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“The Status Quo Is Not Sustainable”: How Medicare for All Would Fill Gaps in Obamacare Coverage

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As Trump attacks the Affordable Care Act, we look at the growing case for Medicare for all. More than 100 Democratic lawmakers co-sponsored a House bill last month to dramatically revamp healthcare in the United States by creating a Medicare-for-all system funded by the federal government. The bill would expand Medicare to include dental, vision and long-term care, while making the federally run health program available to all Americans. It would also eliminate health insurance premiums, copayments and deductibles. We speak with Dr. Adam Gaffney, president of Physicians for a National Health Program, which has endorsed the measure.

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

AMY GOODMAN: This is Democracy Now! I’m Amy Goodman, with Juan González.

JUAN GONZÁLEZ: We continue our conversation on healthcare as we look at the growing case for Medicare for all. Last month, more than a hundred Democratic lawmakers co-sponsored a House bill to dramatically revamp healthcare in the United States by creating a Medicare-for-all system funded by the federal government. The National Economic & Social Rights Initiative calls the legislation, quote, “by far the strongest healthcare proposal being considered by Congress.” The legislation comes at a time when as many as 30 million Americans have no health insurance and tens of millions more are either underinsured or struggling to pay their health insurance premiums.

AMY GOODMAN: The bill would expand Medicare to include dental, vision and long-term care, while making the federally run health program available to all Americans. It would eliminate health insurance premiums, copayments and deductibles, while changing how healthcare providers are paid.

Most 2020 presidential hopefuls have declared support for Medicare for all. Despite the growing support, Politico reports a top aide to House Speaker Nancy Pelosi worked to undercut Medicare for all following the 2018 election. In a November 30th meeting with health policy researchers, Wendell Primus reportedly told a group of two dozen that Medicare for all is a distraction that should be scrutinized, encouraging researchers to oppose the legislation. Pelosi has denied the reports.

For more, we’re joined by Dr. Adam Gaffney, president of Physicians for a National Health Program, instructor in medicine at Harvard Medical School, author of To Heal Humankind.

Welcome to Democracy Now!, Dr. Gaffney. So, we see President Trump somewhat turning around, saying he’s not pushing to end Obamacare right now, just right after the election, when he says Republicans will take over the House. What does that mean for the whole debate around Medicare for all, when in Congress they’re just scrambling to keep the Affordable Care Act?

DR. ADAM GAFFNEY: Well, look, I think it’s very important to protect the gains that are already made, namely the Affordable Care Act, which did cover 20 million people and, as we heard from the last guest, provided some security for many families across the country. But at the same time, we have to acknowledge that the status quo is not sustainable. As you said, 29 million people are uninsured. Forty-four million people are underinsured, meaning that they have health insurance, but it doesn’t actually coverage their costs, doesn’t actually give them the financial security they need. Thirty-five percent of nonelderly adults go without needed care over the course of a year because they can’t afford it. One in five don’t fill a prescription because they cannot afford it.

So, there’s no question that we’ve made gains, and we need to protect those, and we need to push back against those who would degrade them in the name of tax cuts for the rich. But at the same time, we have to acknowledge that this is not good enough, and that as long as these holes and gaps exist, conservatives will attack the status quo. So, we can do both at the same time.

JUAN GONZÁLEZ: How do you respond to those critics who say that if Medicare for all were implemented, that many of the best doctors would desert that system and would not make their services available through it?

DR. ADAM GAFFNEY: That’s a very unreasonable claim. If you look at countries, like Canada, for instance, that have a single-payer system, essentially all of the doctors, all of the hospitals are in network. If anything, in fact, a Medicare-for-all system will increase people’s access to physicians and doctors. There won’t be insurance networks that keeps people separated, that keep people siloed, that cause disruptions in care every time your boss changes the insurance options you have or every time you change jobs. Under a Medicare-for-all system, there will be one big network with all doctors and all hospitals included, essentially. So, it’s really not a valid claim.

AMY GOODMAN: President Trump said he’s having his doctors and health executives in the Senate write legislation to replace the Affordable Care Act, like Rand Paul, who’s a doctor, as well as Dr. Barrasso, a senator, as well as Rick Scott, the now-senator from Florida, who Democrats say oversaw the largest Medicaid fraud in U.S.—Medicare fraud in U.S. history. He was formerly the CEO of Columbia HCA, when the hospital company was fined $1.7 billion for Medicare fraud. So, if you could respond to that, but also explain what exactly Medicare for all would look like when it comes to getting rid of the health insurance companies, for example?

DR. ADAM GAFFNEY: So, I mean, to respond to the first question, I think we should be extremely skeptical that whatever they generate is going to be any better than the really vicious piece of legislation that was proposed during the Affordable Care Act effort back in 2017. As we know, those bills would have slashed spending on public healthcare programs like Medicaid, would have slashed funding for the subsidies that make health insurance more affordable for some people. So, I’m very skeptical that whatever they generate is going to be an iota more friendly than the last bit of, again, vicious proposed legislation. Now, in terms of this—

AMY GOODMAN: Can you respond to Rick Scott, the former healthcare executive, who’s now the Senate? This is what he had to say.

SEN. RICK SCOTT: We do know that Medicare for all, which Senator Sanders is all in on, is going to just ruin our healthcare system.

MARGARET BRENNAN: So, are you—I’m sorry, just to clarify, did you just say that—

SEN. RICK SCOTT: It’s going to ruin Medicare, and it’s also going to ruin private insurance.

MARGARET BRENNAN: Did you just say that you expect the White House to come forward with a proposal first?

SEN. RICK SCOTT: Well, I know—I know the—I know, in the end, the White House is going to have to have their plan. And I know it’s going to be difficult with Nancy Pelosi. But what I’m going to focus on is: How do you drive down costs? The Democrats constantly focus on access. The problem is, the cost of healthcare is too high in this country.

AMY GOODMAN: So, he was speaking on CBS’s Face the Nation. Dr. Gaffney, if you could respond to what he’s saying—Democrats focus on access; I focus on cost?

DR. ADAM GAFFNEY: Well, we know that countries that actually have universal access also have higher costs. These two things go hand in hand. The United States has terrible access and also has overall costs that are about double those of other high-income nations. The notion that there’s a trade-off is simply false. And that’s made clear as soon as you look across the national borders. We can—in fact, we need to—achieve universal coverage, but that will also allow us to control costs moving forward.

JUAN GONZÁLEZ: And how would those costs be controlled moving forward?

DR. ADAM GAFFNEY: So, a universal healthcare system like single payer gives you unique ways of controlling costs. So, for instance, in the House bill that was put forward by lead sponsor Pramila Jayapal recently, that bill would basically create a universal healthcare system in which one plan covered everyone. And what we know about those sorts of plans is that they are far more efficient in terms of administrative overhead.

To give you just a couple of numbers, traditional Medicare, the traditional Medicare program, has a 2% overhead, meaning 2 cents of every dollar go to overhead, 98 cents goes healthcare. For private health insurance companies, if you include profits, the overhead is over 10%. That’s an enormous amount of money when you’re talking about trillions of dollars of healthcare spending. That’s just one way in which a public healthcare system is far more efficient than a privatized, fragmented system like we have now.

JUAN GONZÁLEZ: But to follow up on that, in terms of how this would be paid for, clearly there would be some kind of, I would assume, a payroll tax. And we’re looking at, right now, most Americans—it’s hard to tell what most people pay, because you’re dealing with premiums, you’re dealing with deductibles, you’re dealing with copays, you’re dealiong with co-insurance. Everybody has different plans and different employer contributions. So, what would it look like in the paycheck of average Americans if Medicare for all were actually instituted? Have you been able to cost out what it would mean in terms of a general cost to the average worker?

DR. ADAM GAFFNEY: Sure. Well, I mean, keep in mind for one moment—and I’ll address that directly—that we already publicly finance about two-thirds of our healthcare system. So, about two-thirds of healthcare dollars are already taxpayer-financed. But you are right that people—the other third is things like premiums, copays, co-insurance, deductibles and so on. So we would need to replace much of that private spending with public dollars, with taxes. There was an economic analysis recently from the University of Amherst that looked at a mix of taxes that could replace those payments. And, you know, overall, for the average working American, things would get better.

You know, I think it’s also important to keep in mind how harmful these out-of-pocket costs are for working people. People with high deductibles, we know, go without needed care. They avoid doctors. They avoid the hospitals. In fact, they even avoid the emergency room when they have high-severity conditions. So, it is an issue of dollars and cents, but it’s also an issue of people’s health being on the line, people’s lives, in fact.

AMY GOODMAN: And how do you plan to organize for Medicare for all?

DR. ADAM GAFFNEY: Well, my organization, Physicians for a National Health Program, focuses on the medical professional, although we also work to educate the public. But we do focus on the medical profession. There are many other groups that are involved in this fight—National Nurses United, for one, the largest nursing union in the country, many other organizations.

This is a big fight, let’s be honest. Even though it’s a very rational, logical program that we’re proposing, we are going up against powerful interests, namely the insurance industry and, to some extent, the pharmaceutical industry. So this is a big fight. So it’s—

AMY GOODMAN: We’re going to have to leave it there, but we’ll continue the discussion. Dr. Adam Gaffney, president of Physicians for a National Health Program. I’m Amy Goodman, with Juan González. Thanks so much for joining us.

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