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  August 19, 2016

Departure of Health Insurers From Exchanges Demonstrates Need for Single Payer, Says Advocate

Physicians for a National Health Program founder Dr. Steffie Woolhandler: the fundamental problem is our reliance on market-based solutions to healthcare
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Dr. Steffie Woolhandler is professor at the CUNY School of Public Health at Hunter College and visiting professor of medicine at Harvard Medical School, where she co-directed the general internal medicine fellowship program and practiced primary care internal medicine at Cambridge Hospital.

Dr. Woolhandler earned her bachelor’s degree from Stanford University,  a medical degree from Louisiana State University, and a master’s degree from the University of California. She worked in 1990-1991 as a Robert Wood Johnson Foundation health policy fellow at the Institute of Medicine and the U.S. Congress.

Dr. Woolhandler is a frequent speaker and has written extensively on health policy, administrative overhead and the uninsured. She has authored more than 50 research articles on health care access and financing. A co-founder and board member of Physicians for a National Health Program, Dr. Woolhandler co-edits PNHP’s newsletter and is a principal author of PNHP articles published in the JAMA and the New England Journal of Medicine in conjunction with Dr. David Himmelstein.


JAISAL NOOR, TRNN: Welcome to the Real News Network. I'm Jaisal Noor in Baltimore.

AETNA, the nation's third-largest insurance provider, announced this week it was pulling out of a majority of the Affordable Care Act's health exchanges next year, citing hundreds of millions of dollars in losses. But then the Huffington Post obtained a letter Aetna had sent to the Department of Justice in July in which the insurance giant had threatened this exact move if its merger with rival Humana was blocked. And this is exactly what anti-trust regulators with the DOJ did in late July.

Now joining us to discuss all of this is Steffie Woolhandler. She's a physician and public health professor at the City University of New York. She co-founded Physicians for a National Health Program, whose 20,000 member advocates demand single-payer health insurance. Thanks so much for joining us.


NOOR: So it's not just Aetna that has pulled out. United Health Group has pulled out. Humana has also pulled out of some of the exchanges. Let's start off by talking about the impact on people that have many--you know, for the first time have been able to get insurance, or more affordable insurance, through these health exchanges, also known as Obamacare.

WOOLHANDLER: Right. Well, hundreds of thousands of people are going to lose their current insurance. Many of them are going to be left in counties with only one or even zero options. There's a county in Arizona that has no plans participating as of today. So the people are going to be left with one option, meaning there's no competition and they have no choice whatsoever. It's kind of take it or leave it on the insurance. And of course if they decided to leave it they have to pay a fine under the Obamacare legislation.

I think the thing that's really stunning is how arrogant these insurance giants have become, that they have been invited into the Obamacare system, and then they feel that they can actually threaten the federal government that if you want to take an antitrust action against us, on the behalf of consumers, we're going to threaten you, we're going to pull out of Obamacare altogether.

So I think this really shows that it's a very bad idea to try to get to universal coverage through private insurance companies. Private insurance companies are there to make a profit, and the minute they stop making profit, they want to pull out. And of course, they have a lot of trouble making a profit if the enrolees get sick. So instead of having a system that provides care to sick people, we have a system where insurance companies want to run away from providing care for people who need it.

NOOR: And so this, you know, the Obamacare Affordable Care Act, has been defended by Hillary Clinton during the Democratic primary. Bernie Sanders said we need universal healthcare and the only way we can do that is single-payer. Clinton said, you know, it's not possible to achieve it. We can use Obamacare as a start to help expand coverage. Respond to that argument, because that--you know, Hillary Clinton is now the Democratic nominee, and she's going to be putting forward those policies if she wins the White House. And it goes without saying, the Republicans have vowed to repeal Obamacare.

WOOLHANDLER: Look, Hillary Clinton has been pushed to the left during this election campaign, and she can be pushed more to the left. Polls are showing that 58 percent of the American people now endorse the idea of Medicare for all. So as soon as Senator Sanders started talking about Medicare for all, the majority of Americans said, gee, that sounds pretty good. In fact, about 40 percent of the people who hate Obamacare, who feel Obamacare should be repealed, and most of those people are Republicans, 40 percent of them support a Medicare for all system.

So the American people want this. The thing that's blocking it are the insurance companies and the drug companies. The insurance companies blocked Medicare for all. They blocked the public option. And now Aetna is pulling out of Obamacare basically in retaliation for the Justice Department trying to stop them from forming a monopoly.

So what I would say to that is what's possible is what people believe is possible. If the president, if the Demomcrats go back there and say, we're going to work for single-payer, we're going to challenge the insurance industry and drug company, then it's really possible. As long as politicians are shrugging their shoulders and saying there's nothing I can do, that's a problem.

NOOR: And another issue that many have come across is that even through the exchanges, the price of getting insurance can be very, very high and unaffordable for many even working people.

WOOLHANDLER: Well, absolutely. For someone my age, if I went on the New York State exchange to buy insurance my premium for a bronze plan, the cheapest plan, my premium would be $5,000. And then if I got sick I would have another $5,000 deductible. So I'd be $10,000 out of pocket before my insurance paid one penny.

So you know, that's not affordable care for people, and it's not fair to ask people to pay that kind of money if they're a low-income person. That's why we really need a Medicare for all system, that would be based on a fair tax funding, and be available to everyone on an equal basis.

And of course, the beauty of Medicare for all, the beauty of single-payer, is that you save so much on administrative overhead that you can improve coverage for people, get rid of those copayments, deductibles, get 100 percent universal care without increasing total spending. Aetna last year had overhead of 19.9 percent. Nearly 20 percent overhead. Which mean for every dollar in premiums you handed them they held on to 20 cents. They never gave it to a doctor or a hospital or a drug company. They hold on to 20 cents right there for their overhead and profit. And we simply can't afford to cover everyone if we're going to waste all this money on that overhead and profits of these insurance giants.

NOOR: And so, you know, supporters of the current system would say this is better than what existed before. Millions of people now have insurance that didn't have it before. And that weekend, you know, we can work to reform it. But it's just not possible in the current climate, with Republicans controlling Congress, to get the proposal you have put forward.

WOOLHANDLER: Well, remember, there is an election coming up. So if the politicians say let's go for Medicare for all, maybe we can get it. Certainly Bernie Sanders surprised all of us with the resonance that his message had with the American people. Really very--before he was a little-known senator from a tiny state, and next thing you know he's really a contender in the presidential race because of the force of his ideas, including his idea for Medicare for all.

So by putting those ideas out to the American people, that would help us build the movement that would get us to a single-payer. There's not another way to get there. A movement is really the only thing that's going to defeat these insurance giants and these pharmaceutical giants.

NOOR: All right. Well, Steffie Woolhandler, thanks so much for joining us.

WOOLHANDLER: My pleasure.

NOOR: And thank you for joining us at the Real News Network.




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