Transcript: Oh what a hard question. That’s a terrific question. I would like to interview three people. I’d like to put three people in the room at one . . . at one time: the Speaker of the House, Nancy Pelosi; Harry Reid, the majority leader in the Senate; and President Bush. And I’d like to . . . I’d like to say to them, you know, “When I was a kid I had a favorite aunt – Aunt Jay. And she’d come into the room, and the cousins would all be smacking each other around, and Aunt Jay would say, ‘Now fight nice.’” And I would like to say to Nancy, and Harry, and George, “Why can’t you fight nice?”

Recorded on: 9/27/07

Transcript: It depends on how you measure power. You know there are a lot of people . . . You mentioned the pharmaceutical industry. The pharmaceutical industry has a lot of power because they have a lot of money, and they know how to spread that money around. AARP, I think, does have a lot of power. And that’s because we have lot of voters. And we have a lot of people who are activists. And we have big numbers. We’re up to 39.2 million members. So it depends on how you define power and how you try to use power. As far as me being one of the most powerful lobbyists, lots of people said, “Hey, congratulations!” And I said, “It ain’t me. It’s AARP.”

Recorded on: 9/27/07

Transcript: I think it’s gotten more rancorous. There are more lobbyists today than ever before. You know you’ve got this dreaded K Street corridor. This is where the lobbyists hang out. What you’ve got is more partisanship than ever before. I asked a speaker . . . a recent Speaker of the House, “Do you think it’s worse now than when you started?” And he said, “No it isn’t. In my day they wouldn’t even learn your name.” But other people say, “Yeah it’s very much worse. It is worse now than it’s ever been.” And . . . and there are a variety of reasons for this, but it’s gotta stop. We’ve got to get past this gridlock if we wanna get anything done in Washington.

Recorded on: 9/27/07

Question: Are we headed for Social Security and Medicare crises?

Transcript: Social Security and Medicare are problems. They’re problems waiting to happen. If you look at Social Security first of all, we’re gonna have a problem in about 10 years. Right now we’re sort of in surplus, but the Congress is spending the surplus money. And what we need to do is we need to look at both sides of the Social Security equation. We need to figure out a way to get more revenues into the system, and a way to adjust the benefits. We’ve got to take into account longevity. Social Security was set up when, you know, people lived to be 65. Now they live to be 85. And so we need to do something about that. But this is . . . this is not rocket science. This is something that we could do if we sat down and the two parties reasoned together. And so that’s what . . . that’s what makes it so frustrating. From a Medicare standpoint, Medicare is not sustainable in its current form; but that’s because healthcare is not sustainable in its current form. Medicare is kind of a subset of healthcare. And it’s the healthcare system that we have to fix.

Question: How can we fix Social Security and Medicare?

Transcript: Social Security is . . . as big as it is, it’s the easy one. What we could do is get the two parties together. And what I’ve been saying in Congress is, “Look. It’s going to take two miracles to fix Social Security. One miracle is that you Republicans and Democrats are gonna have to sit down at the same table, and reason together, and come up with a fair, equitable plan for long term solvency. And the second miracle is that the public is gonna have to buy it.” And I think that AARP can help deliver on that second miracle. When we go out and talk to our members and other, you know, elements of the public, we lay out social security. We tell them what the problems are, and they are willing to engage. It’s not the third rail that politicians like to talk about. So we can get that one done. Political will is what we need. The other one, Medicare, as I say . . . the conversation we had on . . . on healthcare is where we have to go. We’ve gotta squeeze down costs, which we can do. We’ve gotta cover the uninsured, which we can do. And we’ve gotta improve quality of care through things like health information technology and electronic prescribing so that we cut down the errors in healthcare and improve the quality of care. We can do all these things, but it’s very hard because of the complexity of the system, and because of the political stalemate in which we find ourselves.

Question: Should we raise the retirement age?

Transcript: It’s a tough question. People do not like that idea. Now you know if you’re 41 or under right now, you’re gonna have to work ‘til you’re 67. But at the same time, many people want to work into their older years. There’s another way to think about it which has been called “longevity indexing”. And some countries do this. And what they basically say is, “Okay. Let’s actuarially figure out how long you’re expected to live. And we’ll give you your Social Security money stretched over that period of time.” So you will get less money per year over a longer period of years. That’s one way to think about it. There are a lot of ways to consider fixing the system.

Recorded on: 9/27/07

Transcript: The pharmaceutical industry has an important role to play in American health. First of all, this is a lifesaving industry. This is the industry that we hope is going to be able to control Alzheimer’s and Parkinson’s and these other diseases of . . . of the elderly. So we are dependent upon the pharmaceutical industry. But at the same time, prescription drugs cost too much in this country, and we have to really move to generics. We have to get costs so that they’re affordable for people. We have to figure out a way so that the pharmaceutical companies can make a reasonable profit, and people can afford their drugs. And right now we’re not there.

Recorded on: 9/27/07

Transcript: Yes. The American health care system is broken. It’s headed for a meltdown. We’ve got declining quality of care. We’ve got these rising costs that people can’t afford. Companies can’t afford them, and individuals can’t afford them. Families can’t afford them. And then we’ve got rising numbers of uninsured. And if you put all those things together, what we have is a system that’s essentially melting down.

Question: How do we fix it?

Transcript: There are a number of things that we have to do. First of all, we’ve got to contain costs. We just can’t keep paying the cost that we’re paying. Right now we pay about twice as much as the next highest industrialized country, and our health outcomes are worse. So we’ve got to . . . We’ve got to squeeze costs out of the system, and there are some obvious ways. Information technology, for example. Bringing down the price of prescription drugs. Doing more to manage chronic disease, which is the most common kind of disease today. These are all things that we need to do. Getting the uninsured covered so that we don’t have all this uncompensated care is another aspect of it. One thing that’s a long term payoff, but that we have to start right now, is wellness programs. We need a national, coherent prevention strategy that’s going to be a long term investment. If we don’t do that, obesity is going to reverse longevity in this country. And of course we talked earlier about tobacco. Diabetes, heart disease, high blood pressure – these are all elements that we can control if we tackle the prevention and health promotion aspects of them. And so those are all ways that we can deal with the healthcare system.

Question: Why isn’t there more focus on preventative care?

Transcript: Right now it’s very, very fragmented. So you’ll have wellness programs at the worksite. You’ll have the government doing two or three things. You’ll have states doing several things. So we have this fragmentation. We don’t have any . . . any national system for it. So that’s . . . that’s one major problem. Another problem is that the payout . . . the payoff is long term. So a company may say, “Well, do I really wanna invest a lot of money in keeping my young workers well? Because in five years they’re going to be working at another country . . . company.” Where a congressman will say, “Well I’m worried about the budget this year. Do I really wanna vote for something that’s gonna be expensive and has a 10-year payout?” So it’s this long term investment that’s being missed.

Question: Whose responsibility is it?

Transcript: It’s all those things. What we need is we need government and the private sector to come together on this. I do not think government can be the answer to prevention and wellness; but I don’t think you can just do it in the private sector either. We need a public-private partnership – some kind of a . . . of a wellness program that’s well-funded, that’s sanctioned by Congress, that everybody buys into. And when I say everybody, I mean everybody. I’m talking about the fast food and the processed food industries. I’m talking about educators, because we’ve gotta do something about wellness in the schools. I’m talking about everybody.

Question: Should the government be doing more?

Transcript: Yeah we need to sanction this thing. It needs to be official. It just can’t be some casual . . . some kind of an informal thing where we ask everybody to come to the table. We need something big. You know one parallel example that some people have talked about is the federal reserve. You know could we take that kind of example and that kind of an analogy? Could we do some kind of a fed for wellness? So that’s the kind of thinking that I . . . that I think is important.

Question: Is health care a universal right?

Transcript: Health care is a universal right. Yes I do believe that. But I think we also have personal responsibilities to say well. You know it doesn’t do to say, “I’m 65 years old,” and you go into a physician and say, you know, “I’m starting Medicare tomorrow. I’m obese and I smoke. Now take care of me.” We have a personal obligation as well as a right to . . . to healthcare.

Question: If health care is a universal right, who should provide it?

Transcript: Well I think health care, again, is a public-private sort of thing, You know there’s this great ideological argument about the single payer versus, you know, let the marketplace prevail. The answer is in between. Right now in California, they’re looking at a plan whereby they would have people be required to buy health insurance; that have the health insurance companies stay in the game, but have to insure people and not be able to cherry pick and leave out those with illnesses. They would have the individual corporations be involved in it. And they would have a sense of personal responsibility involved. So if that ever came to pass, that would be a good model for us.

Question: What other models could we look to?

Transcript: Well I think there are other models in other countries. And I have looked at these models. AARP has looked at these models. The thing is that we are unique. We are unique in terms of our social and our economic systems; and how we treat capitalism; and how we think about government. But we can learn from other countries. But we have to fashion a unique American answer, I think.

Question: Does the pharmaceutical industry have a responsibility to Americans?

Transcript: The pharmaceutical industry has an important role to play in American health. First of all, this is a lifesaving industry. This is the industry that we hope is going to be able to control Alzheimer’s and Parkinson’s and these other diseases of . . . of the elderly. So we are dependent upon the pharmaceutical industry. But at the same time, prescription drugs cost too much in this country, and we have to really move to generics. We have to get costs so that they’re affordable for people. We have to figure out a way so that the pharmaceutical companies can make a reasonable profit, and people can afford their drugs. And right now we’re not there.

Recorded on: 9/27/07

Question: Do we mistreat our elders?

Transcript: We don’t mistreat our elders per se. Yes we have a certain obsession with youth. I think every culture does. But you know I think the boomers are changing that. And the reason I say this is that the 50 plus Americans have the majority of the disposable income in this country. So they’ve got the money. They want to spend it. They’re intelligent. If you look in the AARP magazine, you’ll see ads for everything from computers, to financial services, travel, you name it. Cosmetics. And so as people age – as the boomers get older – they are so strong, and they are so big, and they are so important that companies, and the entertainment industry and others – if they insult older people; if they practice aging stereotypes, they’ll do it at their own peril because boomers are not gonna tolerate that.

Question: Do we treat them well?

Transcript: You know there are several points of view with respect to treatment of older people. There is elder abuse in this country. It’s kind of a hidden, dark, dirty secret. There is that, without (28:56) question. And a lot of it comes from family members. I mean so you always have those kinds of . . . of, you know, negative aspects of any society, of any culture. And we have it too. As far as people going into nursing homes and sending their elders off to nursing homes, many, many people are caring for their loved ones at home. Now it is true that if somebody has Alzheimer’s or some other disease, it becomes very, very difficult to do that. And it is true that we’re a mobile society. And so many of us are living apart from our parents. And for those kinds of reasons, there are people, of course, who are in . . . who have to go into nursing homes. And I think that other countries are beginning to follow suit as well. Everybody would wish they could take care of their loved one at home, but it’s not always possible. And so what we have to do is balance home care and institutional care. And we have to make sure that both of them are quality . . . quality experiences for older Americans. We need to work on that, and I don’t think it’s necessarily a negative thing that people have to go into nursing homes, just so the experience is a good one.

Recorded on: 9/27/07

Transcript: Well I think there’s a formula. And the formula is not a deep secret. The way to age well, I think, is to stay mentally and physically active. And then the obvious things: you know eat well, don’t smoke, those kinds of things. Get plenty of exercise. But mental and physical activity are the most important things that people can do to age well.

Recorded on: 9/27/07

Transcript: I don’t think so. I don’t think our system is broken, but I think it’s out of kilter right now. You know the public is divided into red and blue, but most states are purple. Most states . . . You know the public wants to see something happen. Last November they tried to give a message. They tried to send a message. They voted a lot of incumbents out of office, but I’m not sure the message was received. Now from an AARP standpoint, we try to do a lot of voter education. Last November, 25 percent of all the people who voted across the country were AARP members. So voter education for us is an important thing. And what we . . . what we want people to do is make an informed choice, and tell these people to stop the bickering and do the people’s work.

I have a fierce political philosophy, and it is independence. I really despair when people start off by saying, you know, “I’m a conservative, and therefore . . .” Or, “I’m a liberal, and therefore . . .” You know, “Let’s privatize something,” or “Big government is best.” I just got into this discussion the other day with Newt Gingrich. And what I say is if you’re a business person; if you’re in the military; if you’re a football coach; if you’re anybody – a mother – how do you think? You think about what’s the problem to be solved. And that’s the way we have to be. We have to be pragmatic. So I think of myself as a centrist; as a pragmatic problem solver. And I wish we could get our political leaders to put aside all this ideology and think about problem-solving. Be a centrist. Be independent.

Recorded on: 9/27/07

Transcript: I don’t know that I have a particular hero. I just finished Doris Kearns Goodwin’s book called “A Team of Rivals”. It’s a book about Abraham Lincoln and his cabinet. And one of the most powerful lessons I got out of that book is that Lincoln was a flawed leader. In other words Lincoln was a human being. And we think of him in terms of the Emancipation Proclamation; in terms of winning the Civil War. But what . . . what you really get out of this book is that Lincoln made mistakes. And we all are gonna make mistakes; but we can all be leaders. You don’t just have to be at the top. You can be a leader throughout an organization. You can be a leader in your town, in your neighborhood, in your community. So I think what we have to think to ourselves is we can do it. Yes it’s partly obligation; but it’s partly our desire to leave a legacy, to give back. And then if we make mistakes, that’s okay. Just keep on going.

Recorded on: 9/27/Create an Idea - Big Think07

Transcript: I think we do have an obligation. But I think it’s . . . it’s deeper than that. I think people want to give back. And you see this at virtually . . . in virtually every generation. I mean when we talk about the World War II generation, look what they gave back. We talk about the boomers . . . You know and somebody wrote a book called “Bowling Alone”. And the thesis was that boomers are not going to have social capital. They’re not going to give back. I think that’s wrong. I think what’s happening is we’re seeing now that as boomers get older they want to give back. They’re into things like care giving, which are so important. They’re . . . they’re giving political contributions and social contributions to their churches, and their synagogues, and their universities. What we need for them now is to . . . is to rev up that activism that they had when they were young.

Recorded on: 9/27/07

Question: Do baby boomers still have a contribution to make?

Transcript: The baby boomers have a huge contribution. In fact I wrote a book about it. It’s called “50+: Igniting a Revolution to Reinvent America”. And what “50+” is about is the fact that the boomers have so much more to contribute. They’re going to leave a legacy. They are . . . They’re making change now in terms of working longer; in terms of, you know, what’s happening in the marketplace; some of the other issues I talked about in terms of healthcare and so forth. So the boomers have been catered to their whole lives. They’ve re-invented every aspect of life they’ve gone through. They’re going to reinvent retirement. And they’ve got an attitude.

Question: How will they leave their mark?

Transcript: I do talk about that in the book. I think that what we need is for people, when they think about giving back . . . and boomers do think about this. When they think about volunteering and so forth, I think they . . . what we can do is ask people to think big. So if you can contribute to fixing a playground in your neighborhood, that’s important. That’s great. That’s gonna help your family and your town. But also think bigger. Think about advocating for a bigger cause. Get involved. Understand what the issues are. Vote. In some cases it’s not just voting for an incumbent, but it’s voting against an incumbent. We’ve gotta vote some people out in this country in order to make progress. So there are many ways that boomers can contribute. As I said before, they are better educated. They’re healthier. They intend to work longer. They’re gonna make their mark.

Recorded on: 9/27/07

Question: How are the interests of seniors different?

Transcript: That’s a great question. You know when you look at the research, what it suggests is that . . . that there are some differences in terms of age segments. There are differences in how people use technology. There’s certain differences in terms of what people want. But when you get a little bit lower than that – when you get down to needs, the needs are very similar. And then when you get down to values, what you find is that the generations are really closely connected in our country. This is a powerful force. And so grandparents really care about their grandchildren. They care about their children and vice versa. The grandchildren today . . . young people today care about their parents and their grandparents. So you have this real cohesiveness – this connectedness. And so from our standpoint we try to think that way. We try to think inter-generationally. So just to give you an example right now, we’re working very hard at AARP to try to get the state children’s health insurance program reauthorized and expanded. Now why do we want to do that? We want to do that because those are our grandchildren, and because children are the future of the country. So that interconnectedness is very strong and very important.

Question: How old is “old” these days?

Transcript: Well it’s changing quite rapidly. And the reason for this is as boomers age, and as people in their 60s and 70s age, they tend to be healthier and better educated than previous generations. And so you have people living longer, and you have this huge cohort of boomers – 78 million baby boomers – coming into their older years. So what all this adds up to is that our society is aging. And as far as how old is “old”, nobody really knows. You know there’s a . . . there’s a line that says basically, “Old is 10 years older than I am.”

Question: What are the most pressing issues for AARP’s 35 million members?

Transcript: The pressing issue for us today is to try to get healthcare fixed, because what’s happening is more and more people are unable to afford healthcare insurance even if their employer offers it to them. More and more employers are changing or losing jobs. And when they do that they can’t take their insurance with them. They’re worried about their children. They’re worried about so many aspects of healthcare. So many bankruptcies in this country are due to health costs. And right now about two-thirds of all adults in this country think that the coming generation is going to be worse off than their parents. And if that happened, it would be the first time in American history. And a major reason for that is healthcare, and also financial security – not being able to save enough for retirement; pensions going south; trying to care for aging parents and having kids at home; and not being able really to draw . . . to save at work. So these are the issues that are at the top of the agenda for us.

Question: Do the young have a responsibility to the old?

Transcript: I think the young have a responsibility to the old. And very definitely older people have a responsibility to the young. There’s no question. Every generation has to be responsible to the other. That’s what . . . that’s what society is built upon. And you know there was a congressman who came to the AARP Board one day, and he said, “You know that young people have to pay for older people to receive Social Security. And I’m gonna go out and talk to young people, and I’m going to make them madder than hell about this.” And of course there is no intergenerational warfare in this country. He was . . . he was dead wrong. Young people are interested in their parents and their grandparents. And as I said before, vice versa. We have to all care about each other. And if we do that, we’ll be a better society.

Question: How does one age well?

Transcript: Well I think there’s a formula. And the formula is not a deep secret. The way to age well, I think, is to stay mentally and physically active. And then the obvious things: you know eat well, don’t smoke, those kinds of things. Get plenty of exercise. But mental and physical activity are the most important things that people can do to age well.

Recorded on: 9/27/07

Question: Do you bring your marketing experience to lobbying?

Transcript: Every day. The way I see myself is I’m a person with a marketing and marketing communications background. And I try to apply those tools, those principles and practices to social change. So whether it’s, for example, trying to increase physical activity in people 50 and older; or whether it’s trying to provide education for safe driving; or to help people acquire and protect financial assets – all those different kinds of things that we care about – I believe that you can apply marketing and marketing communications to those kinds of things. Now of course there are a lot of differences because, you know, those are much more difficult subjects to deal with than just selling a product. But every day I apply those principles, and I think that they are principles that are very useful in social change.

I think that there’s always this discussion about a nanny state, or “Is marketing manipulative?” When you’re dealing with these tough issues, they are intractable. They are very difficult to deal with. So if you take something like fixing social security, or healthcare reform, these are issues where we need to bring all parties together. We need to listen to all sides of the debate. So it’s not . . . It’s not like there’s no nuance to the argument. The basic problem is . . . is getting people to focus, and getting political will. Getting political courage to tackle the issues.

Question: Is it difficult to get government officials’ attention?

Transcript: Yeah. Lobbying today . . . or let us say . . . we call it “advocacy” because it’s really broader than just lobbying. But the whole idea of advocacy is one way that you . . . you can address social change. There are other ways as well. We need public education. We need legal strategies. We need all kinds of ways to . . . to move the needle on these big issues. But advocacy . . . advocating for policy change is one way to do that. And it’s very, very difficult to do in America today because the two political parties are so opposed to each other. There is such partisan gridlock. It’s almost toxic at this point. And getting that . . . getting that broken down . . . getting that gridlock broken down so that . . . so that we can make progress in terms of policy is very, very tough.

Recorded on: 9/27/07

Question: Should the government regulate the tobacco industry?

Transcript: Well tobacco is not an ordinary product. So when you’re looking for that balance between, you know, public government oversight and individual responsibility and individual liberties, the line for tobacco is not exactly where it should be with cheeseburgers. Tobacco is the only product which, if you use as directed, it kills you. And of course 80% of all those who become addicted to tobacco become addicted as kids. And so we have a government . . . a national obligation to protect our children. And that’s why the line should be sharper for tobacco than for other products. That’s why we need FDA oversight over tobacco. We need taxes on top of tobacco. We need public education campaigns. And we need to really reign in the tobacco industry.

Question: Do you have a specific policy in mind?

Transcript: There’s a law that’s pending right now as we discuss this. It is to give the food and drug administration oversight over tobacco so that it would be regulated for the first time. Right now you can bring out, you know, a new product of any kind – a new soft drink – easier than you can bring out . . . Oh excuse me. It’s the other way around. Let me try that again. Today you can bring out a tobacco product – a cigarette – far, far easier than you can bring out a new food product because there’s no regulation. There’s no oversight. It’s a historic accident and we have to fix it.

Question: What effects does tobacco have on your AARP constituents?

Transcript: Tobacco kills people later in life. We’re talking about 45, 50, 60, 70 years old. And of course when you’re a kid, you think you’re immortal and invincible, and you don’t think about being 55 or 65 years old. And so that’s why it’s so insidious. It starts early and it kills later. And as far as our members are concerned, what we try to tell them is it’s never too late to quit. You can quit smoking and reap benefits from it.

Recorded on: 9/27/07

Transcript: Well the . . . the biggest issues of all are, at this point in America, health care reform, which is enormous; and financial security. And they both relate to the same thing, which you might describe as the American dream. And we do a lot of research, and what we see is that the . . . the American dream is essentially breaking down. You know people talk about “the deal”. And the deal always was if you worked hard; if you raised your kids; if you played by the rules; if you paid your taxes, then you’d have a shot at . . . at the American dream. You’d have a shot at long term security. And now that’s beginning to fade and people are very worried. And so those are the kinds of big issues that we care about and that we have to address.

Recorded on: 9/27/07

Question: Whom would you like to interview and what would you ask?

Transcript: Oh what a hard question. That’s a terrific question. I would like to interview three people. I’d like to put three people in the room at one . . . at one time: the Speaker of the House, Nancy Pelosi; Harry Reid, the majority leader in the Senate; and President Bush. And I’d like to . . . I’d like to say to them, you know, “When I was a kid I had a favorite aunt – Aunt Jay. And she’d come into the room, and the cousins would all be smacking each other around, and Aunt Jay would say, ‘Now fight nice.’” And I would like to say to Nancy, and Harry, and George, “Why can’t you fight nice?”

Question: What should we be asking ourselves?

Transcript: Well I . . . I think there are many questions we can ask ourselves; but one question is what did you do with the dash? What am I leaving behind? What’s my legacy? And of course, you know you don’t have to leave the great pyramids at Giza behind; but what is it that we can say we left behind?I dedicated my book to my mother and my mother-in-law. And I did that because they were . . . they were women who raised families. They cared about other people, and I think they left a legacy. And that’s the question.

Recorded on: 9/27/07

Transcript: I think we need to be stronger as public citizens. I think we need to demand change and not let people get away with what they’re getting away with. Our political leaders basically lack courage at this point, and we need to give them some backbone. So my counsel is, “Speak out and vote.”

Recorded on: 9/27/07

Transcript: I’m an incurable optimist. I think our best days are yet to come. And I think that there are a lot of reasons for that. I think this country is terribly resilient. I have great hope for my children, and my grandchildren, and for this country.

Recorded on: 9/27/07

Question: When you read the newspaper or watch the news, what issues stand out for you?

Transcript: The big issues are clearly Iraq and immigration, and they are very divisive issues. They have our country divided. They have our Congress and our administration divided with the Congress. So those are the two elephants in the room. But if you get right below those two issues, what you see is that, as I said before, people are very worried. They’re worried about their healthcare. They’re worried about not being able to save for retirement. And one of the things they’re most worried about is their adult kids, because they feel that their children are worse off than they are. And I’ve . . . we’ve done a fair amount of research at AARP among 35 year olds, and 40 year olds, and 25 year olds. And what we see is that those parents are right. They are right to worry, because the middle generation – the generation that’s coming up – is having a very difficult time saving money, and getting healthcare, buying a house, raising a family. These are tough issues right now. So these are the issues that the media don’t often report, but they are top of mine for our public.

Question: Is the American health care system broken?

Transcript: Yes. The American health care system is broken. It’s headed for a meltdown. We’ve got declining quality of care. We’ve got these rising costs that people can’t afford. Companies can’t afford them, and individuals can’t afford them. Families can’t afford them. And then we’ve got rising numbers of uninsured. And if you put all those things together, what we have is a system that’s essentially melting down.

Question: How do we fix it?

Transcript: There are a number of things that we have to do. First of all, we’ve got to contain costs. We just can’t keep paying the cost that we’re paying. Right now we pay about twice as much as the next highest industrialized country, and our health outcomes are worse. So we’ve got to . . . We’ve got to squeeze costs out of the system, and there are some obvious ways. Information technology, for example. Bringing down the price of prescription drugs. Doing more to manage chronic disease, which is the most common kind of disease today. These are all things that we need to do. Getting the uninsured covered so that we don’t have all this uncompensated care is another aspect of it.

One thing that’s a long term payoff, but that we have to start right now, is wellness programs. We need a national, coherent prevention strategy that’s going to be a long term investment. If we don’t do that, obesity is going to reverse longevity in this country. And of course we talked earlier about tobacco. Diabetes, heart disease, high blood pressure – these are all elements that we can control if we tackle the prevention and health promotion aspects of them. And so those are all ways that we can deal with the healthcare system.

Question: Why isn’t there more focus on preventative care?

Transcript: Right now it’s very, very fragmented. So you’ll have wellness programs at the worksite. You’ll have the government doing two or three things. You’ll have states doing several things. So we have this fragmentation. We don’t have any . . . any national system for it. So that’s . . . that’s one major problem. Another problem is that the payout . . . the payoff is long term. So a company may say, “Well, do I really wanna invest a lot of money in keeping my young workers well? Because in five years they’re going to be working at another country . . . company.” Where a congressman will say, “Well I’m worried about the budget this year. Do I really wanna vote for something that’s gonna be expensive and has a 10-year payout?” So it’s this long term investment that’s being missed.

Question: Whose responsibility is it?

Transcript: What we need is we need government and the private sector to come together on this. I do not think government can be the answer to prevention and wellness; but I don’t think you can just do it in the private sector either. We need a public-private partnership – some kind of a . . . of a wellness program that’s well-funded, that’s sanctioned by Congress, that everybody buys into. And when I say everybody, I mean everybody. I’m talking about the fast food and the processed food industries. I’m talking about educators, because we’ve gotta do something about wellness in the schools. I’m talking about everybody.

Question: Should the government be doing more?

Transcript: Yeah we need to sanction this thing. It needs to be official. It just can’t be some casual . . . some kind of an informal thing where we ask everybody to come to the table. We need something big. You know one parallel example that some people have talked about is the federal reserve. You know could we take that kind of example and that kind of an analogy? Could we do some kind of a fed for wellness? So that’s the kind of thinking that I . . . that I think is important.

Question: Is health care a universal right?

Transcript: Healthcare is a universal right. Yes I do believe that. But I think we also have personal responsibilities to say well. You know it doesn’t do to say, “I’m 65 years old,” and you go into a physician and say, you know, “I’m starting Medicare tomorrow. I’m obese and I smoke. Now take care of me.” We have a personal obligation as well as a right to . . . to healthcare.

Question: If health care is a universal right, who should provide it?

Transcript: Well I think health care, again, is a public-private sort of thing, You know there’s this great ideological argument about the single payer versus, you know, let the marketplace prevail. The answer is in between. Right now in California, they’re looking at a plan whereby they would have people be required to buy health insurance; that have the health insurance companies stay in the game, but have to insure people and not be able to cherry pick and leave out those with illnesses. They would have the individual corporations be involved in it. And they would have a sense of personal responsibility involved. So if that ever came to pass, that would be a good model for us.

Question: What other models could we look to?

Transcript: Well I think there are other models in other countries. And I have looked at these models. AARP has looked at these models. The thing is that we are unique. We are unique in terms of our social and our economic systems; and how we treat capitalism; and how we think about government. But we can learn from other countries. But we have to fashion a unique American answer, I think.

Question: Does the pharmaceutical industry have a responsibility to Americans?

Transcript: The pharmaceutical industry has an important role to play in American health. First of all, this is a lifesaving industry. This is the industry that we hope is going to be able to control Alzheimer’s and Parkinson’s and these other diseases of . . . of the elderly. So we are dependent upon the pharmaceutical industry. But at the same time, prescription drugs cost too much in this country, and we have to really move to generics. We have to get costs so that they’re affordable for people. We have to figure out a way so that the pharmaceutical companies can make a reasonable profit, and people can afford their drugs. And right now we’re not there.

Question: Are we headed for Social Security and Medicare crises?

Transcript: Social Security and Medicare are problems. They’re problems waiting to happen. If you look at Social Security first of all, we’re gonna have a problem in about 10 years. Right now we’re sort of in surplus, but the Congress is spending the surplus money. And what we need to do is we need to look at both sides of the Social Security equation. We need to figure out a way to get more revenues into the system, and a way to adjust the benefits. We’ve got to take into account longevity. Social Security was set up when, you know, people lived to be 65. Now they live to be 85. And so we need to do something about that. But this is . . . this is not rocket science. This is something that we could do if we sat down and the two parties reasoned together. And so that’s what . . . that’s what makes it so frustrating. From a Medicare standpoint, Medicare is not sustainable in its current form; but that’s because healthcare is not sustainable in its current form. Medicare is kind of a subset of healthcare. And it’s the healthcare system that we have to fix.

Question: How can we fix Social Security and Medicare?

Transcript: Social Security is . . . as big as it is, it’s the easy one. What we could do is get the two parties together. And what I’ve been saying in Congress is, “Look. It’s going to take two miracles to fix Social Security. One miracle is that you Republicans and Democrats are gonna have to sit down at the same table, and reason together, and come up with a fair, equitable plan for long term solvency. And the second miracle is that the public is gonna have to buy it.” And I think that AARP can help deliver on that second miracle. When we go out and talk to our members and other, you know, elements of the public, we lay out social security. We tell them what the problems are, and they are willing to engage. It’s not the third rail that politicians like to talk about. So we can get that one done. Political will is what we need. The other one, Medicare, as I say . . . the conversation we had on . . . on healthcare is where we have to go. We’ve gotta squeeze down costs, which we can do. We’ve gotta cover the uninsured, which we can do. And we’ve gotta improve quality of care through things like health information technology and electronic prescribing so that we cut down the errors in healthcare and improve the quality of care. We can do all these things, but it’s very hard because of the complexity of the system, and because of the political stalemate in which we find ourselves.

Question: Should we raise the retirement age?

NOVELLI: It’s a tough question. People do not like that idea. Now you know if you’re 41 or under right now, you’re gonna have to work ‘til you’re 67. But at the same time, many people want to work into their older years. There’s another way to think about it which has been called “longevity indexing”. And some countries do this. And what they basically say is, “Okay. Let’s actuarially figure out how long you’re expected to live. And we’ll give you your Social Security money stretched over that period of time.” So you will get less money per year over a longer period of years. That’s one way to think about it. There are a lot of ways to consider fixing the system.

Question: How has Washington changed since you arrived?

Transcript: I think it’s gotten more rancorous. There are more lobbyists today than ever before. You know you’ve got this dreaded K Street corridor. This is where the lobbyists hang out. What you’ve got is more partisanship than ever before. I asked a speaker . . . a recent Speaker of the House, “Do you think it’s worse now than when you started?” And he said, “No it isn’t. In my day they wouldn’t even learn your name.” But other people say, “Yeah it’s very much worse. It is worse now than it’s ever been.” And . . . and there are a variety of reasons for this, but it’s gotta stop. We’ve got to get past this gridlock if we wanna get anything done in Washington.

Question: Is the American political system broken?

Transcript: I don’t think so. I don’t think our system is broken, but I think it’s out of kilter right now. You know the public is divided into red and blue, but most states are purple. Most states . . . You know the public wants to see something happen. Last November they tried to give a message. They tried to send a message. They voted a lot of incumbents out of office, but I’m not sure the message was received. Now from an AARP standpoint, we try to do a lot of voter education. Last November, 25 percent of all the people who voted across the country were AARP members. So voter education for us is an important thing. And what we . . . what we want people to do is make an informed choice, and tell these people to stop the bickering and do the people’s work.

Question: Who really has the power in Washington?

Transcript: It depends on how you measure power. You know there are a lot of people . . . You mentioned the pharmaceutical industry. The pharmaceutical industry has a lot of power because they have a lot of money, and they know how to spread that money around. AARP, I think, does have a lot of power. And that’s because we have a lot of voters. And we have a lot of people who are activists. And we have big numbers. We’re up to 39.2 million members. So it depends on how you define power and how you try to use power. As far as me being one of the most powerful lobbyists, lots of people said, “Hey, congratulations!” And I said, “It ain’t me. It’s AARP.”

Recorded on: 9/27/07