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Election Issue 2004: A Debate on Healthcare

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President Bush and Democratic candidate John Kerry have radically different views on how to run the U.S. healthcare system. We host a debate on healthcare with Harvard professor Dr. Steffie Woolhandler and Sally Pipes of the Pacific Research Institute. [includes rush transcript]

The presidential campaign has been dominated in recent weeks by the military records of President Bush and his contender Senator John Kerry. But it is another issue that is turning out to be one of most important to voters in the election–Healthcare.

Bush and Kerry have radically different views on how the U.S. healthcare system should be run.

Kerry is planning to expand the existing system of employer-provided insurance and federal health programs. Bush wants to rely on market-oriented alternatives to government programs.

The Kerry campaign estimates that their healthcare plan would cost about $650 billion over 10 years and provide coverage for 27 million more Americans by expanding existing government programs and increasing subsidies for private insurance. This according to the Los Angeles Times.

Bush’s plan centers on tax breaks to encourage individuals to buy their own health insurance or to save for future expenses. Bush aides estimate that his plan would cost $145 billion over 10 years and provide coverage for more than 11 million uninsured people.

  • Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard University and co-director of the Harvard Medical School General Internal Medicine Fellowship program. She is a co-founder of Physicians for a National Health Program.
  • Sally Pipes, president of the San Francisco-based Pacific Research Institute. She is the author of the new book “Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t the Answer.”

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

AMY GOODMAN: We’re joined by Dr. Steffie Woolhandler, association professor of Medicine at Harvard University, co-director of the Harvard Medical School General Internal Medicine Fellowship program. Also, Sally Pipes, president of the San Francisco based Pacific Research Institute, author of the new book, Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t the Answer. Sally Pipes, let’s begin with you. You’re assessment of what President Bush has proposed as well as John Kerry?

SALLY PIPES: Yes. Good morning, Amy. I grew up in Canada under Canadian health care, and now the average wait in Canada from seeing a GP to a specialist has gone from in 1993 from nine weeks to 17.9 weeks. So, we have two different plans here. President Bush’s plan is talking about, you know, giving patients and doctors control over the health care rather than government bureaucrats. He’s looking at expanding health savings accounts to provide affordable coverage to individuals and businesses. He’s talking about making changes in tort reform to reduce malpractice awards. He is setting up association health plans so small businesses can band together and provide coverage for workers. Plus refundable tax credits for low income American individuals and families. On the other hand, presidential candidate, Kerry, his plan in my estimate and those of others, economists that I work with, is trillion dollars over ten years. He is saying that he will get this money through rescinding the Bush tax cuts. That would really only cover one-third of the cost. But the real issue in the Kerry plan is he would move the American people more to a Canadian single payer style system. This is just one step. It’s really talking about putting millions of middle income Americans into Medicaid, the federal state health plan for the poor, and putting millions of more Americans into a system of managed competition, which is similar to what Hillary Clinton proposed more than a decade ago. I’ll just make one point on that and you know, when you look at president Clinton and his terrible heart problem, he went in to the doctor on a Thursday, and he had an angiogram Friday, on Monday, he had quadruple bypass. If he lived in Canada, or if Hillary Clinton’s plan had passed, he would be looking at an average wait of 3.4 weeks from seeing a GP to seeing a cardiologist, another 2.1 weeks for having urgent bypass. If it wasn’t that urgent, it would be 10.7 weeks. His plan really is putting more and more government into our lives. The Bush plan is really talking about letting consumers be empowered to take control over their health care and I think that in my opinion, having grown up under Canadian health care, this is the option that Americans will like. You cannot take the American people into that program. It’s just a government program. It’s just not going to work.

JUAN GONZALEZ: Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard University, your response to the Bush plan and also your sense of what Senator Kerry’s plan entails.

DR. STEFFIE WOOLHANDLER: I’ll get to Bush and Kerry in a minute, but I cannot let the falsehoods about Canada stand. When people look scientifically at waits in Canada the average wait for urgent heart surgery is one day. The average wait for non-urgent heart surgery is 17 days. So, Sally’s numbers come from a crackpot research organization that has no credibility, and her organization has been spreading those numbers around and they’re not true. The truth is Canadians have complete free choice of doctor or hospital. They live two to three years longer than Americans, and they’re spending about half of what we do on health care. The reason is that they have so much administrative efficiency by getting rid of the insurance companies and their paperwork, they can afford universal care. Now, our group, Physicians for a National Health Program, which is a leading advocate of single payer health care, does not advocate the Canadian system. We advocate Canada Deluxe. We advocate spending the same amount what they’re spending now twice what they have in Canada, but achieve the administrative efficiency and universal coverage of Canada, so we could cover everyone with no waits of any type. But getting back to the question of Bush and Kerry, Mr. Kerry gets us less than halfway there, even if his plan is successful. He will leave 17 million Americans with no health insurance. Let’s not pretend that’s really universal health care. Mr. Bush’s plan is actually quite a bit worse. He intends to pour money into tax credits which will not succeed in covering people. We know that because Mr. Bush is modeling his plan after an existing tax credit program called the Trade Adjustment Assistance Act, where less than 2% of eligible people have decided to take the tax credit. The reason is that Bush is talking about offering a tax credit of $3,000 for a family to buy health insurance. But the average family policy in this country costs $10,000. This would leave a family with $7,000 they would have to take out of their own pocket in order to get health insurance. And obviously, a low income family, an unemployed family, is not in a position to pay an additional $7,000 out of their pocket for health care. Hence the tax credits are not going to be sufficient to allow low income people to buy health insurance and they’re simply not going to get any coverage out of Mr. Bush.

JUAN GONZALEZ: Sally Pipes, your response, especially on the whole issue of the administrative cost savings as a result of the plans of Senator Kerry; and doesn’t a bigger, more organized system with one buyer have power to control prices better and to prevent health care costs from spiraling?

SALLY PIPES: The Canadian system is expensive. First of all, you’re comparing apples with oranges. Canada doesn’t include the capital costs of hospitals in their numbers. Canada —


SALLY PIPES: Excuse me. Canada has the third most expensive health care system in the world after the United States and Switzerland. Canadians, if you look on websites, you will see the stories of Canadians who are having to wait, who cannot get doctors and are leaving Canada to come to the United States. There’s a woman in Quebec, who is suing the Quebec government in a malpractice suit for $37 million. She’s suing on behalf of 10,000 Quebec breast cancer patients who had to wait over the limit of eight weeks to get radiation oncology. The Canadian Medical Association came out with a report two weeks ago saying that over 50% of Canadians are incredibly dissatisfied with the health care that they are getting, just look on websites and see the number of Canadians who are upset. And Canadians use America as a safety valve. Look at the border towns. Senator Ed Lawson, who was head of the Teamsters union, and became national senator, when he was diagnosed two years ago with heart situations similar to president Clintons, they told him to wait, even a person of such importance as himself, left and came to — went to Seattle, Washington, because he didn’t want to wait two weeks to get an angiogram. So, you know, I’m not a crackpot institute. That was very insulting. I have done a lot of work. I have worked in Canada on this issue. There is tremendous work done by the Frasier Institute in Canada on hospital waiting lists. It’s all scientifically done. The administrative costs in Canada, you’re not comparing apples with apples it is the third most expensive system in the world. In the United States today, 45% of our health care dollars are actually in the government system between Medicaid, Medicare, the State Children’s Health Insurance Program and things like that.

DR. STEFFIE WOOLHANDLER: I’m not calling Sally a crackpot. I’m calling Frasier Institute that she quotes extensively crackpot. This is the group that thinks we ought to privatize the whales. This is a group that thinks that we should abolish medical licenses.

SALLY PIPES: This is a group that thinks there should be private options in Canada. I think a lot of people in the United States think that Canada —

DR. STEFFIE WOOLHANDLER: Sally, I let you talk, okay. Now it’s my turn. The reality is Canada spends half of what we do. I happen to have published a definitive article on the administrative costs in the New England Journal of Medicine. I know what the Canadian hospital cost reports look like. I know what Canadian cost reports look like. Canada spends half of what we do. That’s what the Organisation for Economic Co-operation and Development and the UN say. And that’s the reason why they do have some waits for elective services in Canada. Elective services. Do think that’s a good thing? No. I don’t think we should have to wait for things. But if we have a Canadian style system, and spend twice as much money, then there’s no reason to have any waits. That’s not just my opinion, that’s also the opinion of the US General Accounting Office and the US Congressional Budget Office.

AMY GOODMAN: I’d like to ask Sally Pipes, what do you think is good about John Kerry’s proposal?

SALLY PIPES: Well, I don’t think that there are good things about it. I think the numbers came out from the Census Bureau saying that 45 million Americans do not have insurance. You have to look and analyze who are the 45 million Americans. Because 16% of them are people who are earning over $75,000. 33% are people who are earning over $50,000. Just because you don’t have health insurance does not mean that you don’t get health care. There’s a lot of money spent by individuals who don’t have health insurance who go out and buy their own. They pay out of pocket for their health care. Really, 8 million Americans are people who are chronically uninsured, and low income. Those are the people that I think that the government needs to take care of. And I definitely believe that there are — you know, children and low income families that do need care. I think for the rest of people, we need to open up system to empower consumers to get the best health care they can. People, when you look at any government program, most people do not like the DMV. The post office became more competitive when it opened up to competition from fed ex and UPS and a variety of things. Competition is what makes the world go around. Canadians do not have any form of competition. Any private coverage in Canada is outlawed under the Canada Health Act.

JUAN GONZALEZ: Let me ask you, Sally Pipes, drugs, the cost of prescription drugs have become a huge part of health care costs in this country, and if our system, as it is now structured, is doing so well, why are so many Americans trying to get to Canada, or to Mexico to buy prescription drugs?

SALLY PIPES: Today in America, Americans spend 1% of their income on prescription drugs. In the 1960’s Americans spent 1% of their income on prescription drugs. There are a number of drugs that are available in Canada — in the United States that allow us to — many — the drugs today allow us to live longer and healthier lives. From 1997 to 1999, out of 100 new drugs that became available in the United States, only 43 of them made it onto the formulary in Canada. A lot of the top drugs in the United States that are used in Canada are generically available in the United States, and are cheaper, but the real issue here about prescription drugs, Americans want lower prices for prescription drugs. The reason they’re — the drugs are lower in Europe and Canada is because of price controls. So, what people really want in America is price controls on drugs, which is going to have a negative impact on research and development in this country, and innovation. New drugs have reduced costs for hospital stays because people can use drugs now for ulcers, for — instead of having gall bladder surgery. We’re reducing costs by allowing Americans to have access to the greatest drugs and innovation in the world.

JUAN GONZALEZ: Dr. Steffie Woolhandler, I’d like you to respond to the issue of drugs and the differences between Canada and the United States.

DR. STEFFIE WOOLHANDLER: I want to remind that you, Canadians do live two to three years longer than Americans. That was not true before they went with National Health Insurance. That’s because the National Health Insurance program has allowed them good access to all types of care, including drugs. Canadians, about half of Canadians do get their drugs through their insurance. But all Canadians benefit from a system whereby the government negotiates with drug companies for lower prices. So, Canadians are paying about 60 cents on the dollar that Americans pay, and they’re paying only 60% of what we pay for drugs, and they really are the same drugs. Sally’s idea that you cannot get drugs in Canada is simply not true.

SALLY PIPES: I’m not saying you can’t get drugs.

DR. STEFFIE WOOLHANDLER: They have access to the same drugs that we do, they can just afford them. And similarly, Sally’s contention that uninsured people get all of the health care they need, doesn’t make common sense, but is also belied by a huge body of literature. Most recently, Ayanian colleagues published a study looking at people aged 55 to 65 who have no health insurance, and 10% of the people died over an eight-year period. They died at 33% higher rate than people who had insurance. It’s just common sense that if you don’t have a way to pay for care, you are going to get less of it, and it’s going to impact your health and maybe make your die younger.

AMY GOODMAN: Who benefits under Bush’s plan?

DR. STEFFIE WOOLHANDLER: Well, there’s a big benefit to some middle income taxpayers who end up taking a tax credit where they already had insurance. Now, they can get a tax credit that helps them pay for it. So, there’s some benefit to that. He’s very big, in general, Bush’s policies are very big with the insurance industry and drug industries. Because he has a very hands-off approach, where all of the government taxpayers do is just send more money into the system. There’s no attempt by the government to regulate things or make them more fair.

AMY GOODMAN: Sally pipes?

SALLY PIPES: Well, I’d like it just comment on one thing. Canada is a country of 32 million people, fewer than in the state of California. We have much less ethnically diverse. We don’t have the minority low income populations that are in the United States. If you compare white Canadians to white Americans, Americans are now living longer than Canadians. I think that the Bush plan —

DR. STEFFIE WOOLHANDLER: No, that isn’t true, Sally. It’s simply not true. Canada Health Survey …

AMY GOODMAN: We actually have to leave it there. I want to thank you both for being with us. I know that you both have to race off anyway. Sally Pipes, president of the San Francisco based Pacific Research Institute. Her new book is called Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t the Answer. Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard University, and co-founder of Physicians for a National Health Program.

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