Tom Vilsack, Terry Branstad Former Iowa Governors Tom Vilsack and Terry Branstad (photo) talked Wednesday about the results of public hearings they held on health care before a legislative committee that’s looking into the issue.

Both former governors agree that the state needs to do more to get insurance coverage for those who don’t have it. Vilsack, a Democrat, says there should be a mandate with incentives to go with the insurance.

Vilsack says there should be some sort of requirement on businesses or individuals that they have insurance, and then as part of that there would be incentives to get the insured to have screenings to look for health problems such as cancer. Vilsack says having insurance for everyone is important in making overall changes that lead to savings.

Vilsack says to get the universal coverage, you’re going to have to require it, then you have a way for people to have a medical home, you increase preventative screenings, and you start to see savings. Vilsack says other states, such as Michigan, provide incentives in their insurance plans to get people to do preventative screenings. He says the Michigan plan gives up to a 10-percent reduction in premiums for people who are involved in certain "appropriate healthcare choices and behaviors," which is something he says the state should focus on.

Vilsack says the incentives won’t work if you don’t have universal coverage, and won’t work as well unless people have a medical home and if you don’t have insurance companies that realize they can’t shift the risk, or eliminate risk.

Branstad, a Republican, says the current system waits until people get a disease to treat them. Branstad says that’s very expensive, and if the state invests more money up front on health and prevention and give health risk assessments to identify and reduce problems, that will save substantial amounts of money. And he says people will enjoy a better quality of life for a longer period of time. Branstad says changing people’s attitudes about health care and healthy choices is a long-term undertaking.

Branstad says he agrees with Vilsack that it has to start right away with pre-natal health treatment. Branstad says a lot of young people believe they can get away with smoking, and excessive eating and drinking, but those actions catch up with them later in the form of chronic diseases. Branstad was asked if it is possible to get the issue moving ahead without politics stalling things.

Branstad says he thinks it is possible, as he appointed a bipartisan commission in 1993 that came up with a "pretty substantial" health care plan that passed with only one dissenting vote in the legislature. Branstad and Vilsack says if Iowa takes the lead and other states follow, it will put pressure on federal officials to take action too.