This is a rush transcript from "On the Record," December 11, 2009. This copy may not be in its final form and may be updated.
GRETA VAN SUSTEREN, FOX NEWS HOST: Tonight: Now, try this one on for size. Can you imagine not getting to vote for something but having to pay for it? Well, you might not have to imagine that at all. It looks like it is going to happen. To guess whom? To you. The latest proposal for health care reform includes a huge expansion of Medicare. And that means if this passes, the states -- yes, that means you -- have to pick up a big part of the tab.
So does your state have any money? And if it doesn't, any idea where your state is likely to look for that money? Here's a tip. You.
Who better to ask about this whole issue than former Arkansas governor Mike Huckabee? He's author of the book "A Simple Christmas." And I understand you're the host of a TV show.
MIKE HUCKABEE, FORMER ARKANSAS GOVERNOR, HOST, "HUCKABEE": I hear that. In fact, I'll be hosting this weekend another Christmas show on the "Huckabee."
VAN SUSTEREN: And of course, we'll all be watching.
HUCKABEE: Of course we will.
VAN SUSTEREN: Absolutely!
HUCKABEE: What else would people do on the weekends?
VAN SUSTEREN: All right, well, let's talk about this. This is -- I want you to explain for us this whole Medicare because it -- the federal government's voting on it, but it's not insignificant to governors. Explain how it works.
HUCKABEE: Well, the reason that Medicare matters to states, because states don't pay directly to Medicare, they pay to Medicaid -- however, most people do not understand that when a person is dual-eligible -- that's a term that means they both Medicare and Medicaid qualify...
VAN SUSTEREN: So that would be someone who's -- who's not -- who doesn't have much money, who's 66 years old.
HUCKABEE: That's right. They're poor...
VAN SUSTEREN: Right.
HUCKABEE: ... and they're also old.
VAN SUSTEREN: Right.
HUCKABEE: Historically, that's been if you're 65 and older and you are also poor, even though you're Medicare-eligible, Medicaid is what you're actually covered under, not Medicare. So if we drop the age to 55, at a time when people start getting a whole lot more health care than they did when they were 25 or 35 or 45, first of all, you have escalating health care costs in that age group.
Secondly, any of those people who are under the Medicaid threshold are going to be put on the Medicaid program. And states pay anywhere from 25 percent to 50 percent of that money, which means that for some states, we're talking hundreds of millions of dollars of new obligation for which they are totally unprepared.
VAN SUSTEREN: Which, of course, is why then that -- why that $300 million went to Louisiana, why they were pushing for that, because they have a poor population and because they would get particularly hit hard on this.
HUCKABEE: They would be devastated by it. But not just the poor states and not just the Southern states. They certainly would -- Mississippi, Arkansas, West Virginia, Louisiana, Alabama. California will take one in the teeth, a billion dollars, maybe up to $3 billion in California. Huge impact to states. California's already sucking air. They barely can pay their primary expenses to run the state on a day-to-day basis.
VAN SUSTEREN: OK. Explain to me this. If -- let's say that with Medicare -- not Medicaid, Medicare -- let's say that they lower it to 55. Who's actually paying for that? Is it the federal government or does the state have to pay for it? Who pays for Medicare?
HUCKABEE: The federal government pays for Medicare. The states don't pay.
VAN SUSTEREN: Total, 100 percent.
VAN SUSTEREN: OK. So it's Medicaid we're talking about, which is what the governors get upset about.
HUCKABEE: That's exactly right. But again, if that Medicare person is poor, now you have a whole new generation, a 10-year window of people who are potentially Medicaid that weren't Medicaid before because all they have to do is meet the threshold of being poor. And if -- look, if Congress keeps taxing more and more Americans, there are going to be a lot more poor people than we've ever had before in that age bracket.
VAN SUSTEREN: All right, so how is it different if, let's say, a poor person who's Medicare and Medicaid-eligible has -- and we don't lower it, but just shows up at the emergency room? I mean, who's picking up that cost?
HUCKABEE: Usually, the hospitals and the providers pick up a whole lot of it. There is a certain portion of what's called uncompensated care. Different states deal with it differently. Most states allocate some money to uncompensated care. But I'll tell you who ultimately pays for it, all the people who currently have insurance. So if you're an insured person...
VAN SUSTEREN: Or -- but the other way, you'd pay through your taxes. I mean, you're going pay for it...
HUCKABEE: You're going to pay for it.
VAN SUSTEREN: Right. So I mean, no matter -- I mean -- I mean, whether the person gets care at the emergency room without any sort of government option or Medicaid or anything else, is, you know, everyone does sort of pool (ph) and pay for it somehow.
VAN SUSTEREN: So -- so what -- you know, what's -- what's the -- you know, what's the rub, basically, if you're going to pay for it anyway?
HUCKABEE: The rub is that at least under the current system, there's a chance that there's a private sector insurance that's fighting for cost control and there's some competition. When people use the term "public option," I think it goes right past a lot of people because it sounds like what's the -- option's good, public is good, what's wrong with public option? Public option really means government control. Think government control, not public option.
VAN SUSTEREN: OK. So how -- there's all this discussion about public option. Is Medicare -- are both Medicare and Medicaid public options?
HUCKABEE: They are both public options, but...
VAN SUSTEREN: All right, so we play -- we do an awful lot of playing around with these words and it gets rather confusing.
HUCKABEE: Yes. Government still is going to be paying for it, it's just that government's going to have a big portion of what used to be private sector. Here's one of the problems, Greta, that we're going to have. Currently, there are a lot of doctors that don't want to take Medicare patients, don't want to take Medicaid patients...
VAN SUSTEREN: Because they don't get paid the full amount.
HUCKABEE: No, they don't. They get paid...
VAN SUSTEREN: And so we -- we basically -- we stiff them a little bit on it, the doctors.
HUCKABEE: We stiff them a whole lot.
VAN SUSTEREN: OK. We stiff the doctors, which doesn't seem right, either.
HUCKABEE: No, it's not right. And so a lot of doctors don't want to take those patients because they can't even cover their expenses. If a doctor spends more than 15 minutes with you, he's losing money. And some cases, particularly those in primary care dealing with diabetics, you can't really train a diabetic how to manage his disease in 15 minutes. It simply can't be done.
VAN SUSTEREN: All right, so would -- I mean, would you agree that we got to do something?
HUCKABEE: Something is a good idea.
VAN SUSTEREN: OK. All right. Something. All right. No, no, but I just want to start at the threshold. So you believe in reform.
VAN SUSTEREN: OK. And you disagree with what is being batted around on Capitol Hill right now.
HUCKABEE: Totally disagree.
VAN SUSTEREN: OK. Do you think that everyone should be at least eligible or we should take care of everybody?
HUCKABEE: We can take care of everybody up to a point, but we need to find out what "take care of" means because here's one of the rubs. If somebody's in an accident, should they get treatment? Yes. Somebody comes down with cancer, should they be able to access medical care? Yes. Somebody wants cosmetic surgery, I don't think so. Somebody wants to maybe have a knee or hip replaced not because it's medically necessary, but because it'll make them more comfortable? That's questionable.
VAN SUSTEREN: Well, how about -- OK, the -- OK, if you want to have plastic surgery, that -- you know, that -- you know, that makes a lot of sense. But what about the person who's grossly irresponsible in personal habits and I don't -- and I -- we get a lot of e-mail...
VAN SUSTEREN: ... every time I raise this question -- but who gets grossly overweight...
VAN SUSTEREN: ... and develops diabetes and develops all these -- I mean, it's just sort of a slow, you know, personal responsibility issue.
VAN SUSTEREN: For many. Not for everybody.
HUCKABEE: But here's the deal. Eighty percent of all the medical costs in this country of the $2.5 trillion, 80 percent chronic disease- related. Chronic disease. Three primary behaviors cause it, overeating, underexercising and smoking. Those three behaviors drive most chronic disease, and chronic disease accounts for most all of the money...
VAN SUSTEREN: So what are you going to...
HUCKABEE: ... that we're spending on medical expenses.
VAN SUSTEREN: So -- on in a minute-and-a-half, what would you do in recognition that there is a problem? Tell me -- tell me the Huckabee program.
HUCKABEE: I would separate the insured -- excuse me -- the uninsured from the uninsurable. There are people who are uninsurable. No fault of their own. They have disease...
VAN SUSTEREN: Because of diseases or because they don't have the money?
HUCKABEE: No, because of the diseases, preexisting conditions...
VAN SUSTEREN: What about the...
HUCKABEE: ... developmental disabilities.
VAN SUSTEREN: All right, what about the uninsurable because they simply don't have the money? A lot of people without work.
HUCKABEE: They can be covered. But here's what ought to happen. Put them in a high risk pool, make sure that they have some skin in the game. Don't make it free. And then give them incentives that it costs them actually less if they take better care of themselves. And they don't have to have perfect behavior, but they need to be developing behaviors that are less expensive and that are more responsible, and then they don't have to pay as much.
VAN SUSTEREN: Let me ask you a personal question. You got overweight. What happened? Did you -- what would -- do you assign that responsibility to yourself or...
HUCKABEE: Yes. I mean, it's not somebody else's responsibility. It's mine.
VAN SUSTEREN: How did that happen to you?
HUCKABEE: Well, when the doctor sat me down and told me that if I didn't change my lifestyle, I had a decade to live, I said, I want a different exit strategy. And so, you know, I set about to change some habits and behaviors, and I haven't had diabetic symptoms in almost seven years now.
VAN SUSTEREN: Because that's really -- I mean, because the issue of the weight is a huge -- I mean, it's...
VAN SUSTEREN: ... a lot of people -- it's esthetic for a lot of people...
VAN SUSTEREN: ... but for -- but it's really a real physical -- it's a real health issue.
HUCKABEE: And the key thing is not focusing solely on weight. That's one American problem. We need to look at health. Look at the dashboard of your car. There are many gauges. Weight is one of the gauges. It's not the only one. There's blood pressure, blood sugar, cholesterol, both HDL and LDL. There's a whole bunch of gauges on the dashboard. Build the cost of health care based on how well you're managing your entire dashboard, not just one factor. That's an important part of true reform of the health care system.
VAN SUSTEREN: OK, where are you going to be tomorrow night at 8:00 PM?
HUCKABEE: I'm going to be hosting the "Huckabee" show, and everybody in America's going to be watching.
VAN SUSTEREN: I thought so! Governor, thank you.
HUCKABEE: Thank you, Greta.
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