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Friday, June 12, 2009 FULL SHOW | HEADLINES | NEXT: Report: Health Insurers Hold Billions in Tobacco Stocks
2009-06-12

AMA Opposition to Obama Public Health Plan Echoes Group’s Decades-Long Resistance to Healthcare Reform

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Guests

Mark Hannay, director of the Metro New York Health Care for All Campaign and co-chair of the National Universal Health Care Action Network. He also co-hosts the show Health Action on Pacifica radio station WBAI.

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On Monday, President Obama is scheduled to address the American Medical Association, the nation’s largest doctors’ group with 250,000 members. They have expressed strong opposition to a government-run plan. We take a look at how the AMA has fought almost every major effort at healthcare reform over the past seventy years. [includes rush transcript]

Transcript

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

JUAN GONZALEZ: President Obama has set healthcare reform as his highest domestic legislative priority and has begun an intense push to get a bill through Congress by the end of summer. Obama spoke at a town hall-style meeting in Green Bay, Wisconsin, Thursday, where he defended his call for a government-sponsored health plan to compete with private insurers.

    PRESIDENT BARACK OBAMA: The single biggest problem we have in terms of the debt and the deficit is healthcare. It’s Medicare and Medicaid. That is — when you hear all these projections about all these trillions of dollars and red ink going out as far as the eye can see, almost all of that is because of the increase in Medicare and Medicaid costs that are going up much, much faster than inflation.

JUAN GONZALEZ: Private insurers have opposed a government-run program out of fear they’d be unable to compete with its cheaper costs. Obama did not, however, address his progressive critics who advocate the creation of a single-payer system that would eliminate for-profit insurance companies entirely.

But Obama’s plan to create a “public option” to compete with private coverage is opposed by Republican lawmakers, private insurers and, most recently, the American Medical Association. Senator Max Baucus of Montana, the chairman of the Finance Committee, who is leading an effort to draft a healthcare bill, said Thursday the public plan would take the form of an insurance cooperative that would be owned and operated for the benefit of its members, but not run by the government. The Senate finance panel plans to take up the legislation on June 23rd.

AMY GOODMAN: On Monday, President Obama is scheduled to address the American Medical Association, the nation’s largest doctors’ group with a quarter of a million members. They have expressed strong opposition to a government-run plan. But as our next guest describes, this is nothing new. Over the past seventy years, the AMA has fought almost every major effort at healthcare reform.

Mark Hannay is the director of Metro New York Health Care for All Campaign, co-chair of the National Universal Health Care Action Network, also co-hosts the show Health Action on Pacifica radio station WBAI, joining us in our firehouse studio.

MARK HANNAY: Thank you.

AMY GOODMAN: It’s good to have you with us, Mark.

MARK HANNAY: Thank you.

AMY GOODMAN: Can you just give us a history lesson here?

MARK HANNAY: Well, what will be interesting about the coming debate over national healthcare reform is, are we as a nation finally going to join the rest of the industrialized world and have some kind of national healthcare program? There’s different ways to do it and different opinions on that.

The first major presidential candidate to talk about national healthcare reform was Teddy Roosevelt, when he ran for president in 1912. So we’ve been fighting this fight for a century now. And hopefully, we’re going to make a major advance in this coming legislation that Congress is going to be drafting.

The next major president to talk about it was Franklin Roosevelt in his New Deal package and actually jettisoned national health insurance from that package, so that the rest of the package could go through to provide things that we all now take for granted, such as Social Security, unemployment insurance, and so forth, a whole variety of programs that were part of the New Deal. And they were going to come back with a New Deal II, which was going to include national health insurance. Unfortunately, the Second World War intervenes. Then President Roosevelt died in office.

The next president to talk about —-

AMY GOODMAN: But what about who the major force, the major opposition to Franklin Roosevelt was?

MARK HANNAY: Oh, right, yes. That’s true.

AMY GOODMAN: And Frances Perkins’ key role, Secretary of Labor, who was the one really pushing for national health reform?

MARK HANNAY: Yes, yes, yes. She was absolutely pushing it. But the main reason they jettisoned it was the American Medical Association came out and said that they didn’t think that government had a role in assuring healthcare for all Americans. And really what that was all about was they were afraid of interference with the practice of medicine, which I think is a legitimate concern to some extent. But to many of us, what that’s really about is trying to protect their prerogatives about setting the rates they charge patients.

JUAN GONZALEZ: And then, through the Truman administration, they continued to maintain their opposition to any kind of health insurance, as well?

MARK HANNAY: Right. Then President Truman came forward with a national health insurance program, and it was again stopped by the AMA. And the insurance industry joined them. And this was during the Red Scare period, and it was branded as socialized medicine, and we didn’t want -—

AMY GOODMAN: Was Truman branded as a socialist?

MARK HANNAY: I don’t know whether he actually was personally or not. I’m sure there were people who said that about him in this context. That wouldn’t surprise me at all.

JUAN GONZALEZ: Now, one of the surprising things, apparently, is the AMA also even opposed to the development of health maintenance organizations later on?

MARK HANNAY: Yeah, which we all now think is a pretty conservative approach to healthcare. But at that time, that was considered a really radical socialist idea, that people would get together in prepaid group cooperatives to buy healthcare from providers.

AMY GOODMAN: So, you have the AMA opposing FDR and any kind of national health insurance.

MARK HANNAY: Right, right.

AMY GOODMAN: As well, opposing President Truman and winning.

MARK HANNAY: Right.

AMY GOODMAN: Well, in 1961, the AMA organized a campaign to block Medicare, titled "Operation Coffeecup."

MARK HANNAY: That’s right.

AMY GOODMAN: The campaign stressed that the government-sponsored system would lead to socialism. For a spokesman, the group turned to Ronald Reagan, then a famous actor who had just begun to launch his political career. Reagan lent his voice to a ten-minute-plus recording distributed by the AMA.

    RONALD REAGAN: One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can’t afford it. [...]

    But let’s also look from the other side, at the freedom the doctor loses. A doctor would be reluctant to say this. Well, like you, I am only a patient, so I can say it in his behalf. A doctor begins to lose freedoms. It’s like telling a lie. And one leads to another. First you decide that the doctor can have so many patients. They’re equally divided among the various doctors by the government. But then the doctors aren’t equally divided geographically, so a doctor decides he wants to practice in one town, and the government has to say to him, “You can’t live in that town. They already have enough doctors. You have to go some place else.” And from here, it’s only a short step to dictating where he will go. [...]

    You and I can do this. The only way we can do it is by writing to our congressmen, even if we believe that he’s on our side to begin with. Write to strengthen his hand. Give him the ability to stand before his colleagues in Congress and say, “I have heard from my constituents, and this is what they want.” Write those letters now. Call your friends and tell them to write them. If you don’t, this program, I promise you, will pass just as surely as the sun will come up tomorrow, and behind it will come other federal programs that will invade every area of freedom as we have known it in this country, until one day, as Norman Thomas said, we will awake to find that we have socialism. And if you don’t do this and if I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.

AMY GOODMAN: Yes, that, the voice of actor Ronald Reagan, employed by the American Medical Association in their campaign entitled "Operation Coffee Cup" to stress that the government-sponsored health insurance system would lead to a form of socialism.

Mark Hannay, take us through history from there.

MARK HANNAY: I just have to laugh, listening to that. It’s such beautifully crafted rhetoric.

But moving forward, so this was at the beginning of the fight for Medicare in the 1960s, when this was distributed to the American Medical Association members, who at that point represented the vast, vast majority of physicians, which they do not anymore today. So, it had an impact of a sort.

President Johnson did enact with Congress the Medicare and Medicaid program over the opposition of, again, the American Medical Association, the insurance industry. And this time, what was sort of interesting about the creation of Medicare and Medicaid at that time is that there was opposition from Democratic senators from the South, because what those programs meant was that they were going to have to integrate healthcare facilities and hospitals, in particular, in the South. So, he was able to overcome those barriers.

And that’s also kind of why we got the Medicaid program separate from Medicare. It was for poor people, so there was a way to kind of, if you will, segment out poor people, and particularly, in some communities, people of color, out from the regular mainstream system that the government was creating.

The hospitals, interestingly, were on board for the creation of the Medicare and Medicaid programs, because they were the ones getting stuck with all the uncompensated care. So it was an interesting dynamic, where you had the hospitals and the doctors pitted against each other. But the doctors oftentimes sort of ran the hospitals, so it was kind of an interesting sort of situation.

JUAN GONZALEZ: And what has kept the American Medical Association in these extremely conservative positions throughout its history, given the fact that so many doctors in America clearly would favor a different kind of system, and many, single payer?

MARK HANNAY: Right. I mean, to be fair, doctors are all over the map on this question of national healthcare reform. So, I think the way the AMA — I think primarily its membership now is of specialist kinds of physicians who charge higher fees and so forth. And they really — when you look at their communications to members of Congress in this current round of discussion, almost the first thing that they mention is the aspect of reimbursements. How are they going to get paid? How much are they going to get paid? Who is going to decide how the payment gets set. And so forth like that. And then the larger question is, do I have to participate in this public program, be it Medicare or Medicaid or this new program that’s now being talked about, or can I sit it out?

JUAN GONZALEZ: Well, as we continue our discussion about healthcare, we turn now to a new report in the New England Journal of Medicine that reveals that US, Canadian and British health and life insurance firms hold at least $4.4 billion of investments in companies whose subsidiaries manufacture cigarettes, cigars, chewing tobacco and related products.

The New Jersey-based Prudential Financial, for example, is a major investor in three tobacco firms, including Philip Morris and Reynolds American. Other insurance companies named in the report include the Sun Life Financial, Northwestern Mutual, MassMutual and Standard Life.

AMY GOODMAN: We’re joined by Dr. Wesley Boyd in Boston, co-author of the report, a faculty member at Harvard Medical School, member of Physicians for a National Health Program. He first wrote about the “tobacco-insurance company connection” in 1995.

Dr. Boyd, welcome. Explain what you have exposed in the New England Journal of Medicine.

DR. WESLEY BOYD: Well, thank you, first of all, for having me.

Out of concern for the place that the insurance companies seem to be poised to take in the healthcare reform that Obama is talking about, we thought that if we looked into the fact that they were invested heavily in tobacco — the insurance industry, in general — it would expose and show as clearly as anything the fact that the insurance industry is primarily concerned about making money, not about insuring people’s health and well-being.

AMY GOODMAN: So, explain. Go through the record of these insurance companies. It may well shock many people who are watching and listening and reading right now.

DR. WESLEY BOYD: Well, it is pretty shocking. And we first actually looked into this, the insurance industry investments in tobacco, back in 1995. If I could just give a little history, the reason for that initially was that I was — as a psychiatrist, I take care of a lot of patients in a public clinic, having difficulties getting care authorized by the managed care companies and the insurance companies — they were often sort of putting up roadblocks to me doing what I would like to do with my patients, see them as frequently as I need to, and so on — and came to find out back in 1995 that one of the managed care companies, Merit Behavioral, at the time was owned by the leveraged buyout firm Kohlberg Kravis Roberts, which also owned RJR at the time. And so, that’s where the sort of tobacco-insurance connection initially arose.

We looked into holdings back then and in ’95 found that insurance industry, health insurance industry, was heavily invested in tobacco; revisited the issue in 2000, same story, but less so; and then came back today — well, this past year and found, for example, that, as was reported, Prudential owns $500 million — over $500 million of Imperial Tobacco, $871 million worth of holdings in British American Tobacco. Actually, that’s Prudential out of the UK, I’m sorry. Prudential Financial here in the US, they own $69 million of Reynolds American, almost $9 million of Lorillard, and $186 million of Philip Morris tobacco.

MassMutual, which is a life insurance company here in the US, they provide long-term disability coverage for people, as well as long-term care, in general, also heavily invested in the tobacco industry. I can give you numbers if you’d like. Northwestern Mutual was another company we looked at, as well as a couple of UK companies — Prudential, I already mentioned, and Standard Life, both of which are heavily invested in the British tobacco industry. And Sun Life out of Canada, again, same thing, over a billion dollars invested in tobacco.

JUAN GONZALEZ: Dr. Boyd, how do these companies, that supposedly are insuring people in case they get sick, also justify the fact that they’re investing in companies that will make them sick or kill them?

DR. WESLEY BOYD: Well, the short answer is, they don’t try to justify it. Generally speaking, what they do is they deny that our numbers are correct, even though we’re taking it from a publicly available database. The fact is, it seems that any publicly traded company, like these insurance companies that we’re talking about, their first duty is to earn money for shareholders, not to ensure health and well-being of the people that they’re being insured by. So, I don’t exactly know how they attempt to justify it. In one case, they say, “Well, it’s not our — it’s not so much our direct investments in tobacco, as investments that we are doing on behalf of some of our clients.” And I think that’s just a way to sort of sidestep the issue.

AMY GOODMAN: You know, I don’t know if you know the answer to this question, Dr. Boyd, but with this latest news, the Senate approving a measure that would strengthen government regulation over the tobacco industry, which is very significant, senators voting 79-to-17 to give the FDA new authority in overseeing the manufacture and marketing of tobacco, where these health insurance companies stood on this?

DR. WESLEY BOYD: I really don’t know the answer to that. It would be interesting, given how heavily invested in tobacco the insurance industry is.

AMY GOODMAN: And have you had any dialogue with the health insurance industry around this issue of health insurance making you sick or, as Juan said, killing you?

DR. WESLEY BOYD: Well, right before the letter was published in the New England Journal last week, there were a flurry of emails from one of the companies, essentially denying our numbers, requesting us to pull the piece, saying that we’re going to have to print a retraction, and demanding to know how we arrived at these figures.

And I’ll tell you, the New England Journal sat on our piece for quite some time before they actually published it. I had to send all of my original data sheets in to them. And they, I presume, vetted them fairly carefully. It took them several weeks to go through the numbers and then go ahead and approve publication. And also, a major news outlet, as well, which ran a story about our story, requested me to send my original data sheets to them, as well. They checked the numbers, and everything, you know, worked out fine.

AMY GOODMAN: Finally, are you a member of the AMA, Dr. Boyd?

DR. WESLEY BOYD: I am not a member of the AMA and never have been, actually.

AMY GOODMAN: Well, Physicians for a National Health Program, your organization, many members are. If the polls show that most doctors are actually for single payer, let alone a public health plan, how does the AMA work? I mean, in the American Psychological Association, we know the campaign of people, psychologists within the association, taking on the leadership around the issue of torture. On the issue with the American Medical Association of saying they’re opposed to a public plan, does that represent the majority of doctors in the AMA?

DR. WESLEY BOYD: Well, one of my colleagues, actually, at Cambridge Health Alliance surveyed a broad swath of physicians, both across the country and then across Massachusetts. I’m not sure exactly what the big survey showed, but the — in general, more than half of physicians support a single-payer health program, when you ask them what kind of means of paying for healthcare they most support. But when you ask those same physicians who support single-payer national healthcare what they feel like their colleagues would believe, the majority of them think their colleagues would be opposed to it. So there definitely is, it seems to me, a discrepancy between what most physicians believe about how we ought to, you know, go forward with healthcare reform and what they think most of their colleagues do.

What happens at the AMA, I know that there — I know there are some very good people in the AMA. I know people on the ethics panel, for example, that oversees all the ethical issues at the AMA. You know, very good people, supportive of single-payer healthcare. I don’t know what happens in the leadership such that we get these very sad, very depressing reports that come out, like we saw yesterday.

JUAN GONZALEZ: And, Mark Hannay, I’d like to ask you your expectations now over the summer, as Congress begins to take up healthcare legislation, what you’re hoping, your group is hoping, to accomplish?

MARK HANNAY: Well, I think, essentially, we — it’s going to be fast. This whole thing is going to be over, and the bills are going to be crafted in the next three or four weeks. They’re going to be to the floors and voted on by the 1st of August. Then they’re going to come back in the fall, cobble together a grand bill, hopefully pass it, and will be done by early October. So, it’s fast, fast, fast. That’s the first thing.

I think what we’re hoping to do at this point, at the very least, is to bring the voice of the grassroots, the public, the people, into the conversation, so that it’s not just a conversation between sort of all the usual institutional suspects, like insurance companies and the American Medical Association and the American Hospital Association and so forth, so that we get the perspective of what we, the public, want to see happen in healthcare reform.

AMY GOODMAN: Mark Hannay, we want to thank you for being with us, director of the Metro New York Health Care for All Campaign. And Dr. Wes Boyd, Cambridge Health Alliance and Harvard Medical School, is the leading author in the piece that just appears in the New England Journal of Medicine talking about the billions that health and life insurance industry has invested in tobacco stock.

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