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Part 2: If Obamacare Is Repealed, Advocates Expect "Meaner and Skimpier" Replacement for the Poor

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Guests
Steffie Woolhandler

professor at CUNY-Hunter College and a primary care physician. She is a lecturer at Harvard Medical School and the co-founder of Physicians for a National Health Program.

As Republicans in the newly sworn-in 115th Congress are moving swiftly to repeal the Affordable Care Act, President Obama’s signature healthcare law, we continue our extended interview with Dr. Steffie Woolhandler, a primary care physician and co-founder of Physicians for a National Health Program.

Watch Part 1: Repeal & Run? Republicans Move to Axe Obamacare, But What Will Replacement Look Like?


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

AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman, as we continue with Part 2 of our conversation with Dr. Steffie Woolhandler, a professor at CUNY-Hunter College here in New York, a primary care physician, lecturer at Harvard Medical School, the co-founder of Physicians for a National Health Program, which did not, by the way, embrace Obamacare. But now, three years later, it looks like a record number of sign-ups on HealthCare.gov for 2017 health insurance coverage. CNBC reports federal health officials touted a record 6.4 million customer sign-ups on the federal Obamacare marketplace, HealthCare.gov, so far this enrollment season. That’s quite something for what Republicans are saying is an extremely unpopular program, and they say they are going to repeal it, perhaps as early as this week. Dr. Steffie Woolhandler, your response?

DR. STEFFIE WOOLHANDLER: Well, I’m very glad to see the Medicaid expansion. That was by far the best part of the Obamacare legislation. But there were a lot of very negative things. For one thing, it never got us anywhere close to universal healthcare. There are still close to 30 million Americans who are uninsured. So, the Obamacare legislation didn’t get us to universal. And frankly, it didn’t fix things for people who have insurance but are underinsured. That is, they have insurance, but there’s so many gaps, like copayments and deductibles and uncovered services, that they still can’t afford care. And that underinsurance problem was getting worse before Obamacare and continued to get worse under the Obamacare legislation. And that’s a lot of the reason, I think, why Obamacare was so unpopular. The Democrats were going around saying, "Look, we solved the problem. We have Obamacare. It’s great." And a lot of people were looking at their own insurance, their own healthcare situation, and saying, "Gee, nothing improved for me." Had the Obama and Clinton said, you know, "We got a little bit of improvement, and now we need to fight to get real universal coverage," I think they would have had a lot of resonance with the electorate. Certainly, that’s what Bernie Sanders was saying. He voted for Obamacare and then said, "But let’s move on to Medicare for all." That would have resonated, but the line they took, that, "Gee, we have the ACA. We’ve solved everything," frankly, made them look like liars, you know. And they didn’t solve everything. They got some insurance for a lot of people. Twenty million people is a sizable number of people. But remember, there’s 310 million Americans, and most of them did not benefit under the Obamacare legislation.

AMY GOODMAN: So, let’s talk about the road to single payer. In Part 1 of our conversation, we played several clips of Donald Trump before he won the election, talking about single payer. Unlike other Republicans, who completely denigrate, for example, the Canadian system, he said it works great in Canada. He said it works great in Scotland, where he has his golf courses. He seems open. I mean, as a businessman, he didn’t want to pay for these astronomical costs in healthcare. What is the road to single payer? And what does Medicare for all look like?

DR. STEFFIE WOOLHANDLER: Well, you know, we have another election in less than two years, and I think we need to be looking forward to changing Congress and the Senate, if we’re going to get single payer. Donald Trump used to say a lot of liberal things. He’s not saying them very much anymore. He’s appointed extremely conservative people to his Cabinet, and particularly his health secretary and the head of the CMS, which runs Medicare and Medicaid, are very, very conservative people. So, we do not—

AMY GOODMAN: Congressman Pence’s head of Health and Human Services—

DR. STEFFIE WOOLHANDLER: —expect Donald Trump to be embracing single payer. What we do expect is that the American people are going to be thinking much more about single payer, and also, I think, Democratic legislators, as well, now that it’s clear that Obamacare is kind of played out. It was passed six years ago. It’s been up and running for nearly three years. And the electorate is saying, "No, this is not good enough. We need something better." And, you know, in fact, the only thing that will work is a single-payer plan. That’s, by and large, because if you have a Medicare-for-all, single-payer-type system, you get tremendous administrative savings. You save about 14 percent of total healthcare spending just by reducing the paperwork in getting that single-payer system. So you have hundreds of billions of dollars in administrative savings that you can use to cover the uninsured and to improve coverage for people who now have only partial coverage. So, that’s the way single payer works. That’s the way it works in Canada, the way it works in Scotland. And that’s what we need to do to get healthcare to the American people.

AMY GOODMAN: But how exactly do you do that, when you have the Democrats who, in shaping Obamacare, really pushed aside all of you Medicare-for-all activists? I mean, remember Senator Baucus, his raucous caucus, trying to prevent people who advocated for this Medicare-for-all system from even being a part of the conversation before the legislation was written.

DR. STEFFIE WOOLHANDLER: Yeah, well, the Democratic Party has been changed a lot by this election. The person who was actually popular with working-class people, who actually generated excitement among young people, was Senator Sanders. And, of course, he won 20 states. He has now been incorporated into the Democratic Party leadership. And again, so his position is enhanced. The position of Elizabeth Warren is enhanced. So, Senator Sanders, as you know, ran on a platform of Medicare for all and has continued to say we shouldn’t be talking about a rollback, we should be talking about moving forward to making healthcare a right. So, I think the only way to defend the modest gains, if you will, that were made with the Affordable Care Act—the only way to defend those gains is to be saying to the American people, "Let’s move forward to Medicare for all and improve the situation for everyone, not just 20 or 22 million people, but for everyone." So, I think the Democratic Party has been changed. They’re pretty aware of the fact that you actually have to do something for the majority of working families if you want to get their votes. And certainly single payer would be something that would very substantially improve the lot of Americans, America’s working families.

AMY GOODMAN: Can you explain Donald Trump’s pick of Seema Verma, who you mentioned, together with the Georgia congressman, Tom Price, who really would be the person who is in charge of looking at Medicare and Medicaid?

DR. STEFFIE WOOLHANDLER: Well, Seema Verma would be the administrator of Medicare and Medicaid, which is an extremely powerful position because of the, you know, hundreds and hundreds of billions of dollars federal government spends on those programs. Ms. Verma worked as a consultant in Indiana designing Indiana’s Medicaid—now, they call it the Medicaid reform, but it was really a rollback of Medicaid. It was an extremely punitive Medicaid program requiring very poor people to deposit money in a savings account every single month. And if they missed a payment, which can often happen with a very poor person—they may not have the money one month—they missed a single payment, they would lose their health insurance for six months, or they would get their insurance cut way back so they have to pay a copayment every time they went to see the doctors. So, it’s pretty much the most punitive Medicaid program in the country. And Seema Verma designed that program at the behest of then-Governor Pence. So, I think we know, both from Ms. Verma’s appointment and from what Paul Ryan has said, that they’re planning to really make Medicaid a very skimpy program that does not provide sick poor people with adequate access to care. Basically, it will pay the hospital, so the hospital bill is paid, but really will not allow poor people to get the full range of medical care they need to stay healthy.

Tom Price, you know, he’s trained as a doctor. Thankfully, his views do not represent the views of the majority of U.S. physicians. The majority of U.S. physicians support some form of national health insurance. And Tom Price has opposed Medicaid expansion. He wants to privatize the Medicare program. He wants to close down Planned Parenthood, restrict reproductive rights. Those views are very extreme both within American society and within the medical profession, where many physicians do support national health insurance, and 20,000 physicians have joined with us in Physicians for a National Health Program to support single-payer national health insurance.

AMY GOODMAN: Let me play for you the Senate minority leader now, Chuck Schumer’s response to Donald Trump’s choice of Georgia Congressmember Tom Price to be secretary of health and human services, Price now the chair of the House Budget Committee and member of the Tea Party Caucus and, again, of course, one of the leading opponents of Obamacare, as you point out, supporting privatizing Medicare, opposing abortion and voting to cut all federal funding for Planned Parenthood.

SEN. CHUCK SCHUMER: I was just so disappointed to see the president-elect nominate Congressman Price to serve as secretary of health and human services this morning. When it comes to issues like Medicare, the Affordable Care Act and Planned Parenthood, Congressman Price and the average American couldn’t be further apart. Between this nomination of an avowed Medicare opponent and Republicans here in Washington threatening to privatize Medicare, it’s clear that Washington Republicans are plotting a war on seniors next year. Every senior, every American should hear this loudly and clearly: Democrats will not let them win that fight.

AMY GOODMAN: So there you have the Senate minority leader, Chuck Schumer, talking about Tom Price, talking about senior citizens in this country. You were also talking about Planned Parenthood and the cutting of it. We’re talking about what those in power are doing. But, Dr. Steffie Woolhandler, aside from being a professor at Harvard and CUNY-Hunter College, you’re a primary care physician. You’re going to be in Albuquerque on Friday speaking for your group, the group that you founded, Physicians for a National Health Program. You’ll be participating in the Million Woman March, which is happening not only in Washington, but in Los Angeles, in Albuquerque, in Santa Fe. Talk about how women’s healthcare and reproductive rights fits into this picture and will be affected by what’s happening in Congress now, and how you’re organizing against it, what movements are doing.

DR. STEFFIE WOOLHANDLER: OK. Well, you know, the physician community is close to unanimous in supporting reproductive rights and reproductive healthcare. There are physicians who have a personal religious objection to abortion, but the overwhelming majority of physicians do support a woman’s right to choose. And that’s because it’s a very important public health issue that women have to be able to control their reproduction in order to maintain their own health, in order to maintain the economic security of themselves and their families, in order to plan for healthy families. So, there’s near unanimity in the medical community in support of reproductive rights, which is why the selection of Representative Price is—really, is outside of the mainstream, not just of the American people, but of the medical community.

One of the hospitals where I work in Boston, the doctors are saying that 500 of them are taking buses down to Washington on Saturday, January 21, for the Million Woman March, which is, frankly, extraordinary that doctors are, on their own time and own expense, participating actively. I mean, I do think that the one silver lining, if you will, in the very dark cloud of the Trump administration is that it is really mobilizing people to say, you know, "No more armchair commentary. It’s time to get out on the streets. It’s time to get out and really fight for what we believe." And for the physician community, that includes reproductive rights. That includes the rights of immigrants, the rights of non-Christians, the rights of racial minorities, the rights of unions to organize. So, you know, I think we are seeing a real mobilization of the medical community.

There’s not only the Million Woman March, but there’s actions on January 13th in New York at 4:00 at Trump Tower, a mobilization for single payer. Senator Sanders has called for actions on January 15th. There’s people calling in to their congressmen supporting single payer on January 20th. And Physicians for a National Health Program, along with the American Medical Women’s Association, the American Medical Student Association, the student WhiteCoats4BlackLives, the Physicians for Social Responsibility, the National Nurses United, the largest nurses’ union in the United States, those groups are planning an action at workplaces the day that the Obamacare legislation is repealed, so at the places where people actually work, to support moving forward from Obamacare to universal coverage, but also supporting those other issues—immigrant rights, healthy environment, opposition to racism—all of the issues that are really under threat with the Trump administration and the Republican control of both houses. So, you know, we are mobilizing. We hope other people will want to join us in mobilizing, because that’s the way to protect American democracy and to make sure that eventually we do get a healthcare system that serves everyone in this country.

AMY GOODMAN: Last week, Planned Parenthood supporters tried to deliver petitions with—I think it was 87,000 "Stand with PP," "Stand with Planned Parenthood," petitions, telling Ryan not to defund Planned Parenthood. And he called out six security guards to block them. So, do you see single payer or Medicare for all, if it happens, starting in one state? Vermont attempted it, but it didn’t happen. Where do you see it possibly happening in the United States as a model, sort of like Canada, right? Wasn’t it Kiefer Sutherland’s grandfather, Thomas—Tommy Douglas, who did it in Saskatchewan, and then it became so popular, despite tremendous opposition of the American Medical Association, though that was in the United States, that it simply spread across Canada and was adopted? And he became one of the most popular Canadians of all time.

DR. STEFFIE WOOLHANDLER: Well, certainly, Physicians for a National Health Program has a lot of state chapters that work on state bills in trying to get single payer at the state level. And I’m a big supporter of that work. But we’re going to have to get a Congress and a president who’s going to allow the states to experiment with single payer, and right now we don’t have that. Now, we do have an election in less than two years that could change the nature of Congress and the Senate. So, we don’t have—it may not be that far away. But you do have to get Congress to allow you to incorporate Medicare and federal employees into a state single-payer bill, and that can’t just be done administratively. That has to be done by Congress. So, you do need to get a Congress and a Senate that will accept state experimentation. And, of course, we don’t really have that, at least in the short run.

AMY GOODMAN: And what’s going to happen to rural hospitals, to hospitals overall, with Obamacare being repealed?

DR. STEFFIE WOOLHANDLER: Well, that’s very much up in the air. Certainly, hospitals that are seeing a lot of Medicaid patients and getting a lot of their funding through Medicaid are very frightened about what’s going to happen under this new Republican administration, which does plan to cut way back on Medicaid. So, that would be a lot of our inner-city hospitals. A lot of our rural hospitals, you know, are really going to be facing some problems. I don’t expect very dramatic changes immediately. Even the Republicans seem to realize, if you’re going to make changes of that magnitude, you have to phase them in slowly. Nonetheless, I think there are going to be problems for hospitals that care for a lot of lower-income people.

AMY GOODMAN: And considering that Republicans, and many Democrats, stand for big business, the insurance industry is—aren’t they satisfied with Obamacare? Wouldn’t they be putting enormous pressure on the Republicans not to defund it?

DR. STEFFIE WOOLHANDLER: OK. Well, the thing the insurance companies have been happiest about are the Medicaid expansion, which has most been almost entirely done through private-managed Medicaid plans. So, most of the new Medicaid expansion has been through private plans. Similarly, there’s been a partial privatization of the Medicare program already through the so-called Medicare Advantage Plans, which are private plans that enroll seniors, and then the taxpayers pay the premiums. And for many years, the Medicare program has been overpaying private insurance companies for these Medicare Advantage Plans, and they’ve been quite profitable for the private insurance industry and have been expanding quite rapidly. So, we’re quite sure that the Obama administration [sic] and Price will be pushing for Medicare privatization. It may just be that they’re going to push to accelerate the expansion of these private Medicare Advantage Plans—

AMY GOODMAN: You mean the Trump administration.

DR. STEFFIE WOOLHANDLER: —rather than do the voucher system, which is—frankly, the Republicans have been talking about a voucher system for Medicare for about 20 years and have never gotten any traction with it. It’s wildly unpopular. So, I wouldn’t be surprised if they kind of shift gears and say, "OK, let’s just accelerate the privatization through Medicare Advantage."

AMY GOODMAN: And the cost of drugs?

DR. STEFFIE WOOLHANDLER: Well, very good question. The Republicans have made it clear that they are not going to constrain the pharmaceutical industry. They’ve been talking about, "Oh, we need innovation," which is a buzzword for saying, "Don’t let the FDA look, do a thorough look at the safety of drugs. Just have them pass everything through without a thorough review for safety." They’re very pro-Pharma, and I think we’re likely to see a steady increase in pharmaceutical prices. We may occasionally get some grandstanding, where, over a particular drug, you know, the Congress or Senate makes a big deal and forces the drug industry to roll back. But overall, we’ve actually seen a steady increase in the price of all drugs over the past few years, including generic drugs. And the Republicans seem to be willing to tolerate that and allow that to continue.

AMY GOODMAN: And I wanted to ask you about mental health, a combination, actually, of mental health and the VA, because there’s been this discussion of President-elect Trump starting to talk about privatization of the VA, but these two coming together when you have the shooter in Fort Lauderdale, starting in Alaska, going to an FBI office, saying he’s hearing voices. He was in Iraq for years. He’s institutionalized for a day or two, and then he is released and is given his gun back. But not only soldiers and vets with PTSD, but the whole issue of mental health and what will happen to it in a Trump administration?

DR. STEFFIE WOOLHANDLER: Well, mental health is probably absolutely underfunded in the United States, particularly outpatient care for children and young adults. We’re really not seeing enough care being delivered, you know, in the community where people need it. We’ve also seen a cutback in the number of mental health hospital beds, which is what you need when somebody’s actively suicidal or homicidal, and yet those have been cut back. So, mental health, actually, needs a lot of attention. Even if we go to single payer, we’re going to have to pay a lot of attention to improving the mental health system and making sure that everyone who needs mental health gets it, a particularly big issue with veterans. You know, veterans have been trained to solve problems by shooting guns. And if they have mental health problems, they’ve very likely to pick up a gun and, you know, express their mental health problems through shooting.

But the VA has been, actually, a very good system. It’s a large system. And periodically there’s scandals, or there’s problems. But when you look overall at the data, it’s very clear that the average quality of care in the VA system is higher than the average quality in the—in the civilian sector. And that’s very clear in the medical literature. So, yes, there’s problems in the VA. There’s isolated problems that need to be fixed. But privatization would be a terrible, terrible mistake, because you’d be moving from a system that functions better, albeit with problems, to a system that’s more expensive and functions worse. So, privatization is a terrible idea. I was heartened to see that many veterans’ groups actually stood up and said, "No, we don’t want privatization. We want you to fix the problems that exist in the VA now, but we do not see privatization as the answer."

AMY GOODMAN: Dr. Steffie Woolhandler, we thank you so much for spending this time, professor at City University of New York, CUNY, Hunter College, primary care physician, lecturer at Harvard Medical School, co-founder of Physicians for a National Health Program, one of the major organizations in this country that support Medicare for all. This is Democracy Now! I’m Amy Goodman. Go to democracynow.org for Part 1 of our conversation. Thanks for joining us.

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Repeal & Run? Republicans Move to Axe Obamacare, But What Will Replacement Look Like?

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