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BILL MOYERS: Welcome to the JOURNAL. Health care reform. Itâs the talk of the town – if the town is Washington, D.C. But some possible reforms arenât being talked about at all. Not officially, that is.
The White House and Congress have kept the lid on one of the most controversial but popular options, known as single-payer. Itâs a story the mainstream press has largely ignored and thatâs why we are covering it in this broadcast.
You donât expect to see these people demonstrating in our nationâs capitol. Youâll most likely encounter them in the examining room, the operating theater, the clinic or the laboratory.
Theyâre doctors, nurses, and other health care professionals, unaccustomed to making themselves heard in the streets.
GERI JENKINS: People are fed up with seeing the process hijacked by the insurance industry. So, we have to keep the heat on. We have to keep putting the pressure on them to have the voice of the people heard and what people in this country really want is, which is a single-payer system, publicly funded, privately administered. And weâre going to keep pushing to make sure that message gets out there.
PROTESTERS: Single-payer! Single-payer! Single-payer!
BILL MOYERS: Thatâs exactly what brought them here. They want the White House and Congress to know they canât do their job taking care of us under the health care system the way it is today.
DR. MARGARET FLOWERS:I wanted to take care of patients. And to have insurance companies and administrators that donât know anything about medicine, telling us what we can and canât do, was really ridiculous to me. You know, I couldnât understand it.
DAN HENDERSON: Are we going to let insurance giants decide whatâs best for Americans?
PROTESTERS: No!
BILL MOYERS:Theyâve come here to tell policy makers how the life-and-death choices they make in caregiving are affected by decisions made in corporate board rooms and behind closed doors in Washington.
DR. PAT SALOMON:There were all these arbitrary decisions, which were not about peopleâs health care. They were about profits. How can I get away with the least amount of care offered to this person, so that their premium is going to give me the most profit? Thatâs not the way health care decisions should be made. Itâs wrong. Itâs wrong for us as a nation.
GERI JENKINS:Weâre there around the clock. So we feel a real sense of obligation to advocate for the best interests of our patients and the public. You know, you can talk about policy but when youâre staring at a human face, itâs a whole different story. So I think sometimes people who define policy havenât seen the human side up close and personal like we see it every day.
BILL MOYERS: What the protestors want is single-payer health care – a non-profit system that would remove the role of the insurance companies and unify the financing of the health care system under one entity, a government run organization, like Medicare, that would collect all health care fees, and pay out all health care costs.
DEANN MCEWEN:Single-payer is really the only solution. Itâs the only way weâre going to be able to equitably distribute the resources that we have. Itâs the best system that it can possibly be and serve the most number of people.
PROTESTERS: Health care! Not warfare!
BILL MOYERS:A day earlier some of these nurses and doctors showed up at the Senate Finance Committee where Democratic Chairman Max Baucus was holding hearings on health care reform.
SEN. MAX BAUCUS: Today we host the third of our three roundtable discussions on health care reform.
BILL MOYERS:To protest that no advocate of single-payer had been allowed a place at the table, some stood, turned their backs to the committee, then walked out.
Five stayed. Speaking out one by one, interrupting the proceedings.
PROTESTER: We want guaranteed health care. We want to see our doctors when we need.
SEN. MAX BAUCUS: Can we have a recess until order can be restored?
PROTESTER: We want a single-payer system.
PROTESTER: Health care should be for patients, not for profits.
BILL MOYERS: They were quickly gaveled down, escorted out, and arrested.
PROTESTERS: Free Deann now! Free Deann now!
BILL MOYERS: For nurse Deann McEwen it was worth a little jail time just to be heard.
DEANN MCEWEN:Theyâre our public representatives. You know? Theyâre supposed to represent us. And here they are, representing the interests of the corporations.
And itâs outrageous. And itâs almost like how dare you not listen to us? You know? Weâre here to tell you what we see. Weâre the experts, not you. You sit in that chair and you bring the gavel down on single-payer. Youâre bringing the gavel down on democracy. And you know, not in my lifetime. Not on my profession.
BILL MOYERS: The next day, with several hundred reinforcements, they marched on Congress.
DR MARGARET FLOWERS: Guess what Senator Baucus? You need the police because youâre the criminals, we are not committing a crime, you are committing the crime of not listening to our voice and not being responsible to the American people.
BILL MOYERS: Two members of Congress spoke up in support. Freshman Representative Eric Massa from upstate New York, a DemocratâŠ
REP. ERIC MASSA: Allow us to get President Obama on the right track, cover his back, give him the political cover he needs to make the tough decisions.
PROTESTER: Thank you Senator Sanders.
BILL MOYERS: And Vermontâs Independent Senator, Bernie Sanders.
SEN. BERNIE SANDERS: All over this place, there are thousands of lobbyists representing greed and short-term profits. And itâs nice to see ordinary people coming here to Washington fighting for the rights of their patients and all of our people.
Our current health care system is disintegrating. We need a new system. And what we need is a system not based on the profits of the private health insurance. We donât need a system mired down in bureaucracy and waste.
We donât need a system where CEOs earn all kinds of outrageous salaries. We donât need a system in which companies are paying out huge profits to their stockholders. What we need is a single-payer, national health care system.
BILL MOYERS: After the rally, they fanned out through the halls of Congress, to make the
case for single-payer. But theyâre battling the odds – against deep pockets and swarms of highly-paid lobbyists for huge corporations that reap billions from health care profits. But, they say theyâre not giving up.
DONNA SMITH: The people still matter. We do matter in this process, and itâs the only thing. If we give up, then we do hand it over to the corporate interests. No human rights struggle in the history of this countryâs been an easy one. This is a human rights struggle. Weâre going to win it, but weâre going to have to keep fighting and struggling and speaking out. There may have to be more people arrested. There may have to be more brave nurses out there speaking out, but weâre going to win this.
BILL MOYERS:Donna Smith is with me now. She works as a community organizer and legislative advocate for the California Nurses Association, whose 85 thousand members across the country were early champions for a single-payer program. Welcome to the Journal.
DONNA SMITH: Thank you very much, Bill.
BILL MOYERS: Whatâs going on that you have to take to the streets?
DONNA SMITH: Theyâre not listening. Congress is not listening to advocates of a single-payer system. In fact, they seem to be bent on one direction and one direction only.
BILL MOYERS: What is that?
DONNA SMITH: Expanding the broken system that we have now. We have so many insurance companies involved in making health care decisions in this country, and so many Americans suffering at the hands of those insurance companies, whether itâs through higher premiums and higher co-pays and deductibles, and all the things that American citizens deal with – not to mention 14 thousand of us losing employer-based health care benefits every day. So having-
BILL MOYERS: 14 thousand-
DONNA SMITH: A day, during this economic recession.
BILL MOYERS: Regular people?
DONNA SMITH: Regular people losing their employer-based system. And yet Congress, certainly the Senate, and certainly – as evidenced through Senator Baucusâs committee – seems to be just on the bee line to make a system where we all have to purchase that private health insurance product that has not been serving us very well as patients, and certainly as nurses and doctors, in this country for many years.
BILL MOYERS: So that moves you out to the streets? That says this is the only way weâre going to be heard?
DONNA SMITH: I think itâs the only way we can. So many formal requests have gone in to the, not only to Congress, but to the administration. President Obama set out to have White House forums on health care reform. He had his first one at the White House. Single-payer advocates had to really protest and get quite active and fax and call, and doctors and nurses threatened to go to the streets to be outside the White House advocating for single-payer, to be let into that discussion. And finally two representatives were invited into that White House forum. They didnât speak, however, they were invited in.
BILL MOYERS: Now, you must have an opinion as to why that is.
DONNA SMITH: Because theyâve already made a choice. Theyâve already made a choice, I think, to stay with the moneyed interest, the people who fund the campaigns, the people who fuel the government system as we know it now. You know, certainly where Senator Baucus is concerned, heâs the third highest recipient of donations from the health insurance and health care industry in general. The third. The highest Democratic recipient. And sometimes I feel so strongly that he ought to have to disclose that at the beginning of every single hearing that he chairs.
BILL MOYERS: But he says, of course, âThat doesnât affect my judgment. This doesnât affect my decision.â
DONNA SMITH: I donât think Iâd buy that. And I donât think thereâs very many people in this country that would buy that. If you have someone whoâs giving you money to insure that your position to stay in a very powerful role in the United States Senate – thatâs a prime position politically.
BILL MOYERS: What is it you would like those folks to know, those regular citizens to know about this issue, about single-payer and why itâs important to them?
DONNA SMITH: I tell people, I always ask them to tell me if they understand single-payer and what itâs all about. Itâs a great idea from the left, which is public financing, combined with a great idea from the right, which is private delivery. And you put it together in one system that takes out the waste and the abuse thatâs really happening, which is where all the money goes into the health insurance. Up to 30 percent of the costs have nothing to do with health care at all and everything to do with fueling the health insurance needs.
And Iâve had so many tell me, doctors and nurses who work in offices where doctors have had to spend hours of every day not in patient care but on the phone, hassling with insurance companies, trying to negotiate to get a patient a treatment. It makes it very difficult to deliver the right kind of care.
BILL MOYERS: I saw your testimony before Congress two years ago, 2007. And you were angry.
DONNA SMITH: Very angry.
DONNA SMITH AT SENATE HEARING: You left me broken and battered because you failed to act on health care reform. Just as I have come out of the shadows of economic ruin and shame, so, too, will others come forward to hold you accountable. Remember the hard-working people who elected you. Their bankruptcy shame, my bankruptcy shame due to medical crisis, really is your shame. You are the body that could have acted and has yet not done so.
BILL MOYERS: You had had cancer of the uterus, and while your husband was suffering from heart disease. And you went bankrupt even though you were insured?
DONNA SMITH: Yep. Thatâs why I was asked to testify. I tell people that our story, my husbandâs and my storyâs not unique. Itâs not because weâre so unique that people talk about us because weâre not unique. So many millions of Americans do what all middle-class families do. You hang on. You watch your premiums rise over time and your benefits shrink. And as long as youâre healthy, you absorb some of that cost and you deal with it and you make decisions.
But if you get sick, you find out just how inadequate that insurance may be. And I tell people not only did I have health insurance, I had Aflac disability insurance and a health care savings account on top of that. So we were like the prime example of responsible people who try and keep ourselves covered. And yet when we got sick, there was no way the deductibles and out-of-pocket maximum exposure added up so quickly that we were buried very quickly financially.
BILL MOYERS: There are people who would listen sympathetically to that story and nonetheless say that to move to single-payer now would be disruptive of the health care system. Thatâs
the term they use, disruptive.
Do you think that moving to a single-payer plan, even if it were politically feasible, would disrupt the health care system?
DONNA SMITH: What a great question. And you used some of my favorite words in that, âpolitical feasibility.â I often answer that real quickly in saying I hear tell a year and a half ago that a man named Barack Obama, when polled against John McCain, would have lost in every state but HawaiĂ and Illinois. So political feasibility is all a relative thing, isnât it?
And I trust that if he wanted to make single-payer happen, he could make it happen. Would it be politically difficult? Absolutely. I sat in a committee meeting with some staff members of Senate Finance some time ago. And somebody gave this argument, itâs not politically feasible to do single-payer. So many people who will say, âDonât let the perfect be the enemy of the good.â
And I think, well, thatâs an interesting analogy, acknowledging that the perfect may be single-payer but that you canât do it âcause itâs politically not feasible. So I sat there and I let this person talk. And he said, thereâs a visceral reaction to single-payer.
And I let him talk for a minute. I said, âFrom whom? Whoâs the visceral reaction from?â The Congress, he said, because elections are reality. These people have to run for new terms every so often. The money and the power thatâs exerted in Washington on them from the health insurance and health industry lobbies is very powerful. Itâs hard for them to break out of that loop. It takes an awful lot of nurses and doctors in the streets and being arrested, apparently, and more than 60 percent of the American public to say to them, âWeâre behind this. This is what we want you to do.â
And in terms of disrupting the system, oh, my god, talk about disruption. I just saw Max Baucusâs white paper has just been released on what he envisions or what his committee, not just him, but his committee envisions for the future of health care reform financially in this nation. Wow. You talk about complexity and difficulty with what weâll all have to deal with.
They envision mandates going into effect January 1st of 2013. But any insurance reforms or any tightening up of what happens to insurance companies would be allowed to phase in over a ten-year period.
BILL MOYERS: So what is your strategy? The clock is ticking. The President and Congress have said we want health care reform by the 1st of August. Thatâs just a few months away. What will you be doing between now and then?
DONNA SMITH: Weâre going to stay very active. The nurses, of course, are going to stay in the streets wherever they need to, and very much on the minds of these folks to say this has not been an intellectually honest or policy honest discussion that weâve had so far in this country. And donât you think we owe that to each other to at least be intellectually honest about this discussion? And letâs put it all out on the table and argue on the merits. Letâs have a debate on the merits of single-payer on the floor of the Congress and see where it goes from there.
BILL MOYERS: Youâve been saying that, though, Donna Smith. Youâve been saying that, but last week during your rally, only four members of Congress showed up.
DONNA SMITH: You get louder. You get more insistent. You do what many of our nurses are doing. Weâre going to do a little more action in California next week. You know, Californiaâs passed single-payer legislation twice now. Governor Schwarzenegger has vetoed it twice. I suspect that California will continue to pass it until they have a governor who signs it.
There are some people who believe that passing single-payer will have to come through a state level first. And that once one of the major states passes it, that it will topple over into the rest of the nation. As people see it as the most cost-effective, smartest way to do it not only for governments but for American families.
BILL MOYERS: When we did a report on the Journal 12 or 15 months ago on the California nurses and the fight out there for single-payer, we were inundated with mail saying theyâre socialists and youâre a fellow traveler. What do you say to people like that, who read into what youâre doing a call for state government-run socialistic medical care?
DONNA SMITH: I laugh a little bit in light of the last six months on how much money weâve thrown into Wall Street and how much money weâve thrown in keeping financial markets stable in this country. In three days, we were able to come up with three quarters of a trillion dollars to throw into Wall Street. So the argument about socializing things and making things government-run seems a little bit yesterday to me, just intellectually.
But I tell people, you know, look, donât fear this. This is not- youâre not turning into a Communist red nation. Please donât be afraid. Even in polling data where the words âsocialized medicineâ is used, even in that polling data, almost 50 percent of the American public say, âOkay. Do it.â And data where we just ask about a national health insurance system, and thatâs through âThe New York Timesâ and CNN and Yahoo! and a number of polls, 60 percent of the American public say weâve got to have a national health program. We just have to do it. Itâs the only way we fix this mess. Itâs spun out of control. Itâs going to bury us financially. Itâs going to mortgage our children, and it kills people. It just is not working.
BILL MOYERS: Donna Smith, thank you very much for being with me on The Journal.
DONNA SMITH: Thank you so much, Bill.
SEN. MAX BAUCUS: Weâve got an extremely open process and I just urge everyone to respect the views of others but not interrupting those who are speaking. There will be plenty of time to be with everybody. This is a long haul process. And so, those of you in the audience who are not panelists and wish to be heard, I urge you just to contact my office, weâll figure out a way to talk to you. Iâll figure out a way to listen to you. Iâll be there, personally, to listen to you.
BILL MOYERS: So just who has been getting the chance to testify before Congress? A quick look at this panel of witnesses appearing before the Senate Finance Committee, it tells you all you need to know. The Business Roundtable. The U.S. Chamber Of Commerce. The conservative Heritage Foundation. Representatives of the insurance industry, including Blue Cross Blue Shield – all in favor, more or less, of the status quo.
Progressive groups have been heard from, too – the Center For American Progress, the labor union SEIU, Families USA – those who largely support President Obamaâs goal of a public health insurance plan to compete with the private sector. Hopefully this competition would create a real market that would bring down costs.
Once upon a time, a young Barack Obama thought single-payer was the answer. Listen carefully:
PRESIDENT OBAMA: I happen to be a proponent of a single-payer universal health care plan.
BILL MOYERS: That was State Senator Obama, who said there was just one big obstacle standing in its way.
PRESIDENT OBAMA: We may not get there immediately, because first weâve got
to take back the White House, and weâve got to take back the Senate, and weâve got to take back the House.
BILL MOYERS:Fast forward six years. President Obama has everything he said was needed – Democrats in control of the executive and both houses of Congress. So whatâs happened to single-payer?
For one thing, as President, Obama is now looking for consensus, peace among all the parties. There was a big pow-wow in Washington last week. The president asked representatives of the health care business to reason together with him at the White House. They came, listened and promised to cut health care costs voluntarily over the next ten years.
Some of us looking on at this charm offensive – some of us whoâd been around a long time – were scratching our heads. Weâve heard this call for voluntary restraint before.
Way, way back in the 1970âs Americans were riled up over the rising costs of health care. As a presidential candidate, Jimmy Carter started talking about how the government would be clamping down.
JIMMY CARTER:Weâve built a haphazard, unsound, undirected, inefficient non-system, which has left us unhealthy and unwealthy at the same time. So we must plan, and decisively phase in, simultaneous reform of services and refinancing of cost.
BILL MOYERS:When Carter got to the White House, the very industry that only a decade earlier had tried to strangle Medicare in the cradle, seemed uncharacteristically humble and cooperative. âYou donât have to make us cut costs,â they promised. âWeâll do it voluntarily.â So Uncle Sam backed down, and, you guessed it, pretty soon medical costs were soaring higher than ever.
By the early 1990âs, the public was once again hurting in the pocketbook. Now Bill and Hillary Clinton, feeling our pain, tried once more.
HILLARY CLINTON: Universal coverage has to be the bottom line and do not let anybody tell you any differently.
BILL MOYERS: This time the health care industry acted more like Tony Soprano than Mother Teresa. It came after the Clinton reforms with one of the most expensive and deceitful public relations and advertising campaigns ever conceived.
MAN: Find what you like in the Presidentâs plan?
BILL MOYERS: Who could forget Americaâs sweethearts, Harry and Louise?
WOMAN: It doesnât have the choice we want, look at this. The government picks health plans, then we have to pick a plan from their list.
BILL MOYERS: Paid for, of course, from the industryâs swollen profits.
As the health care business dumped the mangled carcass of reform into the Potomac, they said once again, âDonât worry, weâll cut costs voluntarily.â Sure. Now health care costs are rising 6 percent a year. Anyone with a memory could be excused for raising their eyebrows at these latest promises.
But leaving nothing for granted, the industry is pouring big money into lobbying, more than half a billion dollars last year alone, according to the non-partisan Center for Responsive Politics. Theyâre also shelling out megabucks for a publicity blitz and ads attacking Obamaâs public plan or any health care reform that threatens to reduce the profits from sickness and disease.
TV ADVERTISEMENT: With Congress starting on health care, letâs remind the politicians, Americans know what works.
BILL MOYERS: This is from a group calling themselves Conservatives for Patientsâ Rights. Theyâve been spending more than a million dollars on ads like this in the month of May alone. Theyâve hired a conservative public relations firm called CRC. You remember CRC – the same high-minded folks who brought you the Swift Boat Veterans for Truth, the gang who savaged John Kerryâs service record in Vietnam. Just who runs Conservatives for Patientsâ Rights?
RICHARD L. SCOTT: Letâs have real reform that puts patients first.
BILL MOYERS:The guy in the ads. His name is Richard L. Scott, an entrepreneur who took over two hospitals in Texas and built the largest health care chain in the world, Columbia/HCA.
In 1997, Scott was fired by the board of directors after the company was caught ripping off the feds and state governments for hundreds of millions of dollars in bogus Medicare and Medicaid payments, it was the largest such fraud in history. The company had to cough up $1.7 billion dollars to get out of the mess. Scott got off – you should pardon the expression – scot-free. According to published reports he waltzed away with a $10 million dollar severance deal and $300 million worth of stock. So much for lower overhead.
Rick Scott and other like-minded industry representatives have made their views known. Meanwhile only a handful of expert witnesses in favor of the single-payer option have been allowed to testify in the many congressional hearings on health care reform held this yearâŠ
One of them was Dr. David Himmelstein, who is with me now. Dr. Himmelstein is on the faculty at Harvard Medical School and serves as head of the Division of Social and Community Medicine at Cambridge Hospital, where he practices as an internist.
He and his partner Dr. Steffi Woolhandler founded the advocacy group Physicians for a National Health Program.
Also with us is Dr. Sidney Wolfe, the acting president of the non-partisan group Public Citizen. Heâs been director of that organizationâs health research group since its creation in 1971. Dr. Wolfe also teaches internal medicine at Case Western Reserve and is a senior associate in the Department of Health Policy and Management at Johns Hopkins University. He edits the website worstpills.org.
Welcome to you both.
DR. SIDNEY WOLFE: Nice to be here.
BILL MOYERS: Dr. Wolfe, I am puzzled as a journalist as to why this subject of single-payer, whether one is for it or against it, seems totally out of the debate in Washington. Itâs just not on the table. And itâs not in the- on the radar screen of the press. Why do you think that is?
DR. SIDNEY WOLFE: I think the reason is, unfortunately, simple and frightening. Which is the power of the health insurance industry. Whereas, only about one out of 14 people trust the insurance industry as being honest and trustworthy.
BILL MOYERS: Thatâs a poll?
DR. SIDNEY WOLFE: Itâs a Harris poll last fall. One out of 14 people think that the health insurance industry is honest and trustworthy. On the other hand, in Washington, theyâre in bed with the health insurance industry. Just as Wall Street and the banks have bought the Congress to get what they want in terms of the bailout, the health insurance industry has bought and influenced members of Congress and the President so much that they donât even consider the possibility of a plan that doesnât have a health insurance industry.
DR. DAVID HIMMELSTEIN: Thatâs the big problem here is people want to find a solution that they can get through without a big fight with the insurance industry. Unfortunately itâs economically and medically nonsensical – you canât actually have a health care program that works, if you keep the insuranc
e industry alive.
BILL MOYERS: Well, then how do you account for the fact that so many people in other polls say, âWeâre satisfied with what we have for health care, and we donât want it taken away from usâ?
DR. DAVID HIMMELSTEIN: Well, people are satisfied many times with their doctor and with the hospitals they go to. And most Americans arenât sick and donât actually have experience of their health insurance. But when you get sick, and actually have to use your insurance, thatâs when people find out the dark side of the policies they have. Huge co-payments, huge deductibles.
We did a survey of people filing for bankruptcy in courts around the country. Half of the bankruptcies are medical bankruptcies in this country. And of those medical bankruptcies, three quarters of those people had insurance, at least when they first got sick. But people have insurance that goes away after they actually need it.
BILL MOYERS: But why in the dozen or so hearings that Iâve tracked in Washington recently on health care reform have there been so few advocates of the single-payer?
DR. SIDNEY WOLFE: The seats at the table, or the witnesses at the hearing are, in a sense, controlled by the health insurance industry. They donât want someone essentially saying, âWe donât need a health insurance industry. We can do what most other countries in the world have done. Have the government collect the money and pay the bills and get rid of all these people who are wasting $400 billion a year on excessive administrative costs.â
So, we have got a fragmented health insurance industry. And it thrives on being fragmented. The drug countries make much more money with the fragmentation, because thereâs no price control. The insurance companies make much more money, âcause they can push away people who arenât going to be profitable. The only people that suffer are the patients.
Itâs- 1968, I was one of a group of physicians that disrupted the American Medical Associationâs convention, because they were saying then, and in, for all practical purposes itâs still true, âHealth care is not a right. Itâs a privilege.â And we said, quietly, as we took over the microphone, âThatâs wrong.â Weâre now 41 years later, and itâs still a privilege. And too many people in this country donât have that privilege. Itâs resulting in huge numbers of people being ill, sick, and almost 20 thousand people dying a year because they donât have health insurance.
DR. DAVID HIMMELSTEIN: And thereâs big money being made. I mean, thatâs the basic problem here. There are billions being made from the private health insurance industry, from the drug industry, and that gets spread around Washington. The biggest recipients of insurance money, of drug money, are the powerful people who chair the committees, who decide what witnesses testify. President Obama himself received huge amounts of insurance money.
BILL MOYERS: But then letâs establish what single-payer is. Can you do that succinctly?
DR. DAVID HIMMELSTEIN: Itâs what we used to call national health insurance. So government collects the money for health care from taxes, you donât pay premiums, instead you pay taxes, and pays all the bills. Hospitals remain privately owned and operated. Doctors remain mostly in private practice. But their bills go to the government insurance program, just as they do today with Medicare, but weâd be able to streamline the payment system if we had only one payer instead of Medicare being one among many.
So a hospital would get paid like a fire department does today. You have one check a month that pays for the entire operation. And that means you can eliminate the huge billing apparatus of the hospitals and the doctors offices where weâre employing many people to do our billing. And fighting with insurance companies. You save $400 billion a year that way.
DR. SIDNEY WOLFE: Hereâs an example of what Davidâs talking about. Over the last 30 plus years there have been maybe two and a half, three times more doctors and nurses. Pretty much in proportion with the growth in population. There are 30 times, 3-0 times more health administrators. These people are not doctors. Theyâre not nurses. Theyâre not pharmacists. Theyâre not providing care. Many of them are being paid to deny care. So, they are fighting with the doctors, with the hospitals to see how few bills can be paid. Thatâs how the insurance industry thrives by denying care, paying as little out as it can, getting the healthiest patients, and yet getting reimbursed as though these patients were sicker than they really are.
So, itâs a system that is guaranteed to waste a lot of money. And what weâve said is that the amount of money thatâs just being wasted in one year is enough to pay for more than enough of the premiums for those that are uninsured and the people that are underinsured. So, itâs not a matter of bringing more money. I mean, the industry is now saying, âWe could save $2 trillion over the next ten years. Let us. Trust us. We will lower our costs and everything.â The amount that can be saved over the next ten years by just eliminating the health insurance industry is $4 trillion, in one fell swoop.
BILL MOYERS:Iâve heard you say that several times. Iâve read youâre saying it. We can do away with the health industry. I mean, themâs fightinâ words, a very powerful part of the economy, and theyâre a powerful part of the political statute, as David said.
DR. SIDNEY WOLFE: It absolutely is. And in Canada, back in 1970 or so, they were spending the same percentage of their gross national product as we were on health. They had huge numbers of uninsured people. They had the same insurance companies. Blue Cross Blue Shield. They decided to just get rid of the health insurance industry. That it was the only way to go. They had experimented with it in Saskatchewan ten years earlier. It worked so well, they couldnât wait to do it nationally. So, where thereâs a will, thereâs a way. There is no way we are ever going to get to having good health insurance for everyone, as long as thereâs a health insurance industry, in the way, obstructing care.
BILL MOYERS: What do you say to the argument, though, of people whoâve gone to Canada, and looked at that system. âWell, there are long waiting lines. You canât choose your doctor.â In fact, conservative critics say that this will lead to what they dread which is socialized medicine. Would single-payer in fact mean I could not choose my doctor?
DR. DAVID HIMMELSTEIN: Well, in Canada, actually, you can go to any doctor, any hospital in the country.
DR. SIDNEY WOLFE: Much more choice than here.
DR. DAVID HIMMELSTEIN: Yeah, Canadians have better choice than we do. They spend half as much per person on health care as we do. And if youâre going to cut our budget by 50 percent, weâd have to have some waiting lines. But if weâre willing to keep spending at our current levels, we could cover everybody with first dollar coverage with terrific access to care.
BILL MOYERS: What do you mean first dollar coverage?
DR. DAVID HIMMELSTEIN: No co-payment, no deductible. You go to the doctor. The whole bill is paid. Any doctor, any hospital in the country. Thatâs the model. And thatâs not just m
e who says that. The Congressional Budget Office has said that in the past. The Government Accountability Office says weâre spending enough to do that. And weâre really talking about social insurance, like Medicare is social insurance. But doctors and hospitals remaining privately owned.
BILL MOYERS: Thatâs a good point. Because weâre struggling to manage Medicareâs costs. Great alarm bells going off about the rising cost of Medicare. And are you here proposing more of the same?
DR. DAVID HIMMELSTEIN: Well, Medicare actually takes care of the sickest, most expensive parts of the system. And in a way, they subsidize the private insurers. They take the unprofitable patients off the private insurerâs hands. But also Medicare has adopted the private insurance method of paying for care. So, instead of paying hospitals in a lump sum, without the bureaucracy, they subcontract with Blue Cross, basically, to pay the bills, band aid by band aid, aspirin by aspirin. And thatâs an inefficient way of doing it, that we ought to do away with. We could save Medicare huge amounts of money, as well as the rest of the system.
DR. SIDNEY WOLFE: I mean itâs interesting, aside from the obvious health benefits keeping 18 thousand or 20 thousand people from dying every year, because they donât have insurance, they also- itâs good for business. Because they are essentially taking some- itâs not like a bailout for business, but its money that is going to relieve business of worrying about escalating costs, having to drop workers.
I mean, in this country, the response to these escalating costs is a number of employers say, âWe just arenât going to have health insurance anymore.â So, Canada has been a very good model. Itâs been going on for 38 years. Canadians would revolt, literally, if someone said, âWeâre going to take away your health insurance system.â
BILL MOYERS:Am I correct in thinking on the basis of what Iâve read that with single-payer, the benefits would be publicly financed, as you just said, but that the health care providers would, for the most part, remain private?
DR. DAVID HIMMELSTEIN: They certainly would. As would the hospitals.
BILL MOYERS: They wouldnât work for the state.
DR. DAVID HIMMELSTEIN: No, no.
BILL MOYERS: They wouldnât get their salaries someâŠ
DR. DAVID HIMMELSTEIN: In fact, private practice is more common in Canada than it is here in the U.S. And in the U.S., weâre seeing more practices being taken over by big corporations. And people, basically, doctors becoming employees of large bureaucracies. In Canada, private practices remain the norm. And thatâs what weâre saying ought to continue in the U.S.
DR. SIDNEY WOLFE: I mean, essentially itâs socializing the financing. So, I mean, when people use this scare word âsocialized medicineâ I donât know what they mean. We have socialized libraries. We collect taxes, and we have libraries, we have socialized police. The financing is socialized. In those cases, they are working for a city. In this case, the doctors are in private practice. The hospitals are operating privately. And any patient- itâs interesting the system is called Medicare, and so, everyone in the country has a Medicare card and that allows them to go wherever they want. They donât have this limited number of providers, which is getting more and more limited, as everyone who has health insurance in this country knows.
BILL MOYERS: Let me show you a video of what President Obama said in New Mexico the other day.
BARACK OBAMA: If I were starting a system from scratch, then I think the idea of moving towards a single-payer system could very well make sense. Thatâs the kind of system you have in most industrialized countries around the world. The only problem is that weâre not starting from scratch. We have historically a tradition of employer based health care and although there are a lot of people who are not satisfied with their health care, the truth is that the vast majority of people currently get their health care from their employers, and youâve got this system thatâs already in place. We donât want a huge disruption as we go into health care reform where suddenly we are trying to completely reinvent 1/6th of the economy.
DR. SIDNEY WOLFE: When I hear something like that, you sort of have to say, âWhat about all the people whose health care is so disrupted that they canât even get in the door at all? What about the people that are underinsured?â
Itâs interesting, because before Medicare passed, which is in 1965, we had older people, either uninsured or going to private insurance. And within a year of the time Medicare passed, the disruption, meaning that they were actually able to disrupt not having health insurance or having under insurance, 90 percent of them were already in Medicare. So, we already have a model in this country of how non disruptive it is.
When you hear the word âdisruptiveâ what youâre really hearing is code for âit would disrupt the health insurance industry.â And thatâs exactly what needs to be done. So, disruptive is the wrong word.
DR. DAVID HIMMELSTEIN: And for doctors, patients, nurses, itâs not disruptive. It actually frees us to do our work. But for the insurance industry, for people making $225 thousand a day as CEOs of insurance companies, yes, itâs disruptive for them.
BILL MOYERS: You are both doctors, but are there many doctors like you in support of single-payer? Is there any evidence of their numbers?
DR. DAVID HIMMELSTEIN: Well, we actually started our group, Physicians for a National Health Program with just a few of us. But we now have 16 thousand members. So, there are a lot of doctors who are activists on this issue. But more than that, surveys are showing that most doctors support national health insurance-
BILL MOYERS: Why?
DR. DAVID HIMMELSTEIN: âŠat this point. Because our lives every day taking care of patients drive us to it. The paperwork, the bureaucracy, the game of mother may I we play with the insurance companies. All of those are not what we went into medicine for. We went into medicine, most of us, âcause we wanted to take care of people. This system doesnât let us do that. And even my conservative colleagues, our organization has Republicans in it. There, at this point, single-payer supporters, âcause they say âLet me practice medicine.â
BILL MOYERS: I want to get your thoughts on President Obamaâs plan. As I read it, itâs very difficult, at this moment, to know the details of it.
DR. SIDNEY WOLFE: âCause there arenât any details.
BILL MOYERS: There arenât any details. But he seems to be advocating a public option that would compete with the private insurance-driven sector, as a way of lowering the cost. What do you think about it? Is that- am I reading his plan correctly?
DR. DAVID HIMMELSTEIN: Well, most of the cost savings heâs talking abou
t are really illusory, I think. And my research group has done most of the research work on administrative costs in health care. And the administrative costs heâs talking about saving are a tiny fraction of the potential savings under single-payer. âCause hospitals have to keep their bureaucracy, if youâre dealing with hundreds of different plans. And doctors have to keep the bureaucracy in our office. You donât actually get the streamlining that you get from having one payer that has one set of rules and can pay lump sum budgets to hospitals. But more than that, weâre worried that the public plan actually becomes a dumping ground for the unprofitable patients. As itâs happening in Medicare.
BILL MOYERS: What do you mean? How would that happen?
DR. DAVID HIMMELSTEIN: Well, the private insurers have all kinds of tricks to avoid sick patients, who are the expensive patients. So, you put your signup office on the second floor of a walkup building. And people who canât navigate stairs are the expensive people.
DR. SIDNEY WOLFE: Get rid of the heart failure patients.
DR. DAVID HIMMELSTEIN: Or you have your signup dinners in a rural area at night, where only relatively healthy people are able to drive and stay up that late. So, thereâs a whole science to how you sign up selectively healthier patients. And the insurance industry spends millions and millions of dollars on that. And would continue to as theyâve done under Medicare. Selectively recruiting healthier patients, who are the profitable ones, leaving the losses to the public plan.
And thereâs really, despite regulations in Medicare that says you canât do that, thatâs continued to happen. And it means that every time a patient signs up with a private plan under Medicare, we pay 15 percent more than we would pay if that same patient were in the Medicare program.
BILL MOYERS: We the public?
DR. DAVID HIMMELSTEIN: We the public. But itâs not been efficient. Itâs been effectively a subsidy. And thatâs what we fear will happen with this public.
DR. SIDNEY WOLFE: Well, we also have some experience. Because in seven states, ranging from Washington to Minnesota, to other states, Maine, they have tried what amounts to a mixture of a private and a public plan. And itâs way too expensive as David mentioned. As long as you have private plans in there, everybody still has to do all the bookkeeping.
So, it has failed. I mean, as Einstein has said, the definition of insanity is doing something over and over and over again, and expecting to have a different result. Weâve seen the same unsatisfactory, unacceptable result, in state after state after state after state after state, why mess up the whole country with it?
DR. DAVID HIMMELSTEIN: And Iâm suffering through it as a doctor in Massachusetts, where weâve done really the closest model to what Obama is proposing. And our plan is already starting to fall apart. Theyâre already draining money out of the community clinics and public hospitals that have been the safety net.
BILL MOYERS:Let me read you a quote from this current issue of âNational Review,â which is quite critical of a public plan. âThat failing Massachusetts experiment, like the failed Clinton health plan of 1994, relies on coercion, mandates, price controls, and government rationing. If comprehensive health care reform happens in 2009, it will follow suite and perhaps go even fartherâŠâ Hereâs the concluding punch line. And it seems to me to go to the concern of many people. âUniversal coverage is impossible without coercionâŠâ
DR. SIDNEY WOLFE: Well, if coercion means, just as for libraries, the policies you have to pay, hopefully progressive taxes. That is a minor amount of coercion. In return for which you get: everybody covered. I mean, it isnât as though the United States is right and all the countries that have provided health insurance as a right are wrong. We are wrong.
So the right wing can be all kinds of scare tactics everything, sounds exactly like what the same groups were saying in 1964. If we provide health care for older people in Medicare itâs going to lead to socialized medicine and pretty soon weâre going to have coercion and all that kind of stuff. Theyâve lost that argument but so far theyâve won for the last 44 years in keeping it form going farther and farther means everyone needs to be covered. As Tony Mazzocchi, a former friend, who died a few years ago, said, everybody in, nobody out. And thatâs what weâre talking about. And right nowâŠ
BILL MOYERS: Everybody in and nobody out.
DR. SIDNEY WOLFE: Nobody out. Right now we have millions, tens of millions of nobodies, our friends, people who need health care, who are out. Thatâs unacceptable.
BILL MOYERS: I donât want the two of you to get out of here without wrestling with this very fundamental question. Weâre going to have to set limits, are we not? I mean, President Obama said recently that a decision was made to go forward with a hip replacement for his grandmother, even though she was in the last stages of life. But he knew that whether a hip replacement, when people are terminally ill is a sustainable model, is a very difficult question. He was saying we have to make some tough choices about limiting care, donât we?
DR. DAVID HIMMELSTEIN: Somewhere down the line, we do. But at this point, we do so much useless and even harmful medical care. And we waste so much on bureaucracy. That we could actually do everything that we know is useful for every American for what weâre now spending. Ten years from now, with my colleagueâs inventiveness in figuring out expensive new things to do. Weâre going to have to come to grips with that. But right now, we could reform this health care system. Do everything thatâs helpful for every American for what weâre now spending.
BILL MOYERS: So, what would you like to see in Obamaâs plan?
DR. SIDNEY WOLFE: Well, weâd like to see Obama remember where he came from. And not only say, âIf we were starting now from scratch, we would have a single-payer, but itâs too disruptive.â Instead of saying, âWe are starting out from scratch, because we need to start out from scratch. There are too many people dying, being sick, ill, because they donât have insurance.â And so, we would like Obama to espouse a single-payer program. The majority of people in the Congress would vote for it, if there were some leadership. Instead of saying, âItâs politically impossible.â Itâs politically impossible if everyone agrees that itâs not possible, it wonât happen.
If instead they say, âItâs not only politically possible, politically feasible, and itâs the only practical way it would happen.â Anything short of that is essentially throwing billions of dollars at the insurance industry. And if youâre afraid of the insurance industry, than youâre afraid of doing the right thing.
BILL MOYERS:What makes you say, Sid, that the Congress would vote for this? Because there is a bill in Congress, under 100 members of the House have signed it and not very many Senators. And just this week, you mentioned Maine, Olympia Snowe, Senator from Maine, says, I think we ought to take any public option off the table for several years. I mean,
what gives you the confidence that Congress would go along?
DR. SIDNEY WOLFE: If we had leadership. If Nancy Pelosi, Harry Reid, and Barack Obama said, âLetâs be realistic. The only realistic way of taking care of this problem is to have a single-payer.â We would get it. There is absolutely no barrier other than the insurance industry.
DR. DAVID HIMMELSTEIN: I guess the question is: do politicians actually want a legacy thatâs more than we got elected and made a lot of money for our later lives. So, you know, Tommy Douglas, who started the Canadian national health insurance program, his grandson is Kiefer Sutherland, the well known actor, was recently, in a Canadian survey, voted the greatest leader in Canadaâs history.
BILL MOYERS: The founder of the national insurance program?
DR. SIDNEY WOLFE: Yep.
DR. DAVID HIMMELSTEIN: And thatâs the kind of legacy that Barack Obama and the leaders of this Congress have an opportunity to create.
BILL MOYERS: So, what are you up against? Where is the balance of power in this fight in Washington right now?
DR. SIDNEY WOLFE: What weâre up against, essentially, is the health insurance industry. They pick who sits at the table. They pick who votes. And so forth. I mean, we have a real absence of leadership. John Conyers, to his credit, has introduced HR676, which is a single-payer bill. Bernie Sanders has introduced a single-payer bill in the Senate. But the people who are on top, who could have an enormous amount of influence are too afraid of the insurance industry, the health insurance industry. And in some serious ways, they are as in bed with them as Wall Street and the banks were in bed with the Congress and have gotten their way, with their kind of bailout.
BILL MOYERS:What do the politicians have to fear from the industry? Does it come down just to the power of to the power of money? To the fact that campaign contributions really determine how elections go in this country?
DR. DAVID HIMMELSTEIN: Well, I think there are going to be campaign contributions. There are going to be massive TV advertising campaigns. There is going to be an avalanche of resources put into the field to try and protect the billions of dollars of profits they make each year. So, I think the politicians really are afraid that theyâre going to lose their elections. And lose the pot of gold at the end of their political careers.
DR. SIDNEY WOLFE: Money buys Washington, as you know. So I think we need a whole new culture there, we need a culture of courage, as opposed to a culture of cowardice. We need people who feel the pain of families who lose 20 thousand, 18 thousand people a year. And those are probably conservative estimates, which are probably much higher right now. This is a serious thing. It is a war on the American public being conducted, orchestrated, and thus far won by the health insurance industry.
DR. DAVID HIMMELSTEIN: Iâve been working on this for 30 years, and the encouragement is that the American people are much more mobilized than they were the last time we debated this issue. Iâm old enough to remember that it looked like civil rights legislation was a lost cause, until we had Presidential leadership on it.
BILL MOYERS:Given that hope and these realities, what do you think will happen between now and August when Congress said itâs going to act on health care reform? What should happen between now and then?
DR. DAVID HIMMELSTEIN: Well, I think the American people need to be very vociferous in standing up for what they need and what they want. And that means calling their Congressmen. It means demonstrations. It may mean civil disobedience. It means doctors in white coats coming down to Washington and letting them know that, in large numbers how we feel. And frankly, we need the President and we need the Speaker of the House and the Leader of the Senate to find their voice for the American people.
BILL MOYERS: Sid, youâve been watching this and involved in this since 1971. What happens if they pass comprehensive health reform that is really just more of the same in disguise? What happens to health care after that?
DR. SIDNEY WOLFE: Well, the country, whether itâs the employers who have to pay for it, or the patients who are paying for it, is going to go bankrupt much more quickly. It is not economically feasible to pass anything other than a single-payer, government collecting the money and paying the bills, and provide health care. Itâs never been done in any country. Taiwan, of all places, said, we donât like the fact that 40 percent of our people are uninsured. They passed, essentially, single-payer plan and within a few years 90-95 percent of the people were covered.
So, we have lots of models to draw on. Learn something from Canada, learn something from Taiwan, from a number of other places. Itâs inexcusable that we do anything but that. Anything that passes is not going to work. I guarantee that, 100 percent. And David will agree with me.
DR. DAVID HIMMELSTEIN: Well, and what happens is that the health care system gets worse and worse, fewer and fewer people can actually afford the care they need. And we will be having this debate again, unfortunately, relatively soon. And I guess I fall back to Winston Churchillâs quote that you can always rely on Americans to do the right thing after theyâve exhausted every other possibility. So, thatâs what weâre working on.
BILL MOYERS: David Himmelstein and Sid Wolfe, thank you again for being with us.
DR. SIDNEY WOLFE: Wonderful talking with you.
DR. DAVID HIMMELSTEIN: Thank you.
JULIE ROVNER: The supporters of single-payer health care point out that their plan is not on the table.
SEN. MAX BAUCUS: Thatâs true. They do. They make that quite clear.
JULIE ROVNER:And, as they⊠so what do you say to them as they point out that they have significant support, and yet their plan is the one thing that is not on the table at the moment.
SEN. MAX BAUCUS:Well, just to be honest, itâs not on the table – the only thing thatâs not – because it cannot pass. It just cannot pass. We canât squander this opportunity. We canât spend – we canât waste capital on something thatâs just impossible.
BILL MOYERS: Finally, this week, my friend Louis Bickford spends his days, and often his nights, on the healing and prevention of atrocities and crimes against humanity. Cruelty, horror, and misery are part of his portfolio at the International Center for Transitional Justice, along with the power of memory.
On The Huffington Post, Louis has an essay in which he says that Memorial Day is meant to remind us of the hardship of war. But he goes on to ask, âWhat does it mean to choose how to remember?â What does it say about us, for example, if ââŠwe choose to remember the c
onflicts in Afghanistan and Iraq, more in terms of heroism than errorâŠâ This, he reminds us, is the ââŠtendency of all nations.â
Louis got me to thinking that when we meditate on war this weekend – our recent wars that is – will we overlook the suicides? Sweep under historyâs rug the recent murder in Iraq of five American soldiers by a comrade who may have been driven mad by the horrors around him? Will we forget the death from friendly fire of a Pat Tillman and the shameful cover-up by the brass, including the role of the very general who now heads our operations in Afghanistan?
What of all those villagers killed by drones remotely fired in our name? Why arenât they part of the narrative we tell ourselves about war? Louis Bickford wonders if weâll ever remember, ââŠthat there was a place called Abu Ghraib on the dusty outskirts of Baghdad, and that torture took place there, for which we were responsible?â After all, he says, it was the complicity of Republicans, Democrats, journalists and lawyers – some of them scholars – that allowed us to ignore international and American law prohibiting torture.
Over some 40 years now it has seemed to me that as time goes by we tend to remember wars, and the suffering they bring, as if they were inevitable, natural acts of history, rather than politically inspired choices. But war, as was famously said, is politics by another means – the lethal legacy of failed leadership, enabled, even ennobled, by propaganda, the partisan opiate of politics. It is good to be reminded, as my friend Louis so eloquently reminds us, that war is too important to forget, and thatâs one reason to observe Memorial Day. There is another – to hold before our face a mirror, so that we might see the images of war reflected in our own eyes.
Thatâs it for the JOURNAL. Iâm Bill Moyers and Iâll see you next time.