By Terry Stanton

AAOS Now Exclusive: Interview with James Carville

AAOS Now: What’s your outlook for the 2010 Congressional elections?

Ms. Matalin: To sum up the 2010 midterms, I’d say, relative to the passage of the current healthcare legislation, it’s doomed if you do, doomed if you don’t. Passing healthcare reform threatens the Democrats, because it would keep the opposition united. Depending on how you define margin of victory, somewhere between 49 and 74 seats held by Democrats were won by McCain or Bush. That means that they are highly competitive.

It would be better to do just what both sides agree on—more market mechanisms and competitive notions infused into insurance, pre-existing condition reforms, digitizing medical records, malpractice reform. Then the bias toward incumbency could help. Even though this is a “hate Congress” election, people like their own guy.

If the Blue Dogs could take credit for saying “Let’s do this one step at a time,” the president would save his majority and look like he’s a leader.

AAOS Now: And the presidential election in 2012?

Ms. Matalin: The Republican strategy in 2012 will be the one imposed by the outcome of 2010. Somebody always emerges that we don’t know about. The last time this happened, they were state leaders—governors like Tommy Thompson and John Engler.

Mitt Romney is the clear frontrunner right now. He’s kept his team together. But we just don’t know, and the trajectory will rise from the outcome of 2010.

AAOS Now: Whenever Republican presidential politics are discussed, your name comes up. What you are going to do and whom might you support?

Ms. Matalin: I keep trying to quit. I was a volunteer for Bush in 2000 and 2004, but my candidate in 2008—Fred Thompson—lost in the primaries. I’m a federalist, I’m a constitutionalist; I think that’s the future of this country if there is to be a future of the country. No one is waving that federalist flag sufficiently for me now to stop my life and work on a presidential campaign.

AAOS Now: During your address, tort reform got the biggest response. Many physicians—not just Republicans—say that liability issues drive up costs without improving care and force physicians to move away from certain areas, especially rural ones. Do President Obama and the Democrats think that doctors are exaggerating the need for tort reform?

Ms. Matalin: I can’t say what’s in their hearts; I can only say what comes out of their mouths. They think doctors are somewhere between crazy and highly negligent. This doesn’t comport with reality. People love their doctors and fear losing them.

Doctors are proud of what they do, they want to serve and to heal. It’s not about money. They should make as much money as the market will bear, because people do prioritize and will pay for good health care. Bad doctors are pretty easy to spot. You have all your internal course corrections and mechanisms and licensing. When people are ill-served because of negligence, there is a system to remedy that.

When we say we want malpractice reform, we just want sensible reform. Doctors spend more time doing compliance or defensive medicine, which drives up costs. If doctors could be less imposed on, they could think of ways to reduce costs and put their time to better use. I am not anti–trial lawyers, but I am concerned about the extent that they are overimposing in this area and contributing at the largest levels to Democrats—that’s not literal corruption, but it’s what corrupts the system.

Are doctors completely guilt-free? No, but I presume that there’s a pretty good process for redress if somebody cuts off the wrong limb or rips out your kid’s tonsils unnecessarily.

AAOS Now: Do you think public opinion about tort reform is changing?

Ms. Matalin: Conservatives get this; it’s a huge issue with them. If you collect enough data with the pilot programs, then tort reform can spread. I think it has to go state by state, using state models to make change.

Lawyers are smart. They’ll go some other place where they can make money. There should be some control of the devastation they wreak on the land. Who controls them?

AAOS Now: What do you say to the common refrain that Washington is broken and can’t get anything done?

Ms. Matalin: I’m actually for not getting anything done. The notion that the government exists to keep doing, doing, doing, doing, was not what the Founding Fathers had in mind. They wanted government to be limited, enumerated, with a bias for the individual, the protection of private property, and the protection of life, liberty, and happiness.

So what if it’s broken? The more things they don’t do, the less they are in our face. People will self-govern; we have a propensity for it. The previous mayor of New Orleans didn’t govern for 4 years. And citizen groups—people who weren’t previously activists—stepped in to help. We know how to self-govern, and we govern best as the founders defined it, the closer government is to where we live. There’s more accountability. We know our councilmen and hold them accountable. And when they’re dysfunctional, citizens pick up the slack.

I’m not anti-Washington. Right now, it really is working because what they are trying to get done is not what the democracy favors. This healthcare thing has been so hard to get done and will result in a disintegration, a real blow to the Democratic party.

I say the same thing to Republicans—and I only started calling myself a Republican again recently. I think of myself as a constitutionalist/federalist or conservative. They lost (in 2008) because they did the same thing as the Democrats. We need rule of law, we need commerce regulation that doesn’t stifle competition, we need a government in place to do that. But the only sector where employment is growing is government jobs.

AAOS Now: As a Northerner, you’ve adjusted well to life in New Orleans.

Ms. Matalin: I’m from Chicago, which has some big weather extremes. There’s less of a swing here. The heat and humidity is not as bad as Washington, D.C., but is more balmy. And there’s a joie de vivre here.

The AAOS meeting is the first citywide conference that lets New Orleans show off and be proud of itself. It’s not just economics; it’s a deep love of living here and showing off our culinary arts, which are extraordinary. We’re very excited and very grateful you’re here.

Terry Stanton is the senior science writer for AAOS Now. He can be reached at tstanton@aaos.org

AAOS Now Exclusive: Interview with James Carville