The following is an excerpt from an unofficial transcript of a Jan. 28 telephone interview with Dr. Andrew Coates, president of PNHP and internist in Albany, N.Y., conducted by Dr. Margaret Flowers and Kevin Zeese on their radio show “Clearing the FOG” on We Act Radio, 1480 AM, in Washington, D.C. The program is also streamed at WeActRadio.com. The text below has been slightly edited for clarity.
Dr. Margaret Flowers: Our next guest is Dr. Andy Coates, president of Physicians for a National Health Program. He was recently featured in an article in the Buffalo News in an article titled “Doctor sees shift to single-payer health care.” Good morning, Andy.
Dr. Andrew Coates: Thank you for having me.
Dr. Flowers: In the Buffalo News article you talk about a person who left the hospital early despite having a serious problem. Can you talk about the concept of self-rationing that exists in the United States?
Dr. Coates: We have an incursion, first of all, of high-deductible private health insurance plans. People will pay $1,000, $2,000 even $5,000 out of pocket before their insurance kicks in. And if you think about the median income being in the $40,000 per year range for the average household, you can see the problem.
And then if you think about poor households – like here in New York state, where the middle of the bottom half is somewhere around $14,000 per household, a shockingly low number – the problem is extreme. In upstate New York cities such as Buffalo and Schenectady, we have a third or more – huge numbers – of children living in poverty.
So in view of out-of-pocket costs for health care going up and up and up, all the time now when we discharge people from the hospital we have to think about exactly how much the prescription is going to cost. It could easily be more than a week’s wages just for an antibiotic prescription, for example. And we have chronically ill people who we know are on six, eight medications.
All of those out-of-pocket costs discourage people from getting care. And there are studies to prove it. The randomized control trial that is famous was the RAND study of co-pays, which showed people avoid necessary care when they have to make out-of-pocket payments. But there are oodles of other studies that show co-pays, deductibles, coinsurance – all those things are impediments to care.
As I was thinking about today’s show, I looked at Franklin D. Roosevelt’s second inaugural address, and I just wanted to share with you these five lines or so.
“Here is the challenge to our democracy: In this nation I see tens of millions of its citizens — a substantial part of its whole population — who at this very moment are denied the greater part of what the very lowest standards of today call the necessities of life.
“I see millions of families trying to live on incomes so meager that the pall of family disaster hangs over them day by day.
“I see millions whose daily lives in city and on farms continue under conditions labeled indecent by a so-called polite society half a century ago.
“I see millions denied education, recreation, and the opportunity to better their lot and the lot of their children. …
“I see one-third of a nation ill-housed, ill-clad, ill-nourished.”
This was in 1937. If you think about the pressure that came to bear on that White House and the frank recognition of poverty in these words, it’s a striking contrast to what we have today.
Kevin Zeese: We still have all those same problems. …
Dr. Coates: Absolutely.
Kevin Zeese: Talk a little about medical bankruptcy.
Dr. Coates: In the United States the leading cause of bankruptcy is medical debt, and of those who are bankrupted by medical debt in our society, the big majority have health insurance of some type when illness comes and ends up bankrupting them.
So health insurance does not protect – the way health insurance works in the U.S. today, it does not protect us from the devastating costs of serious illness. This problem continues at the end of life, where patients have bankrupting illnesses that lead them into long-term care under Medicaid.
Many people, out of self-sacrifice, lose their jobs taking care of loved ones – providing bodily care or getting them to appointments. The jobs that working people have don’t have lots of time off or sick leave. The Family Medical Leave Act gets you a pass from the boss, you get to keep your job perhaps, but you don’t have a paycheck, so people lose their homes because their parents are sick. It’s very, very devastating.
And these are the kind of tragedies taking place in our country. Everyone has a family member or an acquaintance who they know rather well who has faced one of these devastating consequences of illness. Yet even though that happens, it remains somehow a private tragedy.
Sometimes people even see it as something shameful, a personal failing. And of course it shouldn’t be viewed that way. It’s a social responsibility, dealing with these kinds of devastating illnesses, because it could happen to any one of us. So it’s in each of our interests to advocate for everyone being able get the best cancer care without going bankrupt, for example.
Dr. Flowers: Right, so let’s talk about Medicare. The dominant conversation out there right now is that we have to cut Medicare.
Kevin Zeese: Or worse, to privatize it.
Dr. Flowers: Yes, it’s horrendous what the Business Roundtable and others are promoting. So, Andy, can you talk about what’s not being talked about enough – about Medicare for all, about the fact that we actually have a solution that would bring us out of these crises – the health care crisis and the economic crisis?
Dr. Coates: It’s definitely an irony that in the United States there are models of care and paying for care that actually work rather well.
Medicare is coming up on its 50th anniversary. It’s perhaps the most popular program of all time in our country. That said, it’s not perfect. Medicare is far from adequate. It could definitely be improved upon and expanded. There are many things Medicare doesn’t pay for. People still face staggering costs. Dental care is left out of the coverage, for example.
But nonetheless, Medicare works, and it has worked well in terms of its cost savings. A big portion of the money goes to the care of human beings – only about 3 percent goes to administrative expense, compared to about 20 percent in the private health insurance industry.
People have come to completely count on Medicare. Upon retirement, it’s there. It’s a lifesaver for the elderly and it’s also there for the disabled. So Medicare has worked very well, and therefore saying that it’s failing and needs to be privatized is quite silly. It’s amazing where the discourse on this matter is at in the mainstream media.
Kevin Zeese: How would Medicare for all affect the deficit?
Dr. Coates: Well, certainly health care spending is gobbling up a huge portion of the economy. What would it mean to the government if all health care spending were redirected to a publicly financed system? There would arguably be enormous savings from the elimination of lots and lots of waste. That would mean real health systems planning, which would in turn mean establishing clinics and hospitals in places that need them – an expansion of infrastructure.
For example, we always talk about dignified home care for the elderly. However, one of the greatest hypocrisies in this society is that while th
ere is so much celebration of the Greatest Generation, the World War II generation – many of whom are in their senescence, some near death – they are not able to get dignified care in their homes because of reasons of cost.
So if a publicly financed Medicare program were improved and expanded to cover home care, that would be our way of showing respect for that generation that they deserve.
We could train and deploy, through a system of local planning, home-care teams that could keep people at home and dignified rather than losing their homes or going into a reverse mortgage or all these other horrible choices.
And what would that mean for the economy and the deficit? Well, I think it would be an incredible jobs program. I think that would go a long way toward reducing any kind of deficit.
Dr. Flowers: Thank you so much Andy for taking time out of your busy day to be with us.
Dr. Coates: Thank you for having me.
To listen to the full program (or to Dr. Coates’ segment, which begins at the 38-minute mark), visit: