Interview With Dr. Steffie Woolhandler (Part 2)
On Friday, House Republicans failed to muster enough support to pass the GOP healthcare plan, which some call Trumpcare. In response, Vermont Senator Bernie Sanders has announced he will soon introduce a bill to create a single-payer healthcare system. Several progressive groups are backing a single-payer system, including the Working Families Party, the Progressive Campaign Change Committee, CREDO, Social Security Works and National Nurses United. For more, we speak with Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program. She is a professor at CUNY-Hunter College and a primary care physician. She is also a lecturer at Harvard Medical School.
This is a rush transcript. Copy may not be in its final form.
DR. STEFFIE WOOLHANDLER: Well, the Republican plan, which was defeated, was just a meaner version of the Affordable Care Act. Unfortunately, both of those acts have left the private insurance industry in the center of the healthcare system. And we actually need to get the private health insurance industry out. Their overhead and profits and the overhead that they impose on doctors and hospitals are costing us $500 billion annually that we do not need to be spending, $500 billion annually that we could save through a single-payer program, use that money to cover the 26 million Americans who now have no coverage, and then to improve the coverage of insured Americans, who often have insurance they can’t afford to use because of the high copayments, the high deductibles. Now, the deductibles and copayments, that’s a problem that predated Obamacare, but Obamacare failed to fix. And a single payer could eliminate that problem, as it has done in other countries.
JUAN GONZÁLEZ: But how would you propose to get from here to there, given the reality that the Republicans have an even larger now base of support in Congress? They control all the houses, and now they’ll soon have a much more conservative Supreme Court. How would you propose to get from where we are there to single payer?
DR. STEFFIE WOOLHANDLER: OK. Well, we have another election in 21 months. We have another presidential election in less than four years. Things can change. And so, we need to be thinking ahead. We’ve already seen a tremendous amount of change just from people getting out to town hall meetings, getting out on the streets, calling their congressmen. Who would have known a, you know, few months ago that the Republicans would not be able to repeal Obamacare? You know, they’re not—they haven’t been able to do it, largely because there’s been pressure from the electorate on the purple state senators and congressmen. So, people need to be out there in the streets. They need to be contacting their congressmen. They need to be demonstrating, educating and preparing for the day when we really can get single payer, which may be sooner than you think.
AMY GOODMAN: So we keep throwing around that word, “single-payer.” Explain exactly what you mean. And is the Sanders plan—it’s just been discussed this weekend. To go right to this, what would be this system in the United States?
DR. STEFFIE WOOLHANDLER: Well, we haven’t seen the Sanders bill yet, but the sort of things that Sanders and congressmen have been putting forward, like Congressman John Conyers, HR 676, would be, you know, everyone just pays their taxes, and everyone is automatically eligible for a program like Medicare, only it would have no copayments, no deductibles for covered services, no participation by the private health insurance industry, so an expanded and improved Medicare, expanded to everyone, improved so it doesn’t have the kind of gaps in uncovered services that do—you know, do exist in the current Medicare program. We’ve been advocating that plan for decades. Frankly, Congressman Conyers and Senator Sanders have, as well. And I’m not sure what piece of legislation—what the legislation is going to look like that gets introduced in the next few days by Welch and Sanders. But certainly, over the long term, we need to be thinking—
AMY GOODMAN: What would happen to the insurance companies?
DR. STEFFIE WOOLHANDLER: Well, the insurance companies would have no role in an efficient Medicare-for-all program. Some of these insurance companies have overhead of 20 percent, meaning that you give them a dollar in premiums, and only 80 cents ever goes to a doctor or hospital or a drug company. Twenty cents stays right there with the insurance company for their overhead and profit. You have to compare that to traditional Medicare, where the overhead is 2 to 3 percent. So, when you add up all of the administrative costs that insurance companies have, the administrative costs they impose on doctors, like me, and hospitals to try to send bills to multiple payers, we’re talking about potential savings of $400 [billion] to $500 billion annually. That’s the money we need to give universal healthcare to everyone.
JUAN GONZÁLEZ: And where do the various stakeholders in the industry—for instance, I know that the hospitals were very much opposed to the current legislation—
DR. STEFFIE WOOLHANDLER: Yeah.
JUAN GONZÁLEZ: —that the Republicans were pushing for. But where would the doctors and the hospitals and the pharmaceuticals and all these others stand in a battle over Medicare for all?
DR. STEFFIE WOOLHANDLER: OK. Well, in the last battle around the Republican bill, there were no doctors’ groups, no real doctors’ groups, supporting the bill. Everyone opposed it. Certainly, nursing groups and hospitals were opposing it, too. In a battle for single payer, things might line up a little different, in that the insurance industry and the pharmaceutical industry will be totally and completely opposed to single payer. For the insurance—health insurance industry, it’s a life-or-death battle. And we can expect them to use all of their lobbying clout to try to prevent it. Big Pharma hasn’t been very happy in single-payer systems, because in single-payer systems, they—they’re forced to lower their prices, in fact, to about half of what people in the United States pay. And indeed, a single-payer system, by lowering those pharmaceutical prices, would save another $100 billion that we could use to cover people. So, pharma is going to be opposed. Insurance industry, the most opposed, because it’s life and death for them.
AMY GOODMAN: So, Reince Priebus, the chief of staff, former head of the RNC, said this weekend, “Democrats, bring your proposals to us now.” We’re seeing a kind of civil war in the Republican Party. Will we see the same in the Democratic Party?
DR. STEFFIE WOOLHANDLER: I’m doubtful about that. Certainly, at this moment, the Democrats, as an opposition party, tend to be much—tend to unify. When they’re actually running things, the divisions come out much more.
AMY GOODMAN: Well, Bernie Sanders is part of the leadership.
DR. STEFFIE WOOLHANDLER: Mm-hmm, yeah.
AMY GOODMAN: So, are you saying that the leadership might actually endorse a Medicare-for-all proposal? And what does a public option proposal mean, a pre-Medicare-for-all proposal?
DR. STEFFIE WOOLHANDLER: Well, the way the leadership can be brought to endorse single payer is by us, the constituents, out there on the streets, calling them up, pressuring them in all the ways we have, saying, “We want single payer.” That’s what will bring the full Democratic leadership around on this.
Public option? You know, public option would be a small step that would ease some of the pain. It would mean that when you are on the exchange buying things, one of your options would be to pay money and buy into Medicare. But, you know, most Americans do not get their care through the exchange. And the public option really doesn’t generate those massive administrative savings that we need in order to be able to afford healthcare for everyone.
AMY GOODMAN: Dr. Steffie Woolhandler, we want to thank you so much for being with us, professor at CUNY-Hunter College, primary care physician, lecturer at Harvard Medical School, co-founder of Physicians for a National Health Program.
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