Friday, January 21, 2005
An Interview with Gordon Bonnyman of Tennessee Justice Center
Three days after Gov. Bredesen's announcement to cut 323,000 off TennCare, I spoke with Gordon Bonnyman by phone. Bonnyman has become the hated target of the state because he and the Tennessee Justice Center took the state to court, seeking consent decrees in favor of TennCare patients. Yesterday, I asked him for updates. Nothing had changed. If you really want to see a good piece about Bonnyman's rise from privilege to advocate of the dispossessed, read the Knoxville Metro Pulse story here. Below is my interview with Bonnyman on Jan 13, 2005.
Q: Why is TennCare in crisis?
Bonnyman: You have to start with the numbers. Just like Watergate, you have to follow the money. Bredesen says there will be a $650 million overrun. He says he's going to save the state money by cutting TennCare. But let's look at that $650 million. Now multiply it by three. With a two-to-one federal match, we're talking about $1.7 - 1.9 billion that would have been spent. So we're not saving the state $600 some million; we're going to cut $1.7 - 1.9 billion from medical services, starting on July 1, 2005.
Q: Your critics say the state is saving money. But you make it sound as if we are not. Are you both on the same page?
Bonnyman: Sure, as far as fault goes. Because this is not Bredesen's fault. And it's not mine either. Still the governor comes from a business background, you know, the private sector. He thinks that TennCare should run like an HMO which is a business model and has no obligation to everyone in society. But TennCare funds the healthcare of all other people not on insurance. The complexity is far greater than insurance companies see it. To put this crisis in context, $4.5 billion is now being spent on acute services. When you include all services, including administrative, it is $8 billion. Almost all the $1.7 - 1.9 billion in cuts are in acute services, not administrative costs.
Q: Obviously the crisis is dire. How do we contain costs and help Tennesseans?
Bonnyman: In order to keep the whole budget in place now we have to resist medical cost inflation, which is several times faster than income growth and revenue growth. This is not a new trend. It has continued since the 1950s--in fact, we have seen healthcare costs going up by 10% while income goes up by only 2% or 3% a year. INFLATION IS THE ISSUE!
Q: So if inflation of healthcare costs is the issue, why is Bredesen cutting the budget?
Bonnyman: First, in one year the loss of $1.7 - 1.9 billion because of cuts will not save the state any money. Bill Clinton used to say, "It's the federal money, stupid." And he was right. But in order to save money the way Bredesen says he wants to do it, Tennessee will have to lose money from the federal government. If the state government wants to stop the fast-rising healthcare costs, why can't it bargain with pharmceutical companies over drug prices?
Q: What will be the number one problem if Bredesen's plan is implemented?
Bonnyman: Loss of life. There will be an additional death every 20 hours in the state, or an additional 438 deaths a year. And why? Because of arbitrary limits set on care. Think of it this way. Just as a robber robs a bank because it is there, the state takes medical care away from those who are sickest because it can--from the deepest corner of the state. If we're not prepared to say, "Let them die, just get over it, let Chattanooga become Calcutta," then let's deal with the problem.
Q: Where did TennCare go wrong, it it did?
Bonnyman: Key structural flaws were made under Sundquist. Look, rigorous studies show that the first seven years of TennCare were a success--saving taxes, providing care. We had favorable financial matching funds to pay for TennCare, providing coverage for more. But in 2002 Bush wanted to save money for tax cuts, tightening fed spending in certain areas, forcing politically weakened Sundquist to quit risk care.
Q: What can we do now?
Bonnyman: We've got a natural disaster coming. Look at what Lousiana and Alabama did when they didn't good management of healthcare. They asked for and received a lump sum of federal money. Almost a billion dollars for Lousiana and about $774 million for Alabama. I've never suggested don't reform. You can't reform TennCare fast enough. But right now we need Uncle Sam to keep the sickest from literally dying. We all want good healthcare. And for those who say healthcare is not a right, okay. But we do have community accountabilty. If someone has VD or TB, we want to know how that will affect the community and we have healthcare for those diseases. We care for someone who has a stroke as well.
Q: What do you and the Tennessee Justice Center plan on doing next?
Bonnyman: I don't intend to go back to court. But this issue was not created by the federal courts, and I don't have a checking account for this problem.
Q: Why is TennCare in crisis?
Bonnyman: You have to start with the numbers. Just like Watergate, you have to follow the money. Bredesen says there will be a $650 million overrun. He says he's going to save the state money by cutting TennCare. But let's look at that $650 million. Now multiply it by three. With a two-to-one federal match, we're talking about $1.7 - 1.9 billion that would have been spent. So we're not saving the state $600 some million; we're going to cut $1.7 - 1.9 billion from medical services, starting on July 1, 2005.
Q: Your critics say the state is saving money. But you make it sound as if we are not. Are you both on the same page?
Bonnyman: Sure, as far as fault goes. Because this is not Bredesen's fault. And it's not mine either. Still the governor comes from a business background, you know, the private sector. He thinks that TennCare should run like an HMO which is a business model and has no obligation to everyone in society. But TennCare funds the healthcare of all other people not on insurance. The complexity is far greater than insurance companies see it. To put this crisis in context, $4.5 billion is now being spent on acute services. When you include all services, including administrative, it is $8 billion. Almost all the $1.7 - 1.9 billion in cuts are in acute services, not administrative costs.
Q: Obviously the crisis is dire. How do we contain costs and help Tennesseans?
Bonnyman: In order to keep the whole budget in place now we have to resist medical cost inflation, which is several times faster than income growth and revenue growth. This is not a new trend. It has continued since the 1950s--in fact, we have seen healthcare costs going up by 10% while income goes up by only 2% or 3% a year. INFLATION IS THE ISSUE!
Q: So if inflation of healthcare costs is the issue, why is Bredesen cutting the budget?
Bonnyman: First, in one year the loss of $1.7 - 1.9 billion because of cuts will not save the state any money. Bill Clinton used to say, "It's the federal money, stupid." And he was right. But in order to save money the way Bredesen says he wants to do it, Tennessee will have to lose money from the federal government. If the state government wants to stop the fast-rising healthcare costs, why can't it bargain with pharmceutical companies over drug prices?
Q: What will be the number one problem if Bredesen's plan is implemented?
Bonnyman: Loss of life. There will be an additional death every 20 hours in the state, or an additional 438 deaths a year. And why? Because of arbitrary limits set on care. Think of it this way. Just as a robber robs a bank because it is there, the state takes medical care away from those who are sickest because it can--from the deepest corner of the state. If we're not prepared to say, "Let them die, just get over it, let Chattanooga become Calcutta," then let's deal with the problem.
Q: Where did TennCare go wrong, it it did?
Bonnyman: Key structural flaws were made under Sundquist. Look, rigorous studies show that the first seven years of TennCare were a success--saving taxes, providing care. We had favorable financial matching funds to pay for TennCare, providing coverage for more. But in 2002 Bush wanted to save money for tax cuts, tightening fed spending in certain areas, forcing politically weakened Sundquist to quit risk care.
Q: What can we do now?
Bonnyman: We've got a natural disaster coming. Look at what Lousiana and Alabama did when they didn't good management of healthcare. They asked for and received a lump sum of federal money. Almost a billion dollars for Lousiana and about $774 million for Alabama. I've never suggested don't reform. You can't reform TennCare fast enough. But right now we need Uncle Sam to keep the sickest from literally dying. We all want good healthcare. And for those who say healthcare is not a right, okay. But we do have community accountabilty. If someone has VD or TB, we want to know how that will affect the community and we have healthcare for those diseases. We care for someone who has a stroke as well.
Q: What do you and the Tennessee Justice Center plan on doing next?
Bonnyman: I don't intend to go back to court. But this issue was not created by the federal courts, and I don't have a checking account for this problem.
