Interview With Dr. Steffie Woolhandler
By Amy Goodman
Democracy Now!, June 27, 2017
PNHP Note: To view video of this interview, click here.
Twenty-two million Americans would lose their health insurance under the Senate Republicans’ healthcare bill over the next decade. That’s according to the Congressional Budget Office, which released its assessment on Monday. Following the report, Republican Senators Susan Collins of Maine and Rand Paul of Kentucky joined Senator Dean Heller of Nevada in pledging to vote against even debating their party’s healthcare bill this week. Republican leaders had been pushing for a vote as early as today, ahead of the July 4 recess. On Monday, the American Medical Association came out against the Senate bill, writing in a letter to Senate leaders, “Medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels.” For more, we speak with Dr. Steffie Woolhandler, a professor at CUNY-Hunter College and a primary care physician. She is a lecturer at Harvard Medical School and the co-founder of Physicians for a National Health Program.
This is a rush transcript. Copy may not be in its final form.
AMY GOODMAN: Twenty-two million Americans would lose their insurance under the Senate Republicans’ healthcare bill just over the next decade. In addition, Medicaid would see a $772 billion cut over the next decade, while wealthy Americans would receive $541 billion in tax cuts. This is according to the Congressional Budget Office, which released its assessment of the Republican healthcare bill in the Senate Monday.
Following the release of the CBO report, Republican Senators Susan Collins of Maine and Rand Paul of Kentucky joined Senator Dean Heller of Nevada in pledging to vote against even debating their party’s healthcare bill this week. Senator Ron Johnson of Wisconsin has suggested he, too, would oppose voting on the bill. Republican leaders had been pushing for a vote this week, ahead of the July 4th recess.
The Republican bill also faces major opposition from all Senate Democrats, a slew of governors from both parties, the majority of the healthcare industry, hospitals, doctors, nurses, patient advocacy groups, the U.S. Conference of Catholic Bishops, and even members of the far-right Koch brothers’ political network, who claim the legislation is not sufficiently conservative.
This is Vermont Senator Bernie Sanders speaking Monday on the Senate floor.
SEN. BERNIE SANDERS: Mr. President, today’s Congressional Budget Office analysis of the Trump-McConnell healthcare bill gives us 22 million reasons why this legislation should not see the light of day. What CBO tells us, in truth, is that this bill really has nothing to do with healthcare. Rather, it is an enormous transfer of wealth from the sick, the elderly, the children, the disabled and the poor into the pockets of the wealthiest people in this country. Mr. President, according to CBO—and that report just came out a few hours ago—this bill would throw 22 million Americans off of health insurance, cut Medicaid by over $770 billion, defund Planned Parenthood and substantially increase premiums for older Americans. … Mr. President, this, in fact, is a barbaric and immoral piece of legislation.
AMY GOODMAN: On Monday, the American Medical Association came out against the Senate bill. In a letter to Senate leaders, the AMA wrote, quote, “Medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels,” unquote.
Meanwhile, a stunning new study in the Annals of Internal Medicine is estimating some 28,600 people could die early deaths if they lose health insurance.
We’re joined now by the author of the study, Dr. Steffie Woolhandler, professor at CUNY-Hunter College, primary care physician, lecturer at Harvard Medical School and co-founder of Physicians for a National Health Program.
Welcome to Democracy Now!
DR. STEFFIE WOOLHANDLER: My pleasure.
AMY GOODMAN: Tell us what you found.
DR. STEFFIE WOOLHANDLER: We reviewed the world’s scientific literature on the relationship between health insurance and mortality. And there is really now a scientific consensus that being uninsured raises the death rates. It raises your death rates by between 3 and 29 percent. And the math on that is that if you take health insurance away from 22 million people, about 29,000 of them will die every year, annually, as a result. That’s what we found by reviewing the literature. There was a similar review in New England Journal of Medicine. We punished our own study in the Annals of Internal Medicine, which is the official organ of the American College of Physicians, the nation’s largest medical specialty society. So, being uninsured raises your death rate. That is established scientific consensus. And many of the Republicans have been trying to say, “Oh, you can take away health insurance from 22 million people, and nothing will happen.” That’s simply contradicted by the scientific consensus.
AMY GOODMAN: And explain how people die as a result.
DR. STEFFIE WOOLHANDLER: Well, people might have an acute illness, like major trauma. You get hit by a car, and you have to go to the hospital. If you’re uninsured and you have major trauma, your death rates are higher. You might have an illness like breast cancer. If you’re uninsured and you have breast cancer, your death rates are higher. But mostly this has to do with that routine medical care to treat high blood pressure, to treat diabetes, before they cause complications, and to prevent those serious complications and deaths. Seems like hypertension, high blood pressure, is probably the largest single contributor to deaths among uninsured people. You need to be taking medicines to control high blood pressure to prevent strokes and heart attacks and death.
AMY GOODMAN: So this number, 22 million people will lose their health insurance over the next 10 years, and then it only goes up from there.
DR. STEFFIE WOOLHANDLER: Well, according to the Congressional Budget Office, yes, it goes up from there, because the Medicaid cuts in the Senate bill are delayed, but then they’re very, very deep. They’re even deeper over the long run than what was in the House bill. So, Medicaid is going to be cut not just for poor people, but for people in nursing homes. You know, most people in a nursing home eventually have to rely on Medicaid to pay the bill, because nursing home care takes all your money, and you have to rely on Medicaid. If you have a disabled child, you have to rely on Medicaid. If you have a relative who has serious mental illness or substance abuse, they’re going to be relying on Medicaid. So it takes money from all of these people, not just the folks who are poor now, to give this giant tax cut to the top 1 percent of taxpayers.
AMY GOODMAN: I wanted to turn to a comment made by the Idaho Republican Congressman Raúl Labrador during a town hall meeting last month. He came under fire for his answer to this question from an audience member.
AUDIENCE MEMBER: You are mandating people on Medicaid accept dying. You are making a mandate that will kill people.
REP. RAÚL LABRADOR: No, no one wants anybody to die. You know, that line is so indefensible. Nobody dies because they don’t have access to healthcare.
AMY GOODMAN: “Nobody dies because they don’t have access to healthcare.” Dr. Steffie Woolhandler?
DR. STEFFIE WOOLHANDLER: Well, Raúl Labrador said it. Senator Ted Cruz has said that. Marco Rubio has said that. Secretary Tom Price, the secretary of health and human services, has implied that, that you can be uninsured and nothing happens. That’s simply not true. The science is showing us that if you lack health insurance, you don’t get the care you need to stay healthy, and that people die earlier as a result. And I think it’s a—the Republicans recognize this is a very dangerous idea for them, that people are going to die because of their behavior. But that’s what the scientific consensus is saying.
AMY GOODMAN: So, what has to happen now?
DR. STEFFIE WOOLHANDLER: Well, right now, the betting markets are saying it’s 50/50 that this Senate bill will pass. So when something’s 50/50, that means now is the time to mobilize. You know, you can call your senator. You can call your congressman. You can demonstrate. There’s demonstrations all over the country about this bill. You can tweet about it. You can tell your friends about it. But now is the time to really get active on this issue.
We also need to be saying, “Let’s move forward to single payer, that covers everyone, not backward through this repeal.” You know, even under the Affordable Care Act, 28 million Americans have no health insurance. Many Americans are underinsured. They have insurance they can’t afford to use because of gaps in their coverage, like copayments, deductibles and uncovered services. So we need to be fighting this Republican step backward, but also saying to our Democratic legislators, “We need to be moving forward to single payer,” that will actually improve care for all Americans.
AMY GOODMAN: You were never an advocate of Obamacare. And now, what will happen? I mean, even if they don’t vote on it, the gutting of the health insurance—of health insurance today is, you know, moving full speed ahead. So what does it look like even if this bill doesn’t move forward?
DR. STEFFIE WOOLHANDLER: Well, there’s more support for the Medicare-for-all, single-payer idea than ever in history. Polls are showing 56 percent of the American people support the idea. The majority of House Democrats have endorsed the Conyers bill, HR 676, a Medicare-for-all bill. More than half of House Democrats have endorsed that bill, about 112. Senator Sanders is putting a bill into the Senate in July. So this is a great time for people to be saying, “We need to move forward from the ACA to single payer.”
AMY GOODMAN: And what would Medicare for all look like?
DR. STEFFIE WOOLHANDLER: OK.
AMY GOODMAN: How would that happen?
DR. STEFFIE WOOLHANDLER: OK, well, it would be expanded and improved Medicare for all. You would get a Medicare card the day you were born, and have it your entire life. All medically necessary care would be covered by a tax-funded Medicare-for-all program, that’s—it would be a lot cheaper over the long run, because you save so much money on administrative costs. All that billing and insurance enrollment is extremely expensive in the United States, consuming 31 percent of total U.S. health spending, according to our research that’s appeared in New England Journal of Medicine. By going to a simple single-payer system, you could save about half of it, about $500 billion a year, which you could use to get to universal healthcare and to remove copayments and deductibles from people who now have them.
So, a single—that’s what’s happened in other countries. Canada has a single-payer system—doesn’t work perfectly, but it does cover everyone. Scotland has a single-payer system. Much of Western Europe has single-payer systems. They cover everyone. They live two years longer. They pay less for healthcare than we do.
AMY GOODMAN: Well, now, this is important, because you talked about mortality, if this bill were to pass and become law, that close to 29,000 people a year could die, more Americans could die. What is our mortality rate with our insurance system compared to others?
DR. STEFFIE WOOLHANDLER: Well, Americans live two to three years shorter than people in Canada, just across the border, with very similar culture, very similar lifestyle, yet we live two years shorter. Similarly, we live about two years shorter than people in many Western European countries. And some of the studies we reviewed in our article actually look at the international evidence, which, again, is totally consistent with the idea that being uninsured is bad for your health, it can cause deaths, and that being fully covered for all medically necessary care, as would happen under Medicare for all, makes people healthier, and it prolongs their life.
AMY GOODMAN: I wanted to turn to President Trump being interviewed recently by Peter Hegseth of Fox & Friends.
PRESIDENT DONALD TRUMP: Because I want to see—I want to see—and I speak from the heart—that’s what I want to see. I want to see a bill with heart.
AMY GOODMAN: Your response?
DR. STEFFIE WOOLHANDLER: Well, Trumpcare has no heart whatsoever. The House bill was going to throw 23 million people off insurance. The Senate bill is going to throw 22 million off in 10 years but then keep throwing more off. You know, they’re going to make health insurance worse for people with private coverage by getting rid of the rules about what has to be covered, so your private insurance will no longer have to cover maternity care. They’re actually robbing money from the Medicare trust fund. They’re taking $117 billion out of the Medicare trust fund, which pays for the health insurance when people turn 65. $117 billion is taken out of that trust fund to give tax cuts to the top 1 percent of taxpayers. That is not heart. That’s the opposite of heart.
AMY GOODMAN: Well, I thank you very much for being with us, Dr. Steffie Woolhandler, professor at CUNY-Hunter College here in New York, primary care physician, lecturer at Harvard Medical School, co-founder of Physicians for a National Health Program. And we’ll link to her report on the mortality that would be related to the Republican healthcare bill becoming law. Roughly 28,600 more Americans could die per year.