

Gephardt: I don’t know that. I heard that suggestion that she energizes a minority of the Republican Party, if they take over the party that will lead the party over the cliff, is that right?

Gephardt: I don’t know the answer to that. I wouldn’t hazard a guess. I am not a republican and I don’t talk to a lot of republicans about it so I don’t know what will happen. During your career, you were an ally of the labor movement, now you are an ally of management being on the board of directors. What is the health of the labor movement and what you see as the role of the auto industry in rejuvenating the country or is the auto industry exiting?

Gephardt: I think labor is coming back in America. I think they have new leadership in a lot of the unions and nationally they are working more in concert with management than you think to solve problems. One of the things I do today is work with business and labor to get what I call win-win contracts and to get workers more equity and more bonus aligned with the top management. In that way, to be able to do better, labor and management and this global competitive world we are in has to work together better to make us competitive and to keep good jobs in America.

You have been around politics not only in Iowa but in the country for a long time. I would like you to step back and give us a bit of a thoughtful answer here. How have things changed since he got into politics? Are politics better? Worse? Different? Give us your take on how politics have evolved over your career.

Gephardt: It is subtly different. A lot of it is technology. Television has had an enormous impact on the politics. The proliferation of media having 500 channels rather than three or four has had an enormous impact. Money has had an enormous impact. When I ran my first race for Congress I raised for two campaigns, a primary and general, all of $70,000 from friends and family. And I thought I had done a big piece of work. A garden variety house seat is now $1 million minimum. Many of them are four, five, ten million. A senate seat is easily $10 million in most states and some of them $50 or $60 million. I don’t have any brilliant answer for that. I wish I did, I don’t. We have a thing called the First Amendment, and unless you can change that, you can’t pull that much money out of politics.

Better or worse?

Gephardt: I think worse, I wish we had public finance of campaigns. I wish we could have candidates just worry about what they’re going to do in office to solve problems.

Borg: Congressman, we’re out of time. If there is a takeaway it’s that politics is a substitute for violence.

Gephardt: It is and this is a great country.

Borg: Hard to tell the difference sometimes. Thank you for being with us. On our next edition of Iowa Press Thanksgiving weekend we’re inviting a couple of political party insiders for some perspective on what’s ahead. Democrat Jerry Crawford and Republican Mike Mahaffey will be here with insight on the candidate maneuvering for next November’s elections, both state and federal. You’ll see our conversation with Jerry Crawford and Mike Mahaffey at our usual Iowa Press times at 7:30 Friday night and 11:30 Sunday morning. Make us a part of your holiday weekend. A reminder that the Internet is your connection to our Iowa Press staff. The e-mail address is

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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. And Iowa Community Foundations … and initiative of the Iowa Council of Foundations, connecting donors to the causes they care about. For good … for Iowa … forever. Details at

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