congressional fellow for Physicians for a National Health Program.
After nearly seven hours of televised debate, President Obama’s so-called bipartisan healthcare summit ended Thursday without any substantive agreement between Republicans and Democrats. Republican lawmakers remained staunchly opposed to using the federal government to regulate health insurance. We speak to Columbia Journalism Review contributing editor Trudy Lieberman and pediatrician Dr. Margaret Flowers of Physicians for a National Health Program. [includes rush transcript]
AMY GOODMAN: After nearly seven hours of televised debate, President Obama’s so-called bipartisan healthcare summit ended Thursday without any substantive agreement between Republicans and Democrats. Republican lawmakers remained staunchly opposed to using the federal government to regulate health insurance.
Following the summit, Illinois Democratic Senator Dick Durbin told reporters, quote, "If nothing comes of this, we’re going to press forward. We just can’t quit. This is a once in a political lifetime opportunity to deal with a healthcare system that is really unsustainable."
Well, earlier in the day, Republican lawmakers had urged the President to drop his healthcare proposal in Congress and start afresh. This is Senator Lamar Alexander of Tennessee.
SEN. LAMAR ALEXANDER: Our country is too big, too complicated, too decentralized, for Washington, a few of us here, just to write a few rules about remaking 17 percent of the economy all at once. That sort of thinking works in the classroom, but it doesn’t work very well in our big complicated country.
AMY GOODMAN: At the end of the session, President Obama acknowledged that the divide between the two parties on this issue might just be too large to bridge, but sent a clear message that Democrats will move forward to pass major legislation with or without Republican support.
PRESIDENT BARACK OBAMA: What I’d like to propose is that I’ve put on the table now some things that I didn’t come in here saying I supported, but that I was willing to work with potential Republican sponsors on. I’d like the Republicans to do a little soul searching and find out are there some things that you’d be willing to embrace that get to this core problem of 30 million people without health insurance and dealing seriously with the pre-existing condition issue.
I don’t know, frankly, whether we can close that gap. And if we can’t close that gap, then I suspect Mitch McConnell and Harry Reid, Nancy Pelosi and John Boehner are going to have a lot of arguments about procedures in Congress about moving forward.
I will tell you this, that when I talk to the parents of children who don’t have healthcare, because they’ve got diabetes or they’ve got some chronic heart disease, when I talk to small businesspeople who are laying people off because they just got their insurance premium, they don’t want us to wait. They can’t afford another five decades.
AMY GOODMAN: Outside the Blair House summit,
across from conservative protesters calling "Kill the bill!" single-payer advocates held a grassroots "Sidewalk Summit for Medicare for All." Physicians for a National Health Program was one of the organizers of the sidewalk summit. Despite repeated requests, the group was not invited to the official summit.
We’re joined in Baltimore now by the congressional fellow for Physicians for a National Health Program, pediatrician Dr. Margaret Flowers. And for more on what happened during the seven-hour summit and what comes next, we’re joined via Democracy Now! video stream by Trudy Lieberman. She’s a contributing editor to the Columbia Journalism Review, and she blogs on healthcare at cjr.org.
We welcome you both to Democracy Now! Trudy Lieberman, let’s begin with you. Even though you are very close to Democracy Now!’s studios, just to let people know the weather report around the country, we have had more than a foot of snow in New York. It is truly astonishing to walk through the streets. The streets are just blanketed in snow. So thank you, though, for joining us from your home by Democracy Now! video stream. Trudy, tell us what was new in yesterday’s seven-day — seven-hour session, if there was anything.
TRUDY LIEBERMAN: Well, I heard one thing that was new. They had a lot at back and forth about the minimum benefit package for insurance policies that would be sold through the insurance exchange. And the insurance exchange is the brokerage service, shopping service, if you will, that the government is planning to set up to help people buy insurance. These are people who don’t have insurance from employers and small businesses. I believe one of the Republicans said that he thought maybe one thing could happen is that the insurance companies that did not have policies that met these minimum benefit standards could sell their policies alongside those that did, and those that did meet benefit standards would have a check or some kind of designation to show that they met some sort of standard that the government had set. That was the first time I had ever heard that being discussed. And whether or not that will survive in the final bell is an unknown question. But for me, that was new.
I think the takeaway, for me, from all of this — and I listened to almost all of it, except for the early morning part — was that, as a country, we are still extremely divided. And this has been a problem that we have had from the very beginning, when this country was founded. We have a deep cleavage in this country about how much government should do and how much government should not do. And for me, that came through in many, many ways. Certainly, it came through in the whole discussion of how much we ought to be regulating insurance companies. Regulation is something that has always been with us. Sometimes we regulate more; sometimes we regulate less. But it’s always a very contentious, tension-filled issue for regulators, for the public and for those who are regulated.
I also came away from the summit thinking that we really have no agreement yet on equity. And the equity issue kind of loomed up here and there during the discussion. It came out in McCain’s comments about the 800,000 Medicare beneficiaries in Florida who are going to not see their Medicare Advantage plans cut if the federal government does succeed in cutting the overpayments to MA plans. He was complaining that his own constituents in Arizona were not getting this kind of a perk, if you will, and that — he was raising the equity issue, in a way, but he was framing it, not in terms of an equity issue, but in terms of the backroom deals that made this carve out for people in Florida.
But I think we really still have no agreement on whether everyone in this country, every citizen, should have healthcare and the ticket to buy it. And I think the President was getting to that point at the very end, when he admitted, quite candidly, he does not know whether we can bridge the gap. And the gap that he identified was how are we going to cover the 30 million people that the government wants to cover and deal with getting everyone into a risk pool, dealing with the pre-existing conditions issue, which keeps people out of this, because in a private insurance market you really — insurance companies can’t really choose people who are sick, or they will go out of business eventually. So that is really the question that has not been resolved.
AMY GOODMAN: In her closing remarks Thursday, House Speaker Nancy Pelosi reminded President Obama he once supported the public option.
HOUSE SPEAKER NANCY PELOSI: Mr. President, I hearken back to that meeting a year ago. At that time, Senator Grassley said to — questioned you about the public option, and you said, “The public option is one way to keep the insurance companies honest and to increase competition. If you have a better way, put it on the table.”
Well, I bring that up because we have come such a long way. We’re talking about how close we are on this, how far apart we are here. But as a representative of the House of Representatives, I want you to know that we were there that day in support of the public option, which would save $120 billion, keep the insurance companies honest, and increase competition. We’ve come a long way to agreeing to a Republican idea: the exchanges. Senator Enzi has been a leader in that. Senator Snowe, along with Senator Durbin, had legislation to that effect, a bipartisan, because the insurance companies opposed the public option. They couldn’t take the competition.
AMY GOODMAN: What about that, Trudy Lieberman? Why did President Obama drop the public option? And what that means?
TRUDY LIEBERMAN: Well, it was never clear to me that he supported it in the first place, although if you go back to the campaign, his campaign boilerplate did say that he supported some kind of a public option. And I had reason to look at that fairly recently, and it was very clear that he did. But perhaps as the campaign went on and campaign contributions came in from stakeholders — not just insurance companies, but the doctors weren’t keen on it. Neither were the hospitals, certainly not the business community, led by the Chamber of Commerce. So it was really a constellation of stakeholders who had contributed to his campaign that did not want the public option. And perhaps he soured on it along the way.
On the advocacy side, it was never really clear, although many of the advocacy groups ran ads for it, gave lip service to it, discussed it in various ways. It was really never clear that they really were 100 percent behind it. And I heard from many people as the debate went on in 2009 that it was basically a bargaining chip. It was something that they could give away in return for something else. And I had always assumed that something else was, let’s get the pre-existing conditions clause removed, let’s have some insurance market reform, let’s find a way to get those 30 million people covered under some kind of insurance. And so, I think that is what happened.
There are some people who believe that the public option was kind of puny, to begin with. Certainly there have been some writers on this who have advanced that theory. That is quite possible, that it never really was robust, to begin with, because if it were robust, it certainly would have been close to a single-payer system, and certainly the stakeholders were not in favor of that.
AMY GOODMAN: Well, let’s go to Margaret Flowers, Baltimore pediatrician and congressional fellow for Physicians for a National Health Program, who is definitely in favor of that. Single payer was not a part of yesterday’s discussion. No advocate was there — Dennis Kucinich, not Physicians for a National Health Program. Your group asked to be represented, Dr. Flowers?
DR. MARGARET FLOWERS: We did, because the President had stated that health experts should be involved in this process. And so, we wanted to offer our services as people that do research in this area. And indeed, they quoted several of our studies during the summit.
AMY GOODMAN: What happened? Why wasn’t anyone represented?
DR. MARGARET FLOWERS: Well, you know, this has been a series of — throughout the entire health process, that we’ve been excluded from this discussion. I think it’s pretty basic. It hearkens back to the special interests that have been involved in this process, you know, and we — it’s really interesting to watch this debate, because so many of the areas that the President and Congress are talking about — cost controls, increasing coverage, excluding pre-existing conditions — all of these would be met through a national Medicare-for-All system. But — so we win, you know, on the policy. But there is such a heavy influence from the insurance and pharmaceutical companies that they, I guess, felt threatened by the presence of the single-payer advocates.
AMY GOODMAN: Just looking at a report from the National Journal by Ashlie Rodriguez, who writes, “Health care interests have given $46.6 million in campaign donations since 2005 to [the] 21 lawmakers” at the bipartisan healthcare summit, including Senator Max Baucus, Senate Minority Leader Mitch McConnell, House Minority Whip Eric Cantor, and to the summit’s host, President Obama, according to this new report. And “Citizens for Responsibility and Ethics in Washington found that health professionals, political action committees, hospitals and nursing homes, pharmaceutical and health product companies, health services firms, HMOs and accident insurers have given heavily to all summit attendees.” How does that affect this discussion, Dr. Flowers?
DR. MARGARET FLOWERS: You know, we could only imagine that it affects it pretty strongly. And we saw that through the year, is that the members of Congress need to get reelected, and if they speak out against the interests who are funding their campaigns, they’re not going to get that funding. So we continue to see these machinations around the dysfunctional situation that we have and tiny efforts to try to patch it together, and we’re missing the bigger picture entirely, which actually the majority of Americans understand and the majority of physicians understand, that we are very different from other industrialized nations because we do not have a health system, we do not take care of everybody in our country.
And we actually could do that. We have a program that’s been working very well for forty-four years now in this country. It’s a model, a model where people can choose which doctor they want to go to. Doctors can choose the treatment for their patients without insurance companies interfering. And it’s also the model that will control healthcare costs and be much more efficient in our healthcare financing. Because we have this system of multiple private, for-profit — or profit-driven, really — insurance companies — their bottom line is not health; it’s profit — we’re wasting a third of our healthcare dollars, over $400 billion a year at this time.
AMY GOODMAN: And you’re talking — of course, you’re talking about Medicare and just dropping the age of eligibility to include everyone. But what about now? Even the public option is off the table. How do you feel about that?
DR. MARGARET FLOWERS: Well, the public option was a very vague concept, to begin with, and so many people didn’t really understand what it was or didn’t have faith that a public option could keep a giant insurance company honest. We have seen evidence over and over at the state level that you can’t keep these insurance companies honest by having a public program. What happens with a public program is that that’s where all of the people who actually need healthcare end up, and the insurance companies continue to avoid the sick, and deny and restrict care, and make huge profits, so that it wasn’t a concept that people could really understand.
But a national improved Medicare-for-All system is very simple to understand, because we’ve seen it working here in this country. It’s familiar. And so, by excluding, I think — by excluding that viewpoint, we really missed an opportunity to push for real reform, because the people do understand national Medicare for All.
AMY GOODMAN: We just have thirty seconds, Dr. Margaret Flowers, but what is the plan of single-payer advocates, of Medicare-for-All advocates, at this point?
DR. MARGARET FLOWERS: We’re going to continue to move forward. You know, I think it’s pretty clear that Congress is not going to be able to do this if left to their own devices. And so we, as a people, are going to have to educate ourselves and get active and get much more involved. And Senator Harkin alluded to the fact that there’s segregation by health status in this country. We can’t allow that to continue. It’s not acceptable. So I hope that more people will get involved with this movement. We’re certainly going to continue to move forward and push for this.
AMY GOODMAN: Dr. Margaret Flowers, Baltimore pediatrician, congressional fellow for Physicians for a National Health Program, she was arrested when she spoke out in Congress trying to get a single-payer advocate included in Max Baucus’s, the Senate healthcare leader, Senate leader of the Finance Committee — getting a healthcare advocate who supported single payer in the discussions in his hearings. Also, Trudy Lieberman, thanks for joining us from here in New York, contributing editor to the Columbia Journalism Review, blogs at cjr.org.