Gary Null (GN): We’re going to talk about the severity of America’s healthcare and review President Obama’s health reform. Our guest is Dr. Quentin Young, and he is quite simply one of our nation’s most distinguished medical physicians and a leading advocate for a universal health plan. Dr. Young recently retired from private practice after 61 years. He served as the physician for Martin Luther King and was the Chairman of the Medical Committee for Human Rights, Chairman of the Medicine department at Cook County Hospital, a founder of the Health and Medicine Policy Research Group and President of the American Public Health Association. Dr. Young is now Clinical Professor of Preventive Medicine and Community Health at the University of Illinois Medical School at Chicago and a founding member and National Coordinator of the Chicago based Physicians For A National Health Program, a nonprofit physician advocacy organization. Dr. Young, it’s nice to have you with us today.
Quentin Young (QY): Thank you very much.
GN: Dr. Young, I’d like to get an insider’s view to set the record straight about what President Obama actually ran his campaign on regarding healthcare reform. There are those who claim he promised a single payer, universal model. Others say that while giving lip service to it he actually dodged a firm commitment to universal care. As a fellow Chicagoan resident and a community leader who provided health consultation and friendship to Obama the Senator and Presidential candidate over the years, how would you compare the would be President Obama with Obama the Commander and Chief for the public’s health crisis?
QY: Well you did a good job of summarizing his evolution. No less than four years ago, he was on the public record saying he supports single payer. It’s the way to go. Then as his fortunes improved—and they certainly did during those four short years when he became a national senator, then presidential candidate and finally the President of the United States—he modified his position. He began by saying that if he was starting from scratch he would go for the single payer system. Then more recently, in fact as we speak, the Administration’s position is that we want to build on what we have experience with in this country. That translates into relying on the employment-based insurance arrangement that many millions of Americans receive. That’s what’s on the table now. That’s where the President is. He no longer says that single payer is the way to go. They sort of mealy mouth the expression that while single payer may work in many countries, in the US we want to build on what we have. Well that has a nice ring to it, but it’s crazy. The plan that we have has put us in desperate straits. Let me be straightforward; the employment-based insurance scheme has proven to be an increasingly empty promise. For example, there are thousands of employees in the big three auto companies who are losing their health insurance as these plants shut down. And we’re seeing an increasing number of uninsured citizens annually for the last 20 years. We’re now up to about 50 million people with no health insurance and another 50 million with very poor insurance. If these people have a serious illness they’re out of the loop. So I am very critical of the President’s compromise. If you were to ask me why he did that—obviously we can’t get inside his mind—the best answer I can give is to replay what happened to President Clinton in 1993 when he came forward with an ambitious plan. The industry attacked the plan ferociously with a multi-million dollar media blitz. By the time it was over in 1994 we had nothing. And now it’s some 15 years later, and we’re seeing another round. So let’s understand why the forces opposing reform are so powerful.
Last year healthcare in this country cost $2.5 trillion. We’re getting used to the word trillion, which is one-sixth of the gross domestic product. In other words, one out of six dollars goes to healthcare. And the companies that profit from it, notably the for-profit insurance companies, Big Pharma, the drug companies, and many other huge players, are very concentrated on making sure the Congress doesn’t do anything to spoil their enormous profits. That’s the way they act, and that is what we should expect. I’m not complaining that they’re acting according to script. I am complaining that they’ve brought the American health system to its knees. We’re spending twice as much per capita. For every person in this country we’re spending $7,800. That’s twice as much as the next three countries in the world. Switzerland, France and Germany spend roughly $4,000 for systems that are much more effective. What I mean by that is their outcomes are better. What are the outcomes?
In healthcare we measure things like life expectancy. These countries do significantly better than we do. Infant mortality and maternal mortality are useful measures. We’re way down on those lists. There is prevention of preventable diseases, meaning immunization and public health measures. Again, we’re 37th in the world on these measures and these countries are in the top ten. So we are not only not getting a decent health system, we’re also paying a confiscatory price. This is being played out in our Congress but it’s not an even playing field. Senator Baucus from Montana is the Chairman of the powerful Finance Committee that has the main jurisdiction in the Senate for this bill. Senator Baucus has said for the past six months, every time he makes a public statement, that everything is on the table except single payer healthcare. Now in a democratic society that’s almost incomprehensible.
The New York Times on June 19 said 82 percent of Americans favor government health insurance. And listen to this. The American medical profession, which I’m a part and I can testify is extremely conservative and was over the years by and large opposed to these forums—has turned around. Last April in The Annals of Internal Medicine, a prestigious refereed journal, a study showed that 59 percent of America’s doctors now favor a government program. Now that’s a turnaround for American doctors. The American doctors discovered that there’s “something” worse than government because everybody was going around with the bogeyman – government medicine – and that “something” is corporations. The corporations now control the American health system. They work for maximum profits. What this translates into is denial of care, raising premiums, and putting people into bankruptcy. You can’t run a health system on those principles.
GN: I appreciate your overview. I’d like to go into some specifics now. I have studied the English, French, and the Canadian healthcare systems. Using the Canadian healthcare system as an example, after looking at actual facts, the ten leading arguments against any of that being done in the United States were wrong. Yet our major media, which should have gone to Canada for itself and do its own original investigation instead of listening to lobby groups and their backers have attacked Canada’s system. When you look at the US you find that over $400 billion a year is accounted for by fraud in our existing system. You also see that 27 to 31 percent of all the money in that system goes to the private insurance industries. One healthcare corporation paid the largest fine in American history for a single corporation. It was over 1.1 billion dollars. You’ve got to ask, “What kind of company has got a billion dollars in cash that it can give away for crimes it committed?” Then I consulted Lexis-Nexis for lawsuits that the insurance companies, medical for-profit corporations and hospital businesses have paid. It’s into the billions and billions of dollars. However, no reputations are sullied. No one says the model itself must be corrected.
Surely the Surgeon General and the US Public Health Service would start to deal with the diseases we know could be lessened if we as a country began to eat better and take account of our environment. However, not a single step has been taken to make Americans healthier except to stop smoking. We don’t look at anything that’s natural and nontoxic. We look only at a pharmaceutical approach when study after study has shown that some drugs work, some don’t and some are deadly. Then you look at the cost of all this. Surely a single payer model would be better after looking at other countries.
Now when it comes to the meetings Obama held in the White House, unless I’m mistaken, you weren’t one of the people invited. In fact, none of the more progressive voices for single payer coverage were invited. Baucus only invited people who are deeply connected to the health insurance agencies, the medical system, and the pharmaceutical industry. Am I off-base about the power that these lobbyists have in controlling our healthcare system?
QY: I certainly agree with absolutely everything you said, and it parallels our experience in The Physicians for a National Health Program. We’ve been around for twenty years. We have very close ties with the Canadian leadership and the Canadian Physician Group. They’re not without criticism, but the difference between the major premises and activities of Canada’s health system and ours are as night and day. When polled, 96 percent of Canadians prefer their system over an American alternative. And they know the US. Canadians and Americans cross their border a lot. So it’s an informed opinion. And I agree with you that from all appearances the power players, the people who are in this for maximum profits, are the ones who have the President’s ear. That’s very bad. Not only in principle are the beneficiaries of a bad system calling the shots, but also their solutions. They’re hardly solutions and their proposals will not solve anything. The system that is now deteriorating is going to get worse.
Just last week there were a number of headlines in the major papers that tell the whole story. For example, Senator Kennedy, who is Mr. Health in the Senate and in the past has supported really good stuff, presently has a bill that will add a trillion dollars during the next ten years and it still leaves 15 million people uninsured. The pundits are saying that puts a huge hole in the President’s program. Now today they’re celebrating the fact the big drug companies are agreeing to cut in half costs of drugs for the poor. Well that begs a question. If you can cut the cost of a drug to a huge sector of the population, what’s been going on for the last 20 or 30 years? The profits that they’ve pocketed are astronomical.
These are minor shifts in the problem. We need a fundamentally sound system that is based on a single payer plan. It’s worth noting that 19 countries share two characteristics. They’re industrialized, therefore their economies are advanced, and they have democratic societies. They have elections and they have accountability. Every one of those 19 countries, except the US, has moved to a single payer system and are doing much better than we are. Getting away with half or less per capita cost, and at the same time much enhanced health status leaves a sense of solidarity, a sense of satisfaction because their governments look after the person on the street. We have a healthcare system that puts people in bankruptcy and jeopardy every day, and then the solutions that are coming forth are not addressing this. To borrow from Senator Baucus, single payer is not on the table. Well, we want it on the table. The American people support the notion of a government tax supported system. We want them to have a voice.
GN: I agree. A nation’s healthcare can be summarized as “the best medical care possible with the least amount of money to the largest number of people.” So there are three things: quality care, low cost and universal access. There are recent claims stating that as many as 119 million Americans would shift from private coverage to a universal government health plan if the latter was in place. So if we look at this figure as a public vote on the quality of healthcare in today’s medical system, it’s clearly an indictment that not only our healthcare system is failing many people but it is also providing horrendous medical services. So what does this say about our legislators who choose not to care what Americans think?
QY: Well we have to first reckon with the fact that the finance of our legislators’ campaigns are heavily indebted to these drug and the healthcare companies. For example, Senator Baucus has the main jurisdiction over health legislation. Last year he received a half million dollars from the industry, and over the preceding six years over a million. Well what can I say? I’m not making an accusation that he’s been bought off. But then you have these huge contributions to a Senator’s political campaign, and then he says publicly with the power to make it stick that single payer is off the table. It’s very hard not to connect those two events. So we have an ongoing problem in this country in campaign finance reform because these people are very sensitive to the issue of contributions. Well I needn’t say the obvious thing. Democracy is dead, and only occasionally can this kind of unity against reform be breeched.
I’m old enough to have participated in the Civil Rights movement in the 50’s and 60’s, and things were bad then in regard to segregation and racism in this country as it is in the health system today. So I have a certain optimism that the healthcare system is very close to that point in history where it’s not tolerable. The irony of this is that we have everything we need to be the best in the world. You know the popular words from the American Medical Association – we have the best system in the world.
This is the one social problem we have where all the tools we need to make it good and to fix it are in place. Certainly there is money. We’re starting out with twice as much per capita as any country in the world. I’d say it is downright unpatriotic for anybody to say that we can’t do as least as well, maybe a little better, than anybody else. We have a superb health workforce: doctors, nurses, and other health workers. So all the tools that we need to make it happen are in place, but the intrusion of for-profit corporations and their transactions have held us back and indeed have dragged us down. American citizens have to recognize there’s a specific task they have to communicate to their legislators and tell them what they would like to have happen. I think that would make a difference. In fact I think it’s beginning to make a difference now.
GN: Just two more issues. I believe this discussion on healthcare reform in Washington is taking place in a vacuum and disconnected from the economic realities facing Americans, especially the crisis facing small business owners who may be required to provide health coverage at a time when Americans are facing a dramatic decrease in savings. This means that it is impossible for most working Americans to be able to save a nest egg for that time when a loved one becomes ill and has to pay out of pocket regardless of whether or not they have moderate coverage. Moreover a recent Tompkins Reuter Survey released this week of 100,000 households shows that 40 percent of respondents feel they need to postpone any healthcare for several months.
Now as a physician you know what this means. Their conditions will only get more serious without care and will become all the more costly as a consequence. How are we to understand the economic crisis as it relates to the necessary conversations on health reform? And what is fundamentally lacking in these discussions in Washington?
QY: Well it’s a fact that with this economic downturn there’s a sharp increase in the number of people who just can’t afford, or feel they can’t afford, to visit a doctor, and they fend for themselves. Of course, some make it. People do get well without physician intervention but many don’t. The condition of health in American is declining, and we’re beginning to resemble third world countries in their absence of real support for the health of the nation. I think the economic downturn, which you allude to, has a profound effect in accelerating the crisis. What hasn’t been done is to bring enough Senators and Representatives together for the kind of reform this country needs. That’s exactly where we are right now.
I would be happiest if President Obama—who has demonstrated superb political skills—would return to the wisdom of just four years ago when he said single payer is the way to go and he supported it. I’m sure he could bring the American people along. Would there be a really tough fight? You can bet your life. These industries I’ve spoken about will spend whatever it takes, tens of millions of dollars in misinformation. But I have at the end of the day enough confidence in the American people that we’ll do the right thing. So you’re right to point out that we’re entering a period where all the contradictions and all the problems are going to get worse, and we need a huge public awareness to get a decent health system for our people.
GN: I really appreciate the opportunity for you to share your ideas with us today. I’m hopeful that at some point President Obama will reconsider his trajectory and realize that there are citizens as well as professionals like yourself who will nudge and remind Obama that he believed in this ideal for the average person. Now he is getting lots of pressure from the special interest groups. And too often we see the special interest groups becoming dominant in what they want. They’re writing laws that protect and self-serve themselves only. They have unwarranted influence, and as a result we have the unintended consequences of their actions. So I’m hopeful there will be change, and I thank you very much Dr. Quentin Young for being with us today to share your insights.
QY: Thank you. I appreciate the opportunity.
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