Democracy Now
NPR
April 21, 2008
Click here to listen to the interview.
While there are differences between the healthcare plans offered by Democratic presidential opponents Barack Obama and Hillary Clinton, neither of them is proposing a single-payer system of national healthcare. That’s despite the endorsement of precisely such a plan last December by the American College of Physicians, the largest medical specialty organization. We speak with Dr. Rocky White, a passionate, if unusual, advocate for a single-payer health insurance program. He describes himself as an evangelical from a conservative background and is on the Board of Directors of the nonprofit Health Care for All Colorado.
AMY GOODMAN: Democratic presidential rivals, Senators Barack Obama and Hillary Clinton, traded barbs over their healthcare proposals while campaigning in Pennsylvania this weekend. The rising cost of medical care has emerged as a key concern for voters, particularly as the economy continues to worsen. A new survey by the AFL-CIO found almost all of the respondents, most of whom were insured and employed, thought the current healthcare system is fundamentally broken and planned to vote for ways to change it in November.
This is an exchange between Clinton and Obama on healthcare from their debate in Los Angeles on January 31st that was hosted by CNN.
SEN. HILLARY CLINTON: We cannot get to universal healthcare, which I believe is both a core Democratic value and an imperative for our country, if we don’t do one of three things. Either you can have a single-payer system, or–which I know a lot of people favor, but for many reasons is difficult to achieve–or you can mandate employers–well, that’s also very controversial–or you can do what I am proposing, which is to have shared responsibility.
Now, in Barack’s plan, he very clearly says he will mandate that parents get health insurance for their children. So it’s not that he is against mandatory provisions; it’s that he doesn’t think it would be politically acceptable to require that for everyone. I just disagree with that. I think we, as Democrats, have to be willing to fight for universal healthcare.
SEN. BARACK OBAMA: What they’re struggling with is they can’t afford the healthcare. And so, I emphasize reducing costs. My belief is–is that if we make it affordable, if we provide subsidies to those who can’t afford it, they will buy it. Senator Clinton has a different approach. She believes that we have to force people who don’t have health insurance to buy it, otherwise there will be a lot of people who don’t get it. I don’t see those folks. And I think that it is important for us to recognize that if, in fact, you’re going to mandate the purchase of insurance and it’s not affordable, then there’s going to have to be some enforcement mechanism that the government uses. And they may charge people who already don’t have healthcare fines or have to take it out of their paychecks. And that, I don’t think, is helping those without health insurance. That is a genuine difference.
AMY GOODMAN: There are important differences between the healthcare plans offered by the Democratic presidential opponents, but neither of them is proposing a single-payer system of national healthcare. That’s despite the endorsement of precisely such a plan last December by the American College of Physicians, the largest medical specialty organization. The candidates’ refusal to consider such a proposal also flies in the face of the latest study indicating a majority of physicians, 59 percent, now support government legislation to establish national health insurance.
Today, I am joined by Dr. Rocky White. He is a passionate, if unusual, advocate for a single-payer health insurance program. He describes himself as an “evangelical from a conservative background.” He is on the Board of Directors of the nonprofit Health Care for All Colorado. Most recently, he revised and updated Dr. Robert LeBow’s classic book advocating single-payer healthcare. It’s called Health Care Meltdown: Confronting the Myths and Fixing Our Failing System. Dr. Rocky White joins us now here in Denver. He just came up last night from Alamosa, Colorado, where he lives.
Welcome to Democracy Now!
DR. ROCKY WHITE: Thank you, Amy.
AMY GOODMAN: It’s good to have you with us. We just drove through on our tour through New Mexico and Colorado–Alamosa yesterday morning–and were reminded of the problem with the water. Before we talk about healthcare, can you talk about what happened to Alamosa’s water?
DR. ROCKY WHITE: Well, several weeks ago, we started seeing sporadic outbreaks of salmonella in the community, and before too long, those sporadic outbreaks began to grow and grow. And it finally became clear that the salmonella was in the city water system. By the time it was all said and done, we’ve had about 300–I think I saw in the paper yesterday 385 cases now of salmonella. And just recently, we had one death. Thankfully, that’s all that we’ve had. But that’s basically what happened.
We really don’t know the source. We don’t know where the breach came from. We had a horrible winter. And so, it could have been just the freeze thaw from the exceedingly frozen ground, and then probably a breach somewhere with the high sublevels from the amount of snow that we’ve had. I suspect that’s probably where it came from, but I’m not sure we’ll ever know.
AMY GOODMAN: I had heard there was some pipe work that was being done and possibly a sewage pipe mixing with the water supply. Is that at all what could have happened?
DR. ROCKY WHITE: There’s a lot of theories out there. I’m not sure that we’ll ever know for sure. But the city was intending on chlorinating the water at some time in the future, but that future is now. So we now have chlorinated water in Alamosa.
AMY GOODMAN: And people are drinking it now?
DR. ROCKY WHITE: And people are drinking it now. You know, it was really tough, Amy, for a couple of weeks. People couldn’t take baths, couldn’t wash their dishes. And, you know, obviously the thing that happened there was the effect on the economy has been devastating. Most of the restaurants had to close down. People got laid off as a result. Then all the businesses downtown, their businesses dropped because the restaurants were closed. And I suspect by the time you think about all the money that’s been spent by the city, all the business that’s been lost and the tax revenues, it’s probably going to cost our community several million dollars by the time it’s all said and done.
AMY GOODMAN: I also understand –we stopped in at Adams State College–that the first government entity to come in when it was clear there was some kind of salmonella outbreak was the Department of Homeland Security.
DR. ROCKY WHITE: Yeah, that is correct. And I think, in some respects, well, the Department of Health is sort of tied to that. And I guess, in a way, this is sort of a homeland security issue, if you would, because the security of the people of Alamosa was in danger. And I think they’re trying to kind of tie those two together. That’s probably how that happened.
AMY GOODMAN: They weren’t concerned about al-Qaeda in Alamosa?
DR. ROCKY WHITE: No, we’re not concerned about al-Qaeda in Alamosa. But, you know, the FBI was there. You know, I think in these days, these times and days, I think people are just so paranoid that’s the first thing that comes to their mind.
AMY GOODMAN: Well, Dr. Rocky White, I want to talk to you about the Health Care Meltdown and about why you are taking on single-payer as your key issue. But first, we’re going to break, and we’re going to break back in New York: live in our studio, Sara Thomsen.
[break]
AMY GOODMAN: We’re broadcasting from Denver, Colorado. Our guest is Dr. Rocky White, an advocate for single-payer healthcare with an unusual background. Dr. White, why don’t you talk about that?
DR. ROCKY WHITE: Well, Amy, I grew up in Nebraska, and I came from a very conservative background, an evangelical background. All of my family members–you know, everyone was Republican, very conservative. And when you grow up in that environment, obviously that’s just something you just sort of adopt as you get older.
After I went through medical school, I intended on going back and practicing medicine in a rural area. And that is eventually what I did. I practiced in western Nebraska for a few years and then ended up in southern Colorado, going on thirteen years ago down in Alamosa. I joined a for-profit, fee-for-service organization down there. And, you know, of the twenty-three physicians that were my partners initially, it was a very conservative group. I mean, this was a fee-for-service group, hard-working. We had one Democrat in the whole group. So that tells you, you know, where we were at, where we stood politically.
But during the four, five years–well, actually, when I moved to the Valley, there were eleven full-time practicing internal medicine specialists at that time. That’s what I do, is practice internal medicine. Just to make a long story short, through the course–as the years went by, as we kind of entered into the new millennium, we started hitting on some very difficult times financially. And eventually we got to the point where we were just about to go broke, and we had to join forces with a hospital. Physicians came and went during those seven or eight years’ period of time. In fact, just in our group alone, there were thirty-four doctors who came and went just in about a seven-year period of time. By the time it was all said and done, when our group finally joined the hospital in 2004, just shortly thereafter, I was the only internal medicine specialist who was practicing full-time in the Valley at that point.
So if you go back to the early ’90s, as our group started to fall apart financially, I was very good at economics, I was very good at the business of medicine. I knew how to run a business, knew how to hire and fire, balance books, etc. I understood that part of the business of medicine. But I didn’t understand the bigger picture, and that is the policies that got us to where we’re at today. And as we started to fall apart, I started to study that and tried to understand what is so wrong with our group–or not just our group, but I began to see it was just the whole healthcare system as a whole, not just our group.
And as I began to study and to look at state policy and federal policy and going back–if you want to understand our healthcare system, you have to go back fifty or a hundred years to see how we evolved into this. You know, there wasn’t some mad scientist in the 1940s who devised this horrible system that we have today. It was just a matter of evolutionary process, so to speak. But as I began to study that and to try and assimilate what it was that was going on, I began to see some very disturbing trends. Part of the reasons that we got to where we’re at today are multiple. There’s not just one “this is what happened.” And as I started to weave that together, I began to say, “Jiminy Christmas! This thing is really screwed up!” And now I’m beginning to understand the healthcare system very well, not just our group, but as a whole.
And then I began to ask myself, what are we going to have to do to fix it? And so, obviously, single-payer was not even something that I would have even considered ten years ago. In fact, ten years ago I didn’t even know the word “single-payer” existed. And so, as I started to look at that and I looked at different ways that we could fix this whole thing–I mean, you talk about subsidies, expanding Medicaid, all of that–I began to realize that the only way that we’re going to fix this system is we’re going to have to put everyone on a Medicare-like system. In order to truly fix the system, we’re going to have to put everyone into one single risk pool, we’re going to have to share that risk, and the most efficient way to do that is through the tax system.
At that time, I didn’t know anything about Physicians for a National Health Program. I had never heard of Bob LeBow. In fact, the word “single-payer,” I hadn’t even heard that, you know, back in the late ’90s. And so, as I started to put all this together, I said, you know, I’m going to write a book about this. This is so important to do this.
And so, one day I was down at the emergency room, and one of my colleagues who’s sort of an old hippy from the ’60s, a very liberal individual, she knew how conservative I was, because at that time I was still a Republican. And I was very sheepish about the whole thing. I mean, here I am, a Republican, thinking about nationalizing healthcare. It just went against the grain of everything that I stood for. But you have to remember something, Amy: I didn’t come to those conclusions with lofty ideals of social justice. It was purely from an economic standpoint. This is the only way that we’re going to do–be able to fix this and do it efficiently.
So, as I started to talk to Beth, she said, “Rocky, have you ever heard of a group called Physicians for a National Health Program?” And I said, “No.” And so, she gave me the webpage, and I got on. And as I started looking at or reading the information that had been written by Steffie Woolhandler and Dave Himmelstein–I think you’ve talked to them before–looking at Bob’s book and things, I thought, “Criminelli! These people are thinking like I’m thinking!” This is–you know, I thought I was this crazy person out in the middle of nowhere coming up with this idea.
And so, that spring, there was a conference in Chicago that Ida Hellander was putting on with training people to be advocates for single-payer. And so, when I went out there, she introduced me to this book, Health Care Meltdown, that was written by Bob LeBow. And as I started going through it, it was sort of one of those Twilight Zone experiences, I guess, because it was really strange, because he had written my book. He had–I mean, even the chapters were very similar. And so–and I guess it’s not surprising, because when you start coming to these conclusions, you start thinking in the same lines. So I thought, you know, I’m not going to write my book; Bob LeBow already did this. I’m just going to get out there and start being an advocate and start speaking.
AMY GOODMAN: And Bob LeBow was president of Physicians for a National Health Program, ultimately was paralyzed in a cycling accident and died about five years ago?
DR. ROCKY WHITE: Yeah, that’s correct.
AMY GOODMAN: So you wrote the introduction to the new edition of Health Care Meltdown–
DR. ROCKY WHITE: Yeah.
AMY GOODMAN: Confronting the Myths and Fixing Our Failing System.
DR. ROCKY WHITE: Yeah, because that’s what’s so strange about that, is because I was up speaking in Idaho and got to meet his wife. And to make a long story short, Ida got a hold of Mrs. LeBow, Gail, and the two of them said, “You know, we’d really like to have Rocky write this,” because my background is so similar to Bob’s. In fact, Bob was a Republican and changed to a Democrat at about the same age that I did that. And Bob practiced rural medicine. He practiced to the underserved areas. He was very passionate about the uninsured, very similar to myself. And so, it was quite an honor when they called me and said, “Would you revise this and update this for the second edition?” And so, I did. I put an introduction in there, I updated all the numbers, brought it all up to date and then added two chapters to the book.
AMY GOODMAN: When you hear, for example, Barack Obama and Hillary Clinton debating healthcare, what are your thoughts? And explain what single-payer is.
DR. ROCKY WHITE: Well, single-payer can be a lot of things, but basically what single-payer means is that you have one organization that handles the financing of healthcare. That one organization could be a for-profit insurance company, if you only had one. It could be the government. It could be a public utility commission. So that’s all single-payer means.
The thing is, you know, you and I grew up in the same era. We have this idea about single-payer and socialized medicine sort of locked together. When I say the word “single-payer,” the first thing that comes into people’s minds is “Oh, my god! Social medicine? We get socialized medicine, and the next thing that’s going to happen is that the hammer and sickle is going to start flying from the top of the Capitol.” And so, when I explain to people that there are a lot of different types of single-payer systems–you could have purely socialized medicine. That’s kind of like what England has. The government owns the hospitals, the government owns the clinics, the government finances all the healthcare, and all the doctors work for the government. That is truly socialized medicine, as opposed to the Canadian system, where the financing comes through their Medicare program, but all the doctors are in private practice. And so, that’s kind of the spectrum, so to speak.
AMY GOODMAN: And when you hear the candidates debating healthcare, do you think that they really do differ? And why do you think they don’t go with this? Hillary Clinton started at the beginning–we heard the clip where she was talking about the options. She started by saying, well, single-payer is an option. Everyone–well, many people cheered in the audience, and she went on to say that wasn’t likely.
DR. ROCKY WHITE: Yeah. Well, I think that part of the problem is that our current healthcare system is so entrenched with the system that we have. We have this plurality of systems, where we actually have a single-payer system, which is Medicare, we have another single-payer system for Medicaid for the poor, and then we’ve got private insurance, which is a speckling of all kinds of crazy things. You know, this industry is a $2 trillion industry, and the profits in the for-profit insurance industry are so huge and it’s so deeply entrenched into Wall Street that people–this country is going to have a hard time extracting that. And I think that Barack Obama and Hillary Clinton understand that, and they don’t want to go ripping up this system for the sake of an ideal. But the fact of the matter is, is until we move to a single-payer system and get rid of the profit motive in financing of healthcare, we will not be able to fix the problems that we have. They will be impossible to fix.
AMY GOODMAN: What do you think is the single biggest misunderstanding about single-payer in this country, and what is your strategy for having it adopted? What do the polls in the United States show of how Americans feel?
DR. ROCKY WHITE: You know, it’s interesting. As you see the polls, as you’ve seen them move through from about 1999 up to the present, you’re seeing an ever-increasing number of people starting to support a national health program. And in fact there was a recent poll that came back from one of the medical associations back east and was just published in JAMA a couple of weeks ago.
AMY GOODMAN: The Journal of the American Medical Association.
DR. ROCKY WHITE: The Journal of the American Medical Association, which shows that 59 percent of practicing physicians today believe that we need to have a national health program. I mean, that’s unheard of, even ten years ago.
AMY GOODMAN: I mean, they were the biggest group opposed, because of the finances.
DR. ROCKY WHITE: Oh, I mean, that’s it. I mean, you know, physicians traditionally have been the group that has been the anchor sunk into the mud that has been dragging this whole healthcare reform process along. In fact, the AMA, the American Medical Association, launched a huge effort back in the 1960s to stop Medicaid and Medicare. And so, it’s amazing to see a new generation of physicians coming up who are disgusted with our current healthcare system. You know, we’re trained to be advocates of patients, we’re trained to save lives, we’re trained to practice medicine. And instead, what we’re doing is we’re practicing Wall Street economics. And they’re too diametrically opposed from the process.
AMY GOODMAN: So how do you inject this idea into the presidential debate?
DR. ROCKY WHITE: What it’s going to take is it’s going to take pressure from the bottom up. You know, I think that our current presidential candidates–I think both of them understand that ideally single-payer would be the best, but they don’t have the political will to move that forward. And so it’s going to take–I use it for this example. I say–you know, as the governor the State of Colorado or the president of the United States, their job is to feel which way the wind is blowing. Our job is to turn that wind.
And that happens by me coming down and speaking to you this morning. And I go out and talk to Kiwanis groups and Rotary groups. And especially the thing that I’ve been doing is going around and speaking with my fellow physicians, because it’s surprising how many doctors don’t even understand the system. I’ll have to admit that eight years ago I didn’t understand the system. And I think once people understand the system and understand what’s wrong with it, they’re going to do the same thing that I did.
AMY GOODMAN: The American College of Physicians has endorsed–this is your association?
DR. ROCKY WHITE: That’s my association of internal medicines. American College of Physicians, they gave a dual support, so to speak. They said if we’re going to fix the system, we either have to do this or this. And surprisingly, one of those was a single-payer system.
AMY GOODMAN: Well, I want to thank you very much for joining us. This is the beginning of a more extended conversation. C. Rocky White has been our guest. He has revised and updated the book by Robert LeBow, Health Care Meltdown: Confronting the Myths and Fixing Our Failing System.