Words from an Irish patriot—
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HELP ENLIGHTEN YOUR FELLOWS. BE SURE TO PASS THIS ON. SURVIVAL DEPENDS ON IT.
GREG WILPERT: It’s The Real News Network, and I’m Greg Wilpert coming to you from Baltimore.
For the midterm elections this year, Republicans have been blasting Democrats on two main issues: immigration and health care. While Trump’s remarks on immigration have been receiving a lot of attention, what he has been saying about healthcare has not received so much attention. In general, Trump is accusing Democrats of wanting to impose socialism, and he uses single-payer healthcare, also known as Medicare for All, as one of his main examples. Here’s what he said recently in one of his rallies.
DONALD TRUMP: A majority of House Democrats have already signed up for socialist healthcare. By the way, it doesn’t work anywhere in the world. Just so you understand. It doesn’t work. It’s good if you don’t mind waiting, like, five weeks to see your doctor. They come from socialist countries. Frankly, they come from Canada because they want to use our doctors. They come from all over the world. And we’re making it now better. And they want to destroy everything that’s been built. All of that great foundation.
GREG WILPERT: Meanwhile, the White House, under the direction of the Council of Economic Advisers, released a pamphlet last month titled The Opportunity Costs of Socialism. This pamphlet develops a detailed critique of state socialism as it was practiced in the Soviet Union, as well as a social democratic government of Scandinavia. One of the main areas of focus of the document is the healthcare system in single-payer countries, system-payer countries, as well as Medicare for All, a bill that Senator Bernie Sanders introduced earlier this year.
Joining me now to take a look at some of the criticisms of single-payer healthcare is Wendell Potter. He’s a former health insurance executive and author of several books, including Deadly Spin, Obamacare: What’s In It for Me? and his latest is Nation on the Take. He’s also the founder of Tarbell.org, an investigative site that examines the role of money in politics. Thanks for joining us today, Wendell.
WENDELL POTTER: My pleasure, Greg.
GREG WILPERT: So there are many criticisms that Republicans have leveled against single-payer healthcare systems; both the proposals for the U.S. healthcare and also the ones that have been implemented in countries such as Canada and various countries of Europe. We can’t go over all of these criticisms, but some of the main ones include increased costs, worse health outcomes, loss of medical innovation, and longer wait times. Let’s take these one by one.
So first, regarding costs, proponents of single-payer healthcare say that increases in taxes will be offset by not having to pay insurance premiums of private insurance companies. Critics, though, say that higher taxes distort the economy, which reduces economic activity, and thus makes the overall cost of healthcare greater. What’s your response to this argument? I mean, what is the balance in terms of the costs? Which would be cheaper, according to your analysis?
WENDELL POTTER: According to my analysis and that of many others, the proponents of Medicare for All have it right. We would be paying ultimately far less than we will be, that we are paying now or will be paying in the future, if we maintain the status quo. The problem is in a multipayer system like we have in the United States, the payers being the insurance companies, the multiple insurance companies that we have supposedly competing with each other, they just don’t have the clout to negotiate good deals with their customers, with big hospital systems and big physician groups, and certainly with the pharmaceutical industry.
So what we have in this country in the US is a classic example of market failure, because the system does not work to control costs, nor does it work to bring everyone into coverage. We still have almost 30 million Americans who do not have insurance. But under a Medicare for All-type plan you can bring everyone into coverage, and you can cover everyone and have better outcomes than you have under our current system.
And when you look at- what people need to do is kind of have a paradigm shift in their thinking. You would no longer have to pay the ever-increasing premiums to your health insurance company, or the ever-increasing deductibles, which means that your insurance doesn’t even kick in until you’ve spent several thousand dollars out of your own pocket, even though you’re making payments for your insurance.
So that would go away. You instead would be making the equivalent of your premium payments in taxes, and the system will be structured so that everyone could be brought into coverage. And studies have shown even in this country that- not only that, but a single-payer system in this country would do much more to control healthcare costs than our multipayer system does now.
GREG WILPERT: Now, a related argument in this regard is that single-payer healthcare costs save money in terms of administrative costs, but those savings are lost then again through fraud. In other words, that there are people who would try to cheat the system. And they claim that there’s a lot of fraud in the Medicare system in the United States, and that doesn’t happen so much in the private system. What’s your response to that?
WENDELL POTTER: I would say that’s absolute nonsense. And having worked in the private system for more than 20 years, I can tell you that fraud is just as prevalent, and probably more so, in the system that we have, the private system of insurance. The company that I worked for most recently, Cigna, instituted a system several years ago to try to detect fraudulent billing. So I can tell you it’s just as rampant, probably more so, in the private system. For one reason, because private companies just don’t have the resources to combat fraud and abuse as much as a single system with combined resources would have.
So it’s a completely bogus argument. In fact, we see, when you look at statistics for other countries that have a single payer or a similar system, there’s far, far less fraud and abuse in those countries and their healthcare system than in the U.S. system.
GREG WILPERT: So now the other main argument that the White House critique of single-payer brings up is that health outcomes would be worse. They cite a fairly specific study of life expectancy in the U.S. and in Europe which claims to show that once cancer is diagnosed, U.S. patients tend to live longer. And the argument is basically that under single-payer healthcare, cancer treatment would be rationed, especially for seniors. And they give examples in Europe, basically, while in the U.S. cancer patients tend to receive better care. What’s the response to this claim in terms of outcomes, health outcomes?
WENDELL POTTER: Well, what you’re seeing here, and as in many of their arguments, they being the opponents of moving to a single-payer system, is the selective use of data and the confusing and misleading use of data.
The reality is that most of the developed countries around the world- and many of them have a single-payer system- all do a better job, broadly, in healthcare outcomes than we do. The Commonwealth Fund in the United States has annually done an analysis of the performance of healthcare systems around the world. They look at 11 countries, developed countries, including the U.S. And the United States consistently, even after the Affordable Care Act was passed, brings up the rear. It’s always number 11 in the composite score. So outcomes are typically better across the board, or in many, by many measurements in other systems.
And as far as cancer treatment is concerned, or life expectancy in particular, the United States is alone in the developed world over the last two years in which life expectancy has been declining. And those are statistics from the government. And we’re seeing that in the other countries, in both the developing and developed world, life expectancy is going up. And we’re pretty much alone in the world going in the opposite, in the wrong direction.
Now, with regards to cancer, you have a lot of people in this country who do not have insurance and who cannot afford to get the care that they need. Period. So we have a lot of people in this country who just simply- and also, even if they have insurance, as I mentioned earlier, people have very high deductibles in most of their plans, if they have a private insurance company. And a lot of those people just don’t have the money to pay out of pocket for the care that they need to spend money for before their their coverage kicks in. So again, it’s the selective use of data and trying to scare people, when in reality the outcomes across the board in other countries are generally far better than they are in the U.S.
GREG WILPERT: Actually, related to this issue of health care outcomes is also the question of innovation. The White House paper argues that single-payer healthcare would reduce innovation; that is, more expensive treatments in the U.S. result in more innovation because there’s more money available for such innovation, whereas price controls, which are usual in single-payer systems, would reduce innovation because there’s less money available for them. What’s your response to this argument?
WENDELL POTTER: The question we often used in the industry- and they still do, obviously- is that any kind of reforms that would move us away from the status quo would have a “chilling effect” on innovation. But that’s not, it’s not true at all. In fact, most of the innovation, actually, in the health insurance industry has been innovation that has been detrimental to the needs of patients in this country. The most prevalent innovation in this country has been shifting more and more of the cost of care from insurance companies and employers to regular folks. So that is a kind of example that I think we could move away from and everyone would benefit from it.
But there’s no, there’s no evidence that suggests that moving to a single-payer system would mean that there would be less innovation on the provider side. In fact, we’re seeing quite a bit of innovation in the UK and Canada that this country should adopt. In the UK, for example, hospitals have a way of treating people. They can admit them, but there’s kind of a blend of inpatient and outpatient that saves the system a lot of money and allows the patient to get much of their care outside of an inpatient setting. So there’s a lot of innovation that you’re saying in single-payer systems that we have not adopted yet in this country. So there’s no reason why if we move to a system like that we would have less innovation than we have now, and probably would have innovation that benefits patients more than we have now.
GREG WILPERT: So finally, the White House paper that I cited earlier argues that wait times in the U.S. are shorter mainly because in single payer systems there are no market signals about what type of care is needed, and that the lack of deductibles and all that would cause an overuse of certain treatments. And so as a result, single-payer systems have much longer wait times. And they specifically cite the example of Canada actually having one of the longest wait times, whereas the U.S. in an international comparison supposedly has the shortest. What’s your response to that argument?
WENDELL POTTER: Well, once again, when you’re looking at the U.S. compared to other countries, keep in mind that many millions of us wait forever for the care that we need because we don’t have the money, and we don’t have insurance. And 30 million of us don’t have insurance. The wait is indefinite. And so that’s something that needs to be factored in, as well, too. There are people in this country who just simply cannot access care at any point. So the wait lines, or the waiting period, is endless for a lot of people.
But even in Canada, the waits have been dramatized in the U.S. by opponents. There is a very short wait for essential care in Canada. Now, it is true that for elective procedures like joint replacement, a knee replacement, for example, the wait time can be fairly long; possibly longer than it would be for some patients to get the same procedure done in the U.S. But the majority, the vast majority of people in Canada, get knee and hip replacements and cataract surgery within the recommended period of time. So again, for essential care, for life-threatening events and for other kinds of care and to see a physician it’s not a significant problem in Canada or other single-payer systems. But in the U.S. for many people it’s an indefinite wait.
GREG WILPERT: OK. Well, we’re going to leave it there for now, but I’m sure we’re going to get back to this topic again very soon. I was speaking to Wendell Potter, former health insurance executive and founder of the website Tarbell.org. Thanks again, Wendell, for having joined us today.
WENDELL POTTER: My pleasure. Thank you, Greg.
GREG WILPERT: And thank you for joining The Real News Network.
ABOUT THE AUTHOR Wendell Potter is a journalist and former health insurance executive. His books include the New York Times bestseller “Deadly Spin, An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans,” and “Nation on the Take: How Big Money Corrupts Our Democracy and What We Can Do About It.”…
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ALL CAPTIONS AND PULL QUOTES BY THE EDITORS NOT THE AUTHORS
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Words from an Irish patriot—
 
BE SURE TO PASS THESE ARTICLES TO FRIENDS AND KIN. A LOT DEPENDS ON THIS. DO YOUR PART.
by JO SIMMONS
The Centers for Medicare and Medicaid Services (CMS) made headlines this month after announcing they would not approve lifetime limits on Medicaid from any state. The ruling came shortly after CMS had also knocked back a request from Kansas state to impose three-year periods on its Medicaid eligibility.
These moves may seem surprising from an administration that has openly declared war on America’s medical system. But in reality, they are mere window-dressing for the abysmal state of healthcare systems in North America, since even Canada’s healthcare – widely regarded as a paragon of how healthcare is “done right” – suffers from the same shortfalls as the US.
Even if the CMS effectively kept overzealous conservative policy-makers in check, this is at best a minor victory. A raft of policies is being discussed at the same time that would turn the 2010 Affordable Care Act and Medicaid, the supposed safety net for the poor, into a vehicle of discrimination.
The primary beneficiaries of the act were minorities, who are traditionally disproportionately affected by a medical coverage gap. In 2013, 53% of those in the coverage gap were from a minority group – a huge rate considering that only 23.1% of the total population are non-white. However, under the Trump administration, that problem is only getting worse. A prime example is a recent bill introduced by Michigan, under which access to Medicaid will be revoked for those who work less than 29 hours per week. People living in counties with high unemployment are exempt – but not those living in cities with the same.
 Obama and the Democrats had every opportunity to get universal healthcare into law. They sabotaged it every single time. The perfidiousness of this proposal is hard to overstate due to its racially discriminatory effect. Under these conditions, the bill becomes a direct attack on the black community, which is mainly concentrated in cities such as Detroit, Flint and Muskegon. Although unemployment rates here are elevated, the surrounding affluence of the suburbs brings the county average down. As a result, the unemployed black populace may lose their healthcare, while their white counterparts living rurally will not.
The bill has understandably caused an outrage, but it’s not only ethnic minorities that have been given a rough ride under Trump’s tenure. Women have also been under attack, with new threats from the administration to withdraw Title X family planning funding from any facility offering abortion services. As this doesn’t technically regulate the service itself, the idea may well come to fruition at the expense of women’s health across the country.
This assault on women’s reproductive freedoms is especially vexing given that Title X funding is very rarely used to subsidize abortions, except in extreme cases. Instead, it’s devoted to screening for serious conditions such as cancer and HIV, as well as contraception. Ironically, the proliferation of contraceptives over the last few decades have led to a decline in abortions since they were officially made legal, but the GOP’s proposals could undermine this progress by making adequate protection more difficult to obtain.
While the problems of prejudice in the US are well-documented, critics of the US system are readily pointing north of the border, hailing Canada for its supposedly progressive healthcare system. However, not everything that glitters is gold, and a closer look reveals that Canada’s healthcare system suffers from some of the same structural and moral deficiencies as America’s – with the difference that barely anyone talks about them.
A dearth of racial data in Canada makes it difficult to quantify the issue in concrete terms, but from the outset it’s clear that people from African, Arab and First Nation backgrounds aren’t receiving equal treatment. Add to this mountains of anecdotal evidence and a bleak picture emerges of how minorities are subconsciously or overtly discriminated against on a daily basis.
Indeed, just like in the US, minorities are more likely to be left out in the cold than others. Unable to afford the high costs of certain medical treatments – costs any just system should cover for them but doesn’t – they are left to fend for themselves. This is already a deeply disturbing scenario in general terms. However, when rare genetic conditions like Duchenne muscular dystrophy (DMD) or spinal muscular atrophy (SMA) are added into the mix, the outlook of patients turns from bad to catastrophic.
After all, for those who suffer from rare diseases, it doesn’t matter their race, gender, or status – it’s safe to say that they are all equally discriminated against by regulators, which have a shameful history of frequently dragging their feet in approving new treatments that come to market. For instance, Spinraza – the only viable treatment for SMA – is still not covered by standard healthcare plans, leading to petitions in 2017 and protests in 2018 to end the status quo.
Despite activists’ efforts to get the government to fund the drug, there is no guarantee there will be progress. On the contrary, if Canadian provinces accept the recommendations of the Canadian Agency for Drugs and Technologies in Health (CADTH), the most vulnerable may stand to lose access to Spinraza.
Sadly, this is par for the course when it comes to those with genetic conditions. Patients with DMD, too, have been woefully neglected when it comes to getting access to much-needed treatments. Deflazacort, the main treatment for this debilitating condition, has not yet been approved in Canada, which means that patients need to apply to Health Canada’s Special Access Program – an unacceptably long and unwieldy process.
It’s clear that with so many obstacles to overcome, North American healthcare systems have a long road ahead. If things continue as they are, a system intended to stop the most vulnerable members of society from falling through its cracks may actually price them even further apart. Politicians in the US and Canada have sabotaged healthcare for too long. Eliminating discrimination once and for all means achieving a level of healthcare that truly is as universal as it ought to be.
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Parting shot—a word from the editors
The Best Definition of Donald Trump We Have Found
 In his zeal to prove to his antagonists in the War Party that he is as bloodthirsty as their champion, Hillary Clinton, and more manly than Barack Obama, Trump seems to have gone “play-crazy” — acting like an unpredictable maniac in order to terrorize the Russians into forcing some kind of dramatic concessions from their Syrian allies, or risk Armageddon.However, the “play-crazy” gambit can only work when the leader is, in real life, a disciplined and intelligent actor, who knows precisely what actual boundaries must not be crossed. That ain’t Donald Trump — a pitifully shallow and ill-disciplined man, emotionally handicapped by obscene privilege and cognitively crippled by white American chauvinism. By pushing Trump into a corner and demanding that he display his most bellicose self, or be ceaselessly mocked as a “puppet” and minion of Russia, a lesser power, the War Party and its media and clandestine services have created a perfect storm of mayhem that may consume us all.— Glen Ford, Editor in Chief, Black Agenda Report
HELP ENLIGHTEN YOUR FELLOWS. BE SURE TO PASS THIS ON. SURVIVAL DEPENDS ON IT.
by MARGARET FLOWERS
The Road to Medicare for Everyone, Jacob Hacker is once again working to dissuade single payer healthcare supporters from demanding National Improved Medicare for All and use our language to send us down a false path. Hacker comes up with a scheme to convince people to ask for less and calls those who disagree “purists”. Hacker calls his “Medicare Part E” “daring and doable,” I call it dumb and dumber. Here’s why.
Hacker makes the same assertions we witnessed in August of 2017 when other progressives tried to dissuade single payer supporters.
 Yale's Jacob Hacker: Beware of false friends in this complex struggle. He starts with “risk aversion,” although he doesn’t use the term in his article. Hacker asserts that those who have health insurance through their employers won’t want to give it up for the new system. Our responses to this are: there is already widespread dislike for the current healthcare system; people don’t like private insurance while there is widespread support across the political spectrum for Medicare and Medicaid; there is also widespread support for single payer; and those with health insurance can be reassured that they will be better off under a single payer system. It is also important to note that employers don’t want to be in the middle of health insurance. Healthcare costs are the biggest complaint by small and medium sized businesses and keep businesses that operate internationally less competitive.
Next, Hacker brings up the costs of the new system and complains that it will create new federal spending. He points to the failures to pass ‘single payer’ in Vermont and California. First, it must be recognized that the state bills were not true single payer bills, and second, states face barriers that the federal government does not, they must balance their budgets. Hacker ignores the numerous studies at the national level, some by the General Accounting Office and the Congressional Budget Office that demonstrate single payer is the best way to save money. Of course there would be an increase in federal spending, the system would be financed through taxes, but the taxes would replace premiums, co-pays and deductibles, which are rising as fast as health insurers can get away with. Hacker proposes a more complex system that will fail to provide the savings needed to cover everyone, the savings that can only exist under a true single payer system.
Hacker confuses “Medicare for All” with simply expanding Medicare to everyone, including the wasteful private plans under Medicare Advantage. This is not what National Improved Medicare for All (NIMA) advocates support. NIMA would take the national infrastructure created by Medicare and use it for a new system that is comprehensive in coverage, including long term care, and doesn’t require co-pays or deductibles.
Hacker also confuses “Medicare for All” with simply expanding Medicare to everyone, including the wasteful private plans under Medicare Advantage. This is not what National Improved Medicare for All (NIMA) advocates support. NIMA would take the national infrastructure created by Medicare and use it for a new system that is comprehensive in coverage, including long term care, and doesn’t require co-pays or deductibles. The system would negotiate reasonable pharmaceutical prices and set prices for services. It would also provide operating budgets for hospitals and other health facilities and use separate capital budgets to make sure that health resources are available where they are needed. And the new system would create a mechanism for negotiation of payment to providers.
Finally, Hacker tries to convince his readers that the opposition to NIMA will be too strong, so we should demand less. We know that the opposition to our lesser demands will also be strong. That was the case in 2009 when people advocated for the ‘public option’ gimmick. If we are going to fight for something, if we are going to take on this opposition, we must fight for something worthwhile, something that will actually solve the healthcare crisis. That something is NIMA. We are well aware that the opposition will be strong, but we also know that when people organize and mobilize, they can win. Every fight for social transformation has been a difficult struggle. We know how to wage these struggles. We have decades of history of successful struggles to guide us.
One gaping hole in Hacker’s approach is that it prevents the social solidarity required to win the fight and to make the solution succeed. Hacker promotes a “Medicare Part E” that some people can buy into. Not only will this forego most of the savings of a single payer system, but it also leaves the public divided. Some people will be in the system and others will be out. This creates vulnerabilities for the opposition to exploit and further divide us. Any difficulties of the new system will be blown out of proportion and those in the system may worry that they are in the wrong place. When we are united in the same system, not only does that create a higher quality system (a lesson we’ve learned from other countries), but it also unites us in fighting to protect and improve that system.
Hacker succeeded in convincing people who support single payer to ask for something less in 2009 and we ended up with a law that is further enriching the health insurance, pharmaceutical and private healthcare institutions enormously while tens of millions of people go without care. Now, Hacker rises again to use the same scare tactics and accusations that he used then to undermine the struggle for NIMA. This is to be expected. The national cry for NIMA is growing and the power holders in both major political parties and their allies in the media and think tanks are afraid of going against the donor class. Social movements have always been told that what they are asking for is impossible, until the tide shifts and it becomes inevitable.
Our task is to shift the tide. We must not be fooled by people like Jacob Hacker. We know that single payer systems work. We have the money to pay for it. We have the framework for a national system and we have the institutions to provide care. Just as we did in 1965 when Medicare and Medicaid were created from scratch, and without the benefit of the Internet, we can create National Improved Medicare for All, a universal system, all at once. Everybody in and nobody out.
We know that we are close to winning when the opposition starts using our language to take us off track. “Medicare Part E” is not National Improved Medicare for All, it is a gimmick to protect the status quo and convince us that we are not powerful. We aren’t falling for it. This is the time to fight harder for NIMA. We will prevail.
ABOUT THE AUTHOR  Dr. Margaret Flowers is a Pediatrician and Activist for Universal Health Care. "The phrase that continuously runs through my mind is 'To be silent is to be complicit.' I cannot be complicit in the face of a healthcare industry that profits at the cost of human lives and in the face of an administration and a Congress that are too dysfunctional to stop this practice."
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
ALL CAPTIONS AND PULL QUOTES BY THE EDITORS NOT THE AUTHORS
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Parting shot—a word from the editors
The Best Definition of Donald Trump We Have Found
In his zeal to prove to his antagonists in the War Party that he is as bloodthirsty as their champion, Hillary Clinton, and more manly than Barack Obama, Trump seems to have gone “play-crazy” — acting like an unpredictable maniac in order to terrorize the Russians into forcing some kind of dramatic concessions from their Syrian allies, or risk Armageddon.However, the “play-crazy” gambit can only work when the leader is, in real life, a disciplined and intelligent actor, who knows precisely what actual boundaries must not be crossed. That ain’t Donald Trump — a pitifully shallow and ill-disciplined man, emotionally handicapped by obscene privilege and cognitively crippled by white American chauvinism. By pushing Trump into a corner and demanding that he display his most bellicose self, or be ceaselessly mocked as a “puppet” and minion of Russia, a lesser power, the War Party and its media and clandestine services have created a perfect storm of mayhem that may consume us all.— Glen Ford, Editor in Chief, Black Agenda Report
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“Some of the ways that these drugs fail specifications is that they had far higher impurities than are permitted. And what he found was that the plants either failed to inspect or investigate these impurities, which they are required to do, or somehow manipulated the testing data so that the impurities didn’t show up.”
“There are three kinds of violence. The first, the mother of all the others, is the institutional violence, the one that legalizes and perpetuates the dominations, the oppressions and the exploitations, the one that crushes and flattens millions of men in its silent and well oiled wheels. The second is revolutionary violence, which arises from the desire to abolish the first. The third is repressive violence, the object of which is to stifle the second by making itself the auxiliary and the accomplice of the first violence, the one that engenders all the others. There is no worse hypocrisy to call violence only the second, by pretending to forget the first, which gives birth to it, and the third which kills it. ”
