By Glen Ford
Black Agenda Radio, March 21, 2011
The Obama administrationâs health care legislation will not prevent Americans from going bankrupt in large numbers due to illness, says Dr. David Himmelstein, an author of a study of the âalmost identicalâ Massachusetts health care program implemented in 2005. âPeople got insurance but, basically, they got such lousy insurance that they ended up bankrupt if they got sick,â said Himmelstein. âFor states like Texas, Louisiana and California,â which have far worse health coverage than Massachusetts, âweâre not going to see much improvementâ under the Obama plan. A transcript of the interview follows.
A new study shows that people in Massachusetts are still going bankrupt in huge numbers because of medical expenses, five years after implementation of a health care plan that is remarkably similar to President Obamaâs health package. Like Obamaâs bill, the Massachusetts plan compels residents to buy private health insurance. Dr. David Himmelstein is one of the authors of this study.
David Himmelstein: What we found is that medical bankruptcies havenât really decreased in Massachusetts, even with our stateâs reform. Basically, people got insurance, but they got such lousy insurance that they ended up bankrupt if they got sick â again, even though they had insurance. They were left with giant co-payments and deductibles and things that werenât covered and the insurance turned out to be like an umbrella that leaks in the rain: itâs not there when you need it.
Glen Ford: So who is it that is helping if there has been little change? And, in fact, in raw numbers there was an increase in bankruptcies.
Himmelstein: Thatâs right. Probably itâs helping some doctors and some hospitals that are getting paid a little bit more, but it doesnât look like most patients are actually getting very much help. Maybe some are getting a little bit around the edges if youâre not seriously ill and not getting huge bills that would drive you into bankruptcy, maybe thereâs a little bit of help there. But we couldnât find very much help for patients at all.
Ford: How much does the Massachusetts plan, in these kinds of effects, resemble President Obamaâs plan?
Himmelstein: Itâs almost identical. I mean, the coverage that people got in Massachusetts is, if anything, a little better than what the national reform says that people have to have. So, just to give you an example, coverage that is most commonly bought through these insurance exchanges here, for someone my age, would cost about $5,600 a year â for the coverage you have to buy. It doesnât cover any of the first $2,000-worth of bills, so that all comes out of your pocket. And, even after that, you pay another $4,000 in co-payments. So, the coverage is really pretty poor, and itâs pretty much what Washington has coming to the rest of the country.
Ford: And yet, a big part of Obamaâs campaign was that it was intolerable that people would go bankrupt on top of the personal catastrophe of illness.
Himmelstein: Well, it made good sound bites, only the legislation they actually passed didnât actually address the problem. What we really need is full coverage for every American. Every Canadian has first-dollar, full coverage and their health care system cost less than ours and they donât have much medical bankruptcy â thatâs been looked at and they have like 10 percent as much medical bankruptcy as we do. Once in a while someone has something where they are basically out of work, and because of that, an illness drives them into bankruptcy, but the medical bills are not a problem under real national health insurance. We didnât get real national health insurance.
Ford: And polls show that thatâs what people were actually expecting, what they were led to believe was going to be in the hopper. Was this kind of bait and switch?
Himmelstein: I think it was and frankly, itâs what the Republicans are saying we got and we shouldnât have. In a way, we have the worst of both worlds â we didnât get really good coverage, and yet the Republicans are claiming that itâs socialized medicine.
Ford: And that, I remember, was one of the great fears. Not only would this bill, this national bill be inadequate to the problem, but that it might create a problem itself forestalling real Medicare for all type coverage.
Himmelstein: Thatâs what we worry about frankly because there was momentum building for real change, for a Medicare-for-all kind of program, and at this point, some of the steam has been taken out of it. But, frankly we think that the American people are going to discover soon that what they got is not real coverage.
Ford: And now we see that the president is going to let some states opt out of his plan entirely.
Himmelstein: Well, they are already letting states weaken the first parts of the bill. Theyâre saying, the bill said that insurance companies canât sell really bare-bones policies, I mean worse than we have in Massachusetts, and get away with it, and the administration has waived that requirement wherever theyâve been asked. So, at McDonaldâs and those kinds of places they offer their workers coverage thatâs like $3,000. Thatâs how much might be covered out of a $100,000 illness. And the Obama administration has said, âThatâs OK,ââ even though the law says itâs not. So, theyâre already waiving some of the better provisions in the law. And, weâre worried they are going to waive more. On the other side, weâd like to see flexibility for states to do better and folks in Vermont are talking about doing a Medicare-for-all kind of plan in Vermont.
Ford: And letâs make it clear, Massachusetts has never been at the bottom of the list or anywhere near it in terms of health care.
Himmelstein: Oh, far from it. Even before our health reform, Massachusetts was one of the better places in the country to be sick. We had relatively few uninsured and we actually had a little bit lower medical bankruptcy rate than the rest of the country, to begin with. We just didnât improve it with this reform.
Ford: So what does this mean for states that have historically provided poorer health care?
Himmelstein: Well, I think itâs a warning sign that we havenât really done much for people in those states. If you look at places like Texas, Louisiana and California, which have huge numbers of uninsured and tremendous numbers of medical bankruptcies, weâre not going to see much improvement there.
That was Dr. David Himmelstein. [Dr. Himmelstein is professor of public health at the City University of New York and co-founder of Physicians for a National Health Program.]
Black Agenda Radio is heard on the Progressive Radio Network, with Glen Ford, editor of Black Agenda Report, and Nellie Bailey.