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2009-09-18

As Baucus Unveils Health Plan Absent of Public Option, New Study Finds 45,000 Uninsured Die Every Year

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Guests

Dr. Steffie Woolhandler, professor of medicine at Harvard University and a primary care physician in Cambridge. She is also co-director of the Harvard Medical School General Internal Medicine Fellowship program and is co-founder of Physicians for a National Health Program.

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A long-awaited healthcare bill from Senate Finance Committee Chair Max Baucus includes no public option and would require almost all Americans to buy insurance or pay a penalty. This comes as a new study finds that nearly 45,000 Americans die every year due to lack of health insurance. We speak with the study’s co-author, Dr. Steffie Woolhandler, a professor of medicine at Harvard University, primary care physician, and co-founder of Physicians for a National Health Program. [includes rush transcript]

Transcript

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

JUAN GONZALEZ: Nearly 45,000 Americans die every year — that’s 122 deaths a day — due to lack of health insurance. That’s the startling finding of a new study that appears in the current issue of the American Journal of Public Health.

The figure is about two-and-a-half times higher than an estimate from the Institute of Medicine in 2002. The Harvard-based researchers found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993. Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease.

News of the study comes as the drive for healthcare reform is entering a new phase on Capitol Hill. On Wednesday, Montana Senator Max Baucus, the chair of the Senate Finance Committee, released his long-awaited healthcare reform proposal. The Finance Committee is the last of five congressional panels to produce legislation.

AMY GOODMAN: Despite months of talks to find a bipartisan compromise, Baucus’s plan had no Republican co-sponsors. The $856 billion proposal would require almost all Americans to buy insurance or pay a penalty and drops a mandate that all employers offer health coverage. The bill does not include a government-backed public option to compete with private insurers, instead proposes funds to set up nonprofit cooperatives.

For more on the proposal, we’re joined by Dr. Steffie Woolhandler, professor of medicine at Harvard University, primary care physician in Cambridge, also co-director of the Harvard Medical School General Internal Medicine Fellowship program. She’s co-founder of Physicians for a National Health Program and co-authored the American Journal of Public Health study called “Health Insurance and Mortality in US Adults,” joining us from Watertown, Massachusetts.

Professor Woolhandler, Dr. Woolhandler, thanks so much for being with us. Assess Baucus’s plan.

DR. STEFFIE WOOLHANDLER: Baucus’s plan is a complete sellout to the insurance industry. The counsel on the Finance Committee that oversaw the development of the bill is a former vice president of WellPoint, a major insurer. And the insurance companies’ interests are protected in the bill, but the interests of the American people really aren’t.

At best, this bill is going to cover — is going to leave 25 million Americans with no health insurance. And our study indicates that about 25,000 will die annually as a result. Really, what Baucus is doing is protecting the profits of the private health insurance industry and sacrificing American lives.

JUAN GONZALEZ: What about the affordability issue that’s been raised by some critics or began to be raised as soon as the announcement came out?

DR. STEFFIE WOOLHANDLER: Well, the way to afford universal healthcare is to go to Medicare for all, also known as single payer, also known as nonprofit national health insurance. That’s the way every other developed nation achieved universal healthcare. They spend less than we do. In fact, the average for other developed nations is about half the per capita cost of healthcare that we have. People in Canada and western Europe live longer. They don’t have to worry about having medical bankruptcies because their health insurance didn’t pay for things.

So the nonprofit, Medicare-for-all approach is the only affordable way to cover all Americans. Of course, the insurance industry hates it, and when you put an insurance industry vice president in charge of writing a bill, you shouldn’t be surprised to see that the insurance industry profits are protected, but American lives are sacrificed.

AMY GOODMAN: Explain what you mean by insurance industry vice president.

DR. STEFFIE WOOLHANDLER: Well, there’s a woman named Liz Fowler, who is the senior counsel for the Judiciary Committee, and her charge was to lead the effort to design this bill. But it’s not just her; it’s the millions of dollars in donations that Baucus and other politicians have accepted, the millions of dollars in donations from the insurance industry to President Obama. It’s President Obama’s decision from the get-go to play ball with the insurance industry, to get — to compromise with the insurance industry, to involve them in the process. And, of course, you give them an inch, they take a mile. And what’s left of this bill is a dream for the insurance industry.

The individual mandate creates millions of mandatory new customers. Uninsured people are being told, “You’re the problem. We’re going to fine you up to $3,800. We’re going to give you a fine, a penalty, because you’re uninsured and you don’t have health insurance.” The individual mandate is a complete misunderstanding where the responsibility for this is. This problem is not caused by the uninsured themselves; it’s caused by the health insurance industry. And our Congress and Senate needs to confront the health insurance industry, say we’re going with Medicare for all. There’s absolutely no reason to have a private health insurance industry. They add no value. They add a lot of costs, and those costs are so high that it means we cannot get to universal coverage with the insurance industry in the middle of things.

JUAN GONZALEZ: Now, you have an individual mandate there in Massachusetts under the Massachusetts plan. How has that worked?

DR. STEFFIE WOOLHANDLER: Well, it hasn’t worked very well. When the individual mandate was rolled out this past year, we saw no improvement in the number of uninsured in the state. We actually saw a deterioration in access to care. The previous year, they had rolled out a Medicaid expansion. That worked. That got some people covered. But when they rolled out the mandate this year, there was no improvement in the number of insured.

The Census Bureau just announced that only — that only half of the uninsured were covered by that Medicaid expansion. It also found that there were five-and-a-half percent of people in the state uninsured. That’s not universal coverage. And then, our private insurance industry just announced that they’re raising all of our premiums ten percent, and they’re saying that’s because of the cost of the reform.

So, in Massachusetts, we’ve spent a lot of money. We’ve managed to cover about half of the uninsured through Medicaid expansion and expansion of Medicaid-like programs. We’ve given the insurance industry absolutely everything they wanted. And what we’re getting is higher prices and still having uninsured people in the state.

AMY GOODMAN: Dr. Woolhandler, this report you just came out with, 45,000 people a year die from lack of health insurance. Where are these numbers coming from?

DR. STEFFIE WOOLHANDLER: Well, this was a federal study done by the CDC. They collected the data; of course, we analyzed it. They collected the data. They interviewed thousands of people and also had them examined by a physician and gave them lab tests. So we have very detailed information, not only about socioeconomic factors like education and income, but also their baseline health, how healthy were they at the beginning. Some were uninsured. And then the CDC followed these people for up to twelve years to see who lived and who died. So we were able to see what was the effect of lacking insurance on death rates and found that, in fact, people with no health insurance had a 40 percent higher death rate than similar people who had insurance.

So this — actually, when you do out the numbers, this implies that for every million people who remain uninsured in this country, about 1,000 deaths can be expected. So, perhaps Senator Baucus is happy with leaving 25 million Americans uninsured, but that translates into, predictably, predictably 25,000 American deaths each year due to the lack of health insurance. And that’s completely unacceptable to me as a physician, and it’s completely unacceptable to the other 17,000 physicians who’ve joined me in Physicians for a National Health Program to advocate for a Medicare-for-all, single-payer national health insurance.

JUAN GONZALEZ: Dr. Woolhandler, there have been numerous reports now about the enormous expenditures that are being made by the health insurance industry and by other businesses in America around health insurance, something like $260 million in the first six months of this year on lobbying, another $20 million in direct political contributions. I think the US Chamber of Commerce is in the lead, $26 million spent on lobbying in the first six months of this year. What’s been the impact of that on all of the various bills that are being shaped through the House and the Senate? And where are the public health advocates, in terms of being able to be at the table, as President Obama promised initially that everyone would be at the table?

DR. STEFFIE WOOLHANDLER: Well, I think — to quote Bob Dylan, money in politics “doesn’t talk, it swears.” And, in fact, the reason we’re getting such a bad bill, that’s expensive, that doesn’t cover people, is because of the insurance industry money and influence.

I have to add that the pharmaceutical industry is planning to spend $150 million advertising in support of this bill.

What we need is a single-payer approach that would save between $300 and $400 billion annually by administrative simplification, by getting rid of the billing paperwork. You save $300 to $400 billion annually, and you use that money to cover the uninsured, but also to plug the gaps in the coverage of people who now have insurance, usually private insurance, that’s full of gaps, like co-payments, deductibles, uncovered services, that mean you can be insured, you can have private insurance, and still, if you get a serious illness, find yourself facing bankruptcy. We need to get rid of the insurance industry, take that administrative savings, and use it in a Medicare-for-all plan that would cover all medically necessary services. And obviously, the insurance industry hates that. They have been quoted as saying, “We’re opposed to single-payer national health insurance. It’s a life-or-death struggle for us.”

But, you know, this is still a democracy, and we need to be holding our representatives’ feet to the fire on this. There’s lots of opportunities in the next month to take a stand for single payer, that for the first time in history, there are bills in the House and the Senate, the Sanders bill in the Senate, the Kucinich-Conyers bill in the House of Representatives. There’s two very important amendments. There’s a substitution amendment by New York Representative Anthony Weiner to substitute single-payer language for the entire House bill. Nancy Pelosi has promised him a vote. There’s also the Kucinich amendment, which would allow state opt-out. We think it’s extremely — a state opt-out and to try some single-payer plans.

So we think it’s extremely important for the viewers to get active right now, to be calling those senators and congressmen and telling them to vote for single payer, to vote for the Weiner amendment, to be signing on to the bills in the House and the Senate. People need to be writing to the newspaper, they need to be calling talk shows. This is the time to be saying that the American people deserve Medicare for all and that the Max Baucus bill and, frankly, the House bill, which would leave 17 million uninsured, those are just unacceptable, that we do need Medicare for all, not just to save the lives of the uninsured, but to make sure that people with insurance can afford healthcare when they get sick.

JUAN GONZALEZ: What about the issue of the public option? You’ve been critical of that as a strategy, but many people who favor single payer say that they’ve got to compromise to be able to get a bill passed and would see the public option as that compromise.

DR. STEFFIE WOOLHANDLER: Let me be perfectly clear. The only reason the public option is even on the table is because of the work of single-payer supporters. And you don’t have to believe me on that. Ask the Congress. When I testified before Congress, they repeatedly say that, that they’re being deluged with calls from supporters of single payer, so they’re offering up a public option.

I personally don’t think a public option will work. It’s been tried in five states, in Tennessee, in Minnesota, in Maine, and it never worked. Now, you haven’t heard about the public option in these five states, because it was not a game changer. It didn’t get us to universal healthcare, and it didn’t control costs. The only public option that really makes sense is Medicare for all.

But it’s worth talking about what Baucus is doing, which is a puny, ridiculous kind of public option. To say that there’s going to be co-ops that are going to go out there and compete with Aetna is like sending the peewee football league in against the NFL. The co-ops are just going to be creamed. There’s no way they can compete, and there’s no way that they offer a real alternative for people who are unhappy with the present insurance system.

AMY GOODMAN: So, Dr. Steffie Woolhandler, I mean, you are the co-founder of Physicians for a National Health Program. How are you organizing right now? I mean, as of mid-August, there were six lobbyists trying to influence healthcare legislation for every single member of the House and Senate, according to Bloomberg News. That’s 3,300 lobbyists working on a single issue, three times the number of defense lobbyists, with nearly three new lobbyists joining the fray each day. What happens now? Baucus has put out his plan. What are you doing?

DR. STEFFIE WOOLHANDLER: OK. Well, we really need to make democracy work. And we need to be out there mobilizing the grassroots to tell the Congress and Senate that we need Medicare for all. Trust me, that’s the only reason we got public option on the table in the first place. That’s the reason we’ve managed to get people like me invited to testify. The people have been willing to lobby. People have actually gotten arrested. Doctors and nurses were arrested at the Baucus hearings. People are deluging the newspapers, Congress and Senate with their support for single payer. That’s the only way that we’re going to be able to fight back against this kind of lobbying clout.

And to be honest, it’s remarkable how much progress we’ve made. Given all the money that the other side has, we have been able to get these amendments and bills to the floor. This is the first time in history we’ve had these bills in both houses. We’ve gotten politicians acknowledging that single payer is popular. We have people like Nancy Pelosi and even Baucus saying, “Gee, I wish we could do single payer.” We have President Obama saying, “If we could start from scratch, I’d do single payer.” That’s not because — the lobbyists didn’t ask him to say that. That’s because of grassroots pressure has been put on. And it’s extremely important right now for people to use our democracy, to make that democracy work, to be talking, to be organizing, to be keeping the pressure on.

AMY GOODMAN: Dr. Steffie Woolhandler, I want to thank you for being with us, professor of medicine at Harvard University, co-director of the Harvard Medical School General Internal Medicine Fellowship program. She’s co-founder of Physicians for a National Health Program and just came out with this report that says that 45,000 people die every year as a result of lack of health insurance. We will link to it at democracynow.org.

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