What’s the largest medical bill you’ve ever received? OK, I don’t want to make you sick thinking back on it, so I’ll tell you mine: Back in 2012, I was slapped with a hospital bill for half a million dollars, which is more than most Americans pay for their house. This wasn’t some elective procedure, either — open-heart surgery very rarely is.
It’s important to note that this happened after the passage of the Affordable Care Act. Obamacare was a nice upgrade to a fundamentally flawed system. More people got health insurance, but it’s often still uber-expensive (and getting worse) and still fully unavailable to tens of millions of Americans. Medicaid is being throttled, Republicans are sabotaging protections, and big pharma is colluding with middlemen to rip-off patients and states. Even people with “good” insurance get screwed — personally, I just got a $500 bill for a ten-minute checkup.
Democrats are finally beginning to realize that continually trying to patch up a ship built to sink is futile. And after years of it being considered a far-left radical idea, single-payer healthcare — or Medicare for All — is becoming the mainstream position of national Democratic leaders.
To take a closer look at the momentum behind the single-payer campaign, I spoke with Dr. Carol Paris, the president of Physicians for a National Health Program. For years, PNHP has been at the forefront of advocating for universal healthcare; during the Trump administration, it has worked to both save Obamacare and educate Democrats and lobby nationally for a more complete overhaul of our still-broken healthcare system. She spoke some hard truths about the state of our politics and party, but they’re important ones for us to understand and accept as we push forward for truly comprehensive universal healthcare.
Note: Because it’s a 501(c)(3), PNHP cannot endorse any political candidates. So, I’ve separately made this list of candidates who support Medicare-for-All — CLICK HERE to donate to them!
Medicare for All has more support amongst Democrats than ever. Why do you think that’s happened?
It really began growing as the reality of the failure of the Affordable Care Act to control costs and insure everyone became clearer… I don’t think that moved the legislators, I think it moved their constituents to put pressure on them to endorse single-payer.
The Affordable Care Act did extend care for a lot of people, but costs still go up. Were you expecting that?
I was not optimistic. The best thing about the Affordable Care Act was the Medicaid expansion. We could have done that with so much less effort and expenditure of resources and just forgotten about the rest. The best part of it and what helped the most people was the Medicaid expansion. With the marketplace and the subsidies, there’s so many problems, because the private for-profit insurance industry is baked into it. That’s a big part of it.
The industry says it can do things more efficiently, but that hasn’t been borne out. What kind of tricks is it still able to pull, despite new regulations?
The individual mandate created a whole market for new customers. Then there was the requirement that insurers can no longer deny coverage to people who are either too sick to be profitable or too old and therefore more risky. Eliminating those but adding the mandate put the insurance industry in a precarious situation of having to figure out how to work around the guaranteed issue and community rating while still drawing in the mandated younger members.
So what they do is they make narrow coverage networks. So you can get a plan with a subsidy or plan on the marketplace that will bring down the cost of your premium, but they do it by requiring you to go on a plan that has a very narrow network. There was a study and it found that in New York, none of the marketplace plans included the number one cancer hospital in the city, Memorial Sloan Kettering.
As far as pharmaceuticals, they’ll just put the expensive pharmaceuticals into a higher tier so that they’re just shifting more and more of the cost of care to the consumer.
So how do you envision a full Medicare-for-All system working?
The only way to actually implement it in a way that will be cost-effective over time is specifically to do it as a single-payer strategy. All single-payer means is instead of multiple insurance companies providing insurance as well as Medicare and Medicaid and Tricare and all the others, everyone is in a single risk pool.
It really is only going to be feasible if it’s done on a national level. when you’ve got 325 million people and everyone working is contributing to the tax base that is paying for our healthcare. You’ve got a big enough tax base then to actually cover everyone’s needs for all medically necessary care — including dental, vision, and long-term care.
The problem people get hung up on is, “Oh my God, my taxes are gonna go up?” This is a situation where your taxes go up modestly and your net income goes up as well, and the reason is because when your taxes go up, it’s for covering the things that you’re now not paying for out of your after tax dollars, premiums, copays, deductibles, out of network costs. All of that goes away.
One thing I can never answer is what happens to all the jobs in the insurance industry?
Written into the House’s Medicare-for-All bill, HR 676, is funding to provide unemployment for a year and retraining for anyone who makes $100,000 a year or less in the insurance industry. And remember that we’re going to need some of those people to administer the Medicare for All plan. So the number of [of workers] isn’t going to go to zero.
I was actually just having dinner last night with a surgeon from Nashville who told me a great story. She’s a 67-year-old general surgeon and she was just saying she was so fed up with trying to get the care for her patients that they need. She does a lot of breast surgery and there’s a particular kind of breast cancer called BCRA 1 and 2, where if you have those genetic markers, it is a reasonable option for a woman to have prophylactic bilateral mastectomy, without having breast cancer.
Blue Cross Blue Shield denied the patient’s claim, her preauthorization to get this done. And what the doctor told me was that she finally remembered that a colleague of hers had quit the practice of medicine and was now working at Blue Cross Blue Shield doing preauthorization. So she called him up and he finally agreed that this was reasonable and authorized it. I’m telling you the story to say there are a number of doctors and nurses who are licensed clinicians in this country who have stopped practicing clinical medicine because they burned out and are now working for the insurance industry. These are people that could go right back into the delivery side of healthcare.
So if Democrats take back Congress and then the White House, how do you make the push for this, after the Affordable Care Act was what they mustered last time?
You’re talking to a person who is not easily persuaded that the Democratic Party is our friend. Remember that in 2009 we had a majority in the House and the Senate and we had a Democratic president and we couldn’t even get single-payer included in the discussion of health care reform. I’m actually of the persuasion that we need to have our grassroots organizing working on Republican members of the House and Senate, too. You get them to co-sponsor single-payer legislation. I don’t think that’s impossible. I think if the grassroots makes it toxic for any member of Congress, Democrat or Republican, for them not to get on board, then they’ll get on board because they want to hold onto their seat.
I think it’s great if people want to put their time and energy into Democratic candidates who say that they will support. But corporate Dems are still in control and I am not convinced that just getting more Democrats elected to office is going to turn the tide. I think what’s going to turn the tide is what we saw last week, with a new Reuters poll that showed 84.5% of Democrats and 51.9 percent of Republicans now support Medicare for All, and 70% overall.
That’s how we’re going to get Medicare, in my opinion, by also having moderate Republicans who are absolutely being screwed by the rising cost of healthcare. I think they’re going to get on board with this and say, “I’ve got to do this for myself and my family and stop listening to Fox News and astroturf groups like the Partnership for America’s Healthcare Future.”
So let’s say we do get Medicare-for-All. What happens when a president or Congress who hate it take office, as we’re seeing right now with the GOP sabotaging the Affordable Care Act?
I actually don’t want to pass Medicare-for-All legislation if it’s done the way the Affordable Care Act was passed, through reconciliation and no bipartisan support. If we do it that way, then they’re just turning it into a hot potato, just like the ACA is, and it’s just going to get beaten back and forth between parties and never have the opportunity to become the beloved program that Medicare became. What I really would hope is that we passed this legislation because there is such a groundswell of support among the American people that members of Congress simply get on because they don’t have any alternative.
We’re seeing more buy-in from the business community, especially small businesses that are beginning to realize that the Chamber of Commerce is not their friend and that it’s in their best interest to support Medicare-for-All, that it would be so much better for their bottom line. And look at the teacher strike in West Virginia, there was actually a picture of a teacher holding up a sign that said, “We’ll work for health insurance.” So I think we need to be just continuing to grow the movement among our own citizens who are day in and day out being beaten and beleaguered by the profiteering healthcare system.