For 15 minutes Tuesday morning I had the ear of Wisconsin's District 2 representative, Tammy Baldwin, to talk about health care. Baldwin is being credited for drafting an amendment in the House Energy and Commerce Committee that bridged the differences dividing conservative and progressive Democrats. With the amendment the committee was able to move this final piece of legislation that will be molded into a health care bill for consideration and discussion on the House floor.

During the interview, Baldwin, a known single payer health care advocate, noted that while single payer supporters have been marginalized during the process there is a major effort currently in motion to have the option discussed in front of the full House of Representatives. Below is a transcription of our interview which can also be heard Friday at 5:30 p.m. on WORT.

Both Speaker Nancy Pelosi and House Energy and Commerce Committee Chair Henry Waxman have said that you played a crucial role in advancing health care legislation before the House broke for recess. How does your amendment reduce cost, but preserve strong health care legislation?

A lot of this takes place in the context of a bill that was introduced and our process really ground to a halt as some conservative Democrats were trying to slow down the process and insist on some particular changes. When they finally broke through that impasse they had extracted some changes in the bill that progressives and even some moderate Democrats felt went too far. So we kind of hit another bump in the road, or another impasse. What I did was I examine the parts of those changes that were really unacceptable to progressives and got us together to figure out what we needed to do to put this back together and keep the momentum moving forward.

What we realized was one of the most objectionable changes that had been made to health care were reductions to subsidies available for working families and moderate income families in the U.S. So we sought to find additional cost savings in our health care system and we channeled those back into the subsidies for working families. In other words, making the premiums for health care more affordable for all. And with that change, that amendment, we really had a breakthrough that allowed all of us in sort of the big tent of the Democratic party to support this bill and move it forward for its next stages. 

Do you feel that the legislation that is moving forward will eventually make it out of the House of Representatives? 

I do, I think...we've had three committees in the House of Representatives work on this measure. There are three committees that have some sort of jurisdiction and oversight over the health care system and each has sort of taken its own approach to this bill. Over the next few weeks our committee chairs and our leadership will be bringing together the changes that were made in each of the committees and presenting us with a package for consideration probably that will take place in early-to-mid September. And I do think that after a healthy floor debate we will be able to move the bill out of the House and send it over to the Senate. 

I do think there are some really exciting things that will happen during that floor consideration. In our committee last week we accepted an agreement to have a floor amendment presented on the single payer system. I know many, like myself, really believe that the true way to reform in the most comprehensive and fair way would be to create a single payer system. Too often in this debate that has been taken off the table. We're glad that a single payer system will get additional scrutiny when the health care measures hit the House floor. 

You've always been a strong supporter of a single payer system. Do you think this bill, even if it passes not as single payer, can it eventually get the country to a single payer system? 

I do believe that's a possibility. What we're insisting on and what remains in this bill is as we set up new choices and options for people without insurance and people who are under insured or people who are unhappy with their insurance, we've insisted that alongside the private insurance companies will be a public option for people to choose. They'll be able to compare the prices and benefits of the private and public offerings and select which makes the most sense for them. And we think if you have a public option, which is going to be focused on high quality health care – not making profits, not huge CEO pay, etc. – they're going to be focusing on high quality health care, we think there is a prospect that many, many people will select that option and if it is shown to be very successful it may become the favored plan and look more and more like a single payer plan.

But in order for that to happen we have to keep a strong public option and it has to be successful, so it will really put government to the test to see if we can continue to deliver high quality health care as we have in the Medicare system, as we have in the VA system, as we have in other health care systems before. I think the answer is, yes, we can, and I think will demonstrate that we can have confidence in a public option that isn't motivated significantly by the want of profit. 

What about the fear that a public option will take away successful health care plans. How do you address those concerns? 

One of the things that has been central to President Obama's call for health care is if you are happy with what you have you get to keep it. There are a number of mechanisms built into the bill to make that be the case. This new exchange we are setting up with the private and public option is really intended for the uninsured, the under insured, or unhappy with the insurance package they have right now for whatever set of reasons.  

It was not intended for the near term to displace people who are happily insured or who have a comprehensive health care package. In fact, it would be difficult on day one to create a system that all 300 million Americans participate in. Obviously that's a huge undertaking, it's a big enough undertaking that we're setting up something that will create greater options and affordable choices for the 47 million who are uninsured and probably an equal number who are under insured or are desperate for a different type of insurance package. 

I believe that as we set this up, and it will take some time, unfortunately it's not something that will be open for business the day the bill is signed into law, but it is intended to offer new choices for those without and to let people who are pleased continue much in the way they are right now. 

The number of years is four after passage before this is implemented? 

Right, if we keep on the track to passing this legislation that we hope to the exchange would be open for business in 2013. 

So, that's the earliest uninsured Americans will start seeing options? 

Actually it's probably not in the sense that in the meantime this bill addresses a number of other polices that would take affect much more rapidly. I think you would see some ability for those that are uninsured to see some options, but if you are talking about when the exchange would be open that won't be until 2013. 

One concern is that Congress is being distracted by health care and not focusing on job creation. I read an editorial online that said this bill wouldn't do anything to create jobs. Do you see anything in the bill that would help produce jobs in the United States? 

There are some things that will lead toward job creation in a number of very specific areas. Right now we have a shortage of primary care physicians and other health care providers focused on primary care versus specialty care. We've seen in states like Massachusetts which adopted a Universal health care mandate some years ago that they enrolled 300,000 new people in insurance who didn't previously have insurance. When that happened they figured out that they had a very severe shortage of primary care physicians. You tend to reach out for preventative and wellness care, annual check-ups, much more frequently if you have insurance. If you don't you tend to wait until you get sick before you present to any medical or health care setting.  

We know we are desperately short, even today, with many people without insurance and we know that as those people gain insurance that shortage is going to get even more desperate. So there is a lot of focus on job creation, both incentivizing more people in medical training to go into primary care, but also recruiting more folks into nursing and other complimentary provider professions that deal with non-specialty care, but just basic primary, preventive and wellness. 

I think another area that you'll see some job creation is as we set up the exchange we really need health educators. People who can help others be wise consumers of health insurance. Frankly, we need that today, but increasingly as we create expectations that every American will have health insurance you need to be able to choose wisely between the offerings. There will be a private offering and a public offering and these are complicated things with a lot of fine print and insurance contracts and people often need someone to help guide them through the process. 

We certainly recognized that fact when we created the Medicare Part-D program. People were terribly confused and didn't know what the best deal was for them and there was increasing need for people with that background to walk people through the process. 

In certain areas I think you see job creation to accommodate close to 50 million new people who will now have health coverage who didn't before. 

The American Recovery and Reinvestment Act calls for health care organizations to make "meaningful use" of an electronic health record in order to receive certain federal funds. How do you think smaller organizations will be able to meet these requirements?  

Part of what was included in the American Recovery and Reinvestment Act, otherwise known as the stimulus, were dollars set aside to help particularly the smaller clinical settings be able to purchase, install, and get training on health information technologies – things like electronic medical records and electronic tracking systems that try to assist these clinical settings in avoiding duplication, reducing redundancy in tests and that sort of thing.

The funding in the stimulus will help with acquiring and using these technologies, but there is a lot of focus on health IT in the health care bill winding its way through Congress. In that, many of the cost savings that we hope to realize in years to come depend upon our rooting out redundancies, repetitive tests, tracking things in a more sophisticated ways, reducing medical errors and medical waste. I'm not suggesting these are intentional errors or waste, but things that happen because the lack of health IT around the country. We do expect an uptick in implementation and deployment of health IT, but once that is in place through wide use of it we expect to see significant improvement in quality and significant reduction in duplication, and waste, and error.  

Jesse Russell

Co-Editor

Jesse was born and raised in Connecticut, began blogging in 1997, and moved to Madison in 2003. In 2005, he co-founded dane101 along with Kristian Knutson and Shane Wealti. In addition to helping nearly a dozen contributors run this website he's helped launch various events in the city including What's Your Damage?!, the MadPubQuiz of Awesomeness, the Fire Ball Masquerade, Dane101's Freakin' Halloweekend, and more.