By: David Mark

Tommy Thompson was secretary of health and human services during President Bush’s first term, after a record 14 years as the Republican governor of Wisconsin.

There, he led the creation of BadgerCare, a state program to provide health coverage to families whose employers don’t provide insurance but who make too much money to qualify for Medicaid. And as HHS secretary, he used the waiver program to replicate the plan in several states.

He also oversaw the federal response to the 2001 anthrax threats and played a key role in formulating the Medicare Part D prescription drug plan.

Thompson’s bid for the 2008 Republican presidential nomination was short-lived, and he’s now a senior partner at the law firm of Akin Gump Strauss Hauer & Feld.

Here are excerpts from an interview by Politico’s David Mark.

Q: Having served as the nation’s top health care official, what are the worries that keep you up at night? What’s the biggest threat to our public health that no one’s talking about?

A: The worst-case scenario to me was food poisoning. That we were not prepared for somebody adulterating the food, and we didn’t have enough inspectors. We’re inspecting less than 1 percent of all the food coming into America.

After 9/11, I was able to get a spike up [in funding for food inspectors]. The organizations that I’m part of were able to get an increase of $175 million into the [Food and Drug Administration] budget, so we’ll be able to ramp back up to where it was a few years ago. But even that’s still not enough.

The second big problem is that we don’t have enough surge capacity for hospitals if there is an attack. No. 3, we don’t have enough vaccines for anthrax. We’re getting there, but we don’t have enough. Or we’re not prepared for a pandemic flu epidemic.

Q: Do you think the presidential candidates understand public health issues in these terms?

A: The thing that we haven’t addressed as much as we should have, and we need to, is the fact that Medicare is going broke. Medicare is going broke in 2012, and that’s only a little more than three years from now.

What’s taking place with the economy — the same type of catastrophic thing is going to hit health care in the year 2012. If we’re not prepared economically, we’re not prepared for the health care demise in 2012. I keep preaching about that, but nobody’s listening.

What’s really concerning me is that nobody is addressing the problems related to Medicare. Medicare right now takes up about 3 percent of the gross national product. In 75 years, and that’s what we have to look at in government, 75 years into the future, Medicare is going to take up 15 percent of the gross national product. By comparison, Social Security now takes up about 5 percent [of GNP], and 75 years from now, it will take up about 7 percent. You can see how much more serious the problem is with Medicare versus Social Security.

You’re going to have to means test Medicare. There isn’t a Republican or Democrat who can do that. So the only way I believe you can fix Medicare — and I’ve called upon both presidential candidates to do this — is, immediately after the election, have a base-closing-type commission, with an equal number of Republicans and Democrats. They’re going to have to make these tough decisions and then allow Congress to vote it up or down.

Q: Do you think it’s feasible for the next president to enact a national health care program? Have Barack Obama and John McCain released any proposals in this area that strike you as particularly worthwhile?

A: Our system, fraught with all the problems it has, is still the best system for bringing new medicines, new therapies and new innovations to the marketplace.

Can our system be improved? Absolutely. But a government-controlled system is not the way to go.

We should require every state to put out for bids, like we did on Medicare Part D. We didn’t know if it was going to work. We thought a competitive model was the way to go, but we had no basis for that. We just prayed and hoped that people were going to bid on it. We had a plethora of choices.

I would set it up in every state for singles and for families and allow you to contribute deductibles, and allow you to choose, just like you do in Medicare Part D. You would be absolutely amazed at how many people would be covered. And if you’re under 125 percent of poverty, the state would subsidize it. You don’t have to have a big-government-controlled system. You can set up a commission or commissioner.

Q: Are there any health care or public health initiatives on the state or local level — such as Mitt Romney’s health insurance effort in Massachusetts, or San Francisco’s experiment with universal access — that you think could be implemented on a larger scale?

A: BadgerCare is by far the best program in America today. It could be applied at the national level, and it could be applied at the state level, too, for the uninsured. It’s by far the best program in the country — not because I started it; even a blind squirrel finds an acorn occasionally. It’s an excellent program, and every state should do it.

I think a bad idea is to think that you can have all the uninsured buy into the Medicare system. When you’ve got a Medicare system that’s going broke, you don’t want to expand it; you want to fix it. And that’s what Obama wants to do — he wants to set up a national insurance exchange, which would be to buy into these federal programs. What I’m saying is, let’s let the free enterprise system fix it at the state level with competitive bids. That’s a much better way. McCain is closer to that.

I think what is happening in our political system is that the Democrats are skewed toward a government fix and would like to get to a government-controlled system. Republicans want a free enterprise fix. There’s going to have to be a dovetailing on health care. It’s impossible to have a total government fix, and it’s naive to think you’re going to have just a free enterprise fix. We’re going to have to have involvement of both.

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