October 27th, 2013

Fleming: No accountability from Sebelius

Today on CNN’s State of the Union with Candy Crowley, Dr. Ezekiel Emanuel, former health policy advisor during the Obama Administration from 2009-2011, and Rep. John Fleming (R-LA), one-time Louisiana Family Doctor of the Year, spoke with CNN about the troubles with the Obamacare website, the accountability for the challenges, and the Health and Human Secretary Kathleen Sebelius.

A transcript and videos are available after the jump.

VIDEO: Emanuel: Care moving ‘into the home’

VIDEO: Will Obamacare harm your family doctor?

VIDEO: Doctors debate Obamacare impact


CROWLEY: Joining me now, Dr. Ezekiel Emanuel, the chairman of the department of medical ethics and health policy at the University of Pennsylvania. He was a health policy adviser to the Obama administration from 2009 to 2011. And Republican congressman John Fleming, a vocal critic of Obamacare. He is also a physician and was named Louisiana family doctor of the year in 2007.

Gentlemen, thank you both so much.

I do want to get to the crux of Obamacare and that relationship and how the medical system is changing. But a question on the dynamics of what is going on as I think we all know it’s been kind of a mess for people trying to sign up. And I wanted to bring something to the secretary of health and human services Kathleen Sebelius said when asked about should she resign?


KATHLEEN SEBELIUS, HEALTH AND HUMAN SERVICES SECRETARY: The majority of people calling for me to resign I would say are people who I don’t work for and who do not want this program to work in the first place.


CROWLEY: So congressman, I know you have called for her resignation. You have been equally critical of how this launch has gone. Do you think that it’s time for someone else to be in charge, that someone really should be fired over this mess?

FLEMING: Well, that’s not my choice, that’s the president’s choice. What I do think is that we should focus on getting the website right and I think the president has taken the first right move of appointing Jeff Zients as a ceo-like figure to get it moving. He’s got a lot of managerial experience. He’s been a consultant for the health care industry. I think he’s got the right qualifications.

I would also like to see the president appoint someone permanently, because Jeff Zients has a job coming up as director of the National Economic Council. And we need someone who is going to see this website over the next two years and make sure that it is constantly revised and constantly upgraded. And that I think is appropriate.

CROWLEY: Do you think, congressman, that certainly the secretary has a case that many of her critics, and there are some Democratic ones although they’re a lot quieter, have never wanted Obamacare to take effect anyway. and it sort of discounts your criticism — one’s criticism of this, Republican Party because, you know, how seriously do you take that criticism when you don’t want it to go into effect?

FLEMING: Candy, Americans both Democrat and Republican demand accountability. And Secretary Sebelius is obviously not taking accountability for this. She says the people who want her to resign she doesn’t work for. I hate to tell you, but I’m a taxpayer. She works for me. She’s a public servant. I’m a public servant. And I work for the American people.

CROWLEY: But are you a (inaudible) messenger, do you think? The Republicans have tried so hard to derail the president’s Affordable Care Act that now anything you do is seen as, yeah, well, it’s…

FLEMING: Not at all, because — what we’ve been, Candy, is try to protect the American people from the damage and the effects. And now after three weeks we’re beginning to see those damage and effect. We never had input to this law to begin with. We tried to tell her all along. She was the biggest cheerleader for this. Please, let — work with us. Let’s work together in cooperation. And instead, she said, no, we don’t want to hear from Republicans on this.

EZEKIEL EMANUEL, UNIVERSITY OF PENNSYLVANIA: Can I — can I set the record straight? When we were trying to pass this law in 2009, when I was working on this law, we had a number of hearings in both houses of congress. Senator Baucus worked with Republicans for nine months from January all the way through the end of August trying to get a bipartisan bill. They absolutely refused.

Let me say a second thing. During that time, we tried to have a Republican — find out the Republican plan that would increase access to all Americans, hold down health care costs and improve the quality of the system through a uniform standard. There was never a Republican plan. The idea that they wanted to work us with is just false.

CROWLEY: OK, I don’t want to get sort of bogged down in, you know…

EMANUEL: He claimed they wanted to work with us.

FLEMING: Remember the president said I will go line by line with any members of congress. We wrote him letters a number of times. He shut the door in our face.

CROWLEY: Let me move this along, because I want to take advantage of both your experiences as a physician. I have talked to a number of primary care physician over the past couple of weeks. Every one of whom, Democrat or Republican, has said I think this is the end of a guy hanging out his shingle and being the family physician that there is no room in here, that Medicare is not enough to keep them alive. I heard all those kind of fears. So, he says yes, you say no.


EMANUEL: So here’s where how the system is going to improve. First of all, if you look at Massachusetts when they enhanced their system under Governor Romney and had a 600,000 more people move in, the Massachusetts Medical Society did assessments on the waiting time. No change for primary care, no change for specialists. So this idea that we’re going to have a shortage is not right. Secondly…

CROWLEY: It’s not so much a shortage as is it profitable to be — I mean they have to make some money. They have got huge bills as you know coming out of medical school, both of you know that. So the question is, is it going to be profitable to be a primary care physician?

FLEMING: Well, for someone who is a primary care physician and who actually has to pay those bills even today, I can tell you first of all the Massachusetts system, the waiting list gets longer and longer.

EMANUEL: That’s factually incorrect.

FLEMING: Half of the primary care doctors are not accepting new patients.

But to your point, Candy, Medicare reimbursements keep going down. The work load in terms of paperwork and all that keeps going up. We have an unprecedented number of primary care doctors who are opting out of Medicare.

And so, look, you’re going to walk into the doctor’s office one day with a card that says I’m entitled to health care and the doctor is not going to be able to accept it. EMANUEL: I don’t think that there is no evidence to that effect. In fact, Scott Gottlieb who is from the American Enterprise Institute, a conservative who worked under President Bush just the other day on CNBC said no doctor shortage and no increased lines. And there’s no evidence to that effect.

Let me also say a word about quality. Let me say a word about quality. The bill can change a number of things that are going to dramatically improve the quality of the system and already has. For example, the number of hospital acquired infections because hospitals have to improve and focus on them otherwise they get their payment decreased has already shown dramatic improvements.

Similarly, readmission rates. Before the bill, 20 percent. We’ve already seen them come down to 17.5 percent. All of those are things are positives on the….

FLEMING: …defensive here about this…

EMANUEL: I’m just giving you the facts.

FLEMING: But these are not factually true at all. You hit it on the head, you’re right…

EMANUEL: All of those are data.

FLEMING: No one is — the primary care doctors are more dispirited today than I’ve ever seen them in history. It’s really terrible what’s going on out there.

CROWLEY: And there is some fear not just among doctors — you know, and I have heard the same kind of thing and surely you have and perhaps explained it to them in different way, but them saying I can’t say any more Medicare patients. Because it’s — you know, I have doctors say I will keep my guys, my guys I have now, but I’m not taking any more Medicare patients. Then what?

EMANUEL: Look, that issue of how the physician-patient relationship is going to change, there’s no doubt it’s going to change.

CROWLEY: In what way?

EMANUEL: Oh, I think much for the better. You’re going to have more of a team. You’re going to have nurse practitioners, you’re going to have physicians, you’re going to have pharmacists, you’re going to have nutritionists advising patients.

The second thing is a lot more care is going to be moved into the home out of the hospital, which is very appropriate because we’re going to have a lot more ability to monitor people in the home: fewer infections, fewer falls and a big cost savings.

FLEMING: And this is coming from a doctor who doesn’t see patients. Talk to me. I can tell you.

EMANUEL: I’m an oncologist. I’m an oncologist. I treat cancer patients.

FLEMING: I have a practice today that still operates. We have three nurse practitioners. I’m telling you that every year that goes by we have to analyze what our payer mix is. Can we take Medicaid? Can we take Medicare? This is happening all across the country, not in ivory towers.

EMANUEL: We have a health care system that is $2.8 trillion, OK. It’s got more than enough money. The issue isn’t money here. The issue is delivering efficient care and making sure that we have the right care at the right place.

CROWLEY: I will say that some of the…

FLEMING: …control does not create efficient care.

CROWLEY: One of the things that I also hear and this mostly from on the patient side is that when the president said over and over and over again if you like your health care, you can keep it. And yet now of course we’re hearing lots of insurance companies are dropping patients who don’t — who have health care plans that don’t meet the standards of Obamacare. So they are going to change doctors. Are they not?

FLEMING: Almost a million Americans have lost their — they’ve had their insurance canceled just in the last few weeks.

EMANUEL: Those insurance plans are not worth the paper they’re written on. Many of them exclude key things…

FLEMING: That’s absurd, doctor. That is absurd.

EMANUEL: Many of them exclude key things that would…

FLEMING: That is totally false.

EMANUEL: …these would not allow.

FLEMING: These are big plans that people are being kicked off…

EMANUEL: Are you going to allow me to finish?

FLEMING: But you are doing all the talking. Filibustering is not going to win your argument here, sir.

EMANUEL: We would not allow unsafe cars without seat belts, without air bags on the roads. Similarly, we should not allow health plans out there that are really not health plans. McDonald’s had offered a plan it they sold to their people for $50 that will entitle them to $2,000 worth of coverage. That is not a health plan.

A health plan that excludes certain kinds of care, like maternity care, is not a health plan. We have to have a minimum standard. If you don’t have a minimum standard, you can you not have no pre- existing conditions and guaranteed issue which is what we want.

CROWLEY: And I’ll give you the last word.

FLEMING: Well, I would say again, Dr. Emanuel, he’s not a physician in the classic sense in terms of actually seeing patients. He doesn’t know what’s happening in the health care economy. He sits behind a desk reading all of the studies and he’s dreaming.

EMANUEL: I have an appointment at a medical school…

FLEMING: Again, please don’t interrupt me.

He was an architect for this law. I don’t blame him for being defensive, but the people are now experiencing all the damage and the hurt that’s coming from this.

CROWLEY: They are, but you would concede, would you not, that people who do not have health care, 30 million, 40 million, whatever it current is — 50 million, will be helped by this and that’s not a bad thing?

FLEMING: Candy, the CBO says that number will never go below 30 million Americans. Never.

EMANUEL: The fact that of the matter is, all of us are —

FLEMING: The CBO says that.

EMANUEL: All of us are hurting from high health care costs and uneven quality. And the bill is going to repair those things. And the Republicans never had a proposal to address high health care cost or uneven quality.

FLEMING: We have…


CROWLEY: I’ll have you back, I promise. Dr. Emanuel – doctor and Congressman thank you so much for being here. We appreciate both of you.

FLEMING: Thank you.