Interview with Adam Gaffney, M.D. and Saurabh Jha, M.D.
The BMJ Podcast, March 29, 2017

Excerpt from Dr. Gaffney, responding to Dr. Jha’s charge that a single-payer national health program would provide overly generous benefits:

I agree that health care is not one size fits all. Health care is unique to the individual. We all have unique wishes, we all have unique wants, we all have unique medical problems, we all would want different things at the end of life, we all have different thoughts about various reproductive health care issues, and so on and so forth.

So health care is unique, but health coverage should be universal, and I think differentiating between those two things is fundamentally important.

Yes, we all have our own wishes and maybe someone who has different life experiences is going to seek out different care than someone who has another set of life experiences. But coverage should be universal. The full spectrum of comprehensive care should be covered.

[Opponents] might say that’s sort of a regressive tax on people who don’t use that much health care, but that is only true if the health care system is being funded in a regressive manner.

If we fund the health care system through progressive taxation, then people people pay in what they can afford to pay in on the basis of their income, and then they use the health care services that they need on the basis of their needs and of their wishes.

full interview:
https://soundcloud.com…

The BMJ Podcast is hosted by Peter Doshi. He was joined by Dr. Adam Gaffney, from Harvard Medical School, and Dr. Saurabh Jha, from the Hospital of the University of Pennsylvania.

By Jack Bernard and Doug Skelton, M.D.
The Telegraph (Macon, Ga.), March 28, 2017

We were encouraged by President Trump’s campaign promise to “cover everyone.” What happened, Mr. President? No wonder Trumpcare/Ryancare failed to even get a House vote.

Trumpcare/Ryancare has been rated by the Congressional Budget Office. It leaves an additional 24 million people out in the cold without insurance. Added to the 30 million now uninsured, that gives us over 50 million with no coverage.

For a “non politician,” you seem to be learning fast. Promise anything to get elected and then renege on your pledges of coverage.

Yes, Trumpcare/Ryancare reduces the deficit. But how: by eliminating the subsidies that enabled working people to afford to pay their premiums and cutting out Medicaid expenditures, dumping the fiscal and moral problem onto the states.

Not only that, but Trumpcare/Ryancare significantly cut taxes for those families making over $250,000 a year. Are these folks the “little man” that you pledged to help in your campaign?

Mr. President, you said health care reform is more complex than you originally thought. We agree. What was the rush to replace Obamacare? It has problems, but it has resulted in 22 million, mostly working-class people, getting insurance. These are the very people who voted you into office, by the way. And, they are the ones hurt by your bill.

The main problem with Obamacare is that it is derived from a free market concept emanating from the right-wing think tank, the Heritage Foundation. It was picked up and promoted by Bob Dole when he ran for president. Mitt Romney adopted it in Massachusetts. And it became Romneycare.

Obama decided he didn’t have the votes to get it through a Democratic Congress in 2009. So, he went with an adaptation of Romneycare which is based on private insurance company expansion, hoping to get GOP support. He did not. Sen. Mitch McConnell made sure he didn’t even get one GOP vote.

In any case, that is the wrong model, as shown by many well-documented studies that compare our health care system to that of other developed nations. Our health care cost per capita is much higher than any other nation and our health status (morbidity and mortality) is worse. Italy and Israel, for example, have fine health care, but their per capita costs are one-third of ours.

You recently had Carol Paris, M.D., ejected from your rally in Nashville for promoting single-payer health care (i.e. expansion of Medicare to cover all ages). Dr. Paris is president of Physicians for a National Health Program (PNHP, www.pnhp.org), a respected 20,000-member group advocating for Medicare for all. Why not consider what they have to say?

Before you became a politician, you advocated repeatedly for single payer. What changed? Are the lobbyists for drug and insurance companies influencing you? What happened to draining the swamp? Do you really want to be saddled with Trumpcare/Ryancare in the next election? Obviously, as shown by the House pulling back from the vote, they do not want to be associated with it in 2018.

Our suggestion is that you create a Health Advisory Council composed of the best health policy experts in the nation in order to evaluate the costs and benefits of true universal coverage, expansion of Medicare, as you promised in the campaign.

Mr. President, you are known for changing your positions frequently. We hope you change back to what really works, Medicare for all, before it is too late for you and our nation, not to mention your party in 2018.

Jack Bernard is a retired senior vice president with a national health care firm and the former director of Health Planning for the state of Georgia.

Doug Skelton is the former dean of Medicine for Mercer School of Medicine. He was also the commissioner of the Georgia Department of Human Resources and chancellor of the Trinity School of Medicine.

http://www.macon.com…

With the implosion of “repeal and replace,” the next logical step in Democratic health care reform is Medicare for All.

By Sarah Jones
The New Republic, March 28, 2017

Trumpcare is dead. President Donald Trump is humiliated and so is House Speaker Paul Ryan. The Democrats can hardly believe their luck: The Republicans have hobbled their own agenda, while Obamacare, aka the Affordable Care Act, lives to fight another day. But unlike the law’s previous brushes with death—most notably its bruising encounters with the Supreme Court in 2012 and 2015—this latest example of its resilience represents a turning point, if Democrats choose to seize the opportunity. For three reasons—political, structural, and moral—now is the time for the Democratic Party to begin building a proposal for a single-payer health care system.

Politically, the momentum clearly points left. Long derided by conservatives and centrists as socialist fantasy, single-payer health care (sometimes called Medicare for All) is having a moment. In January, 60 percent of Americans told Pew Research Center they believe the government has a “responsibility” to ensure health care access. That figure tracks with a 2015 Kaiser Health poll, which revealed that 58 percent of voters supported some version of Medicare for All. Democratic Socialists of America have experienced significant membership growth since Trump’s election, and its activists are canvassing for single-payer in New York and California. California gubernatorial candidate Gavin Newsom just added a version of the policy to his campaign platform. And Senator Bernie Sanders reigns as the country’s most popular politician—and he ran in the Democratic primary on a platform that included Medicare for All.

For long-time advocates of single-payer, this is all rare good news. Dr. Steffie Woolhandler, a co-founder of Physicians for a National Health Program, expressed tentative optimism in an interview with the New Republic. “We’ve been getting a lot of requests from professional journals and physicians and professional organizations to speak on the issue of single payer,” she said. “As someone who’s been doing this a long time, I’m seeing a lot of interest about single payer.”

There’s evidence that this is more than an anecdotal observation. Nobody except the White House and the insurance industry wanted Trumpcare. The bill, otherwise known as the American Health Care Act, would have in many ways returned the health care system to the pre-Obamacare status quo. By upending Medicaid and repealing the individual mandate, it would have taken insurance away from tens of millions of people and made it more expensive for the poor, the elderly, and the sick. A Quinnipiac University poll found that 56 percent of Americans opposed the bill, while a mere 17 percent supported it. Not even a majority of Republican voters supported the bill. Critics of the AHCA were outspoken: They swamped congressional offices with phone calls, an outgrowth of earlier town hall disruptions. Trump’s approval ratings sank to a miserable 37 percent.

Trumpcare failed for numerous reasons, starting with the incompetence of President Trump himself and the dysfunction of the Republican Party. But the defeat of Trumpcare points to a deeper, simpler politics surrounding health care. Most voters have no opinion on the efficacy of high-risk pools. They think in expansive terms: They want health care, and they want more of it, not less. Trumpcare threatened that basic interest. If Democrats are to capitalize on this moment, they can’t satisfy themselves with merely preserving Obamacare. The failure of Trumpcare proved that Obamacare is a floor, not a ceiling; in fact, Trump himself helped establish that floor by duping his supporters into believing that “everybody” would be covered under a Republican health care plan. What voters want is better, more generous care, and the smart response is to give it to them.

Is single-payer the policy answer to more and better coverage? Calls for single-payer invariably provoke concern over its practicality and expense, and it is true that single-payer proposals have to account for a drastic transition process. According to the University of Chicago’s Dr. Harold Pollack, there’s no doubt that “a well-functioning single-payer system would work better than the current American health system.” But he said advocates must account for the dysfunctional system they’ve inherited.

“The challenge that I have is that people often talk about single-payer as an alternative to the pathological political economy that drives American health care and American health politics,” he told the New Republic. “And a single-payer system would have to be a product of that exact same troubled political economy, and would have to bake in many of the defects that we have in our current system in order to come about.”

This dynamic is partially why then-President Barack Obama had to fight conservatives in his own party to pass the incremental reforms offered by the ACA. Obama himself became more conservative on the issue: Though he once supported what he called “a single-payer universal health care program,” he came to believe that single-payer would be “too disruptive” for the health care industry.

But this triangulation leaves us a patchwork system for a universal problem. Most Americans still get health insurance from their employers, but this coverage can still be expensive. Qualify for Medicaid, and you have to hope the government will provide the medications your doctor says you need. Qualify for Medicare, and you may still need to purchase supplemental Medicare plans to cover your expenses. If you qualify for neither, and don’t have insurance from an employer, then the ACA’s exchanges are your only option. But if you can’t afford the premium, you’ll have to pay a fine.

The system’s deficiencies are well-known. For one, this thin safety net doesn’t actually save the country any money. The World Bank reports that, in 2014, America spent more on health care as a total share of its GDP than any other nation save for the Marshall Islands. Our health care system is also one of the most inefficient on the planet: Bloomberg reported last September that America ranks 50th out of 55 nations its health care efficiency index. The question is not if the ACA and Medicare and Medicaid are inadequate. This is self-evidently true.

What is new is that Trumpcare’s failure proved, in the most emphatic way possible, that you can’t go further right than the Affordable Care Act without starting to drop people en masse from health insurance coverage. As David Leonhardt pointed out in the New York Times, Democrats have moved right on the issue for decades, culminating in the ACA—if you want to improve health care in this country, there is nowhere else to go but left. That is why the call from centrist liberals for more “market-based” health care reform makes little sense. People object to the status quo; they will not be content with its maintenance.

Pollack, who supports an incrementalist approach to reform, urged single-payer supporters to focus on defending the ACA’s Medicaid expansion and to demand a public option in the Obamacare exchanges, which would theoretically bring down the costs of health care plans in the individual market.

Woolhandler, meanwhile, says the answer is an improved and expanded version of Medicare. “Make the coverage cover all medically necessary services without copayments and deductibles and proscribe the participation of private health insurance industry in the Medicare program,” she suggested. The result, she argued, would be less expensive than America’s current system. Vijay Das, a strategist for the think tank Demos, suggested a similar strategy, with a particular focus on state-based policies. “I think expanding Medicare to children is a safe way of expanding the risk pool, getting healthy people into the system and lowering costs,” he explained.

All these proposals, in their own ways, logically lead toward single-payer. But they face numerous political obstacles, and Das says the Democratic Party is one of them. “It’s partly because the party that used to be the proponent of single-payer has been largely captured by the interests who think single-payer will destroy their profits,” he explained. “For me, it’s a money in politics issue, not as much as a mobilization issue.” As Lee Fang reported for The Intercept last year, Democratic consultants helped raise $1 million to defeat a single-payer proposal in Colorado. The same consultants had links to the Obama administration and the Clinton campaign.

Health care reform is a problem with a dual nature. It’s a matter of policy, yes, but of morality too, and there is an unassailable moral logic for single-payer. Opponents of single-payer must reckon with it, just as they ask advocates to reckon with political practicalities. Advocates must repeatedly ask: Is the status quo tolerable? “Even with the ACA’s advances,” Das said, “it’s really, really difficult to tell somebody who is in and out of work, is working class, and doesn’t qualify for Medicaid, that their $465 a month-even-with-subsidies-premium is something they should be happy about.”

There is a body count attached to every delay and half-measure. On February 17, Amy Schnelle suffered a seizure and died. She was 31 years old, reported WATE 6 of Knoxville, Tennessee, and unable to work due to the severity of her epilepsy. Medicaid covered her treatment and she lived relatively seizure-free—until September 2016, when Medicaid cut off one of her prescriptions. “I couldn’t imagine what would happen if I’m off of my medicine for a week,” she told the news station at the time. “I could roll into seizures.” She appealed the decision, but no luck. Medicaid’s decision can’t be attributed to Donald Trump, either. It occurred under the Obama administration.

Schnelle slipped through the system’s spiderweb cracks. She was lucky to even qualify for Medicaid: States aren’t required to expand it, and the ACA’s subsidies often aren’t generous enough to make up the difference for people who can’t use it. These cracks are numerous enough, and create a void wide enough, that crowd-funding campaigns proliferate as an alternative. In 2015, the Los Angeles Times reported an “uptick” in the use of websites like GoFundMe, Indiegogo, and YouCaring for health care needs. These campaigns bare the desperation of those in need—and the catastrophic consequences of their inadequacies.  After relocating to care for his dying mother, Shane Boyle, a type-1 diabetic, started a GoFundMe campaign to cover a month’s worth of insulin due to a gap in his insurance coverage. His mother died on March 11. Boyle died of diabetic complications one week later, without meeting his fundraising goal. His family has started a new GoFundMe to pay for his funeral.

The moral case for universal health care is too often obscured by red-baiting. But once you accept that everyone should be covered, and establish that the expansion of government programs is the only viable path to achieving that goal, that case is difficult to ignore. Trumpcare’s defeat offers Democrats a chance to move from a defensive crouch to a positive vision that affirms the moral significance of health care as a human right. The market can’t compensate for the system’s deficiencies. In fact, the market is precisely what restricts the ACA’s salvific properties, and that has deadly consequences for the sick. How many Shane Boyles must we accept in deference to it?

The seed is there if Democrats are willing to water it. The Washington Post’s Dave Weigel reported Sunday that Rep. Jim Langevin (D-RI) and House Minority Leader Nancy Pelosi (D-CA) recently told constituents they are either interested in or expressly support single-payer health care. Rep. Keith Ellison (D-MN) is on record supporting Medicare for All, and Sen. Elizabeth Warren (D-MA) also indicated she supports some version of a single-payer system.

They’ll have a test soon: Sanders has announced that he will re-introduce his Medicare for All bill, and a similar measure in the House has 72 co-sponsors. Neither will pass in a Republican Congress, but that’s not really the point. As Ryan Cooper recently argued in The Week, popular support for Medicare means that Medicare for All proposals are “an excellent organizing signpost.” The concept obviously appeals to the party’s base—and could be marketed in a way that appeals to low-income Republicans at odds with the GOP’s austerity.

The Democrats spent years preparing themselves for Obamacare. Now is the time to do the same for single-payer. Now is the time to organize and to develop evidence-based policies they can actually implement when they’re back in power. The transition will cause disruption, but it can and should be managed. The alternative is intolerable. “We need health care,” a West Virginia coal miner told Sanders during an MSNBC town hall earlier this month. “Everybody in this room needs free health care.” He gets it. Sanders gets it. It’s time everyone else did, too.

Sarah Jones is the social media editor at The New Republic.

https://newrepublic.com…

With the demise of Trumpcare, there’s no better time to fight for single-payer.

By Adam Gaffney, M.D.
Jacobin, March 27, 2017

We should take great pleasure in the fall of the American Health Care Act (AHCA). The AHCA was essentially what you would get if you convinced Ebenezer Scrooge to heavily edit the Affordable Care Act (ACA), which made it at the same time unoriginal, nasty to the poor, and generous to the rich.

In its original form, the AHCA would have, in Dickensian fashion, cut some $880 billion in Medicaid spending over a decade, thereby reducing enrollment by 14 million by 2026 and fulfilling Paul Ryan’s sick collegial dreams. It would have largely turned the ACA’s premium- and income-based tax credits into flat vouchers, leaving millions unable to buy a health plan. It likely would have blocked some women’s access to abortion. And it would have diverted some $883 billion in tax breaks to, for the most part, the very wealthy and the medical-industrial complex.

But now it is as good as dead. Good riddance.

At the same time, its demise does not mean we are moving forward, only that we are treading water. Here are five reflections on the death of the AHCA, and on the path ahead.

1. This was the right-wing plan.

Many described AHCA as hastily conceived and slapdash, which is to some extent true. However, in partial defense of Paul Ryan (words very reluctantly uttered), the AHCA was heavily based on a detailed blueprint, “A Better Way,” that he and the House GOP published nine months ago. The surprise over the bill’s content was itself surprising.

The truth is that in the context of strong popular support for Medicare — and given that the Right has no actual desire to undermine the private health insurance industry — the AHCA was about the most they could (or for that matter, wanted to) achieve: namely, a weird version of the ACA with more regressive funding and paltrier benefits, along with the partial strangulation of Medicaid and a middle finger to Planned Parenthood.

They really don’t have anything else up their sleeve. If they try to repeal Obamacare again, it will likely be with some variety of the same nonsense.

2. The AHCA’s collapse is not an endorsement of the health care status quo.

The AHCA was extremely unpopular, but its failure does not mean all is well with the US health care system. While the AHCA would have increased the ranks of the uninsured to an inhumane 52 million, an estimated 28 million will still remain uninsured by 2026.

Today, families are squeezed by rising drug prices and high copayments and deductibles, too often facing bankruptcy and financial strain. By slashing the health care safety net, the AHCA would have sharply exacerbated these problems. But Paul Ryan’s callousness doesn’t make the present state of affairs any less deplorable.

Indeed, a large part of the popular discontent with the ACA is less about what the law did than what it failed to do. Now fully implemented, the ACA modified — but did not remake — the US health care system. People remain justly angry that they’re still being squeezed.

Wrangling over the ACA’s positives and negatives is going to be less relevant with each passing year: it will remain, as Ryan admitted during a glum press conference last Friday, “the law of the land.” Moving forward, criticism should be aimed less at Barack Obama’s law (which, we should acknowledge, did some real good), and more at the persistent injustices and inequalities intrinsic to the American health care status quo: uninsurance, underinsurance, racial health inequalities, tiers of access based on insurance, extortionist drug prices, medical bankruptcies, inferior health outcomes, needless deaths, and so forth.

3. The Left is winning the discursive battle.

When the Congressional Budget Office reported that the AHCA would result in an additional 24 million uninsured, it was widely seen as a damning indictment. The notion that all should be covered — that there is a right to health care — is increasingly becoming common wisdom, such that even the Right has taken to cribbing the Left’s language: Republicans chattered nonsensically about “universal access,” while Trump vowed that he would cover everybody.

However, on the Left, it is critical that we not allow the language of universal health care to be adulterated. Many already speak of the ACA as a universal health care program, a puzzling assertion given the 28 million or so that remain uninsured.

In addition, we should envision health care universalism along much broader and more egalitarian lines: the elimination of uninsurance, the end of cost-sharing, and the creation of a single tier of coverage that provides equitable access to health care for all.

For instance, as critically important as Medicaid is to the more than 70 million Americans who rely on it, we shouldn’t forget that its participants sometimes receive segregated care, or are relegated to the back of the line. Clearly, health care equity necessitates equitable health care coverage.

And equitable systems save lives: as a widely reported study recently described, individuals with cystic fibrosis (CF) in Canada live on average an entire decade longer than their counterparts in the US. Canadians with CF also received more lung transplants, even though the US is allegedly king when it comes to high-tech care.

4. National single-payer is the next step.

In fact, this is already happening. “In the wake of the Republican failure to repeal the Affordable Care Act on Friday, leading figures in the progressive wing of the Democratic Party are rallying behind a single-payer health insurance,” a Huffington Post article over the weekend began. “Sanders to offer single-payer health care plan,” a headline in Politico yesterday read. Democratic congressman John Conyers reintroduced his single-payer bill in the House earlier this year.

And most importantly, activist groups are organizing with muscle and creativity throughout the country.

The iron is clearly quite hot. With the death of the right-wing challenge, single-payer is the alternative to the health care status quo. Various half-measures are not worth it at this point. For instance, a “public option” is sometimes described as a way to shore up private health insurance exchanges, but that’s precisely what we’re not trying to do. We’re trying to replace them.

5. This is a winnable battle.

A majority of the country wants single-payer. Both physicians and nurses voice strong support. And now the conservative alternative has been disgraced. Politicians have yet to follow the populace, but, with enough grassroots activism, they can be pressured and flipped, or — if recalcitrant — confronted with primary challenges or defeated at the polls.

The insurance industry will no doubt fight to the death, but it’s enormously unpopular, and surmountable.

A single-payer universal health care system would not, by itself, secure the much larger goal of health justice. To accomplish that, all types of oppressions — along racial, gender, economic, and environmental lines — would need to be undone.

But it would be an enormous first step.

Adam Gaffney is an instructor in medicine at Harvard Medical School and a pulmonary and critical care doctor at the Cambridge Health Alliance. He blogs at theprogressivephysician.org.

https://www.jacobinmag.com…

Interview With Dr. Steffie Woolhandler (Part 1)

By Amy Goodman
Democracy Now!, March 27, 2017

PNHP Note: To view video of this interview (parts 1 & 2), click here. To read a transcript of part 2, click here.

Under President Obama, House Republicans voted more than 50 times to repeal or rewrite the Affordable Care Act. But on Friday, the House couldn’t muster the votes needed to pass its own healthcare law, which some call Trumpcare. Just minutes before the vote was scheduled, President Trump pushed House Speaker Paul Ryan to pull the legislation. The bill was opposed by every Democrat, as well as many members of the ultraconservative House Freedom Caucus and some moderate Republicans. 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.

TRANSCRIPT
This is a rush transcript. Copy may not be in its final form.

JUAN GONZÁLEZ: We turn now to healthcare. Under President Obama, House Republicans voted more than 50 times to repeal or rewrite the Affordable Care Act. But on Friday, the House couldn’t muster the votes needed to pass its own healthcare law, what some call Trumpcare. Just minutes before the vote was scheduled, President Trump pushed House Speaker Paul Ryan to pull the legislation. The bill was opposed by every Democrat, as well as many members of the ultraconservative House Freedom Caucus and some moderate Republicans. The House Freedom Caucus wanted more drastic cuts to Obamacare, while the moderate Republicans were concerned about the potential fallout from the bill, which would have left 24 million more people uninsured while giving a major tax break to the rich.

AMY GOODMAN: President Trump and Vice President Mike Pence had heavily lobbied Republican lawmakers ahead of the vote, but the push from the White House didn’t work, leading to Trump’s first major legislative failure. House Speaker Paul Ryan spoke to reporters shortly after pulling the bill.

SPEAKER PAUL RYAN: I don’t know what else to say, other than Obamacare is the law of the land. It’s going to remain the law of the land, until it’s replaced. We did not have quite the votes to replace this law. And so, yeah, we’re going to be living with Obamacare for the foreseeable future. I don’t know how long it’s going to take us to replace this law.

AMY GOODMAN: At the White House, President Trump warned he is now just going to let Obamacare explode.

PRESIDENT DONALD TRUMP: Thank you very much. We were very close. It was a very, very tight margin. We had no Democrat support. We had no votes from the Democrats. They weren’t going to give us a single vote, so it’s a very difficult thing to do. I’ve been saying for the last year and a half that the best thing we can do, politically speaking, is let Obamacare explode. It is exploding right now. It’s—many states have big problems. Almost all states have big problems.

JUAN GONZÁLEZ: While Trump initially blamed Democrats for the legislative failure, he switched his focus to fellow Republicans over the weekend. On Sunday morning, he tweeted, quote, “Democrats are smiling in D.C. that the Freedom Caucus, with the help of Club For Growth and Heritage, have saved Planned Parenthood & Ocare!” Trump tweeted Sunday morning. A day earlier, he urged, on Twitter, his Twitter followers to watch Judge Jeanine on Fox News on Saturday night. Viewers who tuned in would have heard this:

JUDGE JEANINE PIRRO: My opening statement: Paul Ryan needs to step down as speaker of the House. The reason? He failed to deliver the votes on his healthcare bill, the one trumpeted to repeal and replace Obamacare, the one that he had seven years to work on, the one he hid under lock and key in the basement of Congress, the one that had to be pulled to prevent the embarrassment of not having enough votes to pass. But this bill didn’t just fail. It failed when Republicans had the House, the Senate, the White House.

AMY GOODMAN: That’s Judge Jeanine Pirro on Fox News on Saturday. While House Speaker Paul Ryan remains in that position, many observers say he has been politically damaged. Politico is reporting the push to pass the legislation was harmed in part because Trump didn’t appear to know that much—or care that much—about the details of healthcare policy, unlike many congressmembers, who came to him with questions. The Wall Street Journal reports the Trump administration is now ramping up its efforts to weaken the Affordable Care Act by pushing through rule changes and issuing new waivers.

Meanwhile, Senator Bernie Sanders has announced he’ll soon introduce a bill to create single-payer healthcare. 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.

We’re joined now by Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program, professor at CUNY-Hunter College, primary care physician, lecturer at Harvard Medical School.

You never supported Obamacare, but you were very critical of what was happening in Congress, Steffie. Can you talk about what did take place, and then what is being talked about now, not in the corporate media—almost no mention of single-payer this weekend—but among progressive politicians and activists?

DR. STEFFIE WOOLHANDLER: Well, our group, Physicians for a National Health Program, thinks we need to be moving forward from the Affordable Care Act to single payer, and not backward through repeal like the Republicans wanted. You know, we thought it was a very big victory this weekend to block the Republican plan. We think it’s from people showing up at those town hall meetings, pushing senators and congressmen in purple states, and making it impossible for the Republicans to do a straight repeal, which is what the Freedom party wanted and which they’d been talking about for the last, you know, seven or eight years.

So this was a victory, but there’s still a lot more—a lot more fighting to go. We’re very heartened to see Senator Sanders and other politicians endorsing the idea of single payer. Certainly within the medical community, there’s a tremendous amount of discussion and media coverage of the single-payer idea. And we think it’s a great time to be putting that idea forward and moving to a Medicare-for-all program.

JUAN GONZÁLEZ: But when you say it was a victory, as Trump has said, he’s vowing to—he said he would let the Obamacare both implode and explode at the same time. But he is basically—what could he do now in—from an executive position, to be able to further damage the ability of people to access healthcare?

DR. STEFFIE WOOLHANDLER: Well, unfortunately, there’s a lot he can do through the regulatory process. You have to have regulatory underpinnings of a health law. And his secretary, Tom Price, secretary of health and human services, is a staunch opponent of the ACA who’s been trying to destroy the Affordable Care Act for years. So, the—

AMY GOODMAN: In fact, when Trump had his press conference, if you can call it that, on Friday, his press moment, standing on one side of him was Vice President Pence. On the other side was Price.

DR. STEFFIE WOOLHANDLER: Right. So I think we’re going to see the Affordable Care Act have death by a thousand cuts. They’re going to do everything they can, from a regulatory standpoint, from a funding standpoint, to undermine Obamacare, weaken it, you know, bleed it to death, if you will. But—

AMY GOODMAN: Talk about how they can do that, because they’re really set on that. They’re saying—they’re saying, actually, that President Obama set 2017 as the year for it to implode. But they say that they’re just going to let it die. What does that mean? And how would they accelerate this? And how could they stop that?

DR. STEFFIE WOOLHANDLER: Well, there’s lots of regulatory decisions you make about what you’re going to insist insurers, insurance companies, do. That’s all in Tom Price’s bailiwick right now. So-called Medicaid waivers, where you’d say to the states, “Hey, we’ll give you the money and let you do pretty much what you want.” Of course, Tom Price is going to be doing that with a lot of these conservative state governments that have no interest in the Medicaid program or in helping poor people. There’s been a lot of lawsuits—

JUAN GONZÁLEZ: So, just to be clear—

DR. STEFFIE WOOLHANDLER: Yeah.

JUAN GONZÁLEZ: On the waiver issue, that would, in essence, let them do what they were wanting to do in the current bill, which was create sort of a block grant situation for states on Medicaid?

DR. STEFFIE WOOLHANDLER: Well, it’s not quite the same as what they were going to do in the bill, but it does allow them to do things like charge Medicaid enrollees premiums. I have to remind you, these people are really, really poor, and if you require them to pay premiums, some months they’re just not going to be able to pay, and they’re going to lose their healthcare.

The other thing I want to remind you of is, there’s been tons of lawsuits against Obamacare, which, under the Obama administration, the Justice Department defended and fought against. But the Trump Justice Department doesn’t have to defend against those lawsuits. So these lawsuits to cut funding and to restrict access to care, that have failed to date, will—you know, much more likely to succeed if the Justice Department is not fighting them.

So, Trump is going to own the healthcare system. I know he and Bannon want to blame the Democrats for the mess that the healthcare system is going to be, but they own it. You know, there’s a whole lot of problems with Obamacare, like the 26 million people who remain uninsured despite Obamacare. Trump is not going to fix that. He’s going to probably make it worse. The high copayments and deductibles—

AMY GOODMAN: Just to be clear on that—

DR. STEFFIE WOOLHANDLER: Yeah.

AMY GOODMAN: Already, over the next 10 years, 24 million people were going to lose their healthcare under the Republican plan. But you’re talking about 26, 24 million people—

DR. STEFFIE WOOLHANDLER: Yeah.

AMY GOODMAN: —beyond what Obama had insured, the—

DR. STEFFIE WOOLHANDLER: I’m talking about right now, while Obamacare is fully in place, or, you know, January 1, Obamacare fully in place, there are 26 million uninsured Americans. That’s not universal healthcare. You know, that’s almost 10 percent of the population with no healthcare. And that’s why our physicians’ organization is saying we need to move forward to single payer. We need to insure those people.

AMY GOODMAN: Now, it’s interesting that one of their big problems was the 55-to-65-year-old lot, that were their—under the Republican plan, their prices—the cost of their insurance was going to escalate. Wouldn’t it have been interesting if they had just said, “OK, we’ll lower Medicare to 55”? And that would have taken care of all that. So, I want to turn to Congressmember Peter Welch, the Democrat from Vermont, his remarks earlier this month during the Energy and Commerce Committee’s markup of the American Health Care Act, the Republican plan.

REP. PETER WELCH: You know, there’s been a lot of discussion about the fact that this bill has just appeared yesterday and that it was being hidden. Was it really being hidden from Democrats in America, or was it being hidden from your Freedom Caucus? They say that this bill is a phony repeal of Obamacare. And you want to know something? They’re right, because there is a lot of plagiarism in this bill. The insurance reforms that all of you voted against, you’re now bragging you’re keeping. The subsidies that you say are horrible, you have changed from a direct subsidy, that actually provided meaningful access to healthcare, to on-the-cheap tax credits that don’t do the job. But that’s an entitlement that you say you’re against. The mandate, you’ve decried the mandate. But what you’ve done is imposed a 30 percent penalty, and the revenues don’t go to the healthcare program. The revenues go to the insurance companies. What is going on here?

AMY GOODMAN: So, that is Vermont Congressmember Peter Welch, who, together with Senator Bernie Sanders of Vermont, says they will both introduce legislation for single payer. So if you could respond to what he said and then talk about what their plan is and your thoughts on it.

https://www.democracynow.org…

The original content of this program is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License. Please attribute legal copies of this work to democracynow.org. Some of the work(s) that this program incorporates, however, may be separately licensed. For further information or additional permissions, contact us.

Interview With Dr. Steffie Woolhandler (Part 2)

By Amy Goodman
Democracy Now!, March 27, 2017

PNHP Note: To view video of this interview (parts 1 & 2), click here. To read a transcript of part 1, click here.

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.

TRANSCRIPT
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.

https://www.democracynow.org…

The original content of this program is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License. Please attribute legal copies of this work to democracynow.org. Some of the work(s) that this program incorporates, however, may be separately licensed. For further information or additional permissions, contact us.