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The Affordable Care Act has become the symbol of a health care status quo that long pre-dated it, but the Democrats refusal to acknowledge the ACA’s shortcomings and advocate for a truly universal system cost them many voters, says Dr. Steffi Woolhandler

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SHARMINI PERIES: It’s The Real News Network. I’m Sharmini Peries, coming to you from Baltimore. The Affordable Healthcare Act, also known as Obamacare, is in the crosshairs of the Republican majority Congress and the incoming Trump Presidential Administration. During his first press conference since winning the election, President-elect Donald Trump said the replacement for Obamacare following its repeal would essentially be immediate, even within the hour, he said. Let’s have a look. (video clip) DONALD TRUMP: Almost simultaneously, shortly thereafter, a plan. It will be repeal and replace. It will be essentially simultaneously. It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day, could be the same hour. (end video clip) SHARMINI PERIES: The House of Representatives and Senate have also approved measures to begin gutting the Affordable Healthcare Act, however, the Republicans have not yet presented a plan for it replacement. Massachusetts Senator Elizabeth Warren took to the floor earlier this week to speak out against the repeal, saying it would sacrifice progress made towards the improvement of health care in the United States. Let’s have a look. (video clip) ELIZABETH WARREN: Democrats and nonpartisan government officials have worked for years here in Washington to try to make this health system work and we’ve made real progress. Now, Republicans in Congress are ready to throw away these years and years of progress. They’re ready to threaten the collapse of our insurance markets. They are ready to threaten the health and the safety of millions of Americans simply to make a political point. They are ready to repeal and run. (end video clip) SHARMINI PERIES: Here to discuss the fate of Obamacare and the future of our health care system is Dr. Steffie Woolhandler. Dr. Woolhandler is a distinguished university professor at City University of New York’s Hunter College and she’s a primary-care physician in the South Bronx. She was for many years a professor of Medicine at Harvard Medical School where she still serves as a lecturer in Medicine. Dr. Woolhandler is a co-founder and board member of Physicians for a National Health Program, which consists of 20,000 physicians. Thank you so much for joining us today. STEFFIE WOOLHANDLER: My pleasure. SHARMINI PERIES: So, many Democrats are criticizing the Republicans for not having a plan to replace Obamacare. Some Republican Senators, however, have given some indication that some aspects of it will be kept intact. For example, Rand Paul, Republican Senator from Kentucky, has said that he supports keeping the provision that allows children to remain in their parents’ healthcare until age 26. It also seems that Republicans will make changes for covering pre-existing conditions. Let’s have a look at what Rand Paul had to say. (video clip) RAND PAUL: My goal is that there are about 11 million people in the individual insurance market. I want every one of them to be able to buy insurance as part of a group in an association market. So, the goal would be that the people most affected by pre-existing conditions, small businesses and individuals, they would no longer have to have that problem because they would be put into big groups and they would be able to buy insurance as part of a large insurance pool. SHARMINI PERIES: So, Steffie, what do you think Republicans will propose and what do you think of reducing health care costs in general, which is what they say is their objective? STEFFIE WOOLHANDLER: Well, we think that the Republicans will probably maintain the basic structure of the Affordable Care Act but they’ll just make it much skimpier and much meaner with high co-payments and deductibles, particularly for poor people who can’t afford to pay those co-payments and deductibles. I think the biggest effects will be on folks who are getting Medicaid because the Republicans are committed to making Medicaid into a much skimpier, meaner program. There will also be effects on other Americans, as your clips indicate. We’re likely to see the Republicans allowing children up to the age of 26 to stay on their parents’ health insurance. You know, that’s helpful but it only helped a couple million people; that’s not a large amount of Americans who are affected by that. As for the pre-existing conditions, we do expect that the pre-existing condition protections will be weakened under any Republican proposal. Rand Paul was talking about something called high-risk pools. Those have been tried multiple times in the past and do not work to get coverage for people with pre-existing conditions. Representative Ryan and his blueprint for the Republican reforms, which he issued last summer, was talking about while giving you some pre-existing condition protections – but only if you were able to maintain continuous health coverage. And for many people – I mean, including myself – it’s been very hard to make sure that you have continuous coverage and never miss a day or a week or a month in terms of health coverage, given how fragmented and chaotic the insurance system is, even for middle class people like me; that’s been occasionally hard. So, I think most people with pre-existing conditions will find that, you know, if they have to change insurance and miss even a day of coverage, they no longer have pre-existing condition protections. So, we’re expecting that kids-up-to-age-26 provision to stay in the Republican Bill. The pre-existing condition provisions, even though they’re very popular, are going to be hard for the Republicans to support and I think they’ll go away. And I do think that people, everyone, is going to be facing insurance with higher co-payments, higher deductibles, narrower networks but that’s going to be particularly a problem for poor people. SHARMINI PERIES: Dr. Woolhandler, you essentially support a single-payer system and I suppose the organization you represent does as well. What is it that you’re proposing that is directly in conflict to what the Republicans, or what Trump’s new administration, might have available for us to replace Obamacare? STEFFIE WOOLHANDLER: Okay. Well, we have always advocated moving forward from the Affordable Care Act to Universal Coverage through a single-payer system. We advocated that all during the Democratic Administration and we continue to advocate for that now. Of course, Republicans want to move backward to a system where the 20 million people who got coverage under Obamacare are being threatened. But we’re saying, “No, let’s build on Obamacare. Let’s move forward to a single-payer system.” Single-payer is also known as “Improved Medicare for All” and that’s a simple public system like traditional Medicare, where everyone is automatically enrolled. Everyone is automatically covered from the day you’re born to the day you die. You pay for the healthcare system out of taxes and then once you pay your taxes, you know, whether you pay them or not, frankly, but once you’re an American, you’re eligible to get your care at any doctor or hospital without co-payments or deductibles. That is not pie in the sky; that’s a kind of system that they have in other developed countries like Canada or Scotland, where everyone is covered for all medically-necessary care. They have complete free choice of doctor or hospital and they end up living longer and spending less than we do on care. And, of course, that was the type of system that was advocated by Bernie Sanders during his presidential campaign. It’s a system that, you know, when you ask Americans in polls, more than half of them say, “That’s what I want. I want a Medicare for All-Type System”. And yet, we’re obviously not about to get that from the Republicans. We’re likely to see something like the Affordable Care Act only much meaner, much skimpier and much more expensive. SHARMINI PERIES: Right. One of the things that I could not understand is apparently the crowd that Donald Trump appealed to was just ordinary people; working-class people, unemployed and so on. So, when you look at his rallies and the kind of people he spoke to in those rallies, what is their opposition to the Affordable Care Act? STEFFIE WOOLHANDLER: Well, the Affordable Care Act has come to be a symbol of the health-care status quo and the health-care status quo is completely unacceptable. I mean, our organization says that: the high co-payments; the high deductibles; the narrow networks; the overall high costs that people face; the economic insecurity of having this fragmented private health insurance system — that is completely unacceptable. So, Trump said that, and actually Representative Ryan is saying that. When they talk about Obamacare, they talk about the high deductibles and co-payments. Now that problem pre-dated Obamacare. Obamacare did not cause that. That was something that existed before. And yet the Obamacare legislation did not solve that problem. You know, it did some good stuff. It gave health insurance to 20 million people. But there are 290 million other Americans — 91% of the population – who really got nothing out of Obamacare. They did not see their own coverage improve and they’re still facing these high co-payments and deductibles. So, that’s what President-elect Trump spoke to among white, working-class people is the real unhappiness about real problems that persist in the health care system. And, of course, the big mistake the Democrats made was by saying that they were going to defend the status quo and pretending that Obamacare had solved the problem when it really hadn’t. It helped a little bit but it had not solved the problem and the American people, you know, three years into the full implementation of Obamacare at the end of 2016 said, “That’s not true. You have not solved the problems. We have these problems” and President-elect Trump made it look like that was the fault of the Obamacare legislation. What the Democrats needed to be saying then and need to be saying now is, “We are moving forward from Obamacare to truly universal care to single-payer plan;” that would have energized the electorate, that would have really provided something for white, working-class people and would have helped prevent this very disastrous swing of white, working-class families into the Trump, you know, the ranks of Trump voters. I will add, though, as many of you know, affluent people did also vote for Trump and droves of traditional Republican constituencies all stuck with Trump despite his vulgar and racist statements and behavior. SHARMINI PERIES: All right. So, this week we’ve seen a slew of hearings for the confirmation of Donald Trump’s cabinet and we are set to endure more of his agency’s picks over the next few weeks. But the Department of Health and Human Services is going to Representative Tom Price with this appointment. What do you expect with his tenure? Does he have a certain track record in terms of this issue and, specifically, when it comes to say, Medicare, what can we expect? STEFFIE WOOLHANDLER: Okay. Well, Tom Price has supported repeal of the ACA consistently. He has supported acceleration of the privatization of the Medicare program. We do have a partial privatization of the Medicare program already through the Medicare Advantage, but he wants to accelerate that through a full voucher system, where all you get from Medicare is a voucher and you have to add some of your own money and go out and buy private insurance with it. I’m not sure that he’s going to succeed with that voucher plan. The Republicans have been pushing the voucher plan for several decades and never really got much traction with it because it’s extremely unpopular with seniors. But he’s likely to encourage this other method of privatization through the so-called Medicare Advantage Plans, which are private insurance companies that contract with Medicare to provide a full-Medicare package of benefits to Medicare enrollees. And the way he’ll do that is he’ll give more money to private insurance plans, more taxpayer money to private insurance plans. He’ll decrease some of the rules and regulations that are really consumer protections. So, I do think he will further privatize Medicare. I’m not sure he’s going to get his voucher plan through. I do want to say that Tom Price did train as a physician but he does not speak for the physician community. The majority of physician organizations have actually opposed him. Unfortunately, the AMA endorsed him. But most other physician organizations have opposed him. There will be thousands of physicians’ signatures opposing him. And, in fact, polls are showing the majority of the physician community does endorse the idea of some form of non-profit national health insurance. So, Tom Price, despite his training as a physician, does not represent the views of physicians. He represents the views of the extreme right-wing of the Republican Party. SHARMINI PERIES: Right. While all these discussions are going on and the Democrats are coming across as big defenders of Obamacare and public health care, there is the question of whether Democrats will actually support legislation that would challenge both insurance giants and pharmaceutical companies and lead to a single-payer system, as you advocate. In fact, earlier this week 13 Democrats, including New Jersey Senator Cory Booker, voted against legislation that would have permitted importation of drugs from Canada. This would have helped negotiate to lower drug prices. What do you think the Democrats will do given the situation they are now going to be faced with? And will they actually end up doing what you say: move towards a single-payer system? STEFFIE WOOLHANDLER: Well, the Democrats, like the Republicans, get a lot of their campaign contributions from corporate donors and two of the most powerful industries in the country are Big Pharma and Big Insurance. So, the Democrats have been pretty meek, if you will, in not really wanting to confront Big Pharma and Big Insurance. Nonetheless, they have historically been better on these issues than the Republicans and certainly, Price and the Trump Administration is committed to making things easier on Pharma, on giving more money to Pharma, more money to the insurance giants at the expense of the American consumer. I think that the Democrats are going to need to take a more aggressive stance toward protecting the American people from the profit-seeking behavior of Big Pharma and Big Insurance if they’re ever going to win back the White House. And I think, hopefully, they’ll see that. They’ll look at the lessons from the last election and realize that unless the Democrats can do something for the working class that actually improves the situation of working families; that makes their health care more affordable, that makes drugs more affordable, that makes them more secure economically. Unless the Democrats have a platform that does this, they’re not going to be able to win back over those traditional Democratic voters. You know, and I do see some pretty hopeful signs on the horizon. For instance, Senator Sanders has been integrated into the Democratic leadership. Senator Elizabeth Warren’s role in the Democratic Party has been strengthened. Many of the actions that are planned around opposing the repeal of the Obamacare legislation include calls for moving forward to universal health care. We’ve heard those things from many senators and congressmen who, in the past, seemed like they were okay just defending the status quo in the form of the Affordable Care Act. So, I do see signs that traditional Democrats and traditional Democratic constituencies will be moving toward a more, let’s say, aggressive stance to protecting the American people. SHARMINI PERIES: All right, Dr. Steffie Woolhandler. I thank you so much for the great work that you’re doing on behalf of all of us. We look forward to having you back on The Real News. STEFFIE WOOLHANDLER: My pleasure. SHARMINI PERIES: And thank you for joining us on the Real News Network. ————————- END

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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.