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Dr. Flowers: Decision strengthens the role of private insurance
companies and makes the fight for Medicare for All more difficult

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PAUL JAY, SENIOR EDITOR, TRNN: Welcome to The Real News Network. I’m Paul Jay in Baltimore.

The Supreme Court has decided that what everyone calls Obamacare—at least most people call Obamacare—is upheld. It’s constitutional, not under the Commerce Clause, which governs interstate commercial activity, but under Congress’s powers of taxation. It was a little confusing at the beginning. CNN’s first headline was that the law was going to be struck down, and then, a few minutes later, had to say, oh, no, it’s being upheld. But at any rate, now the confusion of the decision has cleared up. It’s clear the entire law has been upheld. The decision was written by Chief Justice Roberts, a Bush appointee and a conservative justice. And that may—some people may find that a bit curious. President Obama a little bit later called all of this a victory for all of America.

Now joining us to give her views on this decision is Dr. Margaret Flowers. She’s a pediatrician in Baltimore who advocates for a national single-payer health care system—Medicare for all, some people call it. She’s an organizer of October2011 and codirector of Thanks for joining us again, Margaret.


JAY: So what’s your take on this decision?

FLOWERS: The Supreme Court decided with the corporations and not with the people on this one. What we’re seeing is people are going to be forced to purchase a private insurance product, even though that product does not mean that they’ll be able to afford the health care they need or that they’ll be protected if they have a serious accident or illness. We’ll still see bankruptcies happening in this country. So we’re disappointed by the outcome of this decision. It was not for the people.

JAY: Well, let’s go through this, ’cause defenders of the legislation will argue, first of all, there’s certainly some gains in it. President Obama himself has said this isn’t the legislation he wanted. But they’re defending it. For example, people under the age of 26 can now stay on their insurance up until the age 26 [incompr.] their parents, people with pre-existing conditions can’t be turned down, children are going to be covered with pre-existing conditions. I mean, aren’t there some things in this legislation that are of real value to families, and so even if one doesn’t like this legislation on the whole and prefers a single-payer system, is this not better than the previous status quo, people will argue?

FLOWERS: Well, that’s the point. There are some positives in it. Each of those positives does have negatives, and we could certainly go through them. You know, the insurance companies love that kids can stay on their parents’ insurance plans until they’re 26, because those are for kids whose parents are employed, probably have better incomes, have better health overall, so they’re, you know, getting more customers.

We have to look at the big picture of this. What this does is it moves our country further in the direction of privatizing our health care. And what we really need to do if we want to control health care costs and cover everyone is move in the other direction, towards having a publicly funded health care system that’s universal. It opens the door for corporations to continue to loot our health care system, to continue to get into our Medicare and our Medicaid and use it for their own benefit. It continues private insurance, which gets in the way between patients and physicians.

So while some people will gain more coverage, we need to really talk about what kind of coverage they’re actually getting. It’s delaying us from doing what we need to do, which is to join every other industrialized nation. We’re already spending enough money to cover everyone. We should have a universal, publicly funded health care system in this country that leaves nobody out.

JAY: Now, when you say publicly funded, you mean a publicly run insurance system.

FLOWERS: Right, that would be paid for. We would pay for our health care system like many other countries do, through our taxes.

JAY: Well, isn’t it a Supreme Court decision which said, essentially, that they’re enabling this only through the taxation powers of Congress? In some ways, doesn’t it actually nudge in that direction by saying that the only way to really do this is through the tax system?

FLOWERS: It would be great if we can make that argument. I’m not sure that’s really going to be successful. What we’re seeing instead is what I would call corporate welfare on steroids, where we’re going to be funneling four hundred and forty-seven billion of our taxpayer dollars directly into the coffers of the private insurance companies. What do we get in return for that? Skimpy coverage. People will still face financial barriers to getting health care. They still face bankruptcy if they have a serious accident or illness.

JAY: Now, the right wing is suggesting that this is the reason they’re opposing this is they think this is a step towards what you’re talking about. You know, they call it socialized medicine. I mean, I think clearly this isn’t, but they say this opens the door to that. You don’t see the current—this legislation as sort of a step towards the kind of single-payer system you’d like to see.

FLOWERS: No, I do not. I see it as further privatizing health care. And I think that what’s interesting is that the discussion is very partisan. So actually what we’re seeing those on the right talking about now are the fact that this bill does not control our health care costs, which is true—they’re going to continue to rise dramatically. What we hear on the left from the Democratic Party is a real defense of the individual mandate. They’re calling it an anti free rider provision, as if there are so many Americans out there who are just not getting insurance because they don’t want to pay for it. And that’s just not the truth. People are not getting insurance because it’s too expensive and it doesn’t cover what they need, you know, when they’re sick anyway.

So we’ve got to really take the partisanship out of this and have an honest discussion about what works here in this country. If we’d had a real health care debate, we would have looked at the three systems that we already have. A truly socialized system would be the Veterans Health Administration, Medicare as a publicly financed but privately delivered system. And then we have our private insurance. If we’d had that discussion, we would see that the VA system and the Medicare system operate much more efficiently, they lower our health disparities, they improve our health outcomes. We would be looking at one of those.

JAY: What about the realpolitik of this, as they say, that you can’t pass in today’s America what you’re talking about? And if the Supreme Court has struck this down, or if after the next election the Republicans control the House and Senate and are able to repeal this, then you’re back to the previous status quo, and that it could be another, I mean, you know, Democrat—Democratic Party leadership will say another decade before anyone tries this again.

FLOWERS: Again, it’s so interesting, this conversation, and how it’s not really grounded in reality. I think it’s important to look at the individual mandate as an idea that came out of the right-wing think tank the Heritage Foundation. It was passed in the bill that Romney passed as governor in Massachusetts in 2006. Obama passed basically the same bill as Romney at the national level. And so it’s not about who is in Congress, which party. I mean, Obama had a Democratic majority, and he still would not allow a real discussion of what the fundamental problems with our health care situation was, would not bring in real health care experts who had solutions to this health care problem. This bill was written by and for the industries that profit off of our current situation. They’re going to continue to profit off of it. The majority of people in the United States, including the majority of physicians, support a national Medicare for all.

JAY: Okay. So, Margaret—.

FLOWERS: And if you look at the Democrats, 80 percent [incompr.]

JAY: Margaret, so what’s next for the people that want Medicare for all? Is this now—I mean, now this is the law of the land, and at the federal level, at least, this is not likely to change for some—many years. Is this now a fight at the state level? And if so, where’s that at?

FLOWERS: Well, it makes the job of advocating for Medicare for all much more difficult. What we’re going to see is our health care costs will continue to rise. Tens of millions of people will be left out of the system completely. The current estimates are that when it’s fully implemented in 2019, close to 30 million people will still have no access to health insurance. Those who have insurance, newly insured, about half of them will have Medicaid, which is going to face its own difficulties at the state level with state budgets trying to pay for that. Other people will have private insurance, but only with skimpy coverage. And so we’re going to see a continued decline of our health care system, a continued health care crisis.

JAY: But, Margaret—.

FLOWERS: The end story is—.

JAY: Yeah. There are fights at the state level, are there not?

FLOWERS: There are fights at the state level, and those are helping to push state legislation to be stronger than it otherwise would be. It’s very difficult to implement a true single-payer system at the state level.

Whatever we—the basic—what it comes down to is this, and it’s the story of every social justice trouble that we’ve had in this country. If we want to get health care for every person, it’s going to have to come from the people organizing and demanding it. It’s not going to come from a Democratic majority or a Republican majority. And so that’s what we need to do. The sooner that we’re out there demanding it, the sooner we’re going to get to a true health care for all. It’s what the people already want. So it’s time for us to come together and actually say that and not compromise and accept these crumbs.

JAY: But in terms of where things are at right now—like, for example, doesn’t San Francisco, just the city itself, have something that approximates the kind of system you’re talking about? So, you know, I understand you’re going to continue fighting at the national level, but at the local and state level, are there not initiatives that people can try to push for?

FLOWERS: There are. San Francisco’s an interesting situation, where they levied a food tax at the restaurants that helps to pay for health care for people in this city. Again, that’s an improvement. Vermont is trying very hard to implement a state single-payer system there. It’s years out before they can do it, if they actually are able to be successful. But they do have better legislation than what the other states are putting together.

We’re advocating for a very simple campaign. Just drop two words from the current Medicare Act: “over 65”. Immediately extend Medicare to every single person in this country. That creates a health care system that’s based on health, not on profit. That is actually a model that we can improve. The Affordable Care Act is never going to be tweaked into something that controls health care costs or is universal. The data shows that in Massachusetts; it shows it in other state efforts that have been tried. So it’s really the sooner that we come together and realize Medicare for all is the first and smallest incremental step that we can take on the path towards health, the sooner we’re going to get it.

JAY: Alright. Thanks very much for joining us, Margaret.

FLOWERS: Thank you for having me.

JAY: And thank you for joining us on The Real News Network. And don’t forget we’re still in our spring/summer fundraising mode. We’re only about twelve, thirteen thousand dollars away from reaching our $100,000 target. Remember, for every dollar you donate, our matching grant kicks in another dollar. So we’re very close. And if you want to see more Real News, we need you, if you haven’t already donated. And if you have, thank you. But if you haven’t and you’re watching, please make a contribution.

Thanks for joining us on The Real News Network.


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Dr. Margaret Flowers is a pediatrician in the Baltimore area and a co-chair of the Maryland chapter of Physicians for a National Health Program (PNHP). She is also a Co-Director of and It's Our Economy. Flowers is currently running as a Green Party candidate for US Senate in the state of Maryland.