C-SPAN/NEWSMAKERS

Host: Susan Swain

Guest: Karen Ignagni, President and CEO of America’s Health Insurance Plans

Reporters: Jennifer Haberkorn, Ezra Klein

SUSAN SWAIN, HOST CSPAN NEWSMAKERS: Karen Ignagni is our guest on Newsmakers this week, President and CEO of America’s Health Insurance Plans, a trade organization here in Washington which she has headed since it was founded in 2003. Ms. Ignagni has spent her entire career in health policy. Thank you for joining us…

KAREN IGNAGNI, PRESIDENT AND CEO, AMERICA’S HEALTH INSURANCE PLANS: Thank you very much.

SWAIN: …this week. Let me introduce our two reporters. Jennifer Haberkorn is a Congressional Reporter for The Washington Times and part of the reporting team following healthcare this year. Ezra Klein, Domestic Policy Reporter and political and policy blogger for The Washington Post and WashingtonPost.com. Thanks to both of you.

Let’s start with you, Jennifer, please.

JENNIFER HABERKORN, CONGRESSIONAL REPORTER, THE WASHINGTON TIMES: Now, you’ve been quoted as saying August is going to be a make-or-break month for healthcare. The president has said the same thing. So far in lot of these town halls we’ve seen a lot of anger, a lot of hostility, a lot of questions on what exactly is in the bill.

If it continues at this pace through the entire month, what impact do you think that’s going to have when Congress returns in September?

IGNAGNI: I think this is a very important question you’re asking. I think if it continues down this path, August will be a lost opportunity to develop the consensus that needs to be developed on the part of the American people. And I think the important and crucial thing for the president and for leaders on Capitol Hill – on both sides – is to break down the components of healthcare reform and talk about where there is consensus because frankly people aren’t getting a sense that there is consensus and there is on important elements, which I know we’ll talk about.

Unfortunately all of the stories are process stories about who’s disagreeing with whom as opposed to where do people agree. And in my view – and I’m hoping we’re going to be talking about this – we’re agreeing throughout the country on about 80 percent of what’s necessary.

And looking back over history, we’ve really never come this far. This is certainly not the case for 1993, ’94. It is the case today, and it would be a terrible lost opportunity. So I think rather than villainizing (ph), rather than conflict and focusing on conflict, a real strong commitment needs to be made to educate and to help build that consensus so that when members come back, they get a sense of yes, we can, basically.

HABERKORN: At the same time, insurance companies have been vilified through this process and have been accused of stirring up some of this hostility in the town halls this year as well as in ’93, ’94. Is that the case?

IGNAGNI: It is not the case. In fact, we put out a statement – a very clear statement – last week. I sent a letter to the four leaders on Capitol Hill at the top of this week. We want people to know that our members are, in fact, men and women who work in our industry, who get up in the morning and do disease management and care coordination and help people navigate through a complicated delivery system, are angry about what’s been said about them, number one. Number two, we have urged them to go to town meetings, tell their story about what they are doing every day and participate in the dialogue.

We are not responsible for unfortunate tactics that are going on. And we’ve made that very clear. There have been a number of assertions out there with no evidence, and we want to make sure that people hear from us directly about what we’re doing and what we are not doing.

We feel strongly about the issues. But we also feel strongly that there is a responsibility for comporting oneself in a particular way which is respectful, providing information, and again, helping to shed light on the fact that our industry strongly supports the elements that the president is talking about today, this weekend, and this week, about insurance market reform. We’ve offered those proposals. We believe in those proposals. We stand behind those proposals.

SWAIN: Ezra Klein.

EZRA KLEIN, DOMESTIC POLICY REPORTER, THE WASHINGTON POST: Let’s talk about some of those insurance market reforms…

IGNAGNI: Sure.

KLEIN: …because in the past month, the White House has refocused healthcare reforms and the messaging on your industry and begin calling it health insurance reform as opposed to healthcare reform. And they’ve really begun to emphasize very strongly essentially policies that would curb the excesses of your industry decision, pre-existing condition discrimination, you know moving towards community rating.

But what’s interesting is that you have agreed to most of these regulations. And…

IGNAGNI: All of these regulations.

KLEIN: …all of them, right, aside with the one notable argument being over the public option, but besides that.

So let me ask you, why did this have to happen in a political context? Why couldn’t this have been done voluntarily within the industry and past due (ph) as if it was recognized as problematic?

IGNAGNI: This is a very important question you’re asking. And I think as you know, a number of states have actually moved forward with market reforms over a period of about 10 to 12 years. And actually we’ve done a very thorough analysis of what happened.

Massachusetts is a great case in point. Prior to the passage of the legislation everyone’s familiar with in Massachusetts, they tried insurance market reforms without getting everyone in, without having everyone participate. Essentially the market blew up. People who were in the market, individuals who were getting insurance, ended up with very high rate shock because the folks who had the lowest risk decided not to participate.

So a number of states – you can talk about Kentucky and you can talk about Washington State and a number of the other New England states – we’ve learned – and Massachusetts learned from its own experiences which is why they were so focused on getting everyone in. When we saw what happened in Massachusetts – this is why it’s such an important question you’re asking – we realized that we could bring reform to the political system, springing off the platform that Massachusetts really shed a light on what was possible, that the people in that state recognized that it was unfair to subsidize people who refused to participate.

Once that principle of getting everybody in is established, it changes everything fundamentally. And indeed we challenged ourselves. Last year we went out on a listening tour, about a year ago this year, all across the country. We presented our proposals and we heard very clearly that people wanted us to do more. They wanted us to talk about guarantee issue, getting everybody in and making sure they stayed in. They wanted us to talk about portability, and they wanted us to make not a voluntary contribution or commitment to that, but they wanted us to be clear and transparent that we would support legislation to do exactly that.

That had a material impact in all of our processes and all of our discussions. And indeed at the end of this year – last year, excuse me – at the end of last year in December we came forward with a very comprehensive program which in fact are the building blocks of what members of Congress are talking about today in the area of insurance reform.

So we’re proud of that. We can contribute to it. We can help educate people on the importance of this and how it works.

KLEIN: So to be – to be sure I understand it, your argument is that universality is the game changer that allows for insurance market reform.

IGNAGNI: Yes.

KLEIN: But once you have everybody in the system then you can begin to restructure the market entirely around that. But until then, if that condition is not met then these insurance market reforms won’t work because sick people or the healthy people won’t come in and there will be risk selection in the system.

IGNAGNI: And this isn’t a hypothesis on our part. This is a view that now has been borne out with experience in a large number of states. We’ve done a report – it wasn’t done by us. We had a third-party do it to make sure that it was being objectively looked at. And if you go around to the various states that had it going down this role without having everyone in, that’s the experience that was found time and time again. It wasn’t just one time, time and time again.

The other thing to talk about, particularly for viewers, is we are talking not of course, as all of you know, not about the employer market. We’re talking about the individual market where people are choosing for themselves to have coverage. There’s about 17 to 18 million people in that market. That’s the conversation that all these issues are about.

HABERKORN: Well, some of the insurance companies weren’t the first to offer some of these proposals for reform. The former (ph) makers, specifically Senator Schumer, has said that you know the insurance industry needs to pony up some dollars. We’ve seen the pharmaceuticals and hospitals saying we’re going to contribute X amount of money to healthcare reform efforts.

Was the insurance sector ever approached with any kind of deal from the White House or the Senate Finance Committee or was that ever discussed?

IGNAGNI: I’m really glad you asked this question. There are three points that I want to make. One, we were – our members, our board members and our community, were the first to step up with saying that we were proposing a comprehensive overhaul of the way the insurance market works. No industry has proposed a comprehensive overhaul of how it works.

We’re proud of that. We think it’s important. It needs to be done. And we’re squarely behind it.

Two, we have been – our industry was one of the first in working with consumer advocates on the concept that as a country that the president said that healthcare costs are crushing the American economy is true, that we strongly believe that we need to have cost containment and bend the cost curve. We’re one of the first in line there.

In the process we joined with a number of other groups in a coalition. And as part of our contribution to that coalition, we pledged that we would support comprehensive administrative simplification. From that time – that was in June – we’ve been working with the various committees on Capitol Hill, and as all the bills come out people will see that our commitment will be fulfilled. We said it shouldn’t be a voluntary effort. It should be required. And it will be part of the proposals that will be moving forward on Capitol Hill.

It’s in the health committee draft. It’s in the tri committee drafts on the House side, and there’ll be even more administrative simplification savings in the finance committee proposal. We’ve been working hard to contribute to that, hard to identify those savings.

I think the only disappointing thing – and I think this is a disappointing thing associated with the whole issue of cost containment – CBO can only score what is on-budget costs. We know from David Cutler at Harvard, we know from Deloitte that looked at a number of studies, we know from McKenzie (ph), we know from a number of consulting firms, that what we are putting on the table will amount to hundreds of billions of dollars over 10 years in system wide savings, really streamlining everything, the way eligibility is determined, the way claims are queried from a physician perspective and doing it in a synergistic way, real-time adjudication – which won’t mean a lot to lay folks listening to this program but will mean a lot to physicians and hospitals.

Those are the kinds of things that we’ve committed to fair game changing. We’ve been standing behind them. You’ll see this as part of what emerges.

And then finally, we’ve been looking at ways to try to help in the transition as we move people into a system who have never been part of the system to make sure that underlying costs don’t rise for people who are already there. And you’ll see aspects of these particular pieces of legislation that will involve our taking responsibility to help smooth that path.

So we’re very proud of that. We’re going to be talking a lot about that. And it’s a variant, Ezra, of a question you just asked me as well. So all of those things we committed to in the context of the cost containment coalition, and you’ll see that as part of the pieces of legislation which are moving forward.

SWAIN: I have a question. Just to take on your point that the media is too consumed with process, I still want to understand the process point. Given what you’ve just described as your seat at the table, working with committees all this year, why is it that your industry was specifically singled out by the Speaker of the House for criticism?

IGNAGNI: Well, I think I have this old-fashioned rule which has served me very well. I pass it on to my family, my son. I think one should never answer for someone else. You should pose that question to the Speaker.

I hypothesize that it is consultant driven, poll driven, it’s a page out of the 1990s approach to healthcare except we’re on a different page in our industry. We’ve worked hard to hear, learn what the American people had to say.

And they sent a strong message to us and frankly other business leaders this year. They said we expect business leaders to stand up and identify solutions to problems. So we didn’t put our head under a blanket and decide to dodge and wait and then comment and maybe be able to productively comment or maybe oppose. We went on a quest to contribute to healthcare reform. We’ve taken that very seriously. We’ve offered comprehensive proposals all the way through.

The country can, in fact, learn and take advantage of the cost containment proposals that we have implemented on the private sector side and incorporate them in Medicare. So there’s still much more to be done in the area of cost containment. We continue to talk to members of Congress.

So why the decision was made? I think it is a distraction that unfortunately masks the fact that there is consensus on elements, key architecture elements, for healthcare, getting everybody in, providing the kinds of insurance market reforms the president is talking about that we support and that a number of republicans and democrats support, making sure there are subsidies for working families and expanding Medicaid.

But we’ve never come this far. So to have the focus now be on that covering the vilification and the who shot John and who’s saying what at town meetings, no individual around the country is getting the message that there is strong support for reform. And that is a shame. And we can’t afford that because when members of Congress come back from recess, they’re not going to have very much time. If they come back with a message that it’s just going to be too hard because people don’t support basic elements, that’s a lost opportunity.

SWAIN: Half way through.

KLEIN: Let’s talk a bit about that 1994 playbook and the differences from there to today. So one of the reasons that Speaker Pelosi and others mistrust your industry is that in 1994 you were behind the famed Harry and Louise ads and that you were sort of a real opponent of reform.

And this year, as you’ve said, you’ve been much more engaged in the process and constructive and have been very clear that you think it is essential that something does pass and we do move forward on this issue.

So what are you actually putting behind that? I mean, do you deny contributions to members who aren’t being constructive or you run ads against them? What is sort of the meat of that commitment to reform? And is there any reverse Harry and Louise strategy that people can look forward to here?

IGNAGNI: This is a very – I appreciate this question. We made the commitment to play a productive role from the beginning of this year. The president invited us to the healthcare summit, and we stated very, very clearly that our members were committed to contributing to the process. We have held to that all the way through.

As part of that there was a technical component which we fulfilled identifying a way to achieve insurance market reforms and cost containment. And frankly, the country has just scratched the surface on cost containment, and I hope we’ll talk about that. But we need to if we’re going to have a sustainable system.

The third issue is making sure that we stand behind what we say. So more than now two and a half weeks ago, toward the third – I believe the end of the third week of July – we put up a commercial that talks about the fact that illness has no geographic boundaries, no boundaries with respect to economic status or race or whatever but it affects everybody. And we are committed. We know there are important things that can be done by way of getting everyone into the system, keeping them there, and making sure they have a safety net. And the end of the commercial indicates we’re for bipartisan reform.

So taking all of the work that we’ve done, packaging it, and putting real dollars around a commercial that communicates to the American people about where we are and what we support. So it’s just taking this outside the beltway of people inside the beltway are familiar with what we’re doing. But that we thought was very important for the August recess.

HABERKORN: One of the bipartisan proposals being put forward in the Senate Finance Committee is cooperatives, establishing insurance cooperatives, assigning (ph) the alternative to the public option which you guys have spoken out against and republicans don’t seem to want to support.

Is that – are cooperatives something you guys can support? And how do you think that would play against private insurers?

IGNAGNI: Well, there’s no way to know what – how these entities will be defined. So let me give you just a broad answer because until we see details obviously I can’t give a specific answer.

But they will be under the auspices in some way of the government, whether they’re at the federal level or the state level. Government per se has no ability to negotiate with providers, with doctors or hospitals. The only arrow and quiver is basically to use administered pricing.

So we fear that although the terminology is more benign than a government-run program, the affect is pretty much the same. And that we’ve been talking about and we’ve been very consistent about because we don’t think that government has the ability to negotiate.

And so we’ve been very clear from the beginning, very out front, about our concerns about a government-run option, and we’re going to be similarly clear about the concerns about if you have – we can have benign language but if it gets down – it devolves down to the same thing then we’re going to have similar concerns.

And by the way, now it’s taken a bit but physicians around the country and a number of hospitals around the country and certainly employers have expressed some of the same concerns that we’ve been expressing about a government-run program. So this is a discussion that members of Congress need to have. And we support the fact that they need to have this discussion straight up.

KLEIN: Let’s talk a bit about the government-run program.

IGNAGNI: Sure.

KLEIN: (inaudible) – obviously the insurance industry has been you know steadfastly opposed to it. And the counter argument about it of course is that we are having this discussion because the insurance industry has failed to reign in costs for (ph) the last couple of years that there have been a number of practices that you agree are you know should be – should be curbed.

And at the same time, Medicare has you know has its own problems but does have a higher satisfaction rate than private health insurance and has done at least an arguably better job controlling cost growth over the past few decades. And so they say why should we trust you to do this. If you can out compete the government option that would be great and we’d much prefer to be with the cheaper Aetna which has better service than any sort of lumbering slow government option but if it goes the opposite way, that there’s not been a record of success here that makes us believe that we should throw in all our chips with you.

IGNAGNI: I’m sorry. Did I step on your last line (ph)?

KLEIN: And so – no, not at all. And so I guess the argument there is why is that not correct right? Why should people believe that they don’t need this sort of potential emergency exit from the system?

IGNAGNI: Well, I think the first thing is a number of individuals that began several years ago to develop a government option had no idea that our community would come forward for such aggressive regulation. And I think had they, they may have gone in a different direction.

So the question is if you have regulation of the type we have endorsed that’s transparent where we are accountable, the question is why is it needed, number one? Number two, in terms of – let’s take it (inaudible). In terms of satisfaction rate, if you compare traditional Medicare to Medicare Advantage, which is people over 65 to people over 65, you will find very similar satisfaction rates, in some cases higher satisfaction with Medicare Advantage if you compare the specific co-population cohorts.

If you look at the kinds of cost containment and quality improvements, none of the elements that we have introduced with physicians in a collaborative way – namely disease management, care coordination, paying for quality – has been actually successfully introduced in Medicare. GAO just did a study saying that imaging in Medicare is rising, excess utilization in traditional Medicare, and they ought to adopt the techniques that private sector plans have.

Unfortunately a number of members of Congress have just written to Medicare saying over their dead body. Don’t incorporate those techniques.

So government has a difficult time getting through to politics. During patient protection, we brought healthcare costs – this is post the ’93, ’94 period – we brought healthcare costs down to zero and in some cases below zero. The message we got from politicians was that we were too aggressive in using utilization review and networks and the kinds of things that people now seek to replicate in accountable healthcare organizations and so on.

So what we did was – well, first of all we sent a message that if we take off all these tools, healthcare costs will soar. We were right. So now we’ve begun to reintroduce the tools. And if you look at the rates of increases in healthcare premiums over the last six years, you’ll see them coming down gradually. We’ve taken pharmaceutical expenditures from 20, 15 to 20 percent year over year down to 4 and 5. That’s a very significant reduction. Some employers are getting three because we’ve encouraged generics, we’ve done tiering, not taking tools away, we’re not taking options away from individuals but letting them weigh the consequences. That’s one example.

Care coordination, Ken Thorpe has written so compellingly about the importance of doing care coordination in Medicare. Well, I can show you now we’re just about to release a study which looks at arc (ph) data, which is government data, comparing care coordination and what we’re doing to get unnecessary utilization down post 30 – the hospitalization within 30 days down, how we’re getting emergencies use down and days per thousand down in Medicare Advantage versus fee for service for all of it because we are coordinating care for people with chronic heart problems, diabetes, et cetera, et cetera.

And we work with physicians in a collaborative way. Government’s using none of these tools. So I think in terms of sustaining the healthcare system, we need to have a balance of public and private.

Nobody in our system would disagree with that. We want to try to get the best of both. We think the private sector tools could be embedded in Medicare, but it’s going to be difficult to get through the politics to actually do that. We think having a regulatory system that’s clear and transparent will allow – we’re only talking about the individual market here because the employer market is guarantee issue. So it’s the individual market we’re 17 million and maybe going up to 25, 30. But they will make sure that they have peace of mind.

So you put that all together, we think you can structure a system that’s much better than the one we have today, that’s more transparent, that allows the benefit of drawing from the different areas of expertise on both sides.

KLEIN: And if I could – if I could just follow up on that quickly. Of course the Medicare Advantage, as you know, is 14 to 19 percent more expensive than traditional Medicare. But what it sounded to me – and I agreed with actually much of what you said – was that you could out compete the government, right? You said the government won’t be able to adopt these wonderful techniques.

So why is there sort of the argument that there shouldn’t be the competitive option?

IGNAGNI: In terms of head-to-head competition?

KLEIN: In terms of head-to-head, so I can choose Aetna or I can choose a public option because if I take what you said, it’s something you could win (ph).

IGNAGNI: Well, the last point that you made was very important. And that’s the last thing I didn’t comment on which is from on a head-to-head basis why is Medicare cheaper? Medicare’s cheaper, as you know, because it’s paying 85 cents on the dollar. So if we’re going to continue to kid ourselves that under paying hospitals means cost containment then that’s going to put us on the path to ruin, which is why so many hospitals have basically stood up and said if you pay us Medicare rates or Medicare plus five, we’re going to go bankrupt. And it’s right. We’re going to dismantle the entire system.

So the question is how do we back up and do the right thing and put together the policy that works and frankly can get past. We think there are key elements here that can get past.

Medicare Advantage, I’d love to come back and talk about that issue because nobody’s really talking about this. You quote the MedPAC data, but they never disaggregate where members of Congress have decided to pay more in areas which have been under served. That – if you disaggregate those you see a very, very different picture from Medicare Advantage. MedPAC has not disaggregated that.

That’s irresponsible in my view because millions of seniors are on the precipice of losing their coverage, their Medicare Advantage coverage, because of what’s been proposed in these bills. And nobody is talking about it. But they would be very concerned about it.

SWAIN: Jennifer, the last question.

HABERKORN: One other thing I wanted to ask, you know you guys have implemented a lot of changes in the last couple years. The insurance industry profits have gone up dramatically. So why not just institute yourself some of the regulations you’re suggesting like you know no longer denying patients on pre-existing conditions and you know community rating, things that you guys have proposed? Why not just do those by yourselves?

IGNAGNI: And actually I’m very glad you gave me a chance to talk about profits. I’ll be happy to provide all the data we’ve – we’ve gotten them all. We’ve compiled them over the last 10 years. On average, health plan profits now are about 3.5 percent, 3.5, the number – the gross number of profits in our industry is $20 billion and we are spending 2.4 trillion on healthcare. It’s less than one cent of every dollar of healthcare expenditures.

We are the smallest sector in terms of profits compared to fractions of drug companies, any kinds of academic medical centers, imaging, that sort of thing. So we think it’s very important to have disclosure and that disclosure requirements ought to apply across the board so the American people can actually get the data so they know exactly what’s going into the system and what’s not.

In terms of mounting an effort to do what you said, if you don’t have everyone in – as Massachusetts found the first time it tried this – then what happens is there’s rate shock for people who stay in the system. And that wasn’t – didn’t prove to be a responsible course, which is why on their second try they got everybody in.

SWAIN: We’re out of time. Thank you so much for being with us.

IGNAGNI: Thank you.

SWAIN: We are back with Jennifer Haberkorn and Ezra Klein of The Washington Times and The Washington Post, respectively, and both very deeply involved in covering the healthcare policy debate this summer.

Let me ask after hearing from the head of the trade association for health insurance companies in the country, Karen Ignagni’s criticism was that the media has been too involved in process. Would you concur with that?

KLEIN: I would absolutely concur with that. I think that it has become a real problem, and it’s something you see in legislation over and over again that when it actually sits for a while you just have all these stories about whether it’s democrats and power (ph) republicans you know committees negotiating with each other and back-biting and getting angrier. And people just begin to forget.

I mean, you hear the pitch of these town halls out in the country, and you would think we were talking about something so massive, I mean, death panels (ph) in euthanasia when we’re really talking about a fairly, a fairly modest transfer of resources from the top (ph) of the system and some from Medicare to give people at the bottom. But for most of us, the bill wouldn’t even have much of an impact.

So I do think she’s right. I don’t think people have a clear idea of what exactly is being discussed here.

SWAIN: How much responsibility do the politicians and the political activists hold? I mean, you’ve watched these town meetings. How often do they start with a here’s where we agree?

HABERKORN: Not very often. Of course, it always goes straight to what we’re divided on. You know if you ask members of Congress, most want to ban insurance companies being able to deny patients on pre-existing conditions. And there’s a lot of things like that they are on the same page.

But at the end of the day it’s very easy to pass a bill that everybody can vote on but that may not have the impact that of more controversial measure that they say is going to have more of an impact that you know that’s going to be a little more difficult to pass something that republicans and democrats can agree would have some teeth.

SWAIN: You know now that I’ve criticized process, let me ask you what you both think after watching a full month almost of town hall meetings and the president on the road and advertisements being run all over, your coverage on the Internet as well. What’s it going to be like in this town in September when members come back?

KLEIN: I think it is very hard to say. You know one thing about the town halls that is complicated, right, is that they’re doing two things simultaneously. One is that they’re discrediting the town halls as a sort of neutral forum for engagement. I don’t think anybody on the left or the right thinks that these are representative of the people they know and the way the majority of the country feels. I mean, they’re just angry or they’re organized and that’s all fine but I think they’ve become a little bit of a tool.

On the other hand, though, I think that a lot of people in the public and the politicians who know this are looking at this process and saying this is chaos. You know healthcare is delicate and it is complex and I’m afraid about it. And how can something secure and how can something really good come out of a process that appears to be this dominated by the extremes?

And so I think at the same time the town halls aren’t very trustworthy to people, they are doing a pretty good job of delegitimizing what’s going on in this town. And I think the degree to which the politicians are able to say you know that wasn’t real and this is is going to be – is very much yet to be seen.

SWAIN: So is it too soon to say whether or not there will be a bill this year, legislation passed?

HABERKORN: I think it’s too soon to say. I mean, whether these town halls are fabricated or totally legitimate, these people may be the ones who show up to vote in a couple months when a lot of these members are up for re-election. And I think the angry person at the town hall is going to be in the back of the mind – in the back of the member’s mind when they come back in September to talk about this and vote about it.

So if the town halls continue at the pace they are now, I’d say it’s not a good sign for this bill. But we have a month. That’s a really long time when we’re talking about Congress.

SWAIN: Last question for you is would you give us your perspective on the question we discussed with Ms. Ignagni and why the speaker of the house has specifically chosen to criticize the insurance industry?

KLEIN: The insurance companies poll terribly. I mean, they poll terribly because they have a business model that is fundamentally not that productive. I mean – and Karen Ignagni made a good point on this. She said that it’s very hard to compete in a way that is productive when you don’t have everyone in the system because then the healthy people can leave, the sick people come. So they risk select.

But in doing that and taking people’s policies back and denying the people who had pneumonia a year ago, they become really quite hated. And you know the political actors are you know simply acting on that knowledge. I mean, the insurance reform has (inaudible) because this is how you and I feel the system is bad to us. It is where we see it. Our doctor’s help us. Our hospitals keep us from bleeding on the carpet.

But the insurers are the people who sit there on the phone and argue with us for hours that you know we didn’t really need what the doctor said we did.

SWAIN: Well, thanks to both of you. We look forward to your continued reporting on this.

KLEIN: Thank you.

HABERKORN: Thank you.

END