Governors Focus on Health
National Governors Association Healthy America Forum and Winter Meeting
NGA Chairman Gov. Mike Huckabee's Blog Roundtable,  February 24, 2006

DEMOCRACY IN ACTION Photo and Transcript.

HUCKABEE: ...It's a fascinating sort of phenomenon what's going on in the world of blogging.  We had invited [columnist] Michelle Malkin here; I wish she could have come.  I know she's been under the gun almost literally I guess here in the last few days.  Pretty amazing that she would be the target of so much attention, and I think it sort of almost goes literally--it shows the level of influence that blogging is taking increasingly in our culture today.  And when bloggers go from folks that are just sort of out there in periphery to people that are now the targets of international hacking and I guess you'd say it's terrorism, then you know that they've certainly become a major part of the communication infrastructure of the country.  So we wanted to have an opportunity to visit with you in this setting to see if there were questions about the Healthy America agenda or other things as we get ready to [inaud. ?bring/crank] the NGA meeting off, and I'll just leave it wide open.  I could talk for a long time, but I don't think that's really what you'd like to do.

QUESTION: I'll throw something out there governor.  I know that it's difficult for a lot of Republican governors to talk about health issues in a way that both allows them to personally connect with their audience and allows them to communicate conservative messages.  I guess what I'd like to hear from you is just some of the ways, not just in your personal experience, but some of the general way that you think that Republican governors can talk better about health policy and better communicate the principles that not just the president has talked about but things back in their states that will help them?

HUCKABEE: Well you know Ben, one of the things that's very consistent with the Republican message is the area of personal responsibility.  Now the reality is that personal responsibility is what has to happen in the great scheme of things, where people assume responsibility for their own personal habits and behaviors, that when we do that individually then we change the culture.  That is not saying that there is not a role for government to play.  I think there's a very important role for government to play and it's just not that we can dictate to people what they can eat or what kind of clothes they can wear.  Americans don't respond very well to someone telling them what they will or will not do. They do respond very well to incentives.  They respond very well when there is a reward for behavior that is positive to them and that has some positive reward, not just to the person requesting it but to the person from who[m?] it's being requested.

I'll point to four areas where I think that there's a great sort of historical lesson in how health habits can change in this country and why I'm very optimistic that we can do it.  The four areas are litter, smoking, seat belt usage and drunk driving.  And in each of those cases, if you go all the way back to the '60s and what Lady Bird Johnson decided--that was start a campaign called "Beautify America" because litter was just everywhere on the highways and even upscale families would drive down the road and take a sack of trash and throw it out without thinking about it.  This was not only unfriendly to the environment, but it was a blight on the landscape.

There were three stages, and it's also applicable for seat belts, smoking and drunk driving.  There was an attitudinal shift.  First there was an awareness and attitude shift that took place where through personalities, celebrities, public service announcements people began to get in their mind that this is not the right thing to do.  I shouldn't be throwing litter; I ought to be wearing seat belts, smoking isn't good for me, and the drunk driving isn't really funny.

The next stage really was one of changing atmosphere.  In the case of litter, we started giving litter bags to people to put in their cars.  We started putting trash cans out and saying put your litter here.  I know that sounds--some of you, all of you I think will be younger than me so it's probably wasn't [inaud.], but I can remember when having a trash can, like at a public park was something relatively new.  To put trash cans on street corners in cities, that was really an innovation.  We changed the atmosphere.  It sort of conditioned people to say if you're going to throw trash away, this is where you throw it.  As crazy as that sounds today.

The third stage was one of action, where the government started saying, okay, we've had an attitude change, we now all agree that it's bad to throw litter, we've given you an opportunity to put it in the right place.  Here's the deal.  If you don't, we're going to fine you, in most states up to $1,000 for littering.

In the case of seat belts, when I was growing up there weren't any.  No one had a seat belt in the car.  It was an after-market addition if anyone had 'em.  In the mid-'60s they became mandated only to be placed in the car and then only in the front seats, as if somebody in the back seat wasn't going to get hurt...but anyway mandated to be placed in the car, but nobody had to war them; you just had to have them.  Changed the atmosphere.  Finally we get to the place now where most states have a primary seat belt law where police can actually give you a ticket if they see that you're not wearing a seat belt.  They don't have to stop you for something else and then say you don't have a seat belt.  So we've come a long way.  Seat belt use is up to a record level.  Now most people wouldn't think about getting in the car without buckling up, even the dashboard tells you that you're not buckled up.

Smoking, obviously that's a pretty clear thing how we've evolved.  Drunk driving, same thing.  So in all of those areas we've made a cultural shift.  It's not just simply that the government has come in and said okay you used to do it this way; now you have to change and do it this way.  That would have never been received in the American public.  But we've evolved.  As it relates to health, not health care but health, it's the same process.  We have to change attitudes, we have to change the atmosphere, we have to ultimately then create an action.  If we start with action, for example putting a tax on a cheeseburger or saying that nobody can eat more than 12 ounces of beef per day, being restrictive, as I call being, I call it the grease police or the sugar sheriff, if we start doing that then we lose the debate because it'll shift from being one of good health habits to one of personal rights, liberties, and who has a right to tell me what to do.

So I think Republican governors have a great opportunity to be consistent with their core values and principles but at the same time be true activists in trying to move the culture.

The economic advantage of this is staggering, and here's what I think people are not necessarily saying.  This is not just about feeling good and living longer.  This is literally about being able for our economy to survive.  The number one driving factor in America's economy being noncompetitive is essentially runaway health care costs.

Two examples.  General Motors this year will spend more money purchasing health care for their employees than they do for purchasing steel that goes into making their cars.  When you buy a Chevrolet, you are not buying a car, you're buying health benefits for the people that put it together.  They are giving you the car as their thank you for covering their employees with health insurance.  Starbucks Coffee, who has a very young, energetic workforce.  Howard Schultz [Starbucks chairman] came to Little Rock; we spent some time talking about the Healthy America agenda because he was fascinated by it.  Here's why he said he came.  He said because this year I'm going to spend more money on health care benefits for my Starbucks employees than I do purchasing coffee.  So the cappuccino you buy is really ma'am just know I'm drinking this to you because this is your health care cost here.  That's amazing and that's what's driving a lot of the economic factors of American business.  So if we're going to make American business competitive or make it more competitive, and if we're going to be able to create a population that we can afford this is again not just a lifestyle/health issue, it is truly an economic issue.

QUESTION: Let me follow on that if I could and we obviously at the National Association of Manufacturers, you probably heard about this last night, we have a lot of food manufacturers in there as well.  You know the most recent lawsuit against Nickelodeon--we call the powerless parents who are suing Nickelodeon.  Nickelodeon advertises food that these parents think isn't healthy and then when the parents get to the supermarket, the kids demand it and there's just nothing they can do, they have to buy it, and then the kids have to eat it.

HUCKABEE: That is absurd.

QUESTION cont'd: Where do you start?  Where do you start?  I mean there is personal responsibility.  The government's job is to say tobacco's not a vegetable.  Okay, but from there people have some free will at some point, and also in the choice of food that they eat.  And litigation's gone crazy.  You must see it as a governor too.  Where do you begin on this?

HUCKABEE: Well I think let's be very clear where we don't begin is turning it into a corporate battle.  And first of all there are those who want to make this the new tobacco, and that's a huge mistake.  Let me tell you why.  There is not healthy purpose for a cigarette.  There is none.  There is not one thing you can do with a cigarette that makes it a healthy product.  Everybody knows that; we've agreed on it.  Done deal.  People can argue that maybe a carrot is more nutritious that a twinkie, but an occasional twinkie is probably not going to kill anyone.  It may not be the best thing in the world but people have a right to do some things that others would choose not to do because it's not in their best interest.

I watched figure skating last night.  Okay.  Don't worry.  I'm not going to be on skates any time soon.  I can't do that, don't want to do it; it would be a significant orthopedic situation for me should I ever try.  I'm not going to do snowboarding.  You won't see me doing freestyle ski jumps.  Do people have a right to do those things?  I guess they do because the rest of us enjoy watching them and so we get our vicarious thrills living through it, whether it's NFL football or whatever it may be.  But by the same token, food is not necessarily good or bad in and of itself.  It's how much of it that we consume, how responsibly we consume it, and there is a sense in which we have to give people a right to make some choices.  The real tragedy of the Nickelodeon example is that Nickelodeon on the other hand has put $30 million into the campaign to combat childhood obesity.  I mean they are I believe genuinely trying to be a very responsible corporate citizen in addressing this issue.

When I hear people say it's the food companies' fault, I'm as perhaps as credible a spokesperson on this as anyone.  I can tell you that my extra 110 pounds was not the fault of McDonald's or Pizza Hut or the supermarket or television.  It was my own fault.  Now I made choices of eating too much and exercising too little.  There were many factors: lifestyle, culture, family history--all those things that I can say were contributing factors, but the ultimate responsibility for my behavior as an adult was mine, and for us to create victims out of everything is a huge mistake, and it almost is going to be the one thing that would keep us from having a responsible cultural shift.  So you know maybe Pat I would say to your point that I think it's very important that we keep shifting this debate back to a healthy balance--no pun intended--a healthy balance between a government role, but a personal responsibility as opposed to I have no responsibility, I am merely a victim.  I was walking down the supermarket aisle; this great big bag of Oreos attacked me and jumped on my flesh and the next thing you know I've gained six pounds.  That's the kind of mentality that we've just got to point out as really ludicrous.

QUESTION: What is government's role?

HUCKABEE: I think government's role is to make sure that people have good nutritional information, and perhaps in a time when we've got to turn the ship, I frankly think government's role is to provide incentives so that people will have a reason to change their habits.

QUESTION: Well what kind of incentives?

HUCKABEE: Let me give you some.  In Arkansas one of the things we're doing is for our state employees--if people will quit smoking we will provide smoking cessation tools: Nicotine patches, counseling with a toll free number they can call in 24 hours a day and talk to a health coach.  We started also with incentives realizing that it was in our best interest if employees would get screened for certain issues like breast cancer and prostate cancer and colon cancer.  We asked our employees why don't you go get these things?  Well because if they have to pay the co-pay and the deductible they might be out a hundred bucks, 150.  And if their choice is do I spend 150 bucks on my co-pay and deductible on the colonoscopy or do I send my kid to band camp, you know what they do?  Send the kid to band camp, because if they're not presenting symptoms, there's no reason for them to think it's important.  But it's in our best interest as an employer that they get those screenings because it they're caught early then medication might be a several hundred dollar problem as opposed to a several hundred thousand dollar problem.  The point is we've removed the impediments.  Now we don't have deductibles or co-pays.  We provide the same kind of assistance to the Medicaid population in our state as we do to state employees to get off tobacco.  We created an incentive program so that if you don't smoke and you'll do a health rick assessment you can get up to $480 a year off of your health insurance premiums as state employees.  When we first announced that on the health risk assessment alone we had over 18,000 state employees who signed up for it, many of whom weren't sure what that meant but they were willing to do it.  We became the first state in the country to do a body mass index screening of every kid in the public school system--450,000 kids and then send a letter home to the parents discretely and confidentially that says to a child's parent, this is your child's body-mass index, here's what that might mean.  A sort of a screening just like we would screen for scoliosis or vision or hearing.

QUESTION: This was elementary school or all levels?

HUCKABEE: All schools, K through 12.  But the beauty of that, it gives us two things.  One it gives us a tool to get to parents.  Because a lot of parents really haven't thought about their child being overweight or obese.  And here's why.  And you say well how could they not?  I'll tell you why.  If you get a chance, look at a photo of yourself and your classmates when you were in the third grade and then go to any school in America and ask to see a current photo of a third grade class.  Now I'll tell you what you will be stunned by.  The entire class is bigger that it was when you were in third grade.  The entire class.  Now there'll be skinny kids and there'll be really overweight kids and there probably were in your third grade class, but the entire class will look substantially larger than that class looked when you were in third grade.  What's happening is because the whole society is getting heavier, we don't tend to be as stunned by the fact that we are all sort of drifting in this direction.

Architects are having to redesign stairwell exits because they were originally designed for people to be able to egress out of a building during a fire at a certain speed, but that no longer holds true because the weight and physical capacity of people means that they can't get out of the building that quick.  The old architectural design of 17 inches for a stadium seat doesn't work any more because there aren't many 17 inch rear ends any more.  So you have to redesign things like theaters and of course the airliners haven't decided to redesign; they still are carrying 13 inch seats.  But my point is it is more than simply a matter of some disease of the month.  This is real, it is having a significant economic impact and the long term impact is even more staggering.

A good example: 700,000 Americans will die this year because of eating too much, lacking activity and smoking.  Now when you stop and start adding, if you think about a headline, 700,000 people die today in America, that'd be a pretty good headline.

QUESTION: Smoking, overeating...?

Smoking, overeating, underexercising, I think it'd be fair to say chronic disease related illnesses that are preventable.  Now by the same token if a person will not smoke, will exercise at least three times a week and will maintain normal body weight it will extend their life by 13 years.  Thirteen years in longevity.  Even more importantly it will extend their life quality substantially.  And to give you some sort of idea of how that works out, the average American today will see 75 percent of his or her lifetime health care costs used in the last 18 months of life.  That's pretty scary.  When you realize that what happens is chronic disease catches up with us in those last years.

Kenneth Cooper is here on Sunday.  He will probably say, because I've heard him say it several times, that the human body really was not designed to sort of gradually just get worse and worse and decrepit and chronically ill and finally just sort of have to be put in long term care and kept in this sort of vegetative state for extended periods of time.  We were designed to be productive, active, physically capable, doing things and then we would kind of suddenly like a light bulb just burn out.  We'd be active and then we wouldn't.  And that that wouldn't happen when were were 60 or 70 but maybe more like 80 or 90 or whenever it happened, but the progression would not be one of this slow lingering excruciating death process.

What's happened, chronic disease has changed the rules and now what we see is this avalanche of long term care necessitated by chronic disease.  So if we roll the pages of history back, early 1900s most Americans died from an infectious disease--lifespan wasn't that great, but it was small pox, yellow fever, malaria, influenza--infectious diseases that killed the average American.  As we enter the 21st century, Americans die from chronic disease--hypertension, diabetes, the effects thereof, heart disease, cancer, things that really in many cases are preventable and they're caused by lifestyle choices.  So it really is more than simply saying we've go a health problem.  It's a lifestyle issue and it's a cultural issue and it has to be addressed that way.

QUESTION: Any results yet from the steps you've taken in Arkansas?

Well we've seen--

QUESTION: I mean it's early.

Yeah it's early.  Right now one of the things we're trying to do with out body mass index reading of kids is to look at what happens in schools when schools adopt certain behaviors like activity levels.  I don't think we've got final numbers; it'll probably be the end of the school year before we start seeing some of those reports.  We certainly can report how many people signed up for the health risk assessment, how many people are saving money on that.  We did a thing called health challenge where we have agencies who challenge other agencies or private sector businesses to see who will lose the most pounds and the most number of people that will quit smoking and they all get pedometers and they get prizes for the most steps walked during a month.  We know that there are some measurable cases and Joe Thompson, who's our state health officer is hopefully, he may even have some stuff here this weekend on some actual cost pictures of where you start seeing the turn from this is how much more we're spending each year to the change it's been.

And we know that there are some private sector companies.  J.B Hunt truck lines saved was it $4 million a year, Joe, when they went to a managed structure?  Not just managed care but what they did they started telling their truck drivers they could call in and get nutrition counseling from the road, they would be able to get health coaching, nutritional information.  They had a lot of problems as you can imagine with truck drivers having lower back problems from those long over the road hours.  They actually started reducing their cost by helping their people to live healthier lifestyles, eat healthier and exercise properly and live properly as opposed to just saying, yep go down to the doctor, we'll get you some more medicine and try to take care of your chronic illness.

QUESTION: If I could change the subject and ask you a question about DC politics and national politics in general.  A lot of conservatives have been a little bit disillusioned with Congress over the last couple of years.  You had the 2003 Medicare drug vote and it didn't sit so well with conservatives.  You have these pork-laden highway transportation bills, you have earmarks that run rampant in Congress and have greased the skids for a lot of other bad legislation.  I wonder if I could get your reaction to those specific pieces of legislation.  Do you agree with what Congress did, the Republican-led Congress or would you have done something differently?

Well it's pr...[continues]