David Himmelstein and Len Nichols debate
Can US Achieve Meaningful Healthcare Reform Within For-Profit System?
Hosted by Amy Goodman and Juan Gonzalez
Democracy Now!
February 27, 2009
(Excerpts)
We host a debate between Dr. David Himmelstein of Physicians for a National Health Program and Len Nichols of the New America Foundation.
Juan Gonzalez: …if these private insurance companies will remain involved in the healthcare — in healthcare insurance in the future, how can those costs be controlled?
Len Nichols: …a lot of the administrative costs that David talked about, which is borne by the providers, I agree completely, they’re wasting a lot of energy now satisfying a lot of different kinds of claims forms. You could have a common claims form required by the government. You would get the industry to agree on what it is or tell them you’re going to impose one. They would agree in about an hour. And then you could have very much more efficient ways of billing and collecting, so that the extra costs that we’re spending now could be taken out of the system by rules and regulations that would make their self-interest pursue our social interest.
Dr. David Himmelstein: …Len Nichols claims all we need is a common billing form for hospitals. We already have that. It’s called UB82. And we have computerized virtually all hospital billing. It hasn’t saved a nickel. It’s because the insurance companies aren’t actually interested in saving money on administration. That’s where they make their dime. And no amount of government regulation is going to change their behavior, as long as they’re still in the game.
Amy Goodman: Len Nichols, we’re talking nationalizing banks. Why not nationalize health insurance? Why not nationalize healthcare in this country?
Len Nichols: You know, it certainly is tempting, and at a certain level, you’re right. The atmosphere is one where it seems like all things are possible. But I would just say the American people, by and large, are not ready for government-run healthcare. Look at the way people can be scared by one-size-fits-all kinds of rhetoric. …but I think the American people are nowhere near ready to have the government take over their healthcare, because that set of decisions about how you treat your illness, etc., is so private and so emotional. They do want choice. They want to believe in their doctor, and they do, in large part, believe in their individual doctor.
Amy Goodman: So, Dr. Himmelstein, respond to that. It’s not practical right now. It’s not achievable.
Dr. David Himmelstein: Well, yeah. I mean, people want choice. They want to be able to choose their doctor, and they want to be able to choose their hospital. They want to choose their care. And that’s what they can’t do at this point. We’re saying every American should be able to go to any doctor, any hospital in the country, and have a completely free choice. And under the private insurance system, they don’t have that.
Juan Gonzalez: …I’d also like to throw in a little personal experience that I’ve had recently. I just had a minor shoulder surgery a few weeks ago. And I have to tell you, because I am insured through my company, and I have to tell you the amount of time that I have had to spend on the phone with my employer, with the health insurer, with the hospital, the various bills from both the hospital, the surgeon, the laboratories, the amount of time that I’ve had to spend to try to maneuver through this incredibly complex system — and is it in network or out of network? And I have to imagine that millions and millions of Americans every day are going through the same procedure, even those who have insurance, enormous amounts of time and energy and frustration spent trying to maneuver through the system.
Len Nichols: Sir, I agree. I’ve shared some of that same frustration in my own life, as have we all. And I would agree, our system is a mess. …Today, insurers make money by excluding the sick and by making it hard for people to get the carrier talking about it. I agree that’s what they’re doing. It’s about that. But if you change the rules and you say, “Look, we’re going to publish patient satisfaction. We’re going to publish what things cost. We’re going to publish what it would cost to be covered by you,” and make all that very clear, and you make — essentially you give people choices among them, they will compete on the right dimensions, because that’s the way they’ll make money.
Amy Goodman: Len Nichols, we started with you. Fifteen seconds, Dr. Himmelstein, we’ll end with you.
Dr. David Himmelstein: Well, we need single-payer national health insurance. If private insurance could solve this problem, I’d be all for it. Unfortunately, it can’t. My patients desperately need it. Our nation desperately needs it. There are things we say are not appropriate for the market, like the fire department and the police department. Medical care ought to be one of those.
Amy Goodman: We’ll leave it there. Dr. David Himmelstein, associate professor of medicine at Harvard University, co-founder of Physicians for a National Health Program. And Len Nichols, director of the Health Policy Program at the New America Foundation.
For the full 18 minute video, audio, and transcript:
http://i4.democracynow.org/2009/2/27/can_us_achieve_meaningful_health_care
Comment:
By Don McCanne, MD
Primarily because of political perceptions, Len Nichols continues to support what he believes to be the pragmatic approach of covering everyone with regulated private plans. However, when experts like David Himmelstein continue to confront him with the facts about our flawed financing system, Nichols’ support for private insurance seems to be shifting from knowing that it would work, to wishing that it could, even though “our system is a mess.” He needs to take the next step of acknowledging that private insurance can’t work so that we can move forward and fix the “mess” by enacting a single payer national health program.