Between the Lines Q&A

A weekly column featuring progressive viewpoints
on national and international issues
under-reported in mainstream media
for release March 25, 2010

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Democrats Win Health Care Reform Law
that Entrenches For-Profit Health Insurance Industry

RealAudio MP3

Interview with Dr. Stephanie Woolhandler,
co-founder of Physicians for a National Health Program,
conducted by Melinda Tuhus

healthcare

The House of Representatives passed the Senate version of the health care reform bill on March 21, capping more than a year of bitter and polarizing debate. The law President Barack Obama signed two days later, further entrenches the private for-profit health insurance industry, after universal health care activists lost the battle for single payer insurance and the less ambitious public option. A bill proposing "improvements" to the new law has passed the House and will soon be considered by the Senate.

Physicians for a National Health Program has 17,000 members who have been fighting for decades to establish a single-payer system, sometimes referred to by supporters as "Medicare for All." The group says that President Obama's bill fails to provide insurance coverage to about 23 million people, which will result in an estimated 23,000 unnecessary deaths annually. PNHP also criticizes the legislation for pressuring millions of middle-income people to buy commercial health insurance policies that will only cover an average 70 percent of their medical expenses, making them vulnerable to financial hardship and/or bankruptcy.

Between The Lines' Melinda Tuhus spoke with Physicians for a National Health Program, co-founder Dr. Steffie Woolhandler, who is a practicing physician in the Boston area and on the faculty of the Harvard Medical School. She says most members of her organization, while acknowledging some positive aspects of the bill -- such as preventing insurance companies from dropping people with pre-existing conditions -- think those benefits are outweighed by the negatives.

DR. STEFFIE WOOLHANDLER:We feel this is a debate about Tylenol versus aspirin for breast cancer; the patient needs surgery, and nothing in this bill solves the problems in health care, which is still dominated by the health insurance industry and the insurance industry dominance is why we have uninsured people in the first place; it's why we have costs that are twice as high as other developed nations where they use non-profit national health insurance. So to continue down this same path with the private health insurance industry in charge is simply not a solution; we are not going to get universal health care that's affordable for the American people.

BETWEEN THE LINES: Analysts are comparing this to the Clinton plan 15 years ago, which was fought tooth and nail by the insurance industry and went down in flames. This one succeeded with support from the very interests that you think are the problem. But given the united front from the Republicans, do you think it could have had a different outcome, honestly?

DR. STEFFIE WOOLHANDLER:Definitely, there was buy-in to the bill by the insurance industry and the pharmaceutical industry. But to get that buy-in, the Obama administration had to make huge compromises, and once they made the compromise with the private insurance industry, they were left with a series of unpalatable choices, like limiting the coverage, leaving 23 million people uninsured at the end of the next decade. They had to cut Medicare, particularly Medicare funds for safety net hospitals and clinics. They had to force middle-income people to pay thousands of dollars for coverage so skimpy, so full of gaps like co-payments and deductibles, that you could have the insurance and still not be able to afford care. And then they had to put a tax on the benefits of workers in order to pay for it. So by putting the private health insurance industry -- with their extremely high overhead, the wasteful paperwork that they impose on the health care system -- Obama had to do a lot of things that were rightfully unpopular with the electorate, and very negative aspects of the bill.

BETWEEN THE LINES: Steffie Woolhandler, there's evidence that when previous major social programs were passed, they were not so comprehensive either, due to political compromise, but eventually became more universal. Do you think that's likely to happen here?

DR. STEFFIE WOOLHANDLER: These major social programs that start small and grew -- such as Medicare, such as Social Security -- none of them started by giving $447 billion to private industry, and that's what this bill does. There's $447 billion in taxpayer money that's being handed over to private health insurance as subsidies for the purchase of private policies. So that money has the effect of strengthening the private insurance industry financially and politically and giving them increased strength to try to block reform in the future. So you know, I'm hoping, I'm wishing, I'd be very happy to hear that this was the beginning of something that was going to improve. I'm not particularly optimistic; I think we do need to continue to push for Medicare for all, single-payer national health insurance.

BETWEEN THE LINES: So, do you think this bill is worse than if nothing had been done to address the problem?

DR. STEFFIE WOOLHANDLER:Well, all the same problems will continue to exist -- the high cost of health care, the inability of families to get access to care, the problem of medical bankruptcy. So all the problems that pushed health reform in the first place are still going to be there, and that's why there will be a movement for real reform. I think there's a lot of confusion engendered by the bill, and that for the next couple of years, we'll probably hear somewhat less about health care reform. I don't anticipate the kind of debate we've had in the last year, the kind of active debate, over the next two or three years. But very soon it will become obvious that none of the problems in the health care system have been solved, and the debate for reform will rise up again.

BETWEEN THE LINES: What does Physicians for a National Health Program plan to do now, to move forward?

DR. STEFFIE WOOLHANDLER:We plan to continue to advocate for nonprofit national health insurance, also known as Medicare for all, also known as single-payer. That's the technique that most other developed nations have used to achieve universal coverage. People in Canada, for instance, where they have Medicare for all, have free access to any doctor and hospital. There's no co-payments, there's no deductibles for covered services. And Canadians live two years longer than Americans. They have lower infant mortality. They have lower death rates from heart disease and treatable cancers. So we know from international experience that a Medicare for all approach will allow you to cover everyone affordably, and what's gone on in Washington will simply not get the job done.

Contact Physicians for a National Health Program's Chicago office at (312) 782-6007 or visit their website at www.pnhp.org

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Melinda Tuhus is a producer of Between The Lines, which can be heard on more than 45 radio stations and in RealAudio and MP3 on our website at http://www.btlonline.org. This interview excerpt was featured on the award-winning, syndicated weekly radio newsmagazine, Between The Lines for the week ending April 2, 2010. This Between The Lines Q&A was compiled by Melinda Tuhus and Anna Manzo.

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