The Democratic presidential candidates remain deeply divided on how to expand healthcare to the tens of millions of Americans who are uninsured or underinsured. Senators Bernie Sanders and Elizabeth Warren have both pushed for abolishing private health insurance and establishing a Medicare for All system. Their rivals have pushed a number of different, more incremental approaches. During the first night of the latest debates, Sanders pointed out that the country has taken sweeping action before to expand health coverage to millions of Americans, referring to the 50th anniversary of the creation of Medicare and Medicaid. We speak with Janet Golden, professor emerita at Rutgers University-Camden and a historian of U.S. medicine, and Wendell Potter, a former health insurance executive.
AMY GOODMAN: This is Democracy Now! I’m Amy Goodman. The Democratic presidential candidates remain deeply divided on how to expand healthcare to the tens of millions of Americans who are uninsured or underinsured. Senators Bernie Sanders and Elizabeth Warren have both pushed for abolishing private health insurance and establishing Medicare for All. Their rivals have pushed a number of different, more incremental approaches. During Tuesday’s debate, Senator Elizabeth Warren and former Colorado Governor John Hickenlooper sparred over the best way forward.
JOHN HICKENLOOPER: And I think proposing a public option that allows some form of Medicare, that maybe is a combination of Medicare Advantage and Medicare, but people choose it. And if enough people choose it, it expands, the quality improves, the cost comes down, more people choose it. Eventually, in 15 years, you can get there, but it would be an evolution, not a revolution.
JAKE TAPPER: Thank you, Governor. Senator Warren?
SEN. ELIZABETH WARREN: You know, we have tried this experiment with the insurance companies. And what they’ve done is they’ve sucked billions of dollars out of our healthcare system, and they force people to have to fight to try to get the healthcare coverage that their doctors and nurses say that they need. Why does everybody — why does every doctor, why does every hospital have to fill out so many complicated forms? It’s because it gives insurance companies a chance to say no and to push that cost back on the patients.
AMY GOODMAN: During the debate, Senator Bernie Sanders pointed out the country has taken sweeping action before to expand health coverage to millions of Americans.
SEN. BERNIE SANDERS: Interestingly enough, today is the anniversary of Medicare. Fifty-four years ago, under Lyndon Johnson and a Democratic Congress, they started a new program — after one year, 19 million elderly people in it. Please don’t tell me that in a four-year period we cannot go from 65 down to 55 to 45 to 35. This is not radical. This is what virtually every other country on Earth does.
JAKE TAPPER: Thank you, Senator.
SEN. BERNIE SANDERS: We are the odd guy out.
AMY GOODMAN: In fact, let’s go back 54 years ago this week, to 1965. This is President Lyndon Johnson signing Medicare into law, July 30th, 1965. Joining him at the signing was former President Harry Truman. This is LBJ.
PRESIDENT LYNDON JOHNSON: There are more than 18 million Americans over the age of 65. Most of them have low income. Most of them are threatened by illness and medical expenses that they cannot afford. And through this new law, Mr. President, every citizen will be able, in his productive years, when he’s earning, to insure himself against the ravages of illness in his old age. This insurance will help pay for care in hospitals, in skilled nursing homes or in the home. And under a separate plan, it will help meet the fees of the doctors. And just think, Mr. President, because of this document and the long years of struggle which so many have put into creating it, in this town and a thousand other towns like it, there are men and women in pain who will now find ease.
AMY GOODMAN: President Lyndon Baines Johnson, July 30th, 1965.
We turn now to Janet Golden, professor emerita at Rutgers-Camden University and a historian of U.S. medicine. Her recent piece in The Philadelphia Inquirer is headlined “Happy Birthday to Medicare and Medicaid.”
Welcome to Democracy Now! Let’s start, Janet Golden, by you telling us: What were the forces then that were working against Medicare and Medicaid? Who were the forces working for it? And then compare to what we’re seeing 54 years later. How did Medicare and Medicaid get established?
JANET GOLDEN: Well, Medicare and Medicaid really have a long history. In 1930s, during the Great Depression, there was a push by the Committee on Costs of Medical Care to extend healthcare. We then had a push in 1935 in the Social Security Act. There was a health insurance piece of that, that was removed. Harry Truman, as you saw in that clip, pushed for healthcare beginning in 1945. And it took until 1965, when we finally got to Medicare and Medicaid.
And interestingly, the forces against it are the same ones we’re hearing about from today: the people who stand to make money from healthcare — although in those days it was more the physicians than the medical establishment and the insurance companies. And the rhetoric was so wonderfully familiar. It was all about socialism and bankrupting America and all the threats that choice would be taken away and healthcare would be rationed.
So, in many ways, the debates remain the same, although the partisans on each side have shifted a little bit, in part because, of course, our healthcare system has changed. Medical education has gotten more important and more extensive and more expensive. Our hospitals are now sucking up a large part of our healthcare budget. And then, of course, the drugs and devices, the Big Pharma, that are playing a role now. And they’re all basically saying, “No, I like the profits as they are now,” as Senator Warren had said.
AMY GOODMAN: But the forces then, those that fought against it and those — how did it get through the Senate and the House? Were the charges of socialism being charged back then? How did it ultimately win?
JANET GOLDEN: It won because we had, with the election of President Johnson, a broad coalition of Democrats who worked to make this happen. Basically, you had a mandate from the American people, through their electoral process, to say, “Yes, we need healthcare.” And the forces were there. The AMA fought it extensively. And I hope you have that clip of former President Reagan, before he was president —
AMY GOODMAN: Oh, wait. Let’s go to that clip.
JANET GOLDEN: — campaigning for that — yes, campaigning against it.
AMY GOODMAN: Let’s go to 1961. This is actor Ronald Reagan, who would become president of the United States, who recorded an album titled Ronald Reagan Speaks Out Against Socialized Medicine.
RONALD REAGAN: Now, what reason could the other people have for backing a bill which says, “We insist on compulsory health insurance for senior citizens on a basis of age alone, regardless of whether they are worth millions of dollars, whether they have an income, whether they’re protected by their own insurance, whether they have savings”? I think we could be excused for believing that, as ex-Congressman Forand said, this was simply an excuse to bring about what they wanted all the time: socialized medicine. We can say right now that we want no further encroachment on these individual liberties and freedoms. And at the moment, the key issue is: We do not want socialized medicine.
AMY GOODMAN: So, at the time, that’s actor Ronald Reagan. Then he became president. Who was he paid by to do that?
JANET GOLDEN: The American Medical Association and some other trade group.
AMY GOODMAN: So fascinating, because the American Medical Association would then go on to push doctors in Canada to fight against Medicare for All, healthcare for all in Canada.
JANET GOLDEN: That’s correct.
AMY GOODMAN: Afraid that if the contagion spread north, that it would then influence people in the United States.
We’re also joined by Wendell Potter, who is a former top executive for health insurance companies Cigna and Humana. At Cigna, he served as head of communications. He’s author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans. He’s now president of the nonprofit Business for Medicare for All.
Wendell Potter, take us from then, back when Medicare and Medicaid was fought — it was then passed, became one of the most popular programs in the United States — and then your own trajectory, what you were doing as the top executive at Cigna and at Humana — one of the top executives — what you were saying about Medicare and Medicaid.
WENDELL POTTER: Well, my first career, I was certainly saying that, “Let’s privatize Medicare. Let’s see what we can do to get as many people into private plans as we possibly can.” And when I first went to work for Humana in 1989, Humana was selling private managed care plans in the Medicare program. And that has become a big cash cow, by the way, for the insurance industry.
But what happened after the Medicare program was enacted in 1965, we just kind of stopped. It was the intent to bring everyone into the Medicare program eventually, but what happened instead was that we allowed private industry to create and construct what has become a Rube Goldberg contraption, that exists to make money for big corporations like the ones that I used to work for. And the reason that we have ever-increasing prices in this country is because all the players now are working very symbiotically. Insurance companies cannot control healthcare costs, nor do they want to.
So I left my job in 2008 as head of corporate communications at Cigna after a crisis of conscience. I realized that what I was doing for a living was making it necessary for people to go without insurance or, even if they had insurance, not being able to go to the doctor because of high deductibles. It’s only gotten worse since then, even after the enactment of the Affordable Care Act. We’re seeing once again the number of people without insurance go back up, and the number of people who are underinsured, who have health plans that are inadequate, is really skyrocketing.
So, we are at a point in our history in which we absolutely have to say, “This isn’t working for anyone except big corporations and their executives and their shareholders.” We’ve got to do something more than just tweak the Affordable Care Act, to get to a system that is more like countries in the other — other countries in the developed world.
AMY GOODMAN: As I was leaving today, right before the broadcast, CNN was doing yet another piece. This one was how Finland’s socialized medicine program is failing. Bernie Sanders pointed out two nights ago in the debate — he was taking on not only some of his Democratic — these other Democratic contenders for president, but CNN itself and how they frame this discussion, and that, he pointed out, in a few minutes they would be running, for sure, a pharmaceutical ad. So, talk about how this is being framed today.
WENDELL POTTER: It’s being framed in the way that I used to frame it myself in my old job, because I used to be a part of the effort to get people to believe things that were not true about the system in Finland or Canada or the U.K. I spent a lot of time developing relationships with reporters and producers at places like CNN, to frame — to get them to talk about healthcare in a way that we wanted them to talk, and to ask questions and to say things that just simply were not true or that, taken out of context, would get people to believe things that was just not an accurate portrayal of a healthcare system. We focused a lot, by the way, on Canada. And one of the things that I’m doing, in particular, is apologizing to the American public for all the misleading that I did in my old career to get people to think that people wait a long time to get care in Canada and other countries. It’s just simply not true.
But the insurance industry and its allies are spending enormous sums of money. And that money is your money, by the way. If you have private insurance, you’re spending money to pay for the propaganda campaigns. The insurance industry, the big hospital companies, the big drug companies have come together. They’re pooling money to create a front group called the Partnership for America’s Health Care Future. It’s the latest front group that the industry has created, over many years. I used to be a part of efforts to work with these front groups. And they exist to mislead people and to get the media to say things and frame questions the way that they want them to be framed.
AMY GOODMAN: I want to turn to Trump —
WENDELL POTTER: It’s —
AMY GOODMAN: Go ahead.
WENDELL POTTER: Go ahead.
AMY GOODMAN: I want to turn to Trump appointee Seema Verma —
WENDELL POTTER: Well, it is — I’ve often called it — yeah.
AMY GOODMAN: — the administrator of the Centers for Medicare and Medicaid Services. She spoke at the Federation of American Hospitals’ 2019 annual meeting earlier this year.
SEEMA VERMA: Medicare for All in reality is Medicare for none. This isn’t hyperbole. As the administrator of one of the largest government-run healthcare programs in the world, I see every day its shortcomings. … It’s true that our present system needs improvement; however, doubling down on government and mimicking the failed socialist healthcare systems of Europe, that ration and restrict care, where patients face long periods of time for care, is not the answer.
AMY GOODMAN: That’s Seema Verma, Trump appointee. Your response, Wendell Potter?
WENDELL POTTER: Well, she’s using the same talking points that the industry wants her to use. It’s just a continuation of what we heard Ronald Reagan saying 54 years ago or longer. I’ve often called these talking points evergray, and they trot them out to scare people every time there is a threat to profits. And we’re seeing that again. It’s not going to work this time, because, increasingly, people are not spooked by terms like “socialized medicine.” People are realizing, day in and day out, that they’ve been sold a bill of goods by the insurance industry.
What we do in this country is ration care based on ability to pay. There are Americans all over this country who do not get the care that they need, not because we have a socialized system like another country — we don’t. And even that term, “socialized medicine,” is used purposely to scare people. We don’t let people get the care that they need, because people don’t have the money to get the care that they need. In particular, we’re talking about people who are so-called middle-income individuals and families. They just simply, in many cases, cannot afford to get the care that they need, because they, in many cases, can’t afford insurance. The Affordable Care Act did some good, but it provides subsidies for people who have relatively low incomes. It doesn’t do much of anything to protect people who have middle — so-called middle incomes.
AMY GOODMAN: Let me ask you a quick question.
WENDELL POTTER: People who are rich and people who are at the lower end are doing OK. Yes.
AMY GOODMAN: We just have a few seconds, and, of course, we’ll continue this discussion in the many months to come. But when you were an insurance industry executive, head of communications — you worked with Humana and Cigna — did you find the networks more receptive to you because you were pouring millions into advertising?
WENDELL POTTER: Oh, no doubt about it. You’ll see a lot of ads from not only the insurance industry, but certainly the drug companies. They absolutely are. They’re not going to have stories, they’re not going to do investigative pieces, on an industry that pays them a lot of money. Absolutely.
AMY GOODMAN: We’re going to leave it there today. I want to thank you so much for being with us, Wendell Potter, former executive —
WENDELL POTTER: Thank you.
AMY GOODMAN: — for health insurance companies Cigna and Humana. He served as head of communications at Cigna, author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans, now president of the nonprofit organization — of a nonprofit organization around healthcare. And Janet Golden is professor emerita at Rutgers University and historian of U.S. medicine. We’ll link to your piece in The Philadelphia Inquirer, “Happy Birthday to Medicare and Medicaid.”
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