Candidates' Prescriptions for Health Care Reform

DATE February 12, 2008 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Jonathan Oberlander of the University of North
Carolina, Chapel Hill, discusses health care and politics
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Health care reform is one of the top issues for voters in the presidential
race, but it's a little confusing trying to figure out the differences in the
candidates' plans. Here to help sort that out is Jonathan Oberlander, who's
joined us several times before to explain health care policy issues. He's an
associate professor of social medicine and health policy and administration at
the University of North Carolina-Chapel Hill. He's also the author of the
book "The Political Life of Medicare." He's written about presidential
politics and health care reform for The New England Journal of Medicine.

Jonathan Oberlander, welcome back to FRESH AIR.

Since health care has been playing a big role in the Obama and Clinton
campaigns, let's start there. You've described the Obama and Clinton plans as
remarkably similar. What are some of the things they have in common.

Mr. JONATHAN OBERLANDER: Both of them really build on the mixed system of
public and private insurance that we already have in the United States. They
both rely on a modified employer mandate, what we like to call "play or pay,"
where employers either have to provide coverage to their workers or they have
to pay a tax to the government that would pay for the cost of their workers to
get that medical care. They also rely on the establishment of purchasing
pools, where people could buy private insurance; and that insurance would be
much more heavily regulated that it is now. And finally, and what I think is
really an interesting part of their plans, they each would create a new public
plan similar to Medicare, and people could choose if they want to keep their
private insurance, if they want to join one of the new private insurance
options, or if they want to join the public plan.

GROSS: And do we have any sense of what those public plans would look like?

Mr. OBERLANDER: They have been fairly vague about that, as candidates often
are in this election season, other than to say it would be like Medicare.

GROSS: So you've mentioned some of the similarities between the Obama and
Clinton health care plans. What are some of the differences.

Mr. OBERLANDER: Well, really there's only one substantial difference, and
that has to do with this issue of individual mandates, which has got them a
lot of attention recently. In Hillary Clinton's plan, she would mandate that
all Americans have to have health insurance. So in other words, there would
be a requirement that you would have to have insurance. In the Obama plans,
he mandates only that children have to have insurance, and that's really what
they've been fighting about for the past few months.

GROSS: Now what's the logic of having a mandate in the first place?

Mr. OBERLANDER: Well, there's both a substantive and political logic. The
substantive logic is that if you make health insurance voluntary, what you may
get is disproportionately sick people taking up the subsidies and joining
private insurance; and if that happens, it's really hard to make the pooling
of risk work. You get something that economists call adverse selection, that
is a risk pool that is sicker than an average population, and that can be
unstable over time.

There's also an argument that everybody should have to contribute their fair
share and therefore pay premiums. If you get in an accident and you're
uninsured in a future health care system, we're still going to treat you at
the emergency room, and the rest of us who are already paying our premiums are
going to pick up your cost. And so the question is, who should pay for that
care? If you force everybody to contribute premiums, you spread medical care
costs across a broad population.

There's also a political argument for doing this and that is that you tap into
a rhetoric of responsibility. Generally, when people have talked about health
care reform, it's been about entitlements, creating a new program, liberal
ideas about rights. When you talk about an individual mandate, it really taps
into notions of responsibility and what everybody has to do, not just the
government.

GROSS: Wow. The downside of the mandate is that some people see it as
punitive. If you don't elect to buy insurance, there might be a consequence
that you face. So what are the consequences that Obama has come up with for
his children's program and that Hillary Clinton has come up with for
everybody?

Mr. OBERLANDER: Neither one has really spelled out, as far as I know, what
the penalties would be. And you're right, a mandate is only as good as the
penalties behind it. I could mandate that all my students come to class and
maybe some of them would come to class out of civic duty; but unless I had
penalties in there, I guarantee you that a few of them aren't going to be
there. So it really depends on, you know, what the financial penalties and
the incentives are and we don't know that yet. What the Obama people argue is
it's unfair to have a mandate until you make health insurance affordable;
because if you do it and health insurance costs people more than they can
afford to spend, you're essentially punishing them for not having health
insurance and that's not right. That's the substantive case against the
mandate.

The political case is exactly what you said, that you make health reform
punitive. That you make it all about penalties, all about garnishing people's
wages, all about taxes, and that's not really a good way to get health reform
passed.

GROSS: So how is Hillary Clinton trying to counter Barack Obama's charges
that her policy is punitive?

Mr. OBERLANDER: What she's saying is that this is the only way to get
universal coverage; and if you do not have the mandate, if you do not require
people to join insurance pools--and you know, most people who are uninsured
want insurance. So we're talking, I think, about a minority of the uninsured
population; but if you don't require that minority to join up, we cannot have
universality, we cannot control costs, we cannot do the things in quality that
we want to do.

GROSS: Does history have anything to say about whether people who are well
are willing to pay for health insurance if they really don't think that
they're going to get sick, because this gets back to the risk pool that you
were taking about?

Mr. OBERLANDER: There's sort of a mixed record here, but we know--one place
to look is the non-group market in insurance. That's where individuals who
don't have employer-sponsored insurance go out and try and buy insurance, and
we know from the way that insurance companies act that they're very worried in
a voluntary situation that sick people are disproportionately going to
purchase health insurance, and we know that part of the uninsured population
are young people who are relatively healthy. You know, they haven't passed
the age of 30, and so their warranty is not expired yet; and some of them, you
know, feel that they're not making a lot of money and they don't want to spend
the money they have on health insurance, and so they have disproportionately
high rates of uninsurance. And it's exactly that population that you do want
to bring in to an insurance pool.

GROSS: Now both Clinton and Obama's health insurance plans call for employers
to fund the major part of it, and this is happening at a time when a lot of
people think we should change the employer-based health care system since so
many people are either unemployed or they're freelancers who don't have a
genuine employer who's going to pay for benefits. So is this an unusual time
to be cementing in the employer-based health care system?

Mr. OBERLANDER: It is sort of incongruous, I suppose. In health care
reform, I think the very first decision you have to make is whether you want
to build on employer-sponsored insurance or away from it. There are a lot of
good reasons to build away form it. It's an expensive system. It's an
inefficient system. It's inequitable. And as you pointed out, it's also a
system that's eroding, frankly. On the other hand, 160 million Americans
under the age of 65 still get their health insurance through their employers,
and I believe employers paid about $450 billion in insurance premiums last
year. What that means concretely if you want to try and move away from
employer-sponsored insurance, you have to effect health insurance for 160
million people, many of whom, by the way, like the insurance they have,
believe that even if the system is a wreck, they're doing pretty well. And it
also means you have to replace employer financing. You're going to have to
substitute taxes for those $500 billion that they're spending, and there
aren't too many candidates who want to do that.

And it's ironic in a sense because really we've had the same debate since
1970; and in the early '70s Richard Nixon proposed universal health insurance
around an employer mandate. And the debate over universal coverage comes down
to many things, but really what it has come down to in the last 35 year, are
we willing to adopt an employer mandate? And so far the answer has been no.

GROSS: What do the Democratic candidates have to say about the responsibility
of employers to pay? And what about like small businesses who often say they
have trouble paying that much in terms of health insurance?

Mr. OBERLANDER: What they say for larger businesses is that either you have
to provide coverage to your workers or you have to pay a payroll tax to the
government to fund medical care for them. For smaller businesses, they would
be exempt from the employer mandate. I believe that Hillary Clinton has said
business with under 25 workers would be exempt from her mandate. She would
also provide a tax credit as a subsidy to encourage them to provide insurance.
I'm not sure that the Obama campaign has released the exact number of workers
where they would exempt the mandate, but they have a similar philosophy. And
that has political rationale. You want to buy off small business because
they've played a role in killing health care reform in the past and it's also
very difficult for them to afford it. The problem you get into is that the
uninsured are disproportionately concentrated in small business; so if you
exempt small businesses from the employer mandate, that's millions of more
workers that you're going to have to pick up and pay for through some other
mechanism.

GROSS: So where is the federal funding for the Obama and Clinton health care
plans coming from?

Mr. OBERLANDER: Most of the funding in their plans come from cancelling the
2001 and 2003 Bush tax cuts for families making over $250,000, and there's a
lot of money to be had there. You can get an estimated 50 to $60 billion a
year from cancelling those tax cuts. But there is, in a sense, less here than
meets the eye, because it's true that they could use that money; and we're
going to have, I think, one of the most important debates in the campaign is
over the future of the tax cuts and the future of tax policy in this country.
And they certainly are right in arguing that if we extend those tax cuts,
that's money we could have used on health care reform.

On the other hand, that money is not going to help them in the budget. We
have what are called pay-go rules, which means pay as you go. You can't enact
a new entitlement program that worsens the federal deficit. Instead, you
either have to have taxes that pay for all of it, or you have to have savings
from another program to offset the cost. And the problem is the Congressional
Budget Office in their estimates already assumed that all the tax cuts, not
just the ones for people making over $250,000, are going to be cancelled. So
in terms of trying to finance this in a way that's going to satisfy the
Congressional Budget Office, which is really what it comes down too, so you
don't worsen the deficit, you actually can't count on 1 cent from us canceling
those tax cuts. And what that means, if either Obama or Clinton come to
office in January 2009, one of their first jobs is going to be how to find the
money to pay for this.

GROSS: Which won't be easy considering the deficit that we have.

Mr. OBERLANDER: No, it's going to be politically difficult. To add the
uninsured to the existing system cost probably in the neighborhood of $100
billion, and that's a lot of money. On the other hand, we already spend $2
trillion on the health care system, so this is a marginal increase. And it's
also worth pointing out that we tend to find money for priorities. When we
went to Afghanistan or we went to Iraq, we found the money to pay for that.
When we did the tax cuts in 2001 and 2003, we didn't' worry about the deficit.
When we enacted Medicare Part D to give seniors prescription drugs, we didn't
worry about where the money came from. And I think the problem that the
uninsured have is not that there's not enough money. It's that they're not a
high enough political priority in the system to compel that money.

GROSS: Anything else you want to mention about the Obama or the Clinton
health insurance plan.

Mr. OBERLANDER: Well, I think, one thing that's interesting is what they do
about cost control. And the paradox here is what really puts health care
reform on the agenda in the United States is rising costs; but the more that a
proposal controls costs, the more difficult it is to actually get it passed.
And so what you see is candidates in both parties, really, in a way,
pretending that they're going to control costs without having very robust
limits on health care spending, and so both Senator Obama and Senator Clinton
have talked about savings from prevention, using electronic medical records
and information, technology, chronic care and disease management. All of
these things, I think, are worth doing. None of them is going to control
costs. And the hope is that maybe if you do enough of the small things
together, maybe you end up controlling costs in the long run. I'm not sure
that's right. I think you can make the case that once you enact a program
like this, a big public program, and once you start spending on it, the
government gets an incentive to control costs. That's essentially what
happened with Medicare in 1965. When it was enacted, it had no cost control
either, and then eventually we got the political will to impose that. But it
is striking that these proposals don't really have tight costs controls.

GROSS: You say that the big difference between the Obama and the Clinton
health insurance plans is the mandatory requirements for each. That Obama has
a mandatory requirement that children be insured. Clinton has a mandatory
requirement that everybody be insured. And then there's the question, is that
necessary, is that punitive? John Edwards is no longer in the race. He had a
different approach to this. He was going to require that individuals show
proof of health insurance when they filed their income taxes; and if they
didn't have insurance, instead of being penalized, they would be automatically
enrolled in an insurance plan. Did that part of his insurance plan get a
reaction?

Mr. OBERLANDER: Well, I think, first of all, you have to credit him because
he was the first candidate out of the box with a universal plan, and I think
on the Democratic side he really set a kind of high bar that the other
candidates had to either jump to or at least get close. And, you know, ever
since the Edwards' plan, they've been busy trying to outuniversalize each
other. Automatic enrollment is something that the other campaigns have talked
about, particularly the Obama campaign, in lieu of an individual mandate; but
Edwards also talked about, at the end of his campaign, potentially garnishing
people's wages. And it probably tells you everything you need to know about
the politics of this issue that the one candidate that talked honestly about
ways to enforce an individual mandate is no longer in the race.

GROSS: My guest is Jonathan Oberlander. He's an associate professor of
social medicine and health policy and administration at the University of
North Carolina-Chapel Hill. We'll talk more about the presidential
candidates' health care plans after a break.

This is FRESH AIR.

(Announcements)

GROSS: If you're just joining us, we're talking about the different
presidential candidates' health care plans. And here to describe them and
analyze them is Jonathan Oberlander. He's an associate professor of social
medicine and health policy and administration at the University of North
Carolina-Chapel Hill. And he's written extensively about health policy over
the years.

Well, let's look at the Republicans. John McCain is the presumptive
Republican presidential nominee. He promises to make health insurance
affordable and available. What does he mean by that?

Mr. OBERLANDER: He has really emphasized cost control. If you go to his Web
site and you look at his plan, or if you hear him talk, that's really how he
comes at the health care issue. And the core of his plan in terms of
improving access is the establishment of a new tax credit. Any American who
purchased private health insurance would get a refundable tax credit of $2500
or $5,000 for a family.

GROSS: And is health insurance mandatory? Is there a national health
insurance that would be offered to people who couldn't afford private
insurance?

Mr. OBERLANDER: What is really striking about the McCain plan and really the
other Republican candidates' plans is what they don't have in them, in
contrast to the Democrats. There is no employer mandate. There is no
individual mandate. There is no enhanced regulation of the insurance
industry. Quite the opposite, he actually wants to deregulate the insurance
industry so people can shop across state lines and purchase insurance.

GROSS: And does he believe that that will lead to competition, which will
keep costs down? Is that the rationale?

Mr. OBERLANDER: Exactly. What I think his campaign would say is that the
system we have right now is not really a good test of competition, and we need
to put those incentives in place that unleash competitive forces, and that
will help restrain health care spending.

GROSS: So for the uninsured what McCain is offering is tax breaks?

Mr. OBERLANDER: Yes. And, you know, I think most health policy analysts
would tell you that through that kind of tax credit system, you're not going
to cover most of the uninsured. Health insurance is too expensive. And what
you're trying to do--and it's interesting in the McCain plan--the Democrats
are building on the status quote of employer-sponsored insurance. What
Senator McCain is trying to do is move away from employer-sponsored insurance
and get people to buy insurance in the non-group, or individual market. The
problem with that is the non-group or individual market is sort of a state of
nature. It's very expensive. It's very inefficient. There's medical
underwriting so sick people often have to pay more for coverage. So it's not
clear that just by giving people a tax credit you're really going to get
enough of the uninsured.

GROSS: Well, and when you're poor and you're not really paying much in taxes
because you're not making enough money to pay a lot of taxes, what does the
tax credit do for you?

Mr. OBERLANDER: Well, he has made the tax credit, I believe, refundable, and
a refundable tax credit is open to anyone; even if you don't pay taxes, you
can still get the money. So that is a good part of the plan and a dramatic
improvement, I think, over some of the other proposals that we've seen in the
last couple years. But really the question is what happens to low-income
folks? Are there going to be subsidies that allow them, on top of these
credits, to purchase insurance? And we don't know a lot of details of his
plan yet, so we haven't heard much about that.

GROSS: What about Mike Huckabee? What's his health insurance plan?

Mr. OBERLANDER: Mike Huckabee is an interesting case because he has his own
powerful personal story of losing a lot of weight and exercising and, you
know, you always see him out running on the campaign trail; and so when he
talks about health reform, he talks a lot about prevention, about exercise.
He talks a lot about taking on the obesity problem in the United States. His
general plan is short on details at this point, but it's in line with the
McCain plan. It would also be a tax deduction. He has proposed in addition a
tax credit for low-income individuals. Like John McCain, he's talked about
reforming the medical malpractice system. But I think maybe the most
important point about his plan is, like the McCain plan, it seeks to move
people away from employer-sponsored insurance and to really beef up the
non-group insurance market.

GROSS:

GROSS: Jonathan Oberlander is an associate professor of social medicine and
health policy and administration at the University of North Carolina-Chapel
Hill. He'll be back in the second half of the show.

I'm Terry Gross and this is FRESH AIR.

(Announcements)

GROSS: This is FRESH AIR. I'm Terry Gross.

We're talking about the health care reforms proposed by the presidential
candidates. My guest, Jonathan Oberlander, has written about presidential
politics and health care reform for The New England Journal of Medicine..
He's an associate professor of social medicine and health policy and
administration at the University of North Carolina-Chapel Hill.

Mitt Romney dropped out of the campaign last week. Now he was governor when
he signed a proposal for a state health care plan in Massachusetts. Did his
national health care plan reflect the successes or the failures of the
Massachusetts experience?

Mr. OBERLANDER: I think his national plan reflected the opportunities and
constraints of running for president in a Republican primary. You know, the
Massachusetts plan is similar in many respects to the Obama plan and the
Clinton plan; although as I've said before, they've added this public plan
option on top of that. But the purchasing pool, the individual mandate,
subsidized access to insurance, all of that is in the Massachusetts plan. All
of that is in the Democrats' plan. He was, when he was running for president,
not committed to his own plan for Massachusetts, but instead preached about
state's rights and using federalism and really having states try different
approaches. And what he argued was, you know, what's right for Massachusetts
may not work, say, for North Carolina. But I think politically what was
crucial is that running for president in the Republican primary on the
Massachusetts plan was just a nonstarter.

GROSS: Has the Massachusetts plan been working out?

Mr. OBERLANDER: The Massachusetts plan has been getting killed. I think
recently in the national media it's taken a lot of bad press. I'm of the
opinion that it's got in a raw deal. I think the Massachusetts plan is not
perfect. It's not universal. It's got a lot of problems. You can argue
about whether some of the insurance policies are really adequate. It
certainly is short on financing; and one of the major problems it faces going
forward is how are they going to finance this. But they have covered 300,000
people since the plan started and I think that's a tremendous accomplishment;
and I think it's the best that we can expect a state to do in this country, is
what Massachusetts has done. And so although it has a lots of problems, I
would give it a pretty good score so far.

GROSS: What are the pluses and minuses of having state health care systems as
opposed to a federal health insurance system?

Mr. OBERLANDER: States have acted where the federal government has not. So
at the moment, the choice has not been between a state-based system and a
federal system. The choice is having states move on their own, or having the
federal government do nothing. Now you can have a state-based universal
system, and some people have proposed this, where we say--the federal
government says, `Everybody has to be covered, but we're going to let states
decide how to do it.' And one of the advantages in having states experiment is
they can try different ideas that fit the political circumstances of their
state. So what works in Massachusetts and what the people of Massachusetts
want is going to be very different than what the people of North Carolina
want. So that's the argument for it, and really the argument for federalism
is laboratories of democracy.

The argument against it is no state has been able to attain universal
coverage. They just don't have the money to do it. And even the
Massachusetts plans is highly dependent on revenues that they're getting from
the federal government. And if you depend on states, you're really going to
institutionalize an inequitable system because some states are much richer
than other states, and they have much more ability to cover people. And I
think if we're going to solve the uninsured problem and we're going to solve
the cost problem, it has to be a national solution although states have been
playing an important role.

One thing that is evidence in Massachusetts and other state plans, they have a
very difficult time controlling costs. In fact, the way that they get these
expansions for the uninsured passed in their states is not to control costs;
because to control costs is to take on the insurance industry and doctors and
hospitals and drug companies. And so they don't control costs and that's
great in the short term, to get the expansion passed. The problem comes in
the long term when you have to pay the bill.

GROSS: Employers, I think, if given the chance, would love to get out of the
health insurance business because the health insurance costs have been rising
so much and employers have been picking up a lot of the tab for that. So if
there's any loopholes in the plan where employers can get out of paying, I
think they would try to do that. Is it possible that with an alternative plan
that relies on employers, that employers would find a kind of way out of it.

Mr. OBERLANDER: My view has always been that if universal coverage comes in
this country, it may actually come from the right and not the left, in the
sense that business may be the industry that brings it to us. Now the
situation for businesses is really, you know, they have to make a calculation:
do we want to keep on trying to maintain private insurance or do we want to
get out and support some kind of government system, maybe a play or pay
mandate where the tax to get out isn't very expensive, so we're going to do
better in the long run? And you have seen some prominent business people.
I'm thinking of Steve Burd, who's the CEO of Safeway out in California, and he
supported the reforms that Governor Schwarzenegger had proposed out there and
is a very strong advocate of universal coverage. Even Wal-Mart, which has
taken a lot of criticism over the years for its own health insurance, has
joined a coalition with labor unions in favor of universal coverage. If
business comes to the side of health care reform, if business comes to the
side of universal coverage, that gives reformers a way to balance the
opposition that is inevitable from the insurance industry and other
stakeholders in the health care system. It really is a realignment in health
care politics.

I'm not sure we're there yet, and of course I can't say anything optimistic
without finding the gray cloud; and the gray cloud to this silver lining is
that the Clinton administration thought exactly the same thing in 1993 and
1994. And what happened to them in part is they overlooked small business,
and small business is ideologically opposed to employer mandates and they
worked very hard to defeat the Clinton plan. Now maybe with these new plans
that are exempting small business, and small business are having a terrible
time with health care costs at the moment, maybe they can sideline them. But
I don't think we're quite at the point where we can say this is going to
happen.

GROSS: On the whole, is the primary campaign making you optimistic that there
will be some meaningful and fundamental health care reform in the near future?

Mr. OBERLANDER: There are two groups of health policy analysts, pessimists
and deep pessimists; and I'm in the second group. So the short answer to your
question is no. I mean, when I look at this, I've seen so much failure
already is, you know, I have a case really of deja vu to the early 1990s; and
I don't see yet any reason why this is going to turn out differently. But it
really depends on the elections. You know, if we were to talk again in
January 2009, and we see who the president is and we see what the majorities
in Congress are, then we'll understand what the chances are for health care
reform.

I am more hopeful than at any point I've been in the past 15 years because
it's on the agenda, because there's a lot of momentum for this; and maybe, we
have failed so much that people are finally ready to come to the grips with
the fact that we need to do something. And I think one point that reformers
have really failed to make enough is that the choice is not between the status
quo and a reformed health care system. Because if we do not act, the status
quo is not going to stay where it is in American health care. It's going to
get much worse, and millions more Americans are going to lose their health
insurance. Costs are going to go through the roof. More business are going
to have difficulty. So we have to understand that if we do not act to fix
this problem now, it's not going to get better on its own. We found that out
in the last decade. It's going to get a lot worse.

GROSS: Jonathan Oberlander, good to talk with you again. Thank you so much.

Mr. OBERLANDER: Thanks for having me on.

GROSS: Jonathan Oberlander is an associate professor of social medicine and
health policy and administration at the University of North Carolina-Chapel
Hill.

Coming up, Mark McKinney, the co-creator and co-star of a really funny TV
series set backstage at a Shakespeare Theater Festival. This is FRESH AIR.

(Announcements)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Writer and performer Mark McKinney discusses his
career and "Slings and Arrows"
TERRY GROSS, host:

This is FRESH AIR.

(Soundbite of "Slings and Arrows")

Unidentified Actress #1: Enter Hamlet.

Unidentified Actor: To be or not to be. That is the question. Whether 'tis
nobler in the minds to suffer the stings and arr--sorry. Huh. The slings and
ar--whether 'tis nobler in the minds to suffer the slings and--and--the slings
and arrows of outrageous fortune or to take arms against the sea of troubles
and by opposing in them...

(End of soundbite)

GROSS: Ouch! That's a Hollywood heartthrob rehearsing "Hamlet" in a scene
from the TV series "Slings and Arrows" set backstage and onstage at a
dysfunctional Canadian theater company that produces an annual Shakespeare
festival. "Slings and Arrows" originated in Canada, has been shown on the
Sundance channel, and just came out on DVD. My guest, Mark McKinney,
co-created and co-wrote the series and plays the role of the company's chief
administration, Richard Smith-Jones. Richard has to deal with two
temperamental directors; one is troubled but brilliant, the other is a
pretentious egomaniac. Mark McKinney was a cast member of the Canadian sketch
comedy series "The Kids in the Hall," and went from there to "Saturday Night
Live."

Here's another scene from "Slings and Arrows." Richard and one of the
company's funders have just come out of seeing a production of the ABBA
musical "Mama Mia." The funder is played by Jennifer Irwin.

(Soundbite of "Slings and Arrows")

Mr. MARK McKINNEY: (As Richard Smith-Jones): Yes.

Ms. JENNIFER IRWIN: Fantastic!

Mr. McKINNEY: (As Smith-Jones) That was fantastic. Truly. Man! The
dancing and the singer. I understood every word.

Ms. IRWIN: I know. I swear to God it gets better every time.

Mr. McKINNEY (As Smith-Jones) Thank you. it just goes to show you got to
keep things in perspective, you know. You know, I saw "Chorus Line" when I
was 16 on Broadway. I was blown away. I cried.

Mr. IRWIN: I love that show.

Mr. McKINNEY: (As Smith-Jones) It's what made me want to go into theater. I
used to listen all those albums. You know "Damn Yankees," "Kiss Me Kate. My
parents thought I was gay? How the hell did I wind up in
New...(unintelligible)...

Mr. IRWIN: OK. Do not torture yourself. Come on. Let's go for a drink.

(Soundbite of pounding on wood)

Mr. McKINNEY: (As Smith-Jones) You know what they are?

Ms. IRWIN: What?

Mr. McKINNEY: (As Smith-Jones) Pure entertainment.

Ms. IRWIN: That's right.

Mr. McKINNEY (As Smith-Jones) I'm so sick of hearing, `It's a dense play.
Oh, it's a difficult play.' I've never seen anyone come dancing and singing
out of the "Swan Lake"...(unintelligible)...

Ms. IRWIN: I know. And why do you think that is?

Mr. McKINNEY (As Smith-Jones) Because Shakespeare! Shakespeare is like...

Ms. IRWIN: Four hundred years old.

Mr. McKINNEY (As Smith-Jones) And I don't even think he was that good! There
I said it. I mean, you know, it entertains people. And I'm not saying that,
like, ABBA were better writers...

Ms. IRWIN: No, no. I know what you mean.

Ms. McKINNEY: (As Smith-Jones) I don't like Shakespeare.

Mr. IRWIN: Nobody does, Richard! That's the thing. You put on plays that
nobody wants to see. God, what a waste.

Ms. McKINNEY (As Smith-Jones) You're right.

(End of soundbite)

GROSS: That's Mark McKinney in a scene from the first season of "Slings and
Arrows."

Mark McKinney, welcome to FRESH AIR.

One of the things I love about "Slings and Arrows," it gets at some of the
things are most wonderful about good theater and most cringe-inducing about
bad theater. So I thought we'd get--we'd start with some of the
cringe-inducing stuff.

Mr. McKINNEY: Mm-hmm.

GROSS: Don McKeller, who's a really good Canadian actor and I think a
director, too--does he direct?

Mr. McKINNEY: Director and writer. Yeah.

GROSS: Yeah. Yeah. So he plays a very pretentious director who's originally
brought in to direct--to take over a production of Hamlet. And this is a
director so pretentious and so wanting to put his own touch on everything, his
own creative touch, that he did a version of "The Tempest" set in Nazi
Germany.

Mr. McKINNEY: Right.

GROSS: So let's hear a scene from episodes three of the first season of
"Slings and Arrows," and this how this very pretentious director introduces
himself to the cast of "Hamlet" when he takes over the production.

(Soundbite "Slings and Arrows")

Mr. DON McKELLER: (As Darren Nichols) Hello, everyone. I am Darren Nichols,
deal with that. All right. RE, "Hamlet." "Hamlet." This play is dead. It
has been dead for over 300 years. It has been strip mined for quotations and
propped up like Lenin in his ice cave. I don't worship dead texts, but that
doesn't mean I don't find interest in them.

Now, as to my vision, I'm talking the word "Rotten," as in "something is
rotten in the state of Denmark," very seriously. I want a rank and
foul-looking, foul acted and if possible foul-smelling Hamlet, a decomposed
vessel somewhere between the swamp and the sewer. Anyway, that's the general
idea. Questions? OK. Let's read this corpse.

(End of soundbite)

GROSS: That's so great. That's Don McKeller in a scene from "Slings and
Arrows," playing a very pretentious director, and my guest Mark McKinney is
one of the writers of the series and one of the stars.

This character must have been so much fun to write. I'm sure you've met
directors kind of like this.

Mr. McKINNEY: Yeah. It's loosely based on a long serious discussion we had
about a couple of, oh, you know, those angry martinet megolomanic--OK, help me
out here. Megalomaniacal. Is that it?

GROSS: Yeah.

Mr. McKINNEY: Yeah. Well, we've all known a few, and so we sort of embodied
it in the characters of Darren Nichols. And I've got to stay that's almost my
favorite line in the series, "My name is Darren Nichols, deal with that." It's
a perfect introductory line. I wish I could claim credit for it. I think
it's Bob.

GROSS: So what are some of the awful traits you gave this director?

Mr. McKINNEY: Well, he's completely self-obsessed; and you know, he's the
second son and Geoffrey, played by Paul Gross, is clearly the gifted one; and
I think he goes around with just this hanging resentment, this bitterness that
he knows he can't dare to get it right, so he just derides and mocks. And
that's where his creativity comes from, is putting down the very thing that he
should be embracing.

GROSS: In the final season of "Slings and Arrows" there's a production of
"Lear" that the Shakespeare festival is doing, and the actor playing Lear is a
leading Shakespearean actor who is secretly dying of cancer. And when this
production happens at the end, it's after they've totally run out of money.
They're only going to do it once. And so this performance that they actually
do give is incredibly moving and the actor who plays the actor playing Lear is
really great. Tell us a little bit about that actor and the circumstances
surrounding this performance.

Mr. McKINNEY: Well, William Hutt, who played the character Charles Kingman,
who's the dying actor, who's the heroin addict and who plays the Lear in the
third series, had actually given a legendary Lear at the Stratford Festival a
couple of years before the series. And for some reason this had never been
taped, and so this is the archive of at least pieces of that great
performance; and we're lucky to get it as he actually died last year.

GROSS: So the actor who played the actor playing Lear died not long after
making the show.

Mr. McKINNEY: No. No, he died--yeah. In the fall.

GROSS: I'd like to play just a clip from that performance of "Lear." The play
within the series.

(Soundbite of "Slings and Arrows")

Mr. WILLIAM HUTT: (As Charles Kingman) Oh, that you were made of stone, and
I had tongue and eyes. I'd used them so that heaven's vault should crack.
She's gone forever. I know when one is dead and when one lives. She's dead.
Lend me a looking glass that if her breath her mist will stain the stone
with...

Unidentified Actress #2: Alex, 57, go. And stand by for curtain call...

(End of soundbite)

GROSS: That's a scene from "Slings and Arrows," and my guest Mark McKinney is
one of the co-writers of the series and one of the stars. And he didn't write
"King Lear," however.

Mr. McKINNEY: Little bits of it.

GROSS: Little bits of it, yeah. In a series about really, you know, creative
directors and actors, why did you cast yourself as the "suit," the money guy,
who kind of wants to be creative but maybe really isn't?

Mr. McKINNEY: Well, I don't know. Maybe because I sort of look at actors as
something other than what I am. Do you know what I mean? And I think I was
kind of brought up to expect people to be reasonable; and I think artistic
behavior, particularly tantrums, used to scare me when I first got into the
business. And so I always had this part of myself that was wrestling with the
reasonable vs. the impulsive, and I see that conflict in Richard, like not
sure what lane he should take here.

GROSS: So I take it you're not the kind of actor who brings the theater into
real life. You know, like some people are so theatrical off stage as well as
on, and they always seem to be in some kind of performance?

Mr. McKINNEY: No, I think on the street you'd mistake me for a
horticulturist.

GROSS: What first got you excited about acting?

Mr. McKINNEY: I think all the things that the characters in the play--I
thought it was magic. I thought it was magical and daring and capable of
achieving perfection. Does that make sense?

GROSS: Mm-hmm.

Mr. McKINNEY: Because so few things in life really are. But it's something
you could do perfectly, if you really, really worked at it.

GROSS: My guest is Mark McKinney. His series "Slings and Arrows" just came
out on DVD. More after a break.

This is FRESH AIR.

(Announcements)

GROSS: My guest is Mark McKinney. He's one of the writers and one of the
stars of the series "Slings and Arrows," which was produced for Canadian
television, then was shown on Sundance, and now is out on DVD.

A lot of people probably know you as one of the cast members of "Kids in the
Hall," the Canadian sketch comedy show that was shown in the United States,
produced by Lorne Michaels, who also produces "Saturday Night Live." Would you
describe some of the characters that you originated for "Kids in the Hall"?

Mr. McKINNEY: Well, I guess the characters that people know, as I--it
was--one of them was the head-crusher, which was sort of a misanthropic, you
know, foreign bag person who crushed people's heads between his thumb and
forefinger.

GROSS: He didn't really. He just would look at their heads...

Mr. McKINNEY: Not literally. No, no.

GROSS: ...through his thumb and forefinger...

Mr. McKINNEY: No, no. There's no bodies up there.

GROSS: ...and acted as if he was.

Mr. McKINNEY: Yep. Yes. Exactly.

GROSS: Right. Then there's a blues man that you do.

Mr. McKINNEY: The blues man that I did, "Mississippi Gary," which was sort
of like a reflective commentary on, you know, my last year of university, was
I was flunking English but learning how to play blues harmonica.

GROSS: Oh. Yeah, tell us the story about that.

Mr. McKINNEY: Well, I was at the University of Newfoundland and...(audio
difficulties)...Roger House, who was a quite good blues guitarist, and so we
left the university together at the same time and sort of made our way towards
Calgary, where all the jobs were. And on the way he taught me how to play
blues harmonica. Just as some point I just thought, `Why am I taking this so
seriously, you know, I'm a, you know, son of a diplomat from Ottawa, Canada.
I don't really have any business playing the blues.' So that's how Mississippi
Gary was born. He knows that he's really not a blues person.

GROSS: And how would you compare that show to "Saturday Night Live"?

Mr. McKINNEY: "Kids in the Hall"?

GROSS: Mm-hmm.

Mr. McKINNEY: Well, "Saturday Night Live" is like an institution. And I
guess it's a bigger, broader American comedy, and I don't mean like in any
sense that it's less. Just that "Kids in the Hall" were the five of us kind
of working our own little, much more personal and idiosyncratic canvas; where
"Saturday Night Live" kind of has a living newspaper instant cultural
commentary feel to it to me.

GROSS: Did you ever do stand-up?

Mr. McKINNEY: Or once or twice. I hated it.

GROSS: Why?

Mr. McKINNEY: Oh, it was too--I always needed a group of people to sort of
be among to face the terror of stage, I think.

GROSS: Have you ever had an issue with stage fright?

Mr. McKINNEY: Yes. Yeah, I did. I think I avoided it by performing without
my glasses for the first four or five years, so I couldn't see the audience,
ever.

GROSS: Well, you know, isn't it true that mostly on stage you can't see the
audience because of the way the audience is dark and the stage is light, so
you're looking at the stage lights and you really can't see who's in the
audience.

Mr. McKINNEY: I guess you can't. I often didn't, but I was lucky enough to
be in a David Lindsay-Abaire's second play I think it was, "Fuddy Meers," at
the Manhattan Theatre Club. And one of the actors in the cast, the great
Robert Stanton, he used to come back always at half-time, reporting in detail
a face that he saw in the fourth row balcony and how they had been sneering at
him or us. So I guess some people see it, some people don't. You sometimes
vividly remember who's in the front row though, days later.

GROSS: You know, I don't act but I've sometimes like spoken on stage. And if
you can actually--when the lights aren't dimmed and you can actually see who's
in the audience, I find my eye goes directly to that one person who's
sleeping, or I obsess on like the empty chairs and forget about the...

Mr. McKINNEY: Right.

GROSS: ...people who are actually there. And all you can think of is like,
`Well, it's not completely filled. I see empty chairs in the back there.' And
it's really...

Mr. McKINNEY: I know exactly what you mean. I just did...

GROSS: It's really rattling. Yeah.

Mr. McKINNEY: ...a show in San Francisco last...(audio difficulties)...
about the four seats that were empty in the fifth row to the left.

GROSS: That's so unhealthy. It's like exactly what--you should always be
thinking about the people...

Mr. McKINNEY: Yeah.

GROSS: ...who have gone out of their way to come and hear you, not the people
who didn't show up.

Mr. McKINNEY: Yeah. Yeah. No. We're--who we're those poor people, Terry.
Who were they? Why didn't they come?

GROSS: So how did you get your mind off that distraction? (Audio
difficulties)...

Mr. McKINNEY: That's what I find performing on stage is like for me. It's a
level, it's a meter of how much I'm into it; and if I'm at a good, high level,
I don't hear or see anything but the other person.

GROSS: Now, one of the movies you were in was "Spice World," the Spice Girls
movie?

Mr. McKINNEY: Do you want me to sign your DVD?

GROSS: Yeah, oh, yeah.

Mr. McKINNEY: Got every one we made? Yes I...

GROSS: What was your part in it? I didn't see the movie. What was your part
in it?

Mr. McKINNEY: What?

GROSS: What?

Mr. McKINNEY: Well why are we doing this interview? My part was George
Wendt and I played sort of a producer/writer team and he was my producer and I
was his writer; and so we were trying to concoct the movie within the movie
for the Spice Girls.

GROSS: You've written so many things that you've been in. You didn't
participate in the writing of this, did you?

Mr. McKINNEY: Of that? No, no.

GROSS: Did you wish you had? I mean, do you sometimes end up performing in
something where you feel like you could make it much better if you were
rewriting it?

Mr. McKINNEY: Not often. No, I've been really lucky. Unless I'm completely
myopic, I haven't been in a lot of junk and I'm lucky that way.

GROSS: You're a writer and you're an actor. Do both of those jobs draw on
different parts of who you are?

Mr. McKINNEY: Yeah, completely. In fact, they affect your lifestyle. On
"Kids in the Hall" it was very dramatic because we would go through cycles.
Three, four, fives weeks of writing, and then sort of a slow prep towards
performing. And when I was writing I would be up at 8:00. My place was neat.
My dishes were done. I wasn't living to excess. And then as we sort of
folded and became actors, you know, the laundry would pile up and the nights
would get later, the behavior more irresponsible until the whole thing would
sort of roll through again. And I think it trades off completely different
sides of your personality.

GROSS: Why would the actor part be more like sloppy or irresponsible?

Mr. McKINNEY: Well because I think you're tapping into sort of an
impulsivity and I think that there's more of a certain type of adrenaline
released when you're performing that, you know, makes you stick around for an
extra beer or, you know, watch three hours of CNN before you go to bed.

GROSS: Well, Mark McKinney, thank you so much for talking with us.

Mr. McKINNEY: Thank you so much for having me on your show.

GROSS: Mark McKinney co-wrote and co-starred in the Canadian TV series
"Slings and Arrows," which just came out on DVD.

(Credits)

GROSS: I'm Terry Gross.

(Soundbite of "Slings and Arrows")

Unidentified Singer: (Singing) Cheer up, Hamlet.
Chin up, Hamlet
Buck up, you melancholy lad
So your uncle is a cad and...(unintelligible)...married mum
That's really no excuse to be as glum as you've become
So wise up, Hamlet
Rise up, Hamlet...

(End of soundbite)
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