A Response to Trump’s Demonization of Single Payer Health Care

GREG WILPERT: Meanwhile, the White House, under the direction of the Council of Economic Advisers, released a pamphlet last month titled The Opportunity Costs of Socialism. This pamphlet develops a detailed critique of state socialism as it was practiced in the Soviet Union, as well as a social democratic government of Scandinavia. One of the main areas of focus of the document is the healthcare system in single-payer countries, system-payer countries, as well as Medicare for All, a bill that Senator Bernie Sanders introduced earlier this year.

Joining me now to take a look at some of the criticisms of single-payer healthcare is Wendell Potter. He’s a former health insurance executive and author of several books, including Deadly Spin, Obamacare: What’s In It for Me? and his latest is Nation on the Take. He’s also the founder of Tarbell.org, an investigative site that examines the role of money in politics. Thanks for joining us today, Wendell.

WENDELL POTTER: My pleasure, Greg.

GREG WILPERT: So there are many criticisms that Republicans have leveled against single-payer healthcare systems; both the proposals for the U.S. healthcare and also the ones that have been implemented in countries such as Canada and various countries of Europe. We can’t go over all of these criticisms, but some of the main ones include increased costs, worse health outcomes, loss of medical innovation, and longer wait times. Let’s take these one by one.

So first, regarding costs, proponents of single-payer healthcare say that increases in taxes will be offset by not having to pay insurance premiums of private insurance companies. Critics, though, say that higher taxes distort the economy, which reduces economic activity, and thus makes the overall cost of healthcare greater. What’s your response to this argument? I mean, what is the balance in terms of the costs? Which would be cheaper, according to your analysis?

WENDELL POTTER: According to my analysis and that of many others, the proponents of Medicare for All have it right. We would be paying ultimately far less than we will be, that we are paying now or will be paying in the future, if we maintain the status quo. The problem is in a multipayer system like we have in the United States, the payers being the insurance companies, the multiple insurance companies that we have supposedly competing with each other, they just don’t have the clout to negotiate good deals with their customers, with big hospital systems and big physician groups, and certainly with the pharmaceutical industry.

So what we have in this country in the US is a classic example of market failure, because the system does not work to control costs, nor does it work to bring everyone into coverage. We still have almost 30 million Americans who do not have insurance. But under a Medicare for All-type plan you can bring everyone into coverage, and you can cover everyone and have better outcomes than you have under our current system.

And when you look at- what people need to do is kind of have a paradigm shift in their thinking. You would no longer have to pay the ever-increasing premiums to your health insurance company, or the ever-increasing deductibles, which means that your insurance doesn’t even kick in until you’ve spent several thousand dollars out of your own pocket, even though you’re making payments for your insurance.

So that would go away. You instead would be making the equivalent of your premium payments in taxes, and the system will be structured so that everyone could be brought into coverage. And studies have shown even in this country that- not only that, but a single-payer system in this country would do much more to control healthcare costs than our multipayer system does now.

GREG WILPERT: Now, a related argument in this regard is that single-payer healthcare costs save money in terms of administrative costs, but those savings are lost then again through fraud. In other words, that there are people who would try to cheat the system. And they claim that there’s a lot of fraud in the Medicare system in the United States, and that doesn’t happen so much in the private system. What’s your response to that?

WENDELL POTTER: I would say that’s absolute nonsense. And having worked in the private system for more than 20 years, I can tell you that fraud is just as prevalent, and probably more so, in the system that we have, the private system of insurance. The company that I worked for most recently, Cigna, instituted a system several years ago to try to detect fraudulent billing. So I can tell you it’s just as rampant, probably more so, in the private system. For one reason, because private companies just don’t have the resources to combat fraud and abuse as much as a single system with combined resources would have.

So it’s a completely bogus argument. In fact, we see, when you look at statistics for other countries that have a single payer or a similar system, there’s far, far less fraud and abuse in those countries and their healthcare system than in the U.S. system.

GREG WILPERT: So now the other main argument that the White House critique of single-payer brings up is that health outcomes would be worse. They cite a fairly specific study of life expectancy in the U.S. and in Europe which claims to show that once cancer is diagnosed, U.S. patients tend to live longer. And the argument is basically that under single-payer healthcare, cancer treatment would be rationed, especially for seniors. And they give examples in Europe, basically, while in the U.S. cancer patients tend to receive better care. What’s the response to this claim in terms of outcomes, health outcomes?

WENDELL POTTER: Well, what you’re seeing here, and as in many of their arguments, they being the opponents of moving to a single-payer system, is the selective use of data and the confusing and misleading use of data.

The reality is that most of the developed countries around the world- and many of them have a single-payer system- all do a better job, broadly, in healthcare outcomes than we do. The Commonwealth Fund in the United States has annually done an analysis of the performance of healthcare systems around the world. They look at 11 countries, developed countries, including the U.S. And the United States consistently, even after the Affordable Care Act was passed, brings up the rear. It’s always number 11 in the composite score. So outcomes are typically better across the board, or in many, by many measurements in other systems.

And as far as cancer treatment is concerned, or life expectancy in particular, the United States is alone in the developed world over the last two years in which life expectancy has been declining. And those are statistics from the government. And we’re seeing that in the other countries, in both the developing and developed world, life expectancy is going up. And we’re pretty much alone in the world going in the opposite, in the wrong direction.

Now, with regards to cancer, you have a lot of people in this country who do not have insurance and who cannot afford to get the care that they need. Period. So we have a lot of people in this country who just simply- and also, even if they have insurance, as I mentioned earlier, people have very high deductibles in most of their plans, if they have a private insurance company. And a lot of those people just don’t have the money to pay out of pocket for the care that they need to spend money for before their their coverage kicks in. So again, it’s the selective use of data and trying to scare people, when in reality the outcomes across the board in other countries are generally far better than they are in the U.S.

GREG WILPERT: Actually, related to this issue of health care outcomes is also the question of innovation. The White House paper argues that single-payer healthcare would reduce innovation; that is, more expensive treatments in the U.S. result in more innovation because there’s more money available for such innovation, whereas price controls, which are usual in single-payer systems, would reduce innovation because there’s less money available for them. What’s your response to this argument?

WENDELL POTTER: The question we often used in the industry- and they still do, obviously- is that any kind of reforms that would move us away from the status quo would have a “chilling effect” on innovation. But that’s not, it’s not true at all. In fact, most of the innovation, actually, in the health insurance industry has been innovation that has been detrimental to the needs of patients in this country. The most prevalent innovation in this country has been shifting more and more of the cost of care from insurance companies and employers to regular folks. So that is a kind of example that I think we could move away from and everyone would benefit from it.

But there’s no, there’s no evidence that suggests that moving to a single-payer system would mean that there would be less innovation on the provider side. In fact, we’re seeing quite a bit of innovation in the UK and Canada that this country should adopt. In the UK, for example, hospitals have a way of treating people. They can admit them, but there’s kind of a blend of inpatient and outpatient that saves the system a lot of money and allows the patient to get much of their care outside of an inpatient setting. So there’s a lot of innovation that you’re saying in single-payer systems that we have not adopted yet in this country. So there’s no reason why if we move to a system like that we would have less innovation than we have now, and probably would have innovation that benefits patients more than we have now.

GREG WILPERT: So finally, the White House paper that I cited earlier argues that wait times in the U.S. are shorter mainly because in single payer systems there are no market signals about what type of care is needed, and that the lack of deductibles and all that would cause an overuse of certain treatments. And so as a result, single-payer systems have much longer wait times. And they specifically cite the example of Canada actually having one of the longest wait times, whereas the U.S. in an international comparison supposedly has the shortest. What’s your response to that argument?

WENDELL POTTER: Well, once again, when you’re looking at the U.S. compared to other countries, keep in mind that many millions of us wait forever for the care that we need because we don’t have the money, and we don’t have insurance. And 30 million of us don’t have insurance. The wait is indefinite. And so that’s something that needs to be factored in, as well, too. There are people in this country who just simply cannot access care at any point. So the wait lines, or the waiting period, is endless for a lot of people.

But even in Canada, the waits have been dramatized in the U.S. by opponents. There is a very short wait for essential care in Canada. Now, it is true that for elective procedures like joint replacement, a knee replacement, for example, the wait time can be fairly long; possibly longer than it would be for some patients to get the same procedure done in the U.S. But the majority, the vast majority of people in Canada, get knee and hip replacements and cataract surgery within the recommended period of time. So again, for essential care, for life-threatening events and for other kinds of care and to see a physician it’s not a significant problem in Canada or other single-payer systems. But in the U.S. for many people it’s an indefinite wait.

GREG WILPERT: OK. Well, we’re going to leave it there for now, but I’m sure we’re going to get back to this topic again very soon. I was speaking to Wendell Potter, former health insurance executive and founder of the website Tarbell.org. Thanks again, Wendell, for having joined us today.

WENDELL POTTER: My pleasure. Thank you, Greg.

GREG WILPERT: And thank you for joining The Real News Network.