By Steffie Woolhandler, M.D.
“To the Point,” KCRW – PRI radio, Oct. 1, 2013
The following text represents the comments of Dr. Steffie Woolhandler, one of PNHP’s co-founders, taken from an unofficial transcript of a radio program that was broadcast by KRCW in Santa Monica, Calif., and Public Radio International on Oct. 1. The host was Warren Olney. The panelists were Mary Agnes Carey of Kaiser Health News, Harold Pollack of the University of Chicago, Dr. Fitzhugh Mullan of George Washington University, and Dr. Woolhandler, who is professor of public health at the City University of New York.
Warren Olney: Dr. Woolhandler, you’re concerned about the Affordable Care Act, as I understand it. Why?
Dr. Steffie Woolhandler: Let’s be clear. The Affordable Care Act is going to leave 31 million people uninsured, and even if the Red state governors had never stepped in, even if the Supreme Court had never stepped in, Obamacare as written was designed to leave 25 million people uninsured. So it’s a very partial solution that, even if enacted as written, would have left half of uninsured Americans still uninsured. And 25 million uninsured is unacceptable to me as a physician, as is 31 million uninsured. We should have gone to a single-payer system, also known as nonprofit national health insurance, also known as expanded and improved Medicare for all, and then the money we spent on health care would have been enough to cover 100 percent of everyone and then we would also have enough to remove co-payments and deductibles from people who have insurance already. So our group, Physicians for a National Health Program, is still pushing for single-payer national health insurance, like they have in Canada and most of Western Europe.
WO: What are the prospects, though? The Affordable Care Act doesn’t even include a public option.
SW: Well, I think as soon as people see the problems in Obamacare – and I do want to agree with the other panelists, there are some improvements that we got through Obamacare. Certainly a lot of people ended up getting Medicaid that didn’t have it before. But there’s still a lot of holes and problems, not the least the 31 million uninsured, not the least the fact that that you end up paying a lot of money for very skimpy coverage on those insurance exchanges — including policies with deductibles of $2,000, co-insurance of 20 percent. When people actually see Obamacare in action, they’re going to say we need to move forward to single payer, we have not solved the problem yet, and single payer is still necessary.
WO: Would single payer eliminate the insurance companies and the amount that’s spent on their overhead?
SW: Absolutely. The insurance companies are allowed an overhead of 15 percent under Obamacare. That’s seven times more than the overhead in single-payer systems like Canada’s, seven times more than is spent in traditional Medicare for overhead. So 15 percent is just pathetic, and we need to be getting the kind of administrative cost savings that are only possible through single-payer systems.
WO: Dr. Woolhandler, if [the previous speaker’s claims are] true, that is, if the Affordable Care Act is so much better than what we have now, what then are the prospects for there being a sufficient amount of backlash that we may actually see a single-payer system?
SW: It may be better, but there are plenty of problems for lots of people, not just the 31 million uninsured. People are going to be shocked to see how skimpy these policies are, particularly if you’re not eligible for subsidies or you’re at the high end of that income range and your subsidy is very small. People are going to be paying premiums of $9,000 a year, they’re going to be paying deductibles of $2,000 per year. It’s part of a trend of insurance policies getting skimpier and skimpier, and Obamacare is actually contributing to that trend. So I think lots of people are going to be dissatisfied, and you know polls already show the majority of Americans support the idea of Medicare for all, a government insurance program funded through taxes. The block to that kind of health reform was not public opinion, it was the money of the insurance industry and Big Pharma, and that’s what we’re going to have to combat to get single payer.
WO: One thing we haven’t talked about is the individual mandate and what it means. [Here another panelist recaps the specific provisions of the law, the fines, etc.] Dr. Woolhandler, does that sound fair to you, as a way of getting enough people enrolled in insurance who will be able to pay the freight?
SW: No. The mandate is a terrible idea. Why is the federal government using its authority to force individuals to hand their money to private health insurance? If they want to do a public, universal system, then it should be paid for through taxes. But citizens should not be required to hand their money over to a private insurance industry. That makes no sense.
For the full radio program, visit: http://www.kcrw.com/news/programs/tp/tp131001the_government_shutd
PNHP note: This week several other PNHP leaders and activists gave broadcast interviews about the Affordable Care Act and the need for single payer, including Dr. Oliver Fein of New York City; Dr. Paul Song of Santa Monica, Calif.; Dr. Margaret Flowers of Baltimore; Dr. Philip Caper of Brooklin, Maine.
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