Flowers v. Baker on Single Payer v. Obamacare

November 19, 2013

Both Margaret Flowers and Dean Baker say they want to see a universal single payer national health care system in the United States.

But Baker says that Affordable Care Act (ACA) is “an enormous advance.”

And Flowers says that it’s “a step backward.”

Flowers is with Physicians for a National Health Program, a single payer group based in Chicago.

Baker is co-director of the Center for Economic and Policy Research, a think tank funded unions and and liberal foundations.

The debate was hosted by the Real News Network.

Baker said that “for the first time, we’re going to have people able to buy insurance without regard to their health condition.”

“That’s a huge issue because insurers don’t want to insure people who are sick,” Baker said. “And beginning in 2014, regardless of your condition, you can sign up and pay the same rate.”

“That’s a huge, huge difference. And what it means is that people have real insurance for the first time. Most of us get our insurance through our job. And we are in a situation where if we are to get a serious illness, we are likely to lose our job. And we will also lose our insurance. And then suddenly, we are in the situation of looking for insurance in the individual market, which clearly is not going to be affordable.”

The ACA “puts an end to that,” Baker said.

“There are lots of grounds for criticizing the ACA. But it’s a huge step forward.  We will have tens of millions of people who will be able to get insurance who hadn’t had it previously. And again, for the the hundred plus million who are now insured, they will actually have real insurance. If they do get sick and lose their job, they will still be able to get affordable insurance through the exchanges. I see that as a big step forward.”

Flowers said that she sees the Affordable Care Act “as a step backward.”

“It takes us farther in the direction of privatized health care,” Flowers said. “We need to go toward a greater publically financed universal health care system. That’s the most efficient and most equitable way to provide health care. The Affordable Care Act requires people to purchase private insurance. But that doesn’t equate to actually being able to get the health care that you need. We haven’t changed the behavior of the private insurance companies. They are still going to find ways to deny payment for care. And people are going to find that while they have paid out hundreds of dollars for health insurance, they won’t have the money to actually pay for health services. A lot of that cost is going to be coming out up front first for the patients before their insurance even kicks in.”

What about the fact that under Obamacare, the health insurance industry can’t deny you health insurance because of pre-existing conditions?

“Because the large private insurers are being required to accept people with pre-existing conditions, they are severely cutting back their networks,” Flowers said. “So, hospitals that provide care to people with serious health problems are not included in their networks. They have restricted the number of physicians in their networks. So, people are going to find it more difficult to actually go to the places they need to go to to get care. If you are getting care outside the network, more of the burden of paying for it falls on the patient. And people in this country just aren’t able to afford that right now.”

Baker said that “it would be great to have universal Medicare.”

“But that wasn’t about to be coming,” Baker said.  “So, basically, our choices were having health care provided through private insurers, or not having it at all. And the fact is, we have 100 million plus people get most of their insurance through private insurers now. Yeah, they do lots of bad things. But the alternative is not getting it at all. I can’t tell people they are better off not getting health care than having it provided through private insurers, as much as I might not like them.”

Flowers said that during the health reform debate, single payer advocates argued — “don’t give hundreds of millions of dollars to private insurance companies.”

“They are going to hang on to a lot of that and still deny people care,” she said. “We should be giving that to our public programs to expand them more and shift us in the direction that we need to go — toward a greater publicly financed health care system.”

“Part of the reason that the Affordable Care Act went through was that it wasn’t challenged by people on the left, by people who supported single payer,” Flowers said. “People were told — well this is all we can get. And so they accepted that. And the truth is that the insurance companies are the most profitable. The insurance company CEOs are the highest [salaried]. They were the ones who wrote this bill. We are not going to get a real health care plan without a struggle. To tell people that this was a step in the right direction took away that demand for the real solution.”

Flowers was asked whether the ACA is a step toward single payer.

“I don’t see how giving more money to the very industries that are influencing this legislation in their favor is moving us toward a real health care system,” Flowers said. “What we see down the road and what is starting to happen is further privatization of our health care. We see large employers moving retirees into the insurance exchanges, Medicaid is going into the exchanges. We heard MIT Economist Jonathan Gruber say that within five years Medicare will be put into the exchanges. So, we are going to be seeing an erosion of our public healthcare systems and further privatization. And that takes us in the wrong direction.”

Baker responded by saying — “it’s an ongoing struggle.”

“We had a chance to test what happens when health care reform goes down,” Baker said. “We lived through it in 1994, it went down. I didn’t see single payer in 1995, 1996, 1997, or 1998. I didn’t see it anywhere close.  And I talked to people on the Hill. And I can tell you, in 2010, I doubt whether you had 20 members who were prepared to vote for a universal Medicare plan. I wish they were. But that’s the reality.”

“So, I just can’t see telling people — don’t get your health care through private insurers because we don’t like them. I don’t like them. . . .There are a lot of people who want to privatize Medicare. Yes, if we lie down and die, they will privatize Medicare. It’s an ongoing struggle. But it’s better having that struggle from the standpoint of having a lot more people insured. And the people who are insured have real insurance, knowing that if they get sick, they will still have insurance through the exchanges rather than being out of luck. I don’t see a downside here.”

“But do they actually have real insurance?” Flowers asked. “We were fighting for so long saying that insurance companies should cover 80 percent of needed services. What the Affordable Care Act has put into law that 60 percent and 70 percent coverage are just fine. And that’s just bankruptcy coverage. People who have 60 or 70 percent plans means that if they have a serious accident or illness are either not going to be able to afford to get the care they need, or they are going to go bankrupt. This the top cause of personal bankruptcies in this country — medical cost and illness. And we haven’t seen that decline in Massachusetts, which has the same plan. And I don’t think we are going to see it decline here.”

“The latest estimate by the Congressional Budget Office is still 31 million people without health insurance when it is all said and done. And I think that is a low estimate. I imagine it will be higher. And people who have insurance are going to have skimpy coverage that’s not there when they need it. So, we are pouring money into this industry with a lot of bureaucracy and added costs, with no cost controls. And I don’t think we are going to see good health outcomes or people getting the care they need.”

“Well that’s 30 million uninsured down from 50 million, which seems to me pretty good,” Baker countered. “And if you look at the case of Massachusetts, it looks on the whole like a pretty good story. They have close to universal coverage. They have better health outcomes. Again, it’s not the ideal. I’d love to see them beat up on the drug industry. Our doctors are paid twice as much as doctors elsewhere in the world. Everyone got a free ride on this. So, there are lots of things to complain about. But I still have a very hard time seeing that this as not being a huge step forward. And again, I couldn’t even think of a story that would get us to universal Medicare in a decade. I might think differently if I did.”

“We are not close. We weren’t close in 2000. We weren’t close in 2010. I don’t see us being close now. And somehow, if we were to make this go away, it’s very hard for me to see how we get to universal Medicare anytime soon.”

Flowers suggested taking a look at what happened during the health reform process.

“Tens of millions of dollars were poured into foundations and organizations to push for not single payer,” Flowers said.  “Eighty percent of Democrats wanted a single payer program. And two-thirds of the total public supported a single payer plan. But the messaging that came down through the media, and these scripted house parties that were held and these progressive groups was — you can’t have that. You are asking for too much. You can maybe have a public option, which was never meant to be in the final legislation anyway.”

“If you are telling the public — you can’t have what you want and that this is a solution when it clearly isn’t a solution — that takes us farther away from our goal of getting a single payer plan,” Flowers said. “This is not going to happen without a struggle. We need leadership. We need people to tell us that that’s what it is about. It’s not going to be easy. And if you want a single payer plan, you need to get out there and fight for it. The public stopped an attack on Syria. That’s unheard of. When have we in the United States ever stopped a President when he declared that he wanted to attack another country? That was because Congress was flooded with public comments saying — don’t do it.”

Baker said he’d “love to see more public pressure.”

“But again, what realistically is out there? Sure, everything could change tomorrow. But it didn’t change yesterday. So, if you want to tell me some story on how things are going to be radically different in 2014, I’d love to see it. I just don’t see it now. What I’m saying is — we have an enormous advance here. There are tens of millions of people who don’t have insurance who will get it through this plan. And most the most important thing is — you have a lot of people who are struggling with medical conditions, particularly older people — people in their late 50s and early 60s, pre-Medicare age  — they are working at jobs, they are struggling with bad health, because that is the only way they can get insurance. This is going to mean a world of difference for those people because they will be able to get insurance through the exchanges. They can quit their jobs. That’s going to make a world of difference for those people’s lives. I have to see that as a huge step forward.”

“Flowers said that “we’ll have to have this discussion again a year from now.”

“I think we will find that the American public will see that they were forced to buy a product that didn’t actually work for them,” Flowers said. “We are going to continue to have people going bankrupt from medical costs and not able to afford the care they need. The most important thing is that we be honest with people and that we tell them that further empowering the insurance industry does not move us closer to our goals of  a universal publicly financed health care system.”