I had a nice chat with Dr. Valerie Arkoosh a couple weeks ago, regarding her race for the 13th District House seat, and the issues she wants to impact in Congress. Dr. Arkoosh worked as an anesthesiologist at the hospital of the University of Pennsylvania and is still a faculty member at the Penn School of Medicine. She is on leave from her clinical work while she is running for Congress.
Jon Geeting: I believe I completely misunderstood where you were coming from on health care politics, and I’m sorry about that, so I wanted to give you a chance to lay out your views on some of these issues in depth for the Keystone Politics readers. I understand you worked with a physicians’ organization that took a number of very progressive positions during the Affordable Care Act debate.
Valerie Arkoosh: The organization is called the National Physicians Alliance and it’s a 501(c)(3) charitable organization, and one of its founding principles is that health care is a human right, and that we need to find a way to make sure all people have access to care. And it’s an organization that also focuses on transparency and integrity in the practice of medicine. So from the “health care for all” side of our viewpoint, I would say that many of the members of the organization are supporters of a single payer system as well, but not everybody believes that’s the current solution.
When it comes to the Affordable Care Act specifically we were involved very early with Health Care for America Now – a coalition with over 1000 organizations by the time it was done. And our organization signed on with the belief that a public insurance option was a critical component of the final law. So we worked very very hard to support passing a public option, but it didn’t end up being in the law for a whole bunch of different political reasons.
On the transparency and integrity side of the mission, we believe the pharmaceutical industry frankly has had undue influence on physician prescribing practices. They used to bring lunch all the time to doctors, and pens and papers with brand name drug names on them. We really encourage physicians to keep the pharma reps out of their offices and get unbiased information about new drugs and devices.
So we supported a provision in the ACA called the Physican Payment Sunshine Act, and that provision actually creates a publicly searchable database which will go live in 2014, where anybody will be able to go online and look up their doctor to see whether or not they have accepted any kind of payments from the pharmaceutical industry.
JG: Many Democrats seem to be of the opinion that we’ve completed health care reform for the time being. Nobody’s really interested in taking up the fight again but obviously there’s still a lot left to do to fix the US health care system. What do you want to see in the next round of health care reform?
VA: Well I have said many times that I believe the ACA is a great first step, but it’s just a beginning of health care reform and by no means the end. And there are several really important things that we need to concentrate on going forward. As you know, we will still have millions of people who will not have health insurance in this country. There are two factors that contribute to that. One is that not all of the states are doing the Medicaid expansion. There are 26 states – PA being one – that have not begun the process to expand Medicaid. But there would still be some number of people – probably between 12 and 15 million – who will still not have access to affordable health insurance.
For me, this is a moral issue. I think we need to provide health care for people. But it also matters for the cost issues we face in this country, because for every person who can’t pay for procedures, the people who can pay are paying a little bit more to cover those who are uninsured. So one of the keys to getting our health care spending under control is to make sure everybody has health care.
We also still have more work to do to make sure the quality of care people get in this country continues to improve. Some of the data from the Institute of Medicine shows that there is still a fairly high number of deaths in this country from avoidable mistakes in medical care. And about a third of our health spending goes to care that is unnecessary or duplicated.
That’s an area I’m particularly interested in, and I believe with my background as a practicing physician, I can bring a lot of value to that discussion.
JG: I understand there’s a live debate as to whether some of what the ACA has in mind for delivery reforms and quality improvements will reduce costs or actually end up increasing costs. Electronic medical records, for example.
VA: In the short term, things like electronic medical records will probably tend to increase health care spending because you have to purchase these systems and install them. That’s not a small undertaking. But in the long term, the hope is that it will reduce the need for duplicated tests like blood tests, X-rays – getting an X-ray when you don’t need one is potentially more harmful because you’re being exposed to some radiation. I think it absolutely will reduce costs in the long term.
I’m an anesthesiologist but I specialize in obstetrics so I spend most of my clinical work on the labor floor. And in the city of Philadelphia there’s a rule that if you’re a pregnant woman and you think you might be in labor and you call an ambulance to take you to the hospital because you don’t have anyone to give you a ride, the ambulance takes you to the closest hospital that delivers babies – whether its your hospital or not.
So it’s not unusual – if you think about how close Jefferson and Penn are to each other – we would not uncommonly get a Jefferson patient who had all their pre-natal and all their tests done at Jefferson. We would get people in at 4 in the morning on a Saturday when it’s too late to get that information from Jefferson Hospital and we would just have to repeat all the blood tests, HIV testing, ultrasound to make sure the baby’s in the right position. If we had a way to share those records, no matter the time of day, that would improve service for patients and also save a lot of money.
JG: We seem to be making impressive progress on this. I read that the number of health care providers using electronic medical records has tripled since 2010 when federal stimulus funds started funding that. Speaking of the stimulus, we obviously still have a major unemployment problem in Southeast PA. What are you prepared to support on the job creation agenda?
VA: The jobs agenda is extremely important. There are a lot of people in the 13th District who have been laid off and are finding it difficult to find new work. I think that the composition of Congress was an issue in 2009, but I would’ve preferred to see a bigger stimulus along the lines of the one the President originally proposed but Congress really cut away at. It seemed clear to me at the time it needed to be bigger, and in retrospect I think that’s been shown to be true, that we didn’t have enough stimulus spending to get us over the hump.
But I think what we need to look at going forward is tax incentives for small businesses to make it easier to start up or hire new employees, and for big businesses, a lot of the incentives of our current tax system encourage them to send jobs overseas. And I’d like to see measures that would encourage businesses to keep jobs here. I also think there are a lot of opportunities to create jobs in the clean energy sector, and I absolutely believe the United States can be a leader there. I increasingly worry that we’re seeing China try to really ramp up in that area, and it would be unconscionable in my mind to cede expertise in clean energy to another country. I think we have the technology and the smarts and the engineering expertise in this country that we should be leading in green technology, and that in turn would create a lot of jobs.
We also have to make sure that job retraining is available to people who have been laid off, particularly people who are further along in their careers where it can be difficult to find reemployment.
JG: I’m glad to hear you say that because I feel like a lot of what we hear from President Obama and current Democrats in Congress is that we should respond to high unemployment with things like more STEM education, which is great for school-age kids, but I don’t see how that helps somebody who’s 55 years old and lost their job due to the recession.
VA: It’s really tough for people like that. But you do continue to see a little bit of a mismatch in some cases with the jobs that are available in a particular area, and the skill sets of individuals who are also in that area. So we also need to make sure our job retraining efforts are matching up with the jobs that exist in our area.
JG: Another problem we’re seeing with so many people nearing retirement is that their wealth and retirement savings are in many cases wiped out. Either they’ve had to draw down their savings early because they’re out of work, or they haven’t had the income to save money during years off the job, or they had investments like homes that lost a lot of value. The 401K model isn’t working for them, and it’s also not working for Millennials who have gotten a late start in their careers and a late start saving for retirement due to the downturn. Would you be willing to support something like Mark Begich’s Preserving and Protecting Social Security Act, which would expand Social Security benefits to address the retirement insecurity problem?
VA: I haven’t read about the plan, can you tell me a little bit about it?
JG: Sure. The Protecting and Preserving Social Security Act removes the cap on high income contributions, which is now at 113,700 dollars. It’s not means-tested so high earners get back higher benefits, just like for earners below the cap. The Congressional Research Service says this would wipe out the actuarial imbalance the program is said to face until 2085. It would also increase benefits by 4.5% by switching to a CPI-E inflation measure that is more sensitive to the goods that seniors buy. And it reduces penalties for retirees who worked more than one job.
VA: So he’s proposing that we lift the cap and people would continue to pay taxes on all of their income? I can’t tell you whether I would support the specific proposal without seeing it, but I can tell you that I would support raising the cap from its current level. It would not have to be raised all that much to ensure the long-term solvency of Social Security. And I believe that the promise of Social Security must be there for people who have been paying into it all our lives. And I would like to see not just halfway measures, but ones that ensure its solvency for the future. One of the key pieces of that solution is to raise the cap. Really that cap has not kept up with inflation.
JG: So you would not support a change to chained CPI.
VA: I think there are a lot of problems with chained CPI. One of the problems with chained CPI is that it doesn’t take into account health care costs, which for seniors is a really highly relevant cost. So there are some other indexes that are relevant to the needs of seniors, and there are some organizations that do advocate moving to CPI-E. But I would not be in favor of using chained CPI.
JG: Are there any pet issues that you’ve been talking about on the stump that we haven’t covered yet?
VA: The environment is really important to folks around the 13th Congressional District, and although we don’t have natural gas extraction and fracking right here in the district, there is a lot of concern by people who live here about fracking in the Delaware River Basin. So I think we need to do more to measure what the environmental impact is from natural gas extraction, and I am very much against the Halliburton loophole for fracking that prevents it from being regulated under federal clean water regulations. That is something that must be revisited for the safety of our environment.
Education is also a major issue in our district, and a lot of that has to do with state political choices and the political make-up of Harrisburg, but at the federal level there are two things I think we can look at. I think we can look at less testing, and having more of that money going to our classrooms. Teachers are just struggling and they need help in our classrooms. They have kids of all ability levels and having even just one teacher’s aid in the classroom can make their lives infinitely easier so kids who need extra help can get it. And the other thing we need is early childhood education. I strongly support universal pre-Kindergarten for all kids, and school lunch programs because kids who show up to school hungry are in no position to learn.
JG: I completely agree about the need for early childhood education, but obviously there is the challenge of paying for it. Do you have an opinion about how to pay for it?
VA: You know, I do not have a ready policy solution for you. I am still investigating what would be the best approach to pay for that but I do believe we need to find a way.
JG: One thing that’s been tough to get through Congress is a carbon tax. The Waxman-Markey cap and trade bill passed the House in 2009, but went nowhere in the Senate and no one in Congress has really been talking about it since. Would you support a cap and trade plan or a carbon tax as a potential revenue raiser?
VA: Yes I would.