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Healthcare Debate: As Supreme Court Hears Landmark Case, Does Law Do Enough to Fix Health Crisis?

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As the Supreme Court weighs whether the Affordable Care Act goes too far, we host a debate on whether the law goes far enough. The case is reviving the heated tensions that surrounded the healthcare reform law in the debate leading up to its passage two years ago. Although support for the measure is often equated with backing the expansion of health coverage for all Americans, there are some who maintain it didn’t go far enough in helping the uninsured. We speak to Dr. Stephanie Woolhandler, co-founder of Physicians for a National Health Program, and John McDonough, who played a key role in shaping Mitt Romney’s healthcare reform law in Massachusetts as well as the Affordable Care Act. The new healthcare law is “going to leave tens of millions of Americans woefully underinsured, with gaps in their coverage like copayments and deductibles, so they’ll still be bankrupted by illness. And it’s not going to control cost,” Woolhandler argues. “So we still need single-payer national health insurance regardless of what happens at the Supreme Court.” But McDonough notes that “the moment when there would be sufficient political will for the Congress and the president to come together and pass meaningful, near-comprehensive reform, that might take another 20 years.” [includes rush transcript]

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

AMY GOODMAN: The Supreme Court is convening a historic session on the constitutionality of the Affordable Care Act, the landmark healthcare reform bill signed by President Obama two years ago. Oral arguments began Monday with a debate over whether the law can be contested in light of a statute that protects taxes from challenge before they take effect. Today, justices will hear arguments over an issue at the heart of so-called “Obamacare,” the individual mandate that requires most people buy health insurance by 2014 or pay a tax penalty. A third and final day of arguments will be held on Wednesday.

The Supreme Court case is expected to have huge implications for the nation and the 2012 elections and is being followed closely by all sides of the healthcare debate. On Monday, supporters and opponents of the healthcare law gathered outside the Supreme Court to make their voices heard.

WILLIAM YOUNG: It’s not about politics. It’s not about being partisan or, you know, linking up to some kind of—linking up to some kind of position that you need to tie yourself to. This is about people taking care of other people. And it’s about the idea that we’re putting profit over people. And big health insurance companies don’t need any help; they’re making a lot of money. And I think that regular people need to advocate for themselves, because the insurance companies are not going to advocate for you. But Obama will, and that’s what this bill does.

ROD RHOADES: We support healthcare reform from our hearts. We are sad when children go to the hospital, and they don’t have insurance. That breaks our hearts. That cannot be here in America. But this bill is unconstitutional. It was—it’s illegal. It was done on bribes and kickbacks to Obama’s campaign supporters. We’re completely against it. We want real reform, where the money goes to the people in the hospitals that need it. That’s what we want.

AMY GOODMAN: Also appearing outside the Supreme Court was Republican presidential hopeful Rick Santorum, who touted his steadfast opposition to the healthcare law.

RICK SANTORUM: This bill has far-reaching consequences for the economic health of this country and for basic liberty in our society. And that’s why this decision and the debate that is going on right now is fundamental. And there’s one candidate in this race who can actually make the contrast that is necessary between the Republican position, the conservative position, and one that is an overwhelmingly supported by the American public, and one that Barack Obama believes in. And that’s Rick Santorum.

AMY GOODMAN: The argument of the Supreme Court case is reviving the heated tensions that surrounded the healthcare law in the debate leading up to its passage two years ago. But although support for the healthcare law is often equated with backing the expansion of healthcare coverage for all Americans, there are some who maintain the bill did not go far enough in helping the uninsured. In an amicus brief filed with the Supreme Court last month, a group of physicians argued against the healthcare mandate altogether, saying Congress should instead legislate a single-payer system to provide universal care for all.

I’m joined now by two guests on opposite sides of this overlooked part of the healthcare debate. Dr. Steffie Woolhandler is co-founder of Physicians for a National Health Program, whose members signed on to the amicus brief arguing against the individual mandate and for single payer. She is a primary care physician who teaches in public health at CUNY-Hunter College and at Harvard Medical School.

And joining me from Boston is John McDonough, professor at the Harvard School of Public Health, director of the New Center for Public Leadership. Between 2008 and 2010, he served as a senior adviser on national health reform to the U.S. Senate Committee on Health, Education, Labor and Pensions. And between 2003 and 2008, he served as executive director of Health Care for All in Massachusetts, playing a key role in the passage of the 2006 Massachusetts health reform law, known as Romneycare, regarded by many as the model for the current healthcare law. He has a new book out; it’s called Inside National Health Reform.

We welcome you both to Democracy Now! And we’re going to begin with Professor McDonough. The importance, the significance, of this Supreme Court hearing over these three days?

JOHN McDONOUGH: Well, it could be very consequential in terms of some of the key features of the law: the Medicaid expansion for 16 million low-income Americans, as well as the success of the private health insurance expansion through the individual mandate. I think, ultimately, far less important than the decision of any—the Supreme Court will be the decision of voters in November, on November 6th. Really, the future of this law will be decided by who controls the White House and who controls Congress next year, and the Supreme Court is really secondary.

AMY GOODMAN: Steffie Woolhandler?

DR. STEFFIE WOOLHANDLER: Well, I want to say, our organization, Physicians for a National Health Program, did not take a position on the Supreme Court deliberations. Some of the members opposed the mandate and did weigh in in the amicus brief. Some were more ambivalent and felt that there was some good in the bill. What we all agree on, however, is that the bill is not a solution. It will leave 27 million Americans uninsured when it’s fully implemented. It’s going to leave tens of millions of Americans woefully underinsured, with gaps in their coverage like copayments and deductibles, so they’ll still be bankrupted by illness. And it’s not going to control cost. So we still need single-payer national health insurance regardless of what happens at the Supreme Court.

AMY GOODMAN: Do you care if the Supreme Court were to reject it, say the individual mandate is not constitutional?

DR. STEFFIE WOOLHANDLER: Well, the individual mandate is a very, very bad idea. The good parts of the bill are things like a Medicaid expansion, which does not require an individual mandate, some regulations on the insurance industry, which does not require a mandate. All of those could have been done without the mandate. The problem with the mandate is it’s telling people that they have to turn over their money to the private health insurance industry. There’s also $447 billion in taxpayer money that is going to be turned over to the private health insurance industry. So the bill is strengthening the position of the private health insurance industry, the very industry that’s responsible for $380 billion in wasted healthcare dollars on bureaucracy and paperwork.

AMY GOODMAN: Professor McDonough?

JOHN McDONOUGH: I don’t disagree with the assertions of my friend, Dr. Woolhandler. And I would agree with her that I think a single-payer plan could be far preferable. The reality was that there was no possibility in 2009, 2010, of achieving passage of anything close to a single payer. And I think, really, the question is, does the Affordable Care Act move the system forward by eliminating pre-existing conditions, by creating the Medicaid expansions, by undertaking so many other important improvements to the healthcare system, tripling the size of the National Health Service Corps, providing important new funding for community health centers, just many, many important provisions? The question is, is, does the Affordable Care Act move the system forward, and was it worth doing? And I guess that’s probably where we disagree. I think that, short of a single-payer system, that the Affordable Care Act was the best that we could get done and that it really will provide significant, meaningful, important improvements for the lives and the health and the well-being of many, many millions of Americans and really does move the system forward in very important ways in terms of trying to address some serious deficiencies in the quality and efficiency of medical care delivery in the United States.

AMY GOODMAN: Dr. Woolhandler, what about that, that Obama got done what he could?

DR. STEFFIE WOOLHANDLER: Well, I practiced primary care for decades in Massachusetts, and I still teach there, and I’m at a public hospital. And I saw what happened in Massachusetts, which—with the Romneycare that was a model for Obamacare. Some people got helped a little bit; some people got hurt a little bit. But for most of the doctors and patients, nothing changed. That is, people still could not afford care and had to seek care in the public sector because they were unable to afford the care that they needed.

AMY GOODMAN: We’re going to break and then come back to this discussion. Dr. Steffie Wooldhandler, co-founder of Physicians for a National Health Program, and Dr. John McDonough of the Harvard School of Public Health, where Dr. Steffie Woolhandler just came from. His new book is called Inside National Health Reform. This is Democracy Now! Back in 45 seconds.


AMY GOODMAN: Our guest, Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program, came from the Harvard School—from Harvard Medical School to New York, and she is teaching now at CUNY, City University of New York. Professor John McDonough is still at the Harvard School of Public Health. His new book is called Inside National Health Reform.

I want to play an excerpt of attorney Robert Long speaking to the high court justices about the Anti-Injunction Act, the federal law that purports to require someone to actually be taxed before they can challenge that tax.

ROBERT LONG: Our initial submission is, you don’t have to determine that this is a tax in order to find that the Anti-Injunction Act applies, because Congress very specifically said that it shall be assessed and collected in the same manner as a tax, even if it’s a tax penalty and not a tax.

AMY GOODMAN: John McDonough, what exactly is attorney Robert Long opposing about the Affordable Care Act?

JOHN McDONOUGH: Well, he’s not opposing or supporting it. He’s saying that there is an 1867 law, the Anti-Injunction Act, and a key part of it says you can’t sue to prevent the collection of a tax until the tax has actually gone into effect and people are paying it. I happen to think, based upon my reading—and I’m not an attorney—that there’s a very strong case that the Anti-Injunction Act prevails. I think, though, that the justices on both sides of the ideological spectrum want to decide this, and that was clear from their questioning yesterday. And so, I think the Anti-Injunction Act kind of is going to be moved to the back of the room or kind of in a closet. And if the justices end up in some kind of a significant deadlock, then they might at the end, if they can’t resolve it, pull the Anti-Injunction Act out of the closet and use it. Otherwise, I think they’re going to do everything they can to try to make some more definitive ruling by June.

AMY GOODMAN: Professor McDonough, you occupy an interesting position. You were key in both Romneycare, the healthcare act in Massachusetts that has become really the basis of what many call Obamacare, or the Affordable Care Act—you were involved with both. Now you have these two presidential candidates most likely going up against each other, and you have Romney saying that he completely opposes what President Obama has managed to have passed into law. What is your response to that?

JOHN McDONOUGH: Mitt Romney found himself in a quite peculiar position. The individual mandate emerged from conservative Republican circles in the late '80s and early ’90s and gained prominence as an alternative to the Clinton health reform vision in ’93, ’94. And Republicans kept beating that drum for years. Mitt Romney mistakenly thought they meant it and were serious, and so he took their idea, and he actually worked to and helped to actualize it in Massachusetts as part of the Massachusetts health reform law. And then, when they attempted to do it on a national basis through the Democrats' healthcare initiative, all the Republicans who said they were for this deserted the ship, jumped off the ship. But Romney couldn’t do it, because he was pictured holding the steering wheel with Ted Kennedy when they made it happen. So, he finds himself in an ironic situation in terms of supporting something that was very much Republican orthodoxy and then watched all the Republicans abandon it.

You know, the truth is that Romney had a very minimalist vision of what Massachusetts health reform would be. It was one that—I was in the advocacy community at the time—that we did not support at all. But the Democrats had overwhelmingly control in the House and the Senate. And we were able to work with them to make what is now referred to as Romneycare much more robust and full. And right now in Massachusetts, more than 98 percent of all residents have health insurance. About 99.8 percent of children have health insurance. It’s not perfect. For every flaw that Dr. Woolhandler names, I could probably name two or three. It is a significant step forward, in terms of doing a better job in terms of providing coverage and some financial protection. And overwhelmingly in Massachusetts, people support it and think it has worked and it’s been a good thing.

AMY GOODMAN: Dr. Steffie Woolhandler?

DR. STEFFIE WOOLHANDLER: Let me tell you that it is not true that 98 percent of people have health insurance in Massachusetts. The Census Bureau says 94 percent. And let me tell you the kind of health insurance that people have. If you go on the exchange website in Massachusetts and try to buy health insurance for someone my age, you’re going to be taking $5,600 out of your pocket to pay the premiums. Then, if you got sick, you would have a $2,000 deductible. So you’re $7,600 out of pocket before the insurance pays a penny. And you’re mandated to buy that coverage; you don’t have a choice. So, things are not—are not at all solved in Massachusetts. Some people were helped; some were hurt. But many people still can’t afford care.

You know, one of the things that happened in Massachusetts, and is going to happen nationally, is money was taken out of safety-net hospitals to pay for the bill. Nationally, $36 billion is going to be removed from safety-net hospitals to pay for Obamacare. And that means that the remaining uninsured—and there will be 27 million uninsured—the tens of millions who are underinsured, may have no place to go when they get sick, because the safety net has been cut. So there’s some very negative consequences to these bills in Massachusetts and nationally, as well as the positive consequences that John is talking about.

AMY GOODMAN: If this Affordable Care Act is ruled unconstitutional by the Supreme Court, it’s possible nothing will change in some 20 years. What do you—do you think that is true?

DR. STEFFIE WOOLHANDLER: Absolutely not. The healthcare system is in a complete state of crisis. And that’s what’s going to reopen the healthcare debate. You know, history is not just made by legislators. It’s also made by small people like us, doctors, nurses, patients, people who write letters to the editor—


DR. STEFFIE WOOLHANDLER: —who go to meetings. You can do state-level reform.

AMY GOODMAN: Well, aren’t a number of states, one by one—for example, Vermont—aren’t they now just adopting a very different—they’re coming up with their own kind of single-payer system.

DR. STEFFIE WOOLHANDLER: Yes. Well, certainly there’s state-level efforts in Vermont and in Hawaii that are talking about single payer. But this debate is not going to shut down for 20 years, because the American people cannot get healthcare. You know, when we talk about 27 million people remaining uninsured under Obamacare, we’re talking about one in 1,000 of them dying every year because they lack health insurance, approximately 27,000 deaths annually from lack of health insurance. And that’s unacceptable to me as a physician, and I think it’s unacceptable to the American people. And the health reform debate will continue regardless of what happens in the Supreme Court this week.

AMY GOODMAN: Professor McDonough, the individual mandate, if it is deemed unconstitutional by the high court, by the Supreme Court, because in the legislation it was made unseverable, would it throw out the whole plan?

JOHN McDONOUGH: No, absolutely not. I think that the most that the court would throw out with the individual mandate, if they did that—and I don’t think they will, but if they did—they would throw out the guaranteed issue, meaning the protection against pre-existing conditions and medical underwriting, and they might throw out the community rating, as well, which we would—I would think would be very unfortunate and would create a less functional insurance market, for sure.

Let me just agree and disagree with my friend Steffie, who I really respect. She’s terrific and does wonderful work. First of all, I totally agree the debate would not end if the law were thrown out. However, the moment when there would be sufficient political will for the Congress and the president to come together and pass meaningful, near-comprehensive reform, that might take another 20 years. The debate certainly would not end. But these moments that occur in the early '90s, in 2009, 2010, in 1965, in 1935, these are not moments that come every session, every decade. These are every generation or every other generation before these chances happen. And that's why it’s important, I think, to build on it. The original Social Security Act that Franklin Roosevelt signed in 1935 excluded two-thirds of working African Americans, excluded more than half of working women, but it was the foundation and the structure that was built on over time to create the Social Security system we have and we know and recognize today. And I think it’s similar with Medicare and Medicaid, and it’s similar with the Affordable Care Act.

AMY GOODMAN: Steffie Woolhandler?

DR. STEFFIE WOOLHANDLER: Well, this is a little like saying that we’re going to start Social Security by handing over money to the private pension funds. What’s going on here in Obamacare is we’re saying we’re going to get to universal healthcare by turning over hundreds of billions of dollars to the private health insurance industry, the group that’s been blocking reform and blocking change for decades. So, we’re starting off in the wrong direction here, if we’re trying to start going toward universal healthcare.

AMY GOODMAN: The Supreme Court decision is being closely followed by many who say they could benefit from the law. Robyn Martin is a mother of a seven-month-old son who suffers from a serious heart condition.

ROBYN MARTIN: We need the Supreme Court to uphold the Affordable Care Act, because we need this little boy to continue to have healthcare without having to worry about hitting a limit, without having to add up each one of our visits to see how close we’re going to get to an arbitrary limit that a health insurance company sets for us.

AMY GOODMAN: Dr. Woolhandler, what do you say to people like Robyn Martin?

DR. STEFFIE WOOLHANDLER: Well, we definitely need the universal healthcare. ’Til we get there, we need guaranteed issue, we need community rating. But all of those things could be done without the mandate. There was community rating in this country for decades when I was growing up, which means that everybody pays the same insurance premium and—under Blue Cross, when I was growing up. So we do not need the individual mandate in order to have these things, and we did not need to hand over hundreds of billions of dollars to the private health insurance industry to get those helpful parts of the legislation.

AMY GOODMAN: How did we get to where we are? How did the Affordable Care Act end up, as you say, captured by the insurance industry?

DR. STEFFIE WOOLHANDLER: Well, the insurance industry wrote the framework for Romneycare in the form of Blue Cross Blue Shield Foundation in Massachusetts that wrote the original framework. When it came time for Obamacare, the Senate framework, which became the backbone of the law, was written by none other than Elizabeth Fowler, whose previous job had been vice president of WellPoint, the nation’s largest private insurance company. The insurance industry spent hundreds of millions of dollars lobbying on this bill. They gave hundreds of millions to the Democrats and hundreds of millions to the Republicans, both supporting and opposing the bill, but assuring that voices from the left who supported real universal healthcare, real single payer, were shut out.

The only way those voices ultimately got heard was because people showed up in front of the White House in white coats and demonstrated. Doctors and nurses got arrested in Senate hearings. We forced the issue of single payer back onto the agenda against the wishes of the private health insurance industry. And that’s what needs to happen if we’re ever going to get to a real universal system that’s affordable, that gets rid of the private health insurance industry, and recaptures that $380 billion in excess paperwork costs and uses it to cover everyone.

AMY GOODMAN: Professor John McDonough, is Governor Romney lying when he says he doesn’t support an individual mandate? Was that your experience in Massachusetts?

JOHN McDONOUGH: Oh, no, he robustly supported it. He did. And I think he would—I don’t think he’s backed away from saying he supports it. I think the way he has parsed it is he said, “Well, I support it on the state level, but not as a federal requirement.”

AMY GOODMAN: Yes, that is what he says.

JOHN McDONOUGH: And so, you can judge that for what you think. But there are many, many statements in 2007, '08 and ’09 where he indicated support for a national mandate. So, either he's lying, or he’s changed his views on the utility of doing it on a national basis.

AMY GOODMAN: Not to mention he and his wife’s support of Planned Parenthood as part of that program.

JOHN McDONOUGH: Well, we have a long list of those kinds of situations we can look at.

AMY GOODMAN: Well, I want to thank you both for being with us. John McDonough is with the Harvard School of Public Health. His new book is called Inside National Health Reform. And Dr. Steffie Woolhandler is co-founder of Physicians for a National Health Program. She was working at Harvard Medical School and has moved to New York, working within the CUNY system, the City University of New York.

This is Democracy Now!, democracynow.org, The War and Peace Report. When we come back, what was the role of Lariam, if any, the controversial malaria drug? Did Robert Bales take it, the soldier in Afghanistan accused of killing 17 Afghans? We will also talk about Who [Bombed] Judi Bari?, a new documentary that’s out about the environmentalist. Stay with us.

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