This Journal focuses on the health care reform that isn’t being talked about. Not officially. The White House and Congress have kept the lid on one of the most controversial but popular options, known as single-payer. The episode explores this health care option that has been largely ignored by Washington and the mainstream press. Also, Bill Moyers reflects on Memorial Day.
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BILL MOYERS: Welcome to the JOURNAL. Health care reform. It’s the talk of the town – if the town is Washington, D.C. But some possible reforms aren’t 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. It’s a story the mainstream press has largely ignored and that’s why we are covering it in this broadcast.
You don’t expect to see these people demonstrating in our nation’s capitol. You’ll most likely encounter them in the examining room, the operating theater, the clinic or the laboratory.
They’re 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 we’re going to keep pushing to make sure that message gets out there.
PROTESTERS: Single-payer! Single-payer! Single-payer!
BILL MOYERS: That’s exactly what brought them here. They want the White House and Congress to know they can’t 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 don’t know anything about medicine, telling us what we can and can’t do, was really ridiculous to me. You know, I couldn’t understand it.
DAN HENDERSON: Are we going to let insurance giants decide what’s best for Americans?
BILL MOYERS: They’ve come here to tell policy makers how the life-and-death choices they make in caregiving are affected by decisions made in corporate boardrooms and behind closed doors in Washington.
DR. PAT SALOMON: There were all these arbitrary decisions, which were not about people’s 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? That’s not the way health care decisions should be made. It’s wrong. It’s wrong for us as a nation.
GERI JENKINS: We’re 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 you’re staring at a human face, it’s a whole different story. So I think sometimes people who define policy haven’t 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. It’s the only way we’re going to be able to equitably distribute the resources that we have. It’s 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: They’re our public representatives. You know? They’re supposed to represent us. And here they are, representing the interests of the corporations.
And it’s outrageous. And it’s almost like how dare you not listen to us? You know? We’re here to tell you what we see. We’re the experts, not you. You sit in that chair and you bring the gavel down on single-payer. You’re 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 you’re 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 Democrat…
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 Vermont’s Independent Senator, Bernie Sanders.
SEN. BERNIE SANDERS: All over this place, there are thousands of lobbyists representing greed and short-term profits. And it’s 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 don’t need a system mired down in bureaucracy and waste.
We don’t need a system where CEOs earn all kinds of outrageous salaries. We don’t 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 they’re 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 they’re not giving up.
DONNA SMITH: The people still matter. We do matter in this process, and it’s 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 country’s been an easy one. This is a human rights struggle. We’re going to win it, but we’re 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 we’re 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: What’s going on that you have to take to the streets?
DONNA SMITH: They’re 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 it’s through higher premiums and higher co-pays and deductibles, and all the things that American citizens deal with – not to mention 14,000 of us losing employer-based health care benefits every day. So having-
BILL MOYERS: 14,000?
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 Baucus’s committee – seems to be just on the beeline 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 we’re going to be heard?
DONNA SMITH: I think it’s 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 didn’t speak, however, they were invited in.
BILL MOYERS: Now, you must have an opinion as to why that is.
DONNA SMITH: Because they’ve already made a choice. They’ve 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, he’s 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, “That doesn’t affect my judgment. This doesn’t affect my decision.”
DONNA SMITH: I don’t think I’d buy that. And I don’t think there’s very many people in this country that would buy that. If you have someone who’s giving you money to insure that your position to stay in a very powerful role in the United States Senate – that’s 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 it’s important to them?
DONNA SMITH: I tell people, I always ask them to tell me if they understand single-payer and what it’s all about. It’s 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 that’s 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 I’ve 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. That’s why I was asked to testify. I tell people that our story, my husband’s and my story’s not unique. It’s not because we’re so unique that people talk about us because we’re 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 you’re 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. That’s 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, “political feasibility.” I often answer that real quickly in saying, I hear till a year and a half ago that a man named Barack Obama, when polled against John McCain, would have lost in every state but Hawaii and Illinois. So political feasibility is all a relative thing, isn’t 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, it’s not politically feasible to do single-payer. So many people who will say, “Don’t let the perfect be the enemy of the good.”
And I think, well, that’s an interesting analogy, acknowledging that the perfect may be single-payer but that you can’t do it cause it’s politically not feasible. So I sat there and I let this person talk. And he said, there’s a visceral reaction to single-payer.
And I let him talk for a minute. I said, “From whom? Who’s the visceral reaction from?” The Congress, he said, because elections are reality. These people have to run for new terms every so often. The money and the power that’s exerted in Washington on them from the health insurance and health industry lobbies is very powerful. It’s 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, “We’re behind this. This is what we want you to do.”
And in terms of disrupting the system, oh, my god, talk about disruption. I just saw Max Baucus’ 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 we’ll 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. That’s just a few months away. What will you be doing between now and then?
DONNA SMITH: We’re 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 we’ve had so far in this country. And don’t you think we owe that to each other to at least be intellectually honest about this discussion? And let’s put it all out on the table and argue on the merits. Let’s have a debate on the merits of single-payer on the floor of the Congress and see where it goes from there.
BILL MOYERS: You’ve been saying that, though, Donna Smith. You’ve 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. We’re going to do a little more action in California next week. You know, California’s 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 they’re socialists and you’re a fellow traveler. What do you say to people like that, who read into what you’re doing as 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 we’ve thrown into Wall Street and how much money we’ve 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, don’t fear this. This is not- you’re not turning into a Communist red nation. Please don’t be afraid. Even in polling data where the words “socialized medicine” is used, even in that polling data, almost 50 percent of the American public say, “Okay. Do it.” And data where we just ask about a national health insurance system, and that’s through The New York Times and CNN and Yahoo! and a number of polls, 60 percent of the American public say we’ve got to have a national health program. We just have to do it. It’s the only way we fix this mess. It’s spun out of control. It’s going to bury us financially. It’s 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: We’ve 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, we’ll figure out a way to talk to you. I’ll figure out a way to listen to you. I’ll 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 Obama’s 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 we’ve got to take back the White House, and we’ve got to take back the Senate, and we’ve 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 what’s 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 who’d been around a long time – were scratching our heads. We’ve heard this call for voluntary restraint before.
Way, way back in the 1970’s 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: We’ve 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. “You don’t have to make us cut costs,” they promised. “We’ll do it voluntarily.” So Uncle Sam backed down, and, you guessed it, pretty soon medical costs were soaring higher than ever.
By the early 1990’s, 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 President’s plan?
BILL MOYERS: Who could forget America’s sweethearts, Harry and Louise?
WOMAN: It doesn’t 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 industry’s swollen profits.
As the health care business dumped the mangled carcass of reform into the Potomac, they said once again, “Don’t worry, we’ll cut costs voluntarily.” 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. They’re also shelling out megabucks for a publicity blitz and ads attacking Obama’s 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, let’s remind the politicians, Americans know what works.
BILL MOYERS: This is from a group calling themselves Conservatives for Patients’ Rights. They’ve been spending more than a million dollars on ads like this in the month of May alone. They’ve 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 Kerry’s service record in Vietnam. Just who runs Conservatives for Patients’ Rights?
RICHARD L. SCOTT: Let’s 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 year.
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. Steffie 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. He’s been director of that organization’s 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. It’s just not on the table. And it’s not 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: That’s a poll?
DR. SIDNEY WOLFE: It’s 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, they’re 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 don’t even consider the possibility of a plan that doesn’t have a health insurance industry.
DR. DAVID HIMMELSTEIN: That’s 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 it’s economically and medically nonsensical – you can’t actually have a health care program that works, if you keep the insurance industry alive.
BILL MOYERS: Well, then how do you account for the fact that so many people in other polls say, “We’re satisfied with what we have for health care, and we don’t want it taken away from us”?
DR. DAVID HIMMELSTEIN: Well, people are satisfied many times with their doctor and with the hospitals they go to. And most Americans aren’t sick and don’t actually have experience of their health insurance. But when you get sick, and actually have to use your insurance, that’s 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 I’ve 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 don’t want someone essentially saying, “We don’t 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.”
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 there’s no price control. The insurance companies make much more money, ’cause they can push away people who aren’t going to be profitable. The only people that suffer are the patients.
It’s 1968, I was one of a group of physicians that disrupted the American Medical Association’s convention, because they were saying then, and in, for all practical purposes it’s still true, “Health care is not a right. It’s a privilege.” And we said, quietly, as we took over the microphone, “That’s wrong.” We’re now 41 years later, and it’s still a privilege. And too many people in this country don’t have that privilege. It’s resulting in huge numbers of people being ill, sick, and almost 20 thousand people dying a year because they don’t have health insurance.
DR. DAVID HIMMELSTEIN: And there’s big money being made. I mean, that’s 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 let’s establish what single-payer is. Can you do that succinctly?
DR. DAVID HIMMELSTEIN: It’s what we used to call national health insurance. So government collects the money for health care from taxes, you don’t 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 we’d 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 we’re employing many people to do our billing. And fighting with insurance companies. You save $400 billion a year that way.
DR. SIDNEY WOLFE: Here’s an example of what David’s 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. They’re not nurses. They’re not pharmacists. They’re 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. That’s 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, it’s a system that is guaranteed to waste a lot of money. And what we’ve said is that the amount of money that’s 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, it’s not a matter of bringing more money. I mean, the industry is now saying, “We could save $2 trillion over the next ten years. Let us. Trust us. We will lower our costs and everything.” 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: I’ve heard you say that several times. I’ve read you’re saying it. We can do away with the health industry. I mean, them’s fightin’ words, a very powerful part of the economy, and they’re 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 couldn’t wait to do it nationally. So, where there’s a will, there’s a way. There is no way we are ever going to get to having good health insurance for everyone, as long as there’s a health insurance industry, in the way, obstructing care.
BILL MOYERS: What do you say to the argument, though, of people who’ve gone to Canada, and looked at that system. “Well, there are long waiting lines. You can’t choose your doctor.” 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 you’re going to cut our budget by 50 percent, we’d have to have some waiting lines. But if we’re 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. That’s the model. And that’s not just me who says that. The Congressional Budget Office has said that in the past. The Government Accountability Office says we’re spending enough to do that. And we’re really talking about social insurance, like Medicare is social insurance. But doctors and hospitals remaining privately owned.
BILL MOYERS: That’s a good point. Because we’re struggling to manage Medicare’s 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 insurer’s 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 that’s 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 it’s interesting, aside from the obvious health benefits keeping 18 thousand or 20 thousand people from dying every year, because they don’t have insurance, they also- it’s good for business. Because they are essentially taking some- it’s 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, “We just aren’t going to have health insurance anymore.” So, Canada has been a very good model. It’s been going on for 38 years. Canadians would revolt, literally, if someone said, “We’re going to take away your health insurance system.”
BILL MOYERS: Am I correct in thinking on the basis of what I’ve 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 wouldn’t work for the state.
DR. DAVID HIMMELSTEIN: No, no.
BILL MOYERS: They wouldn’t get their salaries some…
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., we’re 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 that’s what we’re saying ought to continue in the U.S.
DR. SIDNEY WOLFE: I mean, essentially it’s socializing the financing. So, I mean, when people use this scare word “socialized medicine” I don’t 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- it’s 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 don’t 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. That’s the kind of system you have in most industrialized countries around the world. The only problem is that we’re 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 you’ve got this system that’s already in place. We don’t 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, “What about all the people whose health care is so disrupted that they can’t even get in the door at all? What about the people that are underinsured?”
It’s 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 “disruptive” what you’re really hearing is code for “it would disrupt the health insurance industry.” And that’s exactly what needs to be done. So, disruptive is the wrong word.
DR. DAVID HIMMELSTEIN: And for doctors, patients, nurses, it’s 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, it’s 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: At 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, ’cause we wanted to take care of people. This system doesn’t let us do that. And even my conservative colleagues, our organization has Republicans in it. There, at this point, single-payer supporters, ’cause they say, “Let me practice medicine.”
BILL MOYERS: I want to get your thoughts on President Obama’s plan. As I read it, it’s very difficult, at this moment, to know the details of it.
DR. SIDNEY WOLFE: ‘Cause there aren’t any details.
BILL MOYERS: There aren’t 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 he’s talking about 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 he’s talking about saving are a tiny fraction of the potential savings under single-payer. ‘Cause hospitals have to keep their bureaucracy, if you’re dealing with hundreds of different plans. And doctors have to keep the bureaucracy in our office. You don’t 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, we’re worried that the public plan actually becomes a dumping ground for the unprofitable patients. As it’s 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 can’t 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, there’s 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 they’ve done under Medicare. Selectively recruiting healthier patients, who are the profitable ones, leaving the losses to the public plan.
And there’s really, despite regulations in Medicare that says you can’t do that, that’s 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 it’s not been efficient. It’s been effectively a subsidy. And that’s 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 it’s 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. We’ve 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 I’m suffering through it as a doctor in Massachusetts, where we’ve done really the closest model to what Obama is proposing. And our plan is already starting to fall apart. They’re 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 “National Review,” which is quite critical of a public plan. “That 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 farther…” Here’s the concluding punch line. And it seems to me to go to the concern of many people. “Universal coverage is impossible without coercion…”
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 isn’t 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 it’s going to lead to socialized medicine and pretty soon we’re going to have coercion and all that kind of stuff. They’ve lost that argument but so far they’ve won for the last 44 years in keeping it from 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 that’s what we’re talking about. And right now…
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. That’s unacceptable.
BILL MOYERS: I don’t want the two of you to get out of here without wrestling with this very fundamental question. We’re 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, don’t 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 we’re now spending. Ten years from now, with my colleagues’ inventiveness in figuring out expensive new things to do. We’re going to have to come to grips with that. But right now, we could reform this health care system. Do everything that’s helpful for every American for what we’re now spending.
BILL MOYERS: So, what would you like to see in Obama’s plan?
DR. SIDNEY WOLFE: Well, we’d like to see Obama remember where he came from. And not only say, “If we were starting now from scratch, we would have a single-payer, but it’s too disruptive.” Instead of saying, “We are starting out from scratch, because we need to start out from scratch. There are too many people dying, being sick, ill, because they don’t have insurance.” 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, “It’s politically impossible.” It’s politically impossible if everyone agrees that it’s not possible, it won’t happen.
If instead they say, “It’s not only politically possible, politically feasible, and it’s the only practical way it would happen.” Anything short of that is essentially throwing billions of dollars at the insurance industry. And if you’re afraid of the insurance industry, than you’re 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, “Let’s be realistic. The only realistic way of taking care of this problem is to have a single-payer.” 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 that’s 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 Canada’s history.
BILL MOYERS: The founder of the national insurance program?
DR. SIDNEY WOLFE: Yep.
DR. DAVID HIMMELSTEIN: And that’s 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 we’re 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 H.R. 676, 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 they’re 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, 18,000 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: I’ve 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. I’m 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 it’s 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, you’ve 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 it’s 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 providing health care. It’s never been done in any country. Taiwan, of all places, said, we don’t like the fact that 40 percent of our people are uninsured. They passed, essentially, a single-payer plan and within a few years 90 to 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. It’s 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 Churchill’s quote that you can “always rely on Americans to do the right thing after they’ve exhausted every other possibility.” So, that’s what we’re 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: That’s 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, it’s not on the table – the only thing that’s not – because it cannot pass. It just cannot pass. We can’t squander this opportunity. We can’t spend – we can’t waste capital on something that’s 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, “What does it mean to choose how to remember?” What does it say about us, for example, if “…we choose to remember the conflicts in Afghanistan and Iraq, more in terms of heroism than error…” This, he reminds us, is the “…tendency of all nations.”
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 history’s 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 aren’t they part of the narrative we tell ourselves about war? Louis Bickford wonders if we’ll ever remember, “…that there was a place called Abu Ghraib on the dusty outskirts of Baghdad, and that torture took place there, for which we were responsible?” 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 that’s 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.
That’s it for the JOURNAL. I’m Bill Moyers and I’ll see you next time.
This transcript was entered on June 5, 2015.