Yesterday I attended the “Inside Washington” luncheon featuring US Representative Stephanie Herseth Sandlin hosted by the Sioux Falls Chamber of Commerce. Here is a summary of what took place. Several of the points that the representative tried to make were very convoluted and took great effort to parse. What I have here is lengthy, but by no means a minute-by-minute account of the dialog that took place.
Attendance was just under capacity at what I estimated to be between 300 and 400 attendees.
Rep. Herseth Sandlin was at the podium for just under an hour. She spent the first 20 minutes making her opening remarks followed by 40 minutes of Q and A.
In her opening remarks the representative discussed Congress’ efforts to put forth a healthcare reform bill and the recently passed House “Cap and Trade” bill.
Focusing on healthcare reform here is what Rep. Herseth Sandlin said:
- “Getting it right is more important than getting it done fast.” A bill shouldn’t be written and passed based on arbitrary timelines.
- The way healthcare works in South Dakota (low cost/high value) can be a model for how it can work in the rest of the nation.
- She doesn’t see a public option passing, but she didn’t say she’d oppose one.
- She repeatedly spoke in favor of insurance exchanges although she never explained how it would work.
- Inaction is not an option for Congress. It is more costly to do nothing than to pursue reform.
- Reform should be budget neutral.
There was only time enough for 5 questioners during the Q and A session. The first question was from Troy Larson of the Lewis and Clark Regional Water system regarding federal funding for the system.
The second question came from South Dakota Senator Sandy Jerstad who spent most of her time heaping praise on the representative followed by a brief question that had already been answered by Herseth Sandlin during her opening remarks.
The remaining questions came from people who weren’t clear healthcare reform supporters such as Sen. Jerstad revealed herself to be. The first such question came from an emergency room physician who wanted to know how South Dakota’s high value/low cost approach to healthcare would be implemented across the nation through the political process. Herseth Sandlin responded that it would be very difficult to include in a bill because of liberal opposition, but she hopes it could be applied successfully to an existing system like Medicare as a proof of concept implying that it would then be adopted in other programs. The doctor followed up with a question regarding tort reform and defensive medicine. Specifically, he wanted to know if Representative Herseth Sandlin would favor extending the tort protection of 42 CFR offered to doctors working on behalf of the government to all doctors. The representative answered that she supports the idea, but would also want to explore other options before settling on any action. She gave no indication of what those other options would be.
A second doctor, a cardio surgeon, pressed the tort issue and asked about Herseth Sandlin’s support for placing limitations on punitive damages. Citing her previous answer about tort reform she said that it should be talked about, but it isn’t the only option on the table. She would favor looking at those other options more closely. Again, none of the other options were laid out.
The final questioner brought up issues that consumed the remaining time of the Q and A session. He started by pointing out the fact that many of the currently uninsured are that way by choice, or because they are in this country illegally. In a two part question, he asked the representative if she thought South Dakotans should be responsible for paying for the healthcare of those that don’t pay anything for it themselves, and if she thought that the federal government should be involved, at all, in the delivery of healthcare for the average individual. Before Representative Herseth Sandlin could respond the crowd erupted in widespread, enthusiastic applause. After the applause died down the representative responded that the cost of care for the uninsured is already being shifted to the insured. She stated that it was not the responsibility of South Dakotans, or any American, to pay for the healthcare of “free riders”. Because the medical costs of the uninsured are already being passed on in our current system it is important, according to Herseth Sandlin, to change the system. Unfortunately she failed to explain what kind of change would be necessary to prevent the same cost shifting that we have now.
In response to the second question Representative Herseth Sandlin indicated that she’s not for government-run healthcare or a single payer system, yet didn’t disavow the public option. She once again stated her support for insurance exchanges and backed it up by claiming that the insurance industry supports exchanges and she wants to give them a chance.
Representative Herseth Sandlin finished the Q and A by responding at length to the final questioner in a manner that best can be described as her closing remarks.
Citing Medicare, she asked a rhetorical question asking if the government should no longer be managing that program. The audience responded in the affirmative with mixed applause. Continuing on, Herseth Sandlin noted the Medicare Advantage plan which provides Medicare beneficiaries with an option to receive their benefits through private health plans. Illustrating the cost of the program, the representative tried to correlate the existence of private plans within the program to the expense of the program. From this she moved on to her point weakly asserting that there is a role for government in Medicare implying that government would keep private companies from driving up costs.
Herseth Sandlin then shifted to the issue of government waste. Touting her opposition to the recently passed stimulus bills she insisted that changes to healthcare are necessary because it would create efficiencies and reduce waste. In response, the final questioner, who was still holding the microphone, asserted that lower prices could be achieved by allowing for greater competition. Again the crowd reacted with applause. Becoming defensive the representative got the last word in by proclaiming that she was not looking to make a “boogeyman” out of anyone. She then proceeded to lament the fact that drug companies spend more money on advertising than on research. Taking it further, she related an anecdote about a doctor she knows who complains that he used to practice medicine but now waits for his patients to come in with their formulary and advertisement.
Representative Herseth Sandlin then closed her time at the podium by concluding that more work needs to be done in Washington, and that the costs of doing nothing exceed the costs of doing something.
The crowd was polite, but eager to express their discomfort with the idea of a bigger role for government in healthcare (as evidenced by the applause). Representative Herseth Sandlin was gracious and willing to listen. Unfortunately, her responses were lacking clarity or directness. It is also unfortunate for Sioux Falls that Representative Herseth Sandlin refused to have a public forum. Hopefully, on her next visit to the state she’ll see the value of meeting her constituents openly and in public.
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