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Physicians for A National Health Program’s Adam Gaffney warns that incremental steps can turn into diversions and prevent us from fixing the fundamental problems with our current health care system

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KIM BROWN: Welcome to The Real News Network in Baltimore. I’m Kim Brown. Earlier this month Donald Trump held a listening session at the White House to discuss the status of healthcare and to tout the then-upcoming vote to repeal and replace the Affordable Care Act. DONALD TRUMP: Secretary Price and I, along with my entire administration and a lot of people in the Senate and a lot of people in the House, are committed to repealing and replacing this disastrous law with a healthcare plan that lowers cost, expands choice and ensures access for everyone. KIM BROWN: That was on March 13th. So, fast-forward to late last Thursday and Friday when House Speaker, Paul Ryan, was forced to withdraw the GOP-authored American Healthcare Act, because it lacked support amongst the Republican caucus. PAUL RYAN: I spoke to the President just a little while ago and I told him that the best thing I think to do is to pull this bill and he agreed with that decision. I will not sugarcoat this, this is a disappointing day for us. Doing big things is hard. All of us, all of us, myself included, we will need time to reflect on how we got to this moment. What we could have done to do it better. But ultimately, this all kind of comes down to a choice. Are all of us willing to give a little to get something done? Are we willing to say yes to the good, to the very good, even if it’s not the perfect? Because if we’re willing to do that — we still have such an incredible opportunity in front of us. KIM BROWN: The question now is whether there’s an opportunity to cease upon the shortcomings of Obamacare and, of course the Republican-led healthcare repeal and replace failure, and expand Obamacare to cover all Americans. Is this country read for healthcare for all? Joining us now to discuss this is Dr. Adam Gaffney. Adam is a physician and a writer with the focus on Healthcare Politics, Policy and History. He’s also an instructor of medicine at Harvard Medical School, and a Pulmonary and Critical Care Physician at the Cambridge Health Alliance. He is the Secretary and a member of the board of directors of the Single-Payer Advocacy Organization – Physicians for a National Health Program. So, Adam, we appreciate you joining us today. Thank you. ADAM GAFFNEY: Thanks for having me back. KIM BROWN: So, Adam, Senator Bernie Sanders appeared Sunday on CNN’s State of the Union, and he announced his intention to introduce such legislation that would provide healthcare for all. Let’s have a look. BERNIE SANDERS: Of course, Obamacare has serious problems. Deductibles are too high, premiums are too high, the cost of healthcare is going up at a much faster rate than it should. Ideally where we should be going is to join the rest of the industrialized world and guarantee healthcare to all people as a right. And that’s why I’m going to introduce a Medicare for All single-payer program. Short-term this is what we could do. President Trump said a whole lot of stuff on the campaign trail. One of the things he talked about was lowering the cost of prescription drugs. There is wonderful legislation right now in the Senate to do that. President Trump, come on board. Let’s work together. Let’s end the absurdity of Americans paying, by far, the highest prices in the world for prescription drugs. Are deductibles too high? Of course they are. Are there some parts of the country where people don’t have a choice? Yes, that’s true. Let us do, among other things, a public option. Let us give people in every state in this country a public option from which they can choose. Let’s talk about lowering the age of Medicare eligibility from 65 to 55. Let’s deal with the greed of the pharmaceutical industry. Those are areas that we could work together on. KIM BROWN: So, this is an issue that Bernie campaigned hard on while seeking the Democratic nomination for president. And a Gallop poll taken in May of 2016 seems to indicate that a majority of Americans are with him and favor of a Medicare for all systems. So, Adam, if this is for what the people want then what is holding lawmakers back? We’ve seen the backlash against Republican lawmakers from their constituents in town halls across the country, upset at them, at the thought of the ACA going away. So why not step out on a limb and make ACA bigger and cover everyone? ADAM GAFFNEY: Why not indeed? I think we should. This is absolutely the right next, smart, step. Now what is holding them back? I mean, there’s a number of factors. There’s no question that the lobbying power of the so-called ‘medical-industrial complex’ plays a role. Let’s be honest. The health insurance industry is in no rush to see single-payer come about in their role, more or less, completely supplanted. So, there’s a lot of powerful forces that are aligned against single- payer. However, there are many more powerful forces, the grassroots level, that are advancing this cause. Namely, a majority of the U.S. population, as you alluded to, support single-payer. That Gallup poll found 58% of the nation was in support of a federally funded healthcare program like single- payer. So, we have the popular support. We have the policy evidence and the science. So, what’s really missing at this point is political will. But that’s something that we can change and that people are working to change around the country. And I think that Sanders’ announcement is a step in the right direction. KIM BROWN: So, it seems that we have a lack of political will in Washington, but we have an over-abundance of greed on behalf of the healthcare industry. Because when we hear constantly about how Americans pay the most for health care and comparative to our western European, industrialized nation neighbors, or allies, we see the least when it comes to how much care and access that Americans actually have. So, what is the disconnect here? Is it the healthcare industry that is standing in the way between affordable healthcare, and what Americans can have access to? ADAM GAFFNEY: It certainly is, and let’s be honest, even within the Democratic party there’s a divide. As you mentioned, the issue of single-payer was a major dividing point in last year’s Democratic primary campaign between Hillary Clinton and Bernie Sanders. Sanders strongly supporting a single payer plan, Clinton being quite opposed to it. In fact, using the phrase, “That single-payer would never, ever happen.” So, there’s a divide even within the more liberal of the two political parties. And so yes, the corporate healthcare industry is opposed. But there’s also a lot of work that needs to be done within the political class as well to actually move towards single- payer. KIM BROWN: So, we understand that the Affordable Care Act, when initially proposed by President Obama in early 2009, it took 13 months for this bill to be authored. He held a number of bi-partisan working sessions. So, when we’re talking about Medicare for all, can this be done in one fell swoop or will it have to be done incrementally? How do you envision Medicare for all coming to the United States? ADAM GAFFNEY: Well, I think if Medicare can happen in one fell swoop then Medicare for All can happen in one fell swoop. Medicare was created and everybody age 65 or older, got health insurance. It wasn’t overnight but it was pretty quick. And so, if we’re talking about simply giving Medicare to those below age 65, I don’t see why that cannot happen in one fell swoop. There’s no reason why it’s impossible. I should mention that although Sanders envisioned this as Medicare for all, it’s important to emphasize that we’re talking about an improved and expanded Medicare for all. Medicare’s a good system, but it has some flaws that need to be corrected. You know, we’re going to universalize it. And so, I think we should continue to push for Medicare for all in one fell swoop, as ambitious as that may sound, because it is possible. And let’s not forget that incremental steps can sometimes turn into diversions. If we spend the next five years fighting for a public option, even if we win, we’re going to be left with something that won’t fix the fundamental problems and flaws in the American healthcare system. So, I think it’s important to think big and push ahead for the solution that will solve the major problems of the U.S. healthcare system. KIM BROWN: Adam, you, being a physician, healthcare practitioner, you’re dealing with these things on a regular basis, what specific things about the Affordable Care Act — and as you alluded to with Medicare in general — what needs to be fixed about these programs, in your opinion? ADAM GAFFNEY: Well, with respect to the Affordable Care Act, it reduced un-insurance by 20 million, but it left more than that uninsured. So, for instance, the Congressional Budget Office estimates that in 10 years from now, with the Affordable Care Act in place, 28 million people will remain uninsured. Now, Trumpcare would have increased that by 24 million, but that doesn’t mean the status quo’s acceptable. So, one thing we need to do is get rid of un-insurance. Number two we need to get rid of under-insurance. So, again, many people have healthcare that they have difficulty afford using. Why is that? Because they have high co-payments, deductibles — which have been going up substantially over the last 10 years. And so, under-insurance needs to be addressed. And the best way to address under- insurance, is a universal plan like Bernie has proposed, that would not include cost sharing. It sounds radical, but we can do it. And we know we can do it, because other countries do it. That means you get hospitalized and insurance covers the bill so you don’t need to worry about paying a deductible. It may sound crazy but it really can work. And so those are the two things I’d mention right now. Let’s get rid of un-insurance and let’s get rid of under-insurance, and it’s doable. KIM BROWN: Adam, as you said, other countries do this now. They’ve been doing it for some time. In your opinion which country does healthcare for all the best? And which model do you think the United States could probably emulate? Obviously, our needs are individual. We have a very large country, huge population, but who does Medicare the best in the world, as far as you know? ADAM GAFFNEY: I mean, look, every healthcare system has strengths and weaknesses and I’m not going to dodge your question, but just as a sort of preamble, we’re trying to take the best of what exists in the U.S. healthcare system and combine it with the best of what other international examples offer. So, I think if we turn up to our neighbors to the north in Canada, I think they do a very good job of providing healthcare to everyone through a single-payer system. They don’t have co-payments for doctor’s visits; they don’t have deductibles or co-payments for hospital visits. You know, there was just an article study in the Annals of Internal Medicine about two weeks ago that came out. It found that people with Cystic Fibrosis in Canada live 10 years longer than their counterparts in the United States. And they get more lung transplants. And we’re supposed to be the big high-tech healthcare country. So that’s just one example of our northerly neighbor doing a better job, and helping people live longer as a result of systemic differences. So, I think a single payer system, similar to what they have in Canada, would be a step in the right direction for the United States. Obviously, that’s going to be combined with some aspects of the U.S. healthcare system that work quite well. KIM BROWN: We’ve been speaking with Dr. Adam Gaffney. He is a physician and a writer with the focus on Healthcare Policy and History, along with Politics. He’s an instructor of medicine at Harvard Medical School and a Pulmonary and Critical Care Physician at the Cambridge Health Alliance. He’s also Secretary and a member of the board of directors of the Single-Payer Advocacy Organization – Physicians for a National Health Program. Dr. Gaffney, we appreciate your time today. Thank you. ADAM GAFFNEY: Thanks so much for having me. KIM BROWN: And thank you for watching The Real News Network. ————————- END

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Adam Gaffney is a physician and writer with a focus on health care politics, policy, and history. He is an Instructor in Medicine at Harvard Medical School and a pulmonary and critical care physician at the Cambridge Health Alliance. He is the Secretary and a member of the board of directors of the single-payer advocacy organization Physicians for a National Health Program.