BILL MOYERS JOURNAL: Dr. Marcia Angell on the healthcare proposals


ON THIS VIDEO SEGMENT of Moyers’ Journal we have included Dr. Marcia Angell’s interview with the host. Dr. Angell is a prominent supporter of the single payer plan concept, or “Medicare for all”, and opposes the current Obama proposals as worse than nothing, if not a betrayal of the implicit promises made to “change” the system. WE also feature a few original comments to enrich the presentation.





Is the President’s Health Bill Worth Supporting?

(Photos by Robin Holland)

In January, when Republican Scott Brown won the special election for the Massachusetts Senate seat formerly held by Ted Kennedy, Democrats lost their filibuster-proof majority and the fate of their health reform legislation plunged into uncertainty.

After weeks of strategizing and negotiation, President Obama made headlines Wednesday by encouraging Democratic members of Congress to pass the Senate’s version of the health bill through the controversial tactic known as reconciliation. Originally intended for budget bills rather than more complicated legislation, reconciliation would bypass potential filibusters in the Senate and require only a simple majority of votes in both chambers for passage. Democratic leaders are now working to amass enough support among Democratic Senators and Congressmen, many of whom disagree with aspects of the legislation, to pass the bill despite polls suggesting that a plurality of the public opposes it.

In this week’s JOURNAL, Bill Moyers spoke with two prominent advocates of health reform with very different perspectives on the President’s health bill.

Wendell Potter, a former health insurance executive who has become an outspoken critic of the industry, said that the legislation is flawed but good enough that it should become law:



“We need to look at this as a win for consumers as well. Yes, it’ll be a win for the insurance companies, but I don’t think we’re gonna wind up with the insurance companies walking away [and] winning the whole ball game. If we don’t do anything right now, that’s what will happen. They’ll win everything… I was distraught when I saw what happened, what I saw the Senate voting on. But then I realized – you know, I studied a lot of these efforts over the past many years to get reform – [that] often we’ve come short because we’ve tried to get the perfect, and we’ve never been able to get anything as a consequence… We need to have a foundation, and this may seem to be not an adequate foundation for a lot of people, but there are more than 50 million people in this country who don’t have insurance… Wouldn’t you rather, and I think wouldn’t most Americans rather, that we have something to start from rather than starting from scratch the next time? It’s very hard to build up to doing this in the first place… I’m frankly pretty amazed that we’re getting this close to passing something.”



Dr. Marcia Angell, a Harvard medical lecturer and former editor-in-chief of the NEW ENGLAND JOURNAL OF MEDICINE, has advocated for single-payer reform, in which the federal government would provide a national health insurance program for everyone. Angell argued that the current bill would make a bad situation worse and sour the public on further reforms, so Democrats should regroup and push for better legislation in the future:



“What this bill does is not only permit the commercial insurance industry to remain in place, but it actually expands and cements their position as the linchpin of health care reform… Not only does it keep them in place, but it pours about $500 billion of public money into these companies over 10 years… and it mandates that people buy these companies’ products for whatever they charge. Now that’s a recipe for the growth in health care costs not only to continue but to skyrocket, to grow even faster… The President’s absolutely right that the status quo is awful. If we do nothing, costs will continue to go up. People will continue to lose their coverage… Things will get very bad. The issue is, will this bill make them better or worse? I believe it will make them worse… Let’s say [the bill] is passed. It will begin to unravel almost immediately, and then what will people do? Well, they’ll say ‘We tried health reform, and it didn’t work. Better not try that anymore’… Whereas if the bill dies now, people can say ‘This bill died because it was a bad bill,’ and the problem is still on the front burner.”



Critic of U.S. healthcare system

Although a high-ranking insider of the American medical establishment, Marcia Angell has long spoken frankly of its unhealthy shortcomings. The American healthcare system is in serious crisis, she acknowledged in a PBS special: “If we had set out to design the worst system that we could imagine, we couldn’t have imagined one as bad as we have.”[5] In the PBS interview, she urges the nation to scrap its failing healthcare system and start over:

Our health care system is based on the premise that health care is a commodity like VCRs or computers and that it should be distributed according to the ability to pay in the same way that consumer goods are. That’s not what health care should be. Health care is a need; it’s not a commodity, and it should be distributed according to need. If you’re very sick, you should have a lot of it. If you’re not sick, you shouldn’t have a lot of it. But this should be seen as a personal, individual need, not as a commodity to be distributed like other marketplace commodities. That is a fundamental mistake in the way this country, and only this country, looks at health care. And that market ideology is what has made the health care system so dreadful, so bad at what it does.


Critic of the pharmaceutical industry

Angell is a critic of the pharmaceutical industry. With Arnold S. Relman, she argues, “The few drugs that are truly innovative have usually been based on taxpayer-supported research done in nonprofit academic medical centers or at the National Institutes of Health. In fact, many drugs now sold by drug companies were licensed to them by academic medical centers or small biotechnology companies.” The pharmaceutical industry estimates that each new drug costs them $800 million to develop and bring to market, but Angell and Relman estimate the cost to them is actually closer to $100 million. Examples are imatinib (Gleevec), zidovudine (AZT) and erythropoietin (Epogen). An unpublished internal NIH study in February 2000 of the 5 top-selling drugs in 1995 (ZantacZoviraxCapotenVasotec, and Prozac) found that 16 of the 17 key scientific papers leading to the discovery and development came from outside industry [6]. In 2004, she published The Truth About the Drug Companies: How They Deceive Us and What to Do About It.[7]

Angell’s position has been challenged by Benjamin Zycher, senior fellow at the pharmaceutical industry-funded Manhattan Institute, who argues that government research can create new drugs, but private industry is needed to produce practical products, by developing mass production methods (for erythropoietin) and versions without limiting adverse effects (for antidepressive drugs). [8]


Critic of alternative medicine

Marcia Angell is also a critic of the growing acceptance of alternative medicine. In a 1998 NEJM editorial she wrote with Jerome Kassirer, they argued:

It is time for the scientific community to stop giving alternative medicine a free ride… There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.[9]



What do you think?

Do you think the President’s health bill is worth supporting? Why or why not?

What do you think should be the goals of health reform, and how are you working to get there?

Posted by Moyers Admin on March 5, 2010 10:56 AM | Permalink


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Thank you for a very informative program. Prior to seeing it, my thinking was much like Mr. Potter’s – the very compromised bills in progress in Congress were better than nothing at all. However, Dr. Angell’s position on this was very enlightening: I know am starting to think that maybe it is better to let the current “reform” go and work toward something better. The downside of that is that it may not happen in our lifetimes, given the way Congress works (or doesn’t) in light of the money and interests involved. In the interim, many people will suffer in terms of their health or at least their financial well-being. The only way things are likely to be truly reformed – in God’s lifetime (to cite another poster) – are if things get so bad for so many that the monied interests are no longer able to carry the day.

Posted by: Tom Himmel | March 6, 2010 4:20 PM

Thanks Bill– We appreciate your description of the on-going catastrophe in the stormy sea of healthcare as seen from your high ground. While our citizens struggle in the frothy waters with the current flotsam and jetsum of insurance options thrown to us from the Corporate Cruiseship, our Congressional Coastguard is
wrangling about which end of the lifeboat is front while wearing life preservers thrown to them from the Corporate crew. In the meantime, we are given the options of drowning or being eaten by the sharks — or holding our breath. Our Captain of the Ship of State, Captain Horatio Hornblower is yelling into the wind — ‘do something!’
while the muddled bureaucracy is trying to unsnarl the ropes & lines tying our country to the rocky coast.
(btw — I want the public option.)

Posted by: Jim Graham | March 6, 2010 4:16 PM

Mr. Moyers; Thankyou for this wonderful forum for average Americans to voice their opinions and concerns. I’ve just read through most of the comments and it is clear to me that Most folks: 1.don’t like the choices being debated. 2. They want some form of single payer. They want to pay their fair share of the costs to insure all Americans. 3. The want to make it illegal for insurance companies to deny coverage based on pre-existing conditions. 4. They want to make it illegal for insurance companies to rescind coverage when a person becomes ill. 5. They want to make it illegal for insurance companies to raise rates anymore than the rise in inflation. 6. They don’t want what’s politically expedient for the Congress and Senate to enact; they want health care for all Americans. 7. A little math can go a long way to sheding some sanity on the costs issue. Consider the following: We could add the 50 million uninsured Americans to an extension of Medicare. These 50 milllion folks each pay $100 per month for this insurance. That’s $1200 per year times 50 million, or $60 billion a year in new premiums. That should be enough additional money to cover their healthcare. To summerize: Real solutions could be worked out. Political expediency has no place in this most important issue for the American people. The Health Insurance Industry is not too big to fail. The Healthcare Provider Industry needs fair compensation for their important work; but they do not need to raise rates on the backs of the American people. If our elected officials can’t work together to solve America’s challenges, then they need to go. I’m so tired of Republicans and Democrats attacking each other. America deserves better.

Posted by: Mark Jaffee | March 6, 2010 4:15 PM

I do not believe that the so called health care reform bill as it is now structured should be passed. I am against the requirment for all to purchase for profit private health insurance which has proved a dismal failure in providing health insurance coverage to Americans. I am not necessarily in favor of Medicare for all but I am in favor of Medicare available to all who need coverage. Let those who wish to continue with private for pofit coverage do so. Let those who want or need Medicare be allowed to enroll.

Posted by: Richard | March 6, 2010 4:10 PM

Arguing about whether the proposed Health Care bill is to be, or not to be, to pass the Senate through reconciliation, or to die–that’s the question on everyone’s mind, and the two speakers took opposite views on what should happen. But no matter what happens, pass or fail, Dr Angell’s views or Wendell Potter’s—the health care system will unravel, as Dr. Angell suggested. And then a third option will emerge as the solution–state by state, we’ll get single payer after all. Either California or Pennsylvania will get the ball rolling. It will probably be California. And it will happen very quickly, in fact has already started to happen.

Posted by: Ed Schilling | March 6, 2010 4:08 PM

I just finished watching the Journal from March 05,2010. Dr. Marcia Angell has inspired me to write for the first time. I am a Registered Nurse in California. I am in favor of single-payor health care for all–Medicare for all. For those members of congress opposed, I say…if we would eliminate YOUR health care insurance, maybe then you would see how it would be to be without. Why is it that GREED has to drive those in power…money is NOT everything. I work in a large urban hospital and have for 25 years. What has happened to our government? President Obama, please do the right thing. Throw this bill out and do what is right. Thank you.

Posted by: Joan McCusker | March 6, 2010 4:06 PM

Arguing about whether the proposed Health Care bill is to be, or not to be, to pass the Senate through reconciliation, or to die–that’s the question on everyone’s mind, and the two speakers took opposite views on what should happen. But no matter what happens, pass or fail, Dr Angell’s views or Wendell Potter’s—the health care system will unravel, as Dr. Angell suggested. And then a third option will emerge as the solution–state by state, we’ll get single payer after all. Either California or Pennsylvania will get the ball rolling. It will probably be California. And it will happen very quickly, in fact has already started to happen.