- Dr. Steffie Woolhandlerprofessor of medicine at Harvard University and a primary care physician in Cambridge. She is also a co-founder of Physicians for a National Health Program. She testified about uninsured veterans before Congress in 2007.
On Veterans Day, a new study estimates four times as many US Army veterans died last year because they lacked health insurance than the total number of US soldiers who were killed in Iraq and Afghanistan in the same period. A research team at Harvard Medical School says 2,266 veterans under the age of sixty-five died in 2008 because they were uninsured. We speak to the report’s co-author, Dr. Steffie Woolhandler, professor of medicine at Harvard University and co-founder of Physicians for a National Health Program. [includes rush transcript]
AMY GOODMAN: Today is Veterans Day. We begin with a new study that estimates four times as many US Army veterans died last year because they lacked health insurance than the total number of US soldiers who were killed in Iraq and Afghanistan in the same period. A research team at Harvard Medical School says 2,266 veterans under the age of sixty-five died in 2008 because they were uninsured. Their estimates are based on their recently published findings in the American Journal of Public Health that shows how being uninsured raises a person’s odds of dying prematurely by 40 percent.
The researchers also found that nearly one-and-a-half million Veterans between the ages of eighteen and sixty-four were uninsured last year. While most veterans are eligible to receive care from the Veterans Administration, those who were not injured in combat and whose income is above a certain threshold are often ineligible.
The report’s authors say the healthcare legislation pending in the House and Senate will not significantly improve the situation.
The co-author of the report, Dr. Steffie Woolhandler, joins me here in our firehouse studio. She’s professor of medicine at Harvard University and a primary care physician in Cambridge. She is also co-founder of Physicians for a National Health Program and testified about uninsured veterans before Congress in 2007.
We welcome you to Democracy Now! I mean, these are astounding figures. Tell us exactly what you found.
DR. STEFFIE WOOLHANDLER: Well, the risk of dying is actually elevated by about 40 percent among people who have no health insurance, and there’s just under 1.5 million uninsured veterans nationally. So applying those odds to those folks, it turns out that there’s almost 2,300 folks who die — veterans who die every year due to lack of health insurance.
Many of these folks, these veterans, would not be helped under the bills before the House and Senate, because they’ll be too affluent to qualify for Medicare. If they get subsidies at all — for Medicaid. If they get subsidies at all, the subsidies will be too small to make health insurance affordable. And they’re mostly working families, folks who don’t have the money to buy private insurance, but they have too much money to qualify for Medicaid or means-tested VA benefits.
AMY GOODMAN: I think people would be very surprised to know that once you’re a vet, no matter what your income level, you’re not covered by VA healthcare system for the rest of your life.
DR. STEFFIE WOOLHANDLER: Oh, well, that’s been true for a long time. The VA will cover you if you have a service-connected injury, like you get your leg shot off. They do provide a safety net for people with very low incomes, eligible for Medicaid, or slightly higher incomes. However, many middle-income vets are not eligible for VA care, and that’s who these uninsured veterans are. And sadly, many of them will continue to be uninsured under the House or Senate bills, which, even if they work as planned, will leave somewhere between a third and a half of all uninsured people still uninsured in the year 2020.
AMY GOODMAN: What’s the VA saying about this?
DR. STEFFIE WOOLHANDLER: The VA did show up at the hearings, and I think they would love to have more money in order to be able to expand the care that they give. In fact, I think the VA is a good system and actually a good safety net, if you can get access to it. But currently there’s just not the funding within the VA system to allow them to cover all veterans.
AMY GOODMAN: Are there any examples you can share with us of what has happened to a veteran?
DR. STEFFIE WOOLHANDLER: Well, we do — we did hear stories from people. Often they were folks in the middle-income ranges. They had been out of the service for two or three or five years. They were working, but they were not getting insurance through their work, and they could not qualify for VA care. Similarly, there’s only a limited number of VA facilities. They’re in a lot of cities, but not all cities. And many people just couldn’t get to a VA facility even if they were eligible.
AMY GOODMAN: How does this fit into the bigger picture of what’s happening in the United States today?
DR. STEFFIE WOOLHANDLER: Well, I support Medicare-for-all, single-payer national health insurance. I work with a group of doctors called Physicians for a National Health Program that advocates that. We think everyone — everyone — needs healthcare through a Medicare-for-all approach. And I think the plight of the veterans epitomizes what happens to working families generally. Working families get caught in the middle. They can’t get Medicaid. They can’t get means-tested VA. They can’t afford private insurance. And the House and Senate bills don’t really fix that problem.
AMY GOODMAN: When the House voted on the bill, 220-to-215, what was your reaction? And can you analyze it for us?
DR. STEFFIE WOOLHANDLER: Well, we think that the Congress needs to start from scratch on this bill. The reform process in Washington has been hijacked by the private health insurance industry. If you look at the Baucus framework, which was the basis of the Senate bill — it’s on the Senate Finance Committee website. Just right-click on that document, and it turns out the author of the document was Elizabeth Fowler, who’s a former vice president of Wellpoint, the nation’s largest private insurance company, covering 35 million people. So the private insurance industry has hijacked the process. What’s come out of the House, what’s likely to come out of the Senate, is a completely inadequate bill that takes about $500 billion in taxpayer money and hands it over to the private health insurance industry.
AMY GOODMAN: I mean, explain exactly that, as people are suffering in the midst of this, you know, tremendous economic downturn, this global economic meltdown. You’re talking once again, not only with the bankers, but with the insurance company, of forcing people to buy health insurance, but to buy it from private insurers. So this is an incredible deal for the private insurers.
DR. STEFFIE WOOLHANDLER: Right. Well, the private insurers are getting millions of mandatory new customers. The taxpayers are going to give subsidies. It’s not going to make healthcare affordable, but it’s going to cost the taxpayers a lot of money to give these subsidies.
Private health insurance is a defective product. We know from our studies of bankruptcy that the majority of Americans who face medical bankruptcy start their illness with private health insurance but are bankrupted anyway by gaps in coverage, like co-payments, deductibles and uncovered services.
And under the House and Senate bills, they’ve done nothing to fix private health insurance. They’ve merely made private health insurance mandatory for middle-income working people and forcing those folks to take lots of money out of their pocket to buy this defective product.
AMY GOODMAN: And, of course, most bankruptcies in this country are caused by medical problems; they are medical bankruptcies.
DR. STEFFIE WOOLHANDLER: Right. In our studies, we found that 62 percent of all bankruptcies in the United States are due at least in part to medical illness or medical bills and that the majority of folks in medical bankruptcy started that illness with private health insurance.
AMY GOODMAN: But what about those who perhaps do even support Medicare for all or single payer who are saying, “Well, at least now you’re talking about tens of millions of people who will be insured, who weren’t otherwise”?
DR. STEFFIE WOOLHANDLER: What’s happened in the past when bills like this have passed in the states is that they run out of money very quickly, healthcare is simply unaffordable, and then you start to see the coverage expansions cut back. The subsidies shrink, the Medicaid shrinks, and then you’re back at square one, where you’ve spent a lot of money and not made any progress. And we’ve seen this over and over in the United States — in Massachusetts in 1988, in Oregon in 1992, in Washington 1993 — passed bills virtually identical to what’s being passed in the House right now, and there was no durable improvement in the number of uninsured in those states. Healthcare was not affordable ten years after those bills were passed.
The problem with the House bill is it simply won’t work. And, you know, if we want to expand Medicaid, fine, we should expand Medicaid. If we want more primary care, good, let’s expand primary care. But doing it through $500 billion in subsidies to the private health insurance industry will have the effect of making the health insurance industry more powerful, making the health insurance lobby more powerful. And just as they’ve hijacked this process in Washington, it makes them more able to hijack political processes in the future.
AMY GOODMAN: And the cost of drugs? So it’s not only the mandatory — mandating that people buy health insurance from private companies, but the deal that was worked with the pharmaceutical industry in this country. Explain that.
DR. STEFFIE WOOLHANDLER: OK. Well, the deal with the pharmaceutical industry was minimal. The pharmaceutical industry gave up very little. They said for Medicare recipients who are in the donut hole, they would make low-priced generics available. That’s a very small share of the population. For the rest of us, who may be unable to afford expensive medications, we got nothing out of the pharmaceutical industry.
The pharmaceutical industry, frankly, is thrilled with this bill. And despite all their squawking, the health insurance industry is pretty happy, too. You know, Wall Street has rewarded them by driving up the value of their stocks. And I think any fair and honest reading of this bill would say that it’s a tremendous victory for the health insurance industry. And what we need to do to get to universal healthcare is start from scratch, go for that Medicare-for-all, single-payer approach.
AMY GOODMAN: And the issue of women, reproductive healthcare and abortion?
DR. STEFFIE WOOLHANDLER: Well, that is a horrendous provision in the House bill, which would essentially extend a ban on abortion to private health insurance. In the past, the Hyde Amendment applied only to people who were getting publicly funded care. But in the new bill, any insurance product that’s offered through the exchange has to —-
AMY GOODMAN: And explain the exchange.
DR. STEFFIE WOOLHANDLER: Yes. The exchange would be this marketplace where you would go to buy your insurance. If you had subsidized coverage, you would have to buy your insurance through the exchange.
And any insurance plan purchased through the exchange would have to exclude coverage of abortion. So, for the first time, Congress has stepped in and said that even with your own money, with private money, it’s illegal for insurance to cover abortion. It’s a tremendous step backwards for women’s rights.
AMY GOODMAN: And do you think it will make its way through to the final bill?
DR. STEFFIE WOOLHANDLER: Well, I’m not sure about that. Certainly President Obama has weighed in to say, “Well, let’s try to return to what was there before, with just a ban on public funding of abortion,” which is bad enough. It remains unclear what’s going to happen in the Senate, whether the right-to-life folks will step in and get an anti-choice plank in the Senate bill, as well. They certainly were successful in the House. And, of course, that’s one of the many reasons that we think we need to start from scratch on a new health reform bill.
AMY GOODMAN: Steffie Woolhandler, you come from Massachusetts. That’s often held up as the model. I recently saw on CNN your former Governor Weld interviewed about his plan that has been adopted by all of Massachusetts. Explain the Massachusetts plan and then how we, as Americans, fit into the rest of the world when it comes to our healthcare system.
DR. STEFFIE WOOLHANDLER: OK. Well, the Massachusetts plan is considered the model for the national legislation. There’s a mandate that makes it illegal to refuse to purchase private health insurance. The fine is up to $1,068. The good thing with the Massachusetts plan was there was a big Medicaid expansion, but you didn’t need to do the mandates in order to do the Medicaid expansion.
Much of the Massachusetts plan has been wildly expensive. According to the state’s report to its bondholders, it’s cost $1.3 billion this year. The state has opted to pay for that by stealing money from safety net clinics and hospitals, so that safety net providers that care for immigrants, the mentally ill, people with substance abuse, that provide primary care, they’ve seen their funds shrunken, so that money could be handed over to purchase insurance policies. Massachusetts now has the highest healthcare costs in the history of the world.
You have to compare that to what goes on internationally. With the average per capita cost of healthcare about half those in the United States, yet people in Canada and western Europe live about two years longer. They have complete free choice of doctor and hospital. They have lower infant mortality. People in other developed nations use some form of nonprofit national health insurance to get better care for less money. And that’s why our group supports the Medicare-for-all approach.
AMY GOODMAN: So the question is where that fits in today. Finally, former President Clinton met with Senate Democrats yesterday and basically said nothing -— said something is better than nothing, pass this now. What do you feel about that?
DR. STEFFIE WOOLHANDLER: Well, I think we know — we now know the outlines of what they’re going to pass. It’s not an abstract something; it’s something real. And it’s quite bad. It’s $500 billion in new subsidies to the private health insurance, millions of mandatory new customers for private health insurance.
The public plan option is incredibly puny. According to the Congressional Budget Office, fewer than two percent of Americans will enroll. And the premiums will actually be higher — higher — than premiums in the private sector. So the public plan option will be an expensive, tax-funded subsidy to private health insurance, because the public plan option will take the sickest patients off their hands. It’s not going to be something that’s going to generate coverage or decrease costs.
So, we know what the outlines are of the plan, and there are so many bad and harmful planks to the plan that we do need to start from scratch on health reform.
AMY GOODMAN: Since it doesn’t look like they will, will you not support what is coming out right now? Would you have voted no if you were a congressman — Congress member? Would you vote no in the Senate?
DR. STEFFIE WOOLHANDLER: Well, I’m a, you know, doctor; I’m not a politician. I feel a little bit like we’re debating whether to give aspirin or Tylenol to a patient with breast cancer. The patient needs surgery. And what’s being debated in Washington is really Tylenol or aspirin. And I had said for awhile we’d have to see the final shape of the bill, because, of course, we’d — I’d love to see more Medicaid money. Medicaid is very helpful for very poor people. It’s not perfect, but it’s much better than nothing. But I think there’s so many bad planks in the bill that this bill needs to be scratched, and we need to start over.
AMY GOODMAN: Do think this is a better deal for the health insurance industry, for the private health insurance industry in this country, than we have right now?
DR. STEFFIE WOOLHANDLER: I actually do. Their number one demand was the so-called individual mandate that would make it illegal to not have health insurance. It will become a federal crime to be uninsured. If you have private health insurance through your work, and you hate your private health insurance, tough luck, you have to keep that insurance. The mandate means you have to keep it. You can’t buy the public option. You probably won’t be able to go through the exchange. So they’ve made private health insurance mandatory, giving them hundreds of billions in new — mandatory new customers.
There’s some minimal insurance regulation, and I think more regulation is better than less regulation of insurance, but that’s going to be counterbalanced by the tremendous economic boost that will be given to the private health insurance industry through this bill. And as we know, if you have a lot of money, you can buy a lot of political influence. I think down the line we’re actually likely to be worse off in handing over so much taxpayer money to what is essentially a private health insurance industry bailout.
AMY GOODMAN: Dr. Steffie Woolhandler, I want to thank you very much for being with us, professor of medicine at Harvard University, primary care physician in Cambridge, co-founder of Physicians for a National Health Program. We’ll have a link to their study on our website at democracynow.org.