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David U. Himmelstein M.D. is a Professor of Public Health at the City University of New York at Hunter College and a Visiting Professor of Medicine at Harvard Medical School. He graduated from Columbia University’s College of Physicians and Surgeons, completed a medical residency at Highland Hospital in Oakland, California, a fellowship in General Internal Medicine at Harvard and practiced primary care internal medicine at the public hospital in Cambridge, MA for 28 years. He has authored or co-authored more than 100 journal articles and three books, including widely-cited studies of medical bankruptcy and the high administrative costs of the U.S. health care system. His 1984 study of patient dumping led to the enactment of EMTALA, the law that banned that practice. He co-founded Physicians for a National Health Program, who’s 18,000 members advocate for non-profit, single payer national health insurance.
JESSICA DESVARIEUX, TRNN PRODUCER: Welcome to The Real News Network. I'm Jessica Desvarieux in Baltimore. The U.S. health care system is the most expensive in the world and covers far fewer people than health care systems in other rich countries. Joining us in-studio to discuss all of this is Dr. David Himmelstein. He's a primary care doctor and professor of public health at the City University of New York. He cofounded Physicians for a National Health Program. Thanks for joining us, Doctor.DR. DAVID HIMMELSTEIN, PROF. PUBLIC HEALTH, CITY UNIVERSITY OF NEW YORK: Thanks for having me.DESVARIEUX: So let's just start off. Off the bat, can you just explain how the U.S. has the most costly health care system, and yet we don't cover everyone? How is this even possible?HIMMELSTEIN: Well, we have an enormous number of people making profits and middlemen in the system. So our insurance companies, for every $1 we pay in, we get about $0.86 worth of care out. Fourteen cents of every dollar stays with the insurance firms, doesn't buy any health care. And we have enormous numbers of for-profit hospitals, dialysis companies, nursing homes, a lot of money being made in the health care system, not to delivering the care that people need, but actually supporting corporate profits and interests.DESVARIEUX: So let's talk about that this system that we have now and what we're hoping to implement, which is Obamacare. Do you think that this addresses the root problems at all of what's happening?HIMMELSTEIN: Well, Obamacare is really a compromise with the insurance industry and the drug industry, the people who've been running the health care system into the ground. So it would dump $1 trillion into the private insurance industry over the next ten years trying to get them to behave better. And it may get some people additional coverage, and expanding Medicaid, part of the Obamacare program, is probably a good thing. But it doesn't fundamentally address the problems in our health care system. And, in fact, the $1 trillion we'll give to private insurance companies in a way puts them in a stronger position.DESVARIEUX: But, Dr. Himmelstein, there are people that are saying that we know Obamacare is not perfect. However, it is a path to eventually getting single-payer. What's your response to that?HIMMELSTEIN: Well, we'll have to see whether that's true. I'm concerned that strengthening the private insurance industry may not be the right way to move towards eliminating the private health insurance industry, which is what we need to do to have a decent health care system. I mean, in Canada, insurance takes about 1 percent of running the system; in our system, as I said, about $0.14 of every dollar for insurance. And these new exchanges which are being set up, which are really just a sales force to sell private insurance, they're taking another 3 percent, another $0.03 of every $1, to run them. So we're spending an enormous amount of money pumping more administration, more bureaucracy into the system, and strengthening the private insurance industry. I worry that that doesn't lead us in the direction we need to go.DESVARIEUX: Okay. Let's turn the corner here and talk about how we can actually implement a single-payer system in the United States, 'cause there are some people who are skeptical saying, you know, it works in Canada, it works in Denmark, but it's not going to work in the United States. Can you just lay out a framework of how single-payer could work in the U.S.?HIMMELSTEIN: Yeah. Well, you could expand Medicare to cover everybody in this country, upgrade Medicare coverage. Medicare at present takes only about $0.02 to administer versus that $0.14 in the private insurance industry. And if you expanded Medicare to everybody, you would have that $0.12 on the dollar left over to actually improve the coverage. And you could give first-dollar coverage to everybody in the United States if you did a Medicare program for everybody and cut out some of the bureaucracy that the insurers now make hospitals and doctors put up with. So if you go to a hospital in Canada, there's no billing office in most hospitals, because every Canadian has the same coverage and a hospital gets paid the way a fire department gets paid in our country. They get one check a month to run the entire operation. There's no need to figure out who got each Band-Aid and aspirin tablet. You go to a typical American hospital, there are 150 people doing nothing but billing. And we ought to put those people to work doing useful things, help taking care of people, and put those resources to actually making health care work in our country rather than shuffling papers and enforcing inequality, enforcing that some people have the right to good health care and many others don't.DESVARIEUX: I can attest to that billing, 'cause my mom is actually on in a registered nurse, and much of her time is dealing with billing, 'cause she does home care. But I want to talk a little bit more about the Canadian system. You mentioned that this would be a sort of model a bit. You were referring to it. But there are people that criticize it, saying, oh, there are so many long lines, and the wait time is impossible at times. What is your response?HIMMELSTEIN: Well, Canada spends about half as much per person on health care as we do in this country. And if we were willing to take Canada's system and double the amount of funding, we would have not just better care than they have in Canada, but much, much better care than we have here in the United States. And we know from comparative studies in the two countries that the average Canadian gets care as good as the average insured American today. But you take double the money they spend in Canada, we ought to be able to do very much better than that for every American.DESVARIEUX: And you also claim--I know I read a little bit of your work that this [incompr.] save money not only for the health care recipients, but also for the providers. Can you explain that a bit more?HIMMELSTEIN: Well, for providers, I mean, the average doctor is spending about 20 percent of their time on nothing but billing and bureaucracy. So we'd free up tremendous amount of time of doctors and nurses--you mentioned your mother--to actually do the work that we're trained to do rather than checking the boxes and fighting with insurance companies. And that provides the resources we need, the extra time we need to take care of people, to take care of people who are currently uninsured. The other thing we need to do is stop doing some of the useless and even harmful stuff that doctors are doing today because there's money in it. So we know that a lot of the operations done today actually don't to patients any good, that probably something like one out of five of the cardiac stents that are put in place are done not because they do patients any good but because there's money to be made doing them. So we need to take the profit motive out of the health care system as well.DESVARIEUX: Alright. Dr. Himmelstein, thank you so much for joining us.HIMMELSTEIN: Thank you.DESVARIEUX: And thank you for joining us on The Real News Network.
DISCLAIMER: Please note that transcripts for The Real News Network are typed from a recording of the program. TRNN cannot guarantee their complete accuracy.
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