Dr. Steffie Woolhandler
Health Care Reform
interviewed by Amy Goodman
Dr. Steffie Woolhandler, professor
of medicine at Harvard University and a primary care physician
in Cambridge. She is also a co-founder of Physicians for a National
Health Program. She testified about uninsured veterans before
Congress in 2007.
AMY GOODMAN: Today is Veterans Day. We
begin with a new study that estimates four times as many US Army
veterans died last year because they lacked health insurance than
the total number of US soldiers who were killed in Iraq and Afghanistan
in the same period. A research team at Harvard Medical School
says 2,266 veterans under the age of sixty-five died in 2008 because
they were uninsured. Their estimates are based on their recently
published findings in the American Journal of Public Health that
shows how being uninsured raises a person's odds of dying prematurely
by 40 percent.
The researchers also found that nearly
one-and-a-half million Veterans between the ages of eighteen and
sixty-four were uninsured last year. While most veterans are eligible
to receive care from the Veterans Administration, those who were
not injured in combat and whose income is above a certain threshold
are often ineligible.
The report's authors say the healthcare
legislation pending in the House and Senate will not significantly
improve the situation.
The co-author of the report, Dr. Steffie
Woolhandler, joins me here in our firehouse studio. She's professor
of medicine at Harvard University and a primary care physician
in Cambridge. She is also co-founder of Physicians for a National
Health Program and testified about uninsured veterans before Congress
We welcome you to Democracy Now! I mean,
these are astounding figures. Tell us exactly what you found.
DR. STEFFIE WOOLHANDLER: Well, the risk
of dying is actually elevated by about 40 percent among people
who have no health insurance, and there's just under 1.5 million
uninsured veterans nationally. So applying those odds to those
folks, it turns out that there's almost 2,300 folks who die-veterans
who die every year due to lack of health insurance.
Many of these folks, these veterans, would
not be helped under the bills before the House and Senate, because
they'll be too affluent to qualify for Medicare. If they get subsidies
at all-for Medicaid. If they get subsidies at all, the subsidies
will be too small to make health insurance affordable. And they're
mostly working families, folks who don't have the money to buy
private insurance, but they have too much money to qualify for
Medicaid or means-tested VA benefits.
AMY GOODMAN: I think people would be very
surprised to know that once you're a vet, no matter what your
income level, you're not covered by VA healthcare system for the
rest of your life.
DR. STEFFIE WOOLHANDLER: Oh, well, that's
been true for a long time. The VA will cover you if you have a
service-connected injury, like you get your leg shot off. They
do provide a safety net for people with very low incomes, eligible
for Medicaid, or slightly higher incomes. However, many middle-income
vets are not eligible for VA care, and that's who these uninsured
veterans are. And sadly, many of them will continue to be uninsured
under the House or Senate bills, which, even if they work as planned,
will leave somewhere between a third and a half of all uninsured
people still uninsured in the year 2020.
AMY GOODMAN: What's the VA saying about
DR. STEFFIE WOOLHANDLER: The VA did show
up at the hearings, and I think they would love to have more money
in order to be able to expand the care that they give. In fact,
I think the VA is a good system and actually a good safety net,
if you can get access to it. But currently there's just not the
funding within the VA system to allow them to cover all veterans.
AMY GOODMAN: Are there any examples you
can share with us of what has happened to a veteran?
DR. STEFFIE WOOLHANDLER: Well, we do-we
did hear stories from people. Often they were folks in the middle-income
ranges. They had been out of the service for two or three or five
years. They were working, but they were not getting insurance
through their work, and they could not qualify for VA care. Similarly,
there's only a limited number of VA facilities. They're in a lot
of cities, but not all cities. And many people just couldn't get
to a VA facility even if they were eligible.
AMY GOODMAN: How does this fit into the
bigger picture of what's happening in the United States today?
DR. STEFFIE WOOLHANDLER: Well, I support
Medicare-for-all, single-payer national health insurance. I work
with a group of doctors called Physicians for a National Health
Program that advocates that. We think everyone-everyone-needs
healthcare through a Medicare-for-all approach. And I think the
plight of the veterans epitomizes what happens to working families
generally. Working families get caught in the middle. They can't
get Medicaid. They can't get means-tested VA. They can't afford
private insurance. And the House and Senate bills don't really
fix that problem.
AMY GOODMAN: When the House voted on the
bill, 220-to-215, what was your reaction? And can you analyze
it for us?
DR. STEFFIE WOOLHANDLER: Well, we think
that the Congress needs to start from scratch on this bill. The
reform process in Washington has been hijacked by the private
health insurance industry. If you look at the Baucus framework,
which was the basis of the Senate bill-it's on the Senate Finance
Committee website. Just right-click on that document, and it turns
out the author of the document was Elizabeth Fowler, who's a former
vice president of Wellpoint, the nation's largest private insurance
company, covering 35 million people. So the private insurance
industry has hijacked the process. What's come out of the House,
what's likely to come out of the Senate, is a completely inadequate
bill that takes about $500 billion in taxpayer money and hands
it over to the private health insurance industry.
AMY GOODMAN: I mean, explain exactly that,
as people are suffering in the midst of this, you know, tremendous
economic downturn, this global economic meltdown. You're talking
once again, not only with the bankers, but with the insurance
company, of forcing people to buy health insurance, but to buy
it from private insurers. So this is an incredible deal for the
DR. STEFFIE WOOLHANDLER: Right. Well,
the private insurers are getting millions of mandatory new customers.
The taxpayers are going to give subsidies. It's not going to make
healthcare affordable, but it's going to cost the taxpayers a
lot of money to give these subsidies.
Private health insurance is a defective
product. We know from our studies of bankruptcy that the majority
of Americans who face medical bankruptcy start their illness with
private health insurance but are bankrupted anyway by gaps in
coverage, like co-payments, deductibles and uncovered services.
And under the House and Senate bills,
they've done nothing to fix private health insurance. They've
merely made private health insurance mandatory for middle-income
working people and forcing those folks to take lots of money out
of their pocket to buy this defective product.
AMY GOODMAN: And, of course, most bankruptcies
in this country are caused by medical problems; they are medical
DR. STEFFIE WOOLHANDLER: Right. In our
studies, we found that 62 percent of all bankruptcies in the United
States are due at least in part to medical illness or medical
bills and that the majority of folks in medical bankruptcy started
that illness with private health insurance.
AMY GOODMAN: But what about those who
perhaps do even support Medicare for all or single payer who are
saying, "Well, at least now you're talking about tens of
millions of people who will be insured, who weren't otherwise"?
DR. STEFFIE WOOLHANDLER: What's happened
in the past when bills like this have passed in the states is
that they run out of money very quickly, healthcare is simply
unaffordable, and then you start to see the coverage expansions
cut back. The subsidies shrink, the Medicaid shrinks, and then
you're back at square one, where you've spent a lot of money and
not made any progress. And we've seen this over and over in the
United States-in Massachusetts in 1988, in Oregon in 1992, in
Washington 1993-passed bills virtually identical to what's being
passed in the House right now, and there was no durable improvement
in the number of uninsured in those states. Healthcare was not
affordable ten years after those bills were passed.
The problem with the House bill is it
simply won't work. And, you know, if we want to expand Medicaid,
fine, we should expand Medicaid. If we want more primary care,
good, let's expand primary care. But doing it through $500 billion
in subsidies to the private health insurance industry will have
the effect of making the health insurance industry more powerful,
making the health insurance lobby more powerful. And just as they've
hijacked this process in Washington, it makes them more able to
hijack political processes in the future.
AMY GOODMAN: And the cost of drugs? So
it's not only the mandatory-mandating that people buy health insurance
from private companies, but the deal that was worked with the
pharmaceutical industry in this country. Explain that.
DR. STEFFIE WOOLHANDLER: OK. Well, the
deal with the pharmaceutical industry was minimal. The pharmaceutical
industry gave up very little. They said for Medicare recipients
who are in the donut hole, they would make low-priced generics
available. That's a very small share of the population. For the
rest of us, who may be unable to afford expensive medications,
we got nothing out of the pharmaceutical industry.
The pharmaceutical industry, frankly,
is thrilled with this bill. And despite all their squawking, the
health insurance industry is pretty happy, too. You know, Wall
Street has rewarded them by driving up the value of their stocks.
And I think any fair and honest reading of this bill would say
that it's a tremendous victory for the health insurance industry.
And what we need to do to get to universal healthcare is start
from scratch, go for that Medicare-for-all, single-payer approach.
AMY GOODMAN: And the issue of women, reproductive
healthcare and abortion?
DR. STEFFIE WOOLHANDLER: Well, that is
a horrendous provision in the House bill, which would essentially
extend a ban on abortion to private health insurance. In the past,
the Hyde Amendment applied only to people who were getting publicly
funded care. But in the new bill, any insurance product that's
offered through the exchange has to-
AMY GOODMAN: And explain the exchange.
DR. STEFFIE WOOLHANDLER: Yes. The exchange
would be this marketplace where you would go to buy your insurance.
If you had subsidized coverage, you would have to buy your insurance
through the exchange.
And any insurance plan purchased through
the exchange would have to exclude coverage of abortion. So, for
the first time, Congress has stepped in and said that even with
your own money, with private money, it's illegal for insurance
to cover abortion. It's a tremendous step backwards for women's
AMY GOODMAN: And do you think it will
make its way through to the final bill?
DR. STEFFIE WOOLHANDLER: Well, I'm not
sure about that. Certainly President Obama has weighed in to say,
"Well, let's try to return to what was there before, with
just a ban on public funding of abortion," which is bad enough.
It remains unclear what's going to happen in the Senate, whether
the right-to-life folks will step in and get an anti-choice plank
in the Senate bill, as well. They certainly were successful in
the House. And, of course, that's one of the many reasons that
we think we need to start from scratch on a new health reform
AMY GOODMAN: Steffie Woolhandler, you
come from Massachusetts. That's often held up as the model. I
recently saw on CNN your former Governor Weld interviewed about
his plan that has been adopted by all of Massachusetts. Explain
the Massachusetts plan and then how we, as Americans, fit into
the rest of the world when it comes to our healthcare system.
DR. STEFFIE WOOLHANDLER: OK. Well, the
Massachusetts plan is considered the model for the national legislation.
There's a mandate that makes it illegal to refuse to purchase
private health insurance. The fine is up to $1,068. The good thing
with the Massachusetts plan was there was a big Medicaid expansion,
but you didn't need to do the mandates in order to do the Medicaid
Much of the Massachusetts plan has been
wildly expensive. According to the state's report to its bondholders,
it's cost $1.3 billion this year. The state has opted to pay for
that by stealing money from safety net clinics and hospitals,
so that safety net providers that care for immigrants, the mentally
ill, people with substance abuse, that provide primary care, they've
seen their funds shrunken, so that money could be handed over
to purchase insurance policies. Massachusetts now has the highest
healthcare costs in the history of the world.
You have to compare that to what goes
on internationally. With the average per capita cost of healthcare
about half those in the United States, yet people in Canada and
western Europe live about two years longer. They have complete
free choice of doctor and hospital. They have lower infant mortality.
People in other developed nations use some form of nonprofit national
health insurance to get better care for less money. And that's
why our group supports the Medicare-for-all approach.
AMY GOODMAN: So the question is where
that fits in today. Finally, former President Clinton met with
Senate Democrats yesterday and basically said nothing-said something
is better than nothing, pass this now. What do you feel about
DR. STEFFIE WOOLHANDLER: Well, I think
we know-we now know the outlines of what they're going to pass.
It's not an abstract something; it's something real. And it's
quite bad. It's $500 billion in new subsidies to the private health
insurance, millions of mandatory new customers for private health
The public plan option is incredibly puny.
According to the Congressional Budget Office, fewer than two percent
of Americans will enroll. And the premiums will actually be higher-higher-than
premiums in the private sector. So the public plan option will
be an expensive, tax-funded subsidy to private health insurance,
because the public plan option will take the sickest patients
off their hands. It's not going to be something that's going to
generate coverage or decrease costs.
So, we know what the outlines are of the
plan, and there are so many bad and harmful planks to the plan
that we do need to start from scratch on health reform.
AMY GOODMAN: Since it doesn't look like
they will, will you not support what is coming out right now?
Would you have voted no if you were a congressman-Congress member?
Would you vote no in the Senate?
DR. STEFFIE WOOLHANDLER: Well, I'm a,
you know, doctor; I'm not a politician. I feel a little bit like
we're debating whether to give aspirin or Tylenol to a patient
with breast cancer. The patient needs surgery. And what's being
debated in Washington is really Tylenol or aspirin. And I had
said for awhile we'd have to see the final shape of the bill,
because, of course, we'd-I'd love to see more Medicaid money.
Medicaid is very helpful for very poor people. It's not perfect,
but it's much better than nothing. But I think there's so many
bad planks in the bill that this bill needs to be scratched, and
we need to start over.
AMY GOODMAN: Do think this is a better
deal for the health insurance industry, for the private health
insurance industry in this country, than we have right now?
DR. STEFFIE WOOLHANDLER: I actually do.
Their number one demand was the so-called individual mandate that
would make it illegal to not have health insurance. It will become
a federal crime to be uninsured. If you have private health insurance
through your work, and you hate your private health insurance,
tough luck, you have to keep that insurance. The mandate means
you have to keep it. You can't buy the public option. You probably
won't be able to go through the exchange. So they've made private
health insurance mandatory, giving them hundreds of billions in
new-mandatory new customers.
There's some minimal insurance regulation,
and I think more regulation is better than less regulation of
insurance, but that's going to be counterbalanced by the tremendous
economic boost that will be given to the private health insurance
industry through this bill. And as we know, if you have a lot
of money, you can buy a lot of political influence. I think down
the line we're actually likely to be worse off in handing over
so much taxpayer money to what is essentially a private health
insurance industry bailout.
AMY GOODMAN: Dr. Steffie Woolhandler,
I want to thank you very much for being with us, professor of
medicine at Harvard University, primary care physician in Cambridge,
co-founder of Physicians for a National Health Program. We'll
have a link to their study on our website at democracynow.org