Ep. 122 - Mike Leavitt

Update: 2017-02-16
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Mike Leavitt, former governor of Utah, talks with David Axelrod about the Republican path forward on the Affordable Care Act, the health care lessons he learned serving as President Bush’s Health and Human Services Secretary, his views as a former EPA administrator on effective ways in which to address climate change, and much more.

Following script is auto-generated by Speech to Text Technology:

the board for the acts files comes from rockin' mortgage my Quicken loans lift the burden of getting a home loan with rockin' mortgage and get a secure transparent home loan approval in minutes skip the bank of the waiting then go completely online at Quicken loans dot com slash X Files This podcast is brought you by sixty DB listen to conversations that go beyond the headlines business sports politics today's news plus all of your favorite podcasts download the free sixty DB at today the The The The and now from the University of Chicago Institute of Politics and CNN The X Files with your host David Axelrod the the baby no more quietly accomplished official in American political life than former Governor Mike Leavitt of Utah served three terms there as administrator of the EPA under George W Bush and then in Bush's second term as secretary of Health and Human Services Mike Leavitt is deeply respected by people on both sides of the aisle something that's hard to find these days and had a deep and into issues that are on the front burner in Washington today health care and the environment we talked about it the other day we sat down at the University should the governor Mike Leavitt thank you so much for being here you know I in and getting ready to have this conversation today I looked at a little bit of your history I can't say that I know anybody else who can point to their lineage on down one lane to the Puritans and the other two Mormon pioneers tell me about your family well I'm a Westerner and that is of course by heritage my my father's heritage comes from England my mother's comes from Sweden they were both Mormon pioneer families who found their way in different ways actually through Illinois and then to Utah my father grew up in a small town in the south the southern corner of of Nevada called bunker Hill my mother in a very small town I were talking the time of three hundred people in both these cases a very small in the south central part of Utah called Low A Utah they met in a little town called Cedar City which is a college town where they both came to be the first in their family to go to college and they married and lived in a little mobile home with no Rhett Rhett with no bathroom I was the oldest born to them they walked to the hospital a few blocks away and had me I lived in that little town for in the mobile home actually we graduated from the mobile home to a basement not too long after that but life has got nothing but better and I have great parents I have five brothers no sisters grew up in this small town I tell people but if you knew the sitcom Leave It To Beaver and the adventure bonanza and you molded those two that that is my adolescence I am old enough to understand that if you go then the note here that that Thomas Dudley the second colonial governor Massachusetts was an ancestor of yours what you have to be pretty studious to get to it but it's true that actually the the eleventh landed in Massachusetts and I think seven or sixteen twenty nine of the King's forest or I was eleven and he was sent here to find out if there was anything worth having in these new colonies and he returned saying and so the first Levitt actually to come to the United States to them to the colonies actually was a Stow away as best I can tell he was an Apprentice tailor and hated it and that was of course a contract a very serious contract and he broke it stowed away on the ship that went to Massachusetts found his way into the northern into into Vermont and that's that's the history and the course of that that line works its way into Thomas Dudley so the governor thing was sore in Eugene water with actors predestined I pray that I have no choice Thomas Dudley in sixteen hundred made it possible we're going to talk about the healthcare issue in a few minutes but you of your family as a familiarity with this whole issue insurance issue not just as a governmental policy issue but professionally because your dad went to the insurance business and you followed him in that this I've actually had three careers and my life and one of the lucky people who have enjoyed everything I have done my first career was building businesses in the risk management world and the second was my government service in the third I had the good fortune of spending most of my time thinking about health care since I left public service so that the whole of how you manage risk and how you take care of people's needs in both economic sense as well as a public policy sense has been a big part of my life and your dad built this business he did he started in the basement of some of his home and I'm over the course of it still operates they have one hundred and thirty some odd insurance brokerages around the country and it's a great American dream story and I've watched it happen because his office was right next to my bedroom when he started and health care was part of that it was a minor part of it it was mostly in other lines of insurance property and casualty but it ultimately became part of it in and it was that was a valuable background for made the whole area of how you manage risk and how you create pools of risk and how what it takes to have the integrity of actuarial science is a big part of what I learned as a young professional gal that's a handy handy bit of knowledge right now we're talking about how to recast the Affordable Care Act and I want to talk about that in a minute but your dad drifted into politics and you apparently drifted with him along the way my first recollection of anything political was going to the Iron County Fair where my father was running for the state legislature and to my great humiliation my mother required that we wear a white T shirt with a campaign brochure Elmer's glued to the front back and our job was to walk around and draw attention to ourselves it was it was not a good start but he then became a member of the state Legislature and ultimately ran for governor and there was no one to manage his campaign who would work harder or cheaper than me and I ended up managing it well he did not lose he exceeded expectations and it launched me into an entirely different path than I had expected and what about it the word appeal to you about it because you're not you don't strike me as someone who paced things to himself to call attention to him so well that was not my mother's insistence that night I point is you're not an A and I spent some time in Utah I worked with Wayne Owens who you'll very well or CS and D four D The mayor of Salt Lake City was an old Klein mine so I got a chance to spend a lot of time in Utah on your temperament actually is well suited to the state but it's not a kind a look at me sort of approach to politics I got into politics and I can see by accident have always been interested in it but I started managing campaigns and I managed for Senate campaigns a couple of governors campaign has gotten from the presidential election and it taught me the process and then I got engaged in public service and I found first in education and if I could see that you really want to get things done you need to be as a say in the Hamilton musical in the room and that drew me to an opportunity and as they say this the rest is history I ran for governor and was fortunate enough to win I served for three terms had opportunities to play in to occupy couple of seats in the president's cabinet it's been a great ride and I think what I've enjoyed about it mostly is that makes you feel like you're involved in something bigger than yourself and I think we all want that in one form or another to feel as though our life matters that our thoughts and ideas are focused on the improvement of society and I found it there you um you worked on the healthcare issue then in Utah knew that you took your own measures to try and expand coverage and particularly to children talk about that but I ran for governor in nineteen ninety two of course you'll remember that was the year Bill Clinton was elected a health care was a big issue now be honest I did not see it coming as a candidate but it became evident to me I needed to learn more about it and that was natural for me because of my risk management background but I dug into it and found it to be an issue that I found enormously interesting I concluded that ultimately the approach was that was being taken nationally was not the right approach meaning not talking about the policy of it I'm talking about the mechanics of how you get it done rather than try to pass it on one bill I felt that there was a better way to approach it and a blueprint in nineteen ninety three and every year for the next five years we added to the blueprint or we can be completed part of it and so we did a lot of the things in the nineties that the Affordable Care Act did we expanded coverage to age twenty six we dealt with a lot of them of the rating issues so that none of this was new to me I had dealt with it when I was when I was governor and would to to good results to you now I'm reading it you ensured a four hundred thousand more state residents which is a large number in a small in a small state and you reduced Oprah capita costs of healthcare twenty five percent below the national average um what's your fundamental philosophy on health care and to this big debate as to availability access what should our aspiration be in terms of health care I believe there's a widely held aspiration in America for everyone have access to affordable insurance policy I don't think that divides us I think that unites us how we go about it is a bit different the way I expanded in Utah is I think interesting and somewhat relevant to this day I observed that as we were expanding Medicaid for example that there were certain of those populations that were getting benefits that went well beyond what a person who was working at a mail order at a car dealership might have in that and so I went to the federal government said if you'll let me engineer the development of the benefits just a bit differently I'll take the savings and I'll apply it into a network that can cover more people will give everyone something that we would consider to be credible coverage is opposed to giving a few substantially better with an aspiration that someday everybody will get the best and it worked and then we began to focus on quality and recognizing that that you can that the least expensive health care is generally the best care that is to say you're doing things at the right time and the right way I had the benefit as governor of having a great health care system that was quite dominant in the area called Intermountain its well respected other systems that do things similar but I was very early in the process when I began to learn about the importance of quality and cost not just cost not just quality but the combination of quality and cost and people refer to that has value and I think that's why so much more discussion today is centered around that that intersection I listen to talk and you know I was around the room of those years when the Affordable Care Act was being discussed a lot of the time a lot of subject matter was the same which is how we had we reduced the cost increase value better practices and how we use the savings to expand coverage and so on of how what what what is the affordable care I know this is a frayed question in today's red hot political environment but you know you've heard the president described it as a disaster and others of this is an in which hyperbolic language tends to rule the roost here but what is your analysis of what was accomplished what was an accomplished and what to do now let me start with what I think is the most important part of the Affordable Care Act and that is that something happened the system had been in gridlock for so long that there was it was hard to get the molecules to move in a way that could create any kind of I'm speaking of the figure to flee yes I would have done a lot of things differently but the fact is they passed a bill and since that time they've been a lot of changes that have occurred some have been intended some have not I think you have to look at health reform four year or in a year or a twelve year proposition I think we are actually twenty five years into a forty year transition and that what happened in the Affordable Care Act was important because it allowed change to start we're going we're going to go through another iteration of change I think over the next few years or however long that this process last but it will build I think to a large extent on the chassis that was that was built because there are things that Republicans and Democrats fundamentally agree on an outside the politics if you can come back to the kind of Google Earth view of this there's progress being made reiterating through different political periods but there's progress that's being made one of the things that I think you advocated were health care exchanges um and obviously those are core of this bill and allow Republicans frankly were supportive of that concept over the years and Governor Romney applied them in Massachusetts do still believe in the exchange of fire I have believed that it's a market based idea if you look at the history of this you'll see that the first exchange conversation actually took place in the seventies with Richard next and then you roll forward until the the Clinton health reform where they had what they called Think of a regional co op with exchanges the Republicans hated that and and they ultimately defeated in two thousand and two or so the Heritage Foundation came up with a concept they called an exchange Democrats hated that because Republican idea and they killed it and then you go forward to two thousand and nine or ten riders of the A C A did a kind of clever thing they they took the Democrat idea that Hillary Clinton put forward they took the Republican name of an exchange and they put it into the bill and what we had was a disagreement over whether it ought to look like what the Heritage Foundation had designed the difference between that that idea of what we've got well only what happened in the is that they compromised not lots made of that but we had a situation where they said every state can have its own if you want like Hillary Clinton designed do it if you want to have one like the Heritage Foundation then do it and there was a difference between the two it's mostly the role of government which is what actually what a lot of this boils down to it is no difference in an aspiration it's a question of What's the role of government and the ACCA as well as what had been proposed in the nineties had a lot of government involvement and lot of government decision making I mean I have observed over time as a scholar of political thought that these things boil down to really three questions Who matters Who pays and who decides and in the context of the Democrat version typically they'll go a lot deeper in terms of who matters and who pays though they're willing to shift income from one and who decides of the federal government decide the Republicans will be held likely not apply it to as many people they will have the state government for consumers making decisions and they'll have they'll have less shifting of in common but it's not a difference in our view of what ought to be done and I think that's the foundation on which progress will always be made is building on the things that you agree on on the subject of who pays I got to take a quick break here for word from our sponsor so we'll be right back with Governor Mike Leavitt rocket mortgage by Quicken loans proudly supports the X Files when it comes to the big decision of choosing a mortgage lender it's important to work with someone you can trust leisure best interests in mind with rockin' mortgage you'll get a transparent online process that gives you the confidence you need to make an informed decision skip the bank of the waiting and go completely online at Quicken loans dot com slash X Files equal Housing lender license in all fifty states and MLS consumer access dot org Number thirty thirty you say that there there is a basis for mutual agreement or understanding on this but doesn't feel that way now there's a huge gulf between the way Republicans and Democrats in Washington and frankly it's sort of morphed into the state's describe it describe this what is the way phone well in this environment have been out of Washington for a while and so have I And it and it's his way we look so healthy well it's certainly why what shapes our views I mean I've observed and I'm sure you did that what drives Washington is two things prepped preparation for the next election and maintaining control the news cycle and if you and both sides believe fervently that the other side won't do the right thing and therefore they ought to have nothing happen until they become in control and do the right thing and so you end up then always at the same thing happening and that is the party coming into power will overreach and and and they tend not to get as much done as they could I think there are things that Republicans and Democrats agree on we started with the fact that people ought to have insurance I think you can get them agree to agree that that coordinated care is a lot better than uncoordinated care I think you can get them to agree that the way we pay for health care is wrong on that we ought to change it away from this what we call the fee for service system to something whether working on value I think there's we moved in that ER and we have moved in that direction and I think that ought to be acknowledged in fact I look at the Affordable Care Act and if you were to ask me what I think its biggest contribution has been it aside from just getting us started I think it has given great momentum to the idea that we need to change the way we pay for health care that that alone over the course of a decade or two will be among the most significant contributions that any period could could make at the core of that is this notion that if you pay a fee for service it puts it it puts pressure on the providers to to to encourage the use of of medical services of doctors appointments of tests and all the incentives are misplaced I said at times it's it's like a disease chronic more everybody gets does better with more and that's not good for the system if you want to make more money as a healthcare provider just do more more procedures if you're a if you're a consumer and and and you're not paying for it then why not just get more and so the system has to change or the problem won't be resolved and I think the Affordable Care Act at least began to acknowledge the fact I want to say this that was in the Affordable Care Act but I know with some certainty that the writers of the bill said we can't just go about getting everybody insured we have to do something to change the cost curve and they went to CMS the Centers for Medicare and Medicaid Services and said to them you folks have anything that would help us bend the cost curve and I to have said yes we have a lot of things that we've been working with are working to accomplish the last four years there's a lot of demonstration projects on this thing called value based care and the reason that and they basically just put him in the statute that was developed during the the second term of George W Bush now we all think of the A anything that's bipartisan but the reality is exchanges were an idea that had been to a large extent thought of as Republican idea the whole idea of value payment was not and knew it was something that we had been working hard on and it's those are the things that for the most part have endured yeah and Nancy and the PA role is here with you today for program at the Institute of Politics had a conversation with me earlier and she also points out that the reduction of of of infection rates in hospitals and re admission rates in hospitals I know you are a big proponent of early proponent of healthcare I T so that you could connect people's medical records in a way have to really replicate tests and you could make the system more efficient all this was part of that I think it's one of the reasons why the projected growth of health care from two thousand fourteen to two thousand and nineteen is about eleven percent lower than they had anticipated because some of these reforms have taken hold but let me ask you this you are a retired politician of them I don't know if you plan to run for anything again but you look relatively sane to me and pretty happy so I'm assuming that you're not ready to jump in right at this moment of them but if you were if you are Republican politician right now what are the hazards of yes the oven as saying just what you just said there are things about this that are good Federer valuable we should retain and that we should build on that seems almost like a revolutionary concept in this hot house environment that we're well there are lots of people who say it but I having been in politics I know the value of a good phrase and the Republicans dined out for three elections in the idea of repeal and replace and I think it's to be expected that there will be a bill that will be titled repeal and replace and that's probably about the only thing we know with certainty what we don't know is how will the word repeal be defined workplace be defined and again I think if you look at this in the context of history and say that we are twenty five years into a forty year process this didn't start with Brock Obama it started before Bill Clinton and it's being driven by something other than politics is being driven by economic imperatives that we have as a country that's the critical thing to understand is that this is not being driven by politics it's it's being guided at times by politics is being affected by politics or maybe times exploited by politicians but it's clearly being driven by an economic imperative that we have is a country there's no place on the economic leader board for a country that spends twenty five percent of its Gross Domestic Product on health care we have to fix this and I think as the pressure for that intensifies the reality will will the emergency will become greater now you ask about my view on the Republicans I think the Republicans have a profound opportunity if they if they will act in a responsible way and solve some of the deficiencies of the of the Affordable Care Act and there are some of it they will They will in fact have a doubly rewarded now the question will be will they overreach they've got to have they've got to have Democratic votes in the Senate and so at some point in time this will follow the same pattern it always falls and that is that they will overreach initially and then be some pushback and the big question is will the pressure be great enough or will it happen soon enough that the politics of this won't take over they could make some very good adjustments and we could mark march forward as a society far better served the you write that use of the Republicans have done then repeal replace or take a minute later when there was this recognition that you know there are actually some popular elements of this program and the popular elements of the program are things like the inclusion of people with preexisting conditions the end of lifetime caps on insurance so that if you get seriously ill you can you're not going to face those kind limitations the insurance of people under twenty six new mention that you are an early proponent of of that on their parents' insurance you know you know the modeling better than anybody I have you maintain the things their way loves about the Affordable Care Act even if they don't like the brand of Obamacare how do you preserve those the president says he wants to the Congress as they want to preserve those and Andrew repeal the law and take the mandate that encourages people to join so you have a large enough pool you talk about risk pools how you do that I think we have first of all have to just acknowledge that words matter and manner to different people for different reasons and we fight over words a lot more than we ought to other Republicans right now on to fight on repeal and replace the Democrats want to fight that not happen while when it gets right down to it the Republicans are going to call whatever they do repeal and replace and when they get down to what they can actually get done it's likely to be that we some new things but for the most part it's going to be finding ways to make more functional that which we had before the or that
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Ep. 122 - Mike Leavitt

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