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James Carville


Published 11/1/2008
Peter Pollack

Carville, Rove take aim at healthcare issues

They both see a crisis, but no immediate responses

In an often raucous and energetic session, political advisors Karl Rove and James Carville addressed topics ranging from tort reform to Congressional expectations at the America’s Health Care at Risk conference in Orlando, Fla. The conference, organized by a coalition of groups led by the American Association of Orthopaedic Surgeons and Doctors for Medical Liability Reform, was created to serve as a bipartisan path to a solution for the healthcare issues facing the United States.

Mr. Rove, former deputy Chief of Staff and Senior Advisor to President George W. Bush, and Mr. Carville, lead strategist for former President Bill Clinton’s presidential campaign, traded barbs and opposing points-of-view before the assembled members of the healthcare industry, government representatives, policy experts, patient advocates, and business leaders.

No simple answer
According to Mr. Rove, the healthcare system is broken, and the two political parties have “deeply divergent views” on how it can be fixed. He believes that the Democratic answer is to simply turn more [health care] over to the government. Republicans, he says, are more willing to look for ways to encourage market competition and closer relationships between patient and the caregiver..

Mr. Rove pointed out that Republican presidential candidate Sen. John McCain doesn’t take a simple approach to addressing the healthcare system. Instead, he says that Sen. McCain has put forth six or seven complex ideas to confront this complex problem.

Unfortunately, said Mr. Carville, any steps to address the current crisis in health care are liable to be delayed several months, as Congress and the president struggle to address the crisis in the financial sector.

According to Mr. Carville, the recent proposals for the government to stabilize the troubled economy will take precedence over any legislation to change the healthcare system. Whether the next president is a Republican or a Democrat, “the push is going to be elsewhere for a while.”

One illness from disaster
Asked their opinions on the driving force for healthcare reform in the mind of the public, both panelists suggested a different answer.

James Carville
Karl Rove

According to Mr. Carville, the public response is generally, “I feel like I’m one illness away from disaster.” He believes that even those who have insurance are concerned about losing their jobs and health insurance, or being unable to meet their premium or copayment requirements. And he thinks that the situation has gotten worse in the last 6 months.

Mr. Rove agreed, but also noted that many people are concerned about the growing proliferation of intermediaries between patients and their physicians. He pointed to the increasing numbers of third-parties involved in healthcare decisions and said that people would rather deal directly with their physicians in making decisions.

The fact that healthcare coverage is tied to employment is also problematic, according to Mr. Rove. He said that people may feel “stuck” in a job simply because it offers healthcare benefits; a healthcare program that included portability could address this issue.

Make your case to the people
During the audience question-and-answer session, a physician from Texas spoke about how effective tort reform has been in his state and asked the panelists how physicians can convince their legislators of the need for medical liability reform. The response from Mr. Rove was to “get involved.”

He urged doctors to “make your case to the people,” be persistent, and put “a human face” on the issue. He urged doctors to take time out of their schedules and deliver face-to-face messages to members of Congress.

The current malpractice system, he said, is hurting people, raising the cost of health care for everybody, abusing the healthcare system, and enriching a few people. As a result, physicians are leaving the system and quality is not improving.

According to Mr. Rove, the business of medicine is to “get people healthy.” The business of trial lawyers, on the other hand is to “find ways to sue people.” Lawsuits, said Mr. Rove, don’t make anyone any healthier.

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org