Democrats and health care
Panel discussion with Heidi Hartmann, Jan Rodolfo and Dr. Aaron Carroll
PAUL JAY, SENIOR EDITOR: Good evening, and welcome to our ongoing special coverage of the Democratic National Convention in Denver, Colorado. Tonight, Hillary Clinton stepped firmly in line with Barack Obama’s run for the presidency, delivering a final, rousing note on a day dedicated to Obama’s plans to renew the economy, what he calls keeping America’s promise and strengthening the middle class. But what about Senator Obama’s promises when it comes to the issue we most closely associated with Hillary Clinton herself—health care? Considering half of all personal bankruptcies in the United States are caused by illness or medical bills, many Americans say that strengthening the middle class should involve breaking ties with the corporate lobby and legislating a single-payer health care system once and for all.
SEN. HILLARY CLINTON (D-NY): That is our mission, Democrats. Let’s elect Barack Obama and Joe Biden for that future worthy of our great country. Thank you. God bless you and God speed.
JAY: Joining me live from Denver to discuss Hillary Clinton’s speech and the Obama platform is Dr. Heidi Hartmann, president of the Washington-based Institute for Women’s Policy Research; Jan Rodolfo, a nurse with the California Nurses Association, who are actively lobbying for single-payer health care legislation; and from Westfield, Indiana, is Dr. Aaron Carroll, assistant professor of pediatrics at the Indiana University School of Medicine. So we just heard a rather rousing speech. Before we get into the health care issue itself, we just heard a rather rousing speech by Hillary Clinton calling for unity in the party. Heidi Hartmann, did she accomplish her mission to rouse the party around Barack Obama?
HEIDI HARTMANN, INSTITUTE FOR WOMEN’S POLICY RESEARCH: I think it did. I mean, I was very impressed by it. I felt it was an emotional speech. She certainly did review her entire campaign and everything she stood for, and then she said, "And this is what Barack Obama stands for as well. And to those of you who are having trouble shifting your allegiance"—I’m not exactly sure what words she used—"did you do it for me? Your support of me—was that for me? Or was that for what we were trying to achieve? Because if it was for what we were trying to achieve, then we all need to vote for Obama and make sure he wins." So I thought it was very effective and very moving.
JAY: I was a little struck that it was a somewhat pragmatic request for support. What I mean by that is Obama as himself, as a person, as a character, about who he is, she didn’t have a lot to say. It was very much about political positioning, that you were fighting for a cause, and now that cause is led by Barack Obama and we must unite around him. And I thought she made that very forcefully, that argument. But not really much great things to say about him or his qualities as a leader.
HARTMANN: Well, she certainly did say a few things about him. She said he was strong, he was a good leader, "I think that he would take us in the direction the country needs to go," he’s creative, and that he would be able to do it. Now, yes, perhaps you would have liked her to say more about him, but I’m not sure that that’s what the people here in the hall needed to hear; I think they needed to hear that she is supporting him and she wants them to support him.
JAY: Jan Rodolfo, the polls are showing, apparently, three out of ten Clinton supporters are going to vote for McCain or not vote for Obama. Jan, do you think that speech will make a difference to those people?
JAN RODOLFO, REGISTERED NURSE: I think that a number of people were inspired by her campaign on the basis of her being the first woman who had a serious chance of actually winning the presidency. And she was able to make the argument that McCain posed a danger to women’s rights, that McCain was not going to get rid of the glass ceiling, and that Obama would play that role. And I think that’s going to go a long way towards building support amongst her supporters for Obama.
JAY: Dr. Carroll, let’s move into the health care question now. If you’re a health care researcher, you’re a doctor, for an ordinary person’s point of view, compare McCain and Obama’s health care plan.
DR. AARON CARROLL, MD, MS, INDIANA UNIVERSITY SCHOOL OF MEDICINE: They couldn’t be very much—I mean, they couldn’t be any more different. Really what McCain is saying, Senator McCain is saying, is that he really wants to leave things to some extent as they are and, if anything, drive things further away, I think, from any true reform. He’s very much into health savings accounts, which will basically give, theoretically, people more control of their money, but what they really do is move away from what people think generally of as insurance, in that insurance works by people giving money to a pot, and then those who are sick get the money. With the health savings account, people who don’t get sick get their money back, which of course leaves no money left for the people who truly get sick. Senator Obama is to some extent moving more towards trying to get everybody insurance, although he doesn’t go all the way towards a true single-payer insurance plan. He wants to increase the safety nets. He wants to give people more access to purchase insurance, even if they’re not through their employer, and he also wants to make insurance companies give people plans, even if they have prior conditions. How, actually, he’s going to accomplish that, it’s not totally clear, but at least he’s moving towards trying to get everybody insurance.
JAY: So I think you probably all three agree, I mean, certainly those of you who consider yourself Democrats will agree—I think that maybe it’s all of you. But the question, Jan, is the nurse’s association doesn’t think the Obama plan goes far enough. And the nurse’s association is supporting a piece of legislation called HR 676, which proposes a more fuller single-payer plan. First of all, just in case there’s someone out there that doesn’t know, tell us what single-payer means, first of all, and then what’s different about this piece of legislation and what the Obama plan is.
RODOLFO: Single-payer is that instead of guaranteeing every American health insurance, you’re actually guaranteeing every American health care. A single-payer system, very simply, is a system where there is only one source of funding for health care. So whether you’re a doctor’s office or a hospital or a nursing home, you simply bill the single-payer government system for reimbursement, unlike *the current system, where you have thousands of insurance companies—
JAY: *So, essentially, the single payer is the government.
RODOLFO: —that each you have to bill separately and fight for reimbursement.
JAY: That’s a lovely music track behind you. It will help our conversation on the health care system. So you think the single-payer plan is better for ordinary people than the Obama plan. So just a little bit more about what Obama is proposing and what you think the Obama plan’s missing.
RODOLFO: I think what Obama aims to do is to extend insurance to as many people as possible. What it fails to do and where it falls short is that we have a serious problem in this country not just of uninsured, 47 million uninsured, but rather people who are under-insured, who, when they actually get sick, find that they’re unable to afford their deductibles, unable to afford their copayments, or find that they’re faced with having their insurance policy rescinded altogether if they actually file claims for care. And so just extending insurance to everybody doesn’t mean that they’re actually going to get the health care that they need.
JAY: Heidi, I know you’re not an expert on the health care question itself, but there’s kind of a political argument here which perhaps you can dig into. A single-payer plan, which I think you could also call the government health care plan—. And I go back and forth myself between Canada and the United States. I happen to, luckily, if I got sick, been more a Canadian resident, so I have access to the Canadian health care plan. But the Obama plan falls far short of this single-payer government insurance plan. Why do you think the Obama campaign and Democratic Party has not adopted this kind of proposal the Nurses Association is proposing?
HARTMANN: Well, I’m not entirely sure about that, but I did want to just clarify for the people who are listening and watching us that in a single-payer plan, while the government is paying, you still have the opportunity to choose whichever doctor you want. So there are many sources of health care who are private doctors. Some of them may work for public hospitals or private hospitals or have their own private offices. Government health care doesn’t mean that it is supplied by doctors who are on the government payroll, as it might be in England, for example. So just to clarify that. You know, that has been a sort of a point of debate about what people in most of the world, most of the US, that isn’t paying a great of attention to all these details is that they understand that both Hillary and Obama were arguing for, are arguing for more complete health care. Whether we do it through health insurance or through a single payer, which is the government being the insurer, is relevant, then, I think, to the idea that these are people who are going to lead us in the direction to get this change. I mean, looking back at what happened before under the Clinton administration, you know, I think Congress is going to be a very big player in this, and Obama may just be saying, you know, "This is going to be what we can get. My administration’s going to propose something." It’s going to have to go through the house and the Senate. There’s going to be an awful lot of factors. And, you know, sure, I think single-payer is a better plan. I certainly hope the US moves in that direction eventually, and if we can do it now, that’s great.
JAY: Is it a political calculation? Both Senator Clinton and Obama were far short of this kind of single-payer plan. And I would kind of guess if you polled most Democrats, they’re probably in favor of it, just as you are. I mean, it would require a big struggle. I mean, certainly the health care industry on the whole is not in favor of it.
HARTMANN: The health insurance industry is not in favor of it. The health insurance industry is not in favor of it, and there are many doctors who are in favor of single-payer. In the last go round, what happened was—and I’m sure Jan will want to comment on this—the alternative to the original Clinton plan that had the most supporters was the single-payer plan. It had a minority of members of the House signed up for it, but there were more signed up for that than there were to any other alternative to the Clinton plan at that time. So it’s a strong minority position, and that’s good, because with that strong minority position, we should be able to get something pretty good.
JAY: Dr. Carroll, talk a little bit about the difference between the government-style single-payer plan and what’s been proposed both by Senator Clinton and Barack Obama, particularly when it comes to the cost of health care. I think one of the things that doesn’t get talked about that much is how a single-payer government plan (it’s hard to get all these things out of your mouth in one go) can actually reduce the cost to the system, because now pharmaceutical companies in particular and other aspects of the health care industry, they’ll have to negotiate with essentially a government monopoly. So, for example, in Canada, the price of health care is actually far, far less than it is in the United States.
CARROLL: It’s far less than pretty much every big country in the world other than the United States [sic]. The United States pays two to three times per person for health care what any other country pays in the world, and most of the countries actually achieve outcomes far superior to that of the United States. The thing is, to truly achieve the economies of scale and to truly get the cost savings that would come from that, you really need to go to a one-payer system, which is what we have with Medicare. When we talk about Canada and we talk about how it’s not feasible, it’s a hard argument to swallow, because to some extent a single-payer system already exists in the United States. It’s Medicare. Everybody over the age of 65 has a government-run/-financed health care plan, where the government’s paying the insurance cost but not actually providing the care. That’s Medicare. And it’s hard to swallow how Medicare is American as apple pie if you’re 65 but a socialist nightmare if you’re 64.
JAY: So how do you explain the Obama and Clinton position on this?
CARROLL: I think that they’ve decided, right or wrong, that the pragmatic choice is to some extent to keep the status quo as much as possible while trying to move incrementally towards getting everybody covered. Both of them, although, I mean, if you look at the primary fight, you would think that there were huge differences between their plans. In fact, there were very small differences, and it all came down to the mandate, which is what they kept saying, where Senator Clinton was saying that everybody had to buy in, and Senator Obama was saying, "Well, some people can choose to opt out." The truth of the matter is that the plans were incredibly similar: increase the size of the safety nets, try to increase SCHIP, increase Medicaid, try to get more people covered by government programs, allow people to buy in large groups during the federal insurance plan, even if they were not employed, and to try to force insurance companies to take all comers, even if they had prior conditions. There really aren’t that many differences. The problem is that they’re not going to achieve much in the way of cost savings—their plans are going to cost a significant amount of money. And the only way to save that money is to move towards a more effective and more cost-effective single-payer system, which neither one thought was politically feasible.
JAY: Jan Rodolfo, are you concerned—and I guess this is a little bit of a softball question to the nurses association that’s already pushing a different piece of legislation—but are you concerned that if the Democrats don’t get elected with a platform based on single-payer system, then they won’t have a mandate to even try to get anywhere near it afterwards. It’s quite a commitment not to go there. So in terms of your legislation, 676, to what extent do you have support in Congress? What are the possibilities that Congress might push Obama further than he’s willing to go in the campaign?
RODOLFO: Sure. HR 676 currently has 91 cosponsors in Congress. And so it’s actually very well supported. It has the most cosponsors of any health care reform currently. And a growing movement in the country, both within the labor movement and within health care reform groups, are supporting HR 676. I think there’s a real danger in the pragmatism that Clinton or Obama would argue, and that is that you can’t figure out what’s really politically feasible, what a movement will support, what the country will support. You can’t decide that in advance. You have to actually argue for what you think the best solution is and try to inspire people to fight for that solution. And if you propose instead a system of incrementalism that gives insurance companies more profit and more control, what you do is you demoralize and deflate the movement for real change. And that’s a real problem. There’s been an argument in the past for incrementalism. That’s how Medicare ended up being just for people over the age of 65. The argument was we’d start there, and then [inaudible] when you settle for incrementalism, you fall short of the solution that really needs to happen here.
JAY: Heidi, what do you make of that argument [inaudible]
HARTMANN: I am a known supporter of Obama, so I do want to put that out there. But I feel that Obama is the last person who is going to resist a people’s movement in America for a single-payer plan. I don’t really feel that Senator Obama is totally committed against a single-payer plan. He’s put something forward that he thinks is practical, that he thinks can move. But I am sure that he would be very open to a movement in a more progressive direction. I could be wrong, of course, but I feel that he’s very open to that. I think, you know, if you talk to people who were involved in the Clinton health care reform, that was actually a different story. Much as I was a supporter of Hillary in this primary before I’d become a supporter of Obama and did support her very strongly throughout this electoral
campaign, she really was very interested at the time of, you know, ’93, ’94, in a system that would preserve the role of insurance companies. She was committed to that—she rejected single-payer at that time. So I think, if anything, she had a stronger commitment against single-payer than Senator Obama has. That’s just my impression from talking to people in his policy shop and, you know, just sort of looking at the way he operates.
JAY: So, Jan, what do you make of what Heidi just said? It’s up to the movement to push Obama, not quite what you said—Obama should be actually inspiring and fighting for the movement.
RODOLFO: I think that the two need to go together. I absolutely believe that it’s not possible to win single-payer in the United States without the combination of a movement putting pressure on politicians, in combination with politicians who are strong enough to stand up and do what’s right, despite the fact that they obviously face issues with campaign finance and worrying about donations from the industry. I think it’s essential that there’s a movement here. But you’ll notice when Hillary Clinton was speaking, when she mentioned health care reform, it was one of the biggest sort of up-swells in sound kind of during her speech. And there’s a great, deep desire in this country amongst the populace for real health care reform. And so I would hope that we really reach for single-payer, which has worked everywhere else—we have it in Medicare—that we actually take that step and don’t sell ourselves short.
JAY: Dr. Carroll, this kind of single-payer health care reform, and if one wants to make the pragmatic argument that what’s possible or what isn’t impossible in American politics, and it somewhat hearkens back a little bit to what John Edwards, although this week not many people are mentioning John Edwards now. But John Edwards said you actually have to be willing to fight. And the issue was, if you’re going to have this, you’ve got to actually wage a major struggle with the pharmaceutical industry and in private insurance companies. There doesn’t seem to be that fight in the platform of the Democratic Party.
CARROLL: Maybe not in the platform, but I think you’re going to see it in people and, I think, in people who are running for office. You need only look to history. The passage of Medicare was just as big a fight as what we’re seeing now, and it was just as hard to get done. The same people who are opposed, the same forces that are opposed to getting any kind of real health reform are the exact same forces that were opposed, you know, back in the ’70s and ’60s to Medicare. And the day after Medicare was passed, everybody loved it. And you will see no politicians today running on a platform of Medicare is evil, Medicare is socialism, and Medicare’s got to go. To some extent, once it was passed, everybody was really in favor of it. I think we’re seeing the same fight today. It’s going to take the same kind of dedication, the same kind of people getting behind it, the same kind of grassroots forces, and the same kind of politicians who are willing to step forward and lead and push the line a bit further to finally get this passed. Once you see major health reform passed, no one’s going to fight against it. It’s going to be the same thing as Medicare. Once it’s there, most people are going to find that a system that is more efficient, that costs less, that provides more people care, and likely leads to better outcomes is going to be very popular. It’s just getting to that point and getting over the hill. And I think lately, with the way things are, with the economy, with the fact that the largest-growing group of uninsured in this country is the middle class—it’s people making $50,000 to $75,000 a year. These people need health care, and these people are going to fight, and these people are going to vote. And I think you’re likely going to see change in the near future.
JAY: I guess part of the problem’s going to be for HR 676, that in the Senate, the person who’s probably going to lead the charge for the Democratic Party is Senator Clinton. And Heidi just said she’s fairly committed not to have a single-payer health care system. So it’s going to be a rather interesting fight in Congress.
CARROLL: I agree, but I think it’s the kind of thing where Senator Obama has said in public that if he had to design a system from scratch, he would favor a single-payer system. He just believes that because of the way things are, that pragmatically an approach that sort of moves for incremental reform is the most likely to get passed. I think if you saw the American public rise up, I think if you saw more politicians say, "No, no, no—we can really do this," that he’d get behind it. And if you have a president who’s going to get behind it and you have people in the Senate and in the House who are going to push it—and there are people who are going to push it—it’s possible to get things done.
JAY: So I guess the first step is to see who wins the presidency. Thank you all for joining us, and I hope you’ll join us again to talk about the health care issue further over the next couple of months as we head towards the election. And thank you for joining us. The fight for HR 676, I guess, is really going to take place in Congress, one way or the other, and we will see whether Americans are willing to move towards a single-payer system or not. Thanks for joining us for our coverage on The Real News Network. Goodnight.
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