Dissident Voice

August 16, 2003

Transcript of Democracy Now! radio program, August 13, 2003.

AMY GOODMAN: Nearly 8,000 physicians including two former U.S. surgeon generals are calling for a government-run universal health insurance system. In a special communication to the prestigious journal, the American medical association or JAMA, the doctors wrote yesterday that Americans are overpaying for medical care and point out 41 million people lack any kind of health insurance at all. They argue universal healthcare systems would not only be more fair but would be cheaper and more efficient than the current patchwork system. Medicare and Medicaid offer care to patients who are old enough, disabled enough or poor enough to qualify for the state federal health plan, but many doctors do not participate. States trying to balance budgets have been forced to cut Medicaid and Medicare services.

Unlike countries such as Canada, Britain and France, the United States relies on a combination of private and government healthcare. Most Americans are insured through their employers, but small employers are not required and not often able to provide health insurance. Former Surgeon General, Julius Richmond, who served under President Carter and Dr. David Satcher, a Case Western Reserve School of Medicine graduate, who served under President Clinton, endorse the plan. Dr. David Satcher joins us on the telephone, welcome to Democracy Now!

DAVID SATCHER: Thank you, Amy, I'm delighted to be with you.

AMY GOODMAN: It's good to have you on with us. Well, lay out what you have written to the Journal of the American Medical Association and what you said in your news conference yesterday.

DAVID SATCHER: Well, I think you've described it pretty well. I think the two major characteristics of this proposal are one, universal coverage. It is critical that all people in this country have access to healthcare. And it begins with universal coverage. As you know right now over 41 million people are uninsured and probably that number at least underinsured. And those numbers are going up as more people lose their jobs, as more employers decide that they cannot afford to cover their employees. The other component is so critical is, it is possible to do this without any increase in cost. It is possible to save up to $200 million from administrative costs. And that has been verified by the congressional budget office and G.A.O. So it is possible to find $200 billion of savings in the present system. We spend 42% more per capita than the next highest paying country in the world in terms of healthcare. So we pay more than anybody else, more per capita, a larger percent of our gross national product, and yet we have so many people uninsured. However, I should point out, Amy, it's not just the uninsured. There are many Americans who have insurance, but it doesn't necessarily cover mental health and when a family has a mental health problem they're not necessarily covered. If so they're covered inadequately. An the other issue of course, is long term care, where many people work all their lives to save and to purchase homes, and then when they suffer a very critical illness like Alzheimer's, their families might have to sell everything they have, in order to provide long term care. This proposal would cover long term care, mental healthcare, dental care, all the other things that people really need to be human in this country, to have life, liberty and the pursuit of happiness.

AMY GOODMAN: We're talking to former Surgeon General, Dr. David Satcher who has come out for universal healthcare in this country. Can you talk about the racial disparities in who gets covered these days and who doesn't.

DAVID SATCHER: Well, as you know one of the goals of Healthy People 2010 which I helped to develop as Surgeon General, I was assistant Secretary to Health, is the goal of eliminating disparities in health among different racial and ethnic groups in the country. There's a growing diversity in this country and diversity should be one of our major strengths. However there are major problems in terms of access to care for Hispanics and African Americans in this country. Disproportionately left out: Over 30% of Hispanics are uninsured, over 20% of African Americans. We're never going to begin to eliminate disparities in health as long as people don't have access to healthcare. So, we're very concerned about that. But I also want to point out that in addition to the concern about the poor and minorities, all Americans are paying a price for this system that is not functioning efficiently. The World Health Organization in 2000 ranked us No. 37 in terms of health system deficiency, despite the fact that we're number one in terms of cost.

AMY GOODMAN: Dr. David Satcher, who are the forces that are fighting against this? If you ask most people in this country how they feel, what would they say and who is shaping public opinion right now?

DAVID SATCHER: I think most studies show that the majority of Americans favor a national health plan. I think most of the studies that have been done, most academic physicians, most deans of medical schools favor the national health plan. I think the problem in this country is that health is treated as a commodity to be traded in the marketplace to the highest bidder. And I don't think you can sustain a healthcare system. We don't really have a healthcare system. We have a disease care system because you make more money treating diseases. So we could prevent many of the Diseases that we treat, and many of their complications, but there's not a lot of money in preventing diseases and promoting health. And so there's not an incentive for us to do that. Less than 2% of our health budget, less than 2%, is spent on population-based prevention. So we have this tremendous rise in Type 2 diabetes, tremendous rise now in childhood and adult obesity, threatening to increase again cardiovascular deaths and cancer deaths as well as certainly continuing increase in diabetes. But I think it's the marketplace treatment of health that is our problem. And we have to find a way to say that the health is a right, that people deserve to be healthy. They deserve the chance to have optimal health. And it's good for the country. It's good for the security of the country, good for the health of the country for people to be healthy, and we should invest in that.

AMY GOODMAN: Have you evaluated the presidential candidates announced so far in regard to their stand on universal healthcare.

DAVID SATCHER: No. I have not evaluated them. I want to...because I don't want to get into the politics yet. I tried as Surgeon General to be credible by not being political. And as we make this proposal I would love to see a presidential candidate of course, of merit come out and support this proposal. But think it would be very early for me to criticize that proposal. I don't think there is a proposal on the table that completely matches the one that JAMA will publish today providing universal coverage, doing away with the tremendous administrative costs that characterize our system and covering long term care, mental healthcare, dental care, maybe one that comes very close. But I'm not ready to get political with this yet.

AMY GOODMAN: Dr. Satcher, what will be your strategy and strategy of the organization that you're working with right now, Physicians for a National Health Plan.

DAVID SATCHER: I think the first strategy is education. Because I think most people feel that it's virtually impossible to cover everybody in this country and to do so without increased cost. You talk to business leaders and they will tell you that their costs for covering their employees is going up double digits. I was talking to one yesterday who said their cost went up 30% in the last year. So many employers are not able to cover their employees. And that sometimes means going out of business or laying off people.

AMY GOODMAN: But what is education mean? This has been going on for so long. What most people hear is that Canadian universal healthcare doesn't work.

DAVID SATCHER: Well, but I think number one I think it does work. It might well be that people might complain of waiting longer for elective procedures. But I don't think that many people in the world would say that the Canadian system doesn't work for the health of the Canadian people. And that's why we're having the difficulty now with Americans trying to figure out how to get medications going to Canada. I think I'm not saying the Canadian system is perfect, but I am saying that we have the ability in this country to maintain our tremendous research enterprise, which is so characteristic of our health system, our great training programs and at the same time provide coverage for everybody and to do so without increased costs.

AMY GOODMAN: I guess the question I'm asking is, not as much what the Canadian health plan is about, but for years the insurance companies in partnership, in bed with the politicians, have managed to preserve private health insurance in this country. And I'm wondering what would change now, what kind of strategy and coalitions are being formed in this election year that might turn this around.

DAVID SATCHER: Well, I think it's really important for all sectors to understand what this proposal means for them since we're at a point in our history when everybody seems to be frustrated with the health system. Not just patients, not just the poor. Payers are frustrated, physicians are frustrated. And every time there's an announced cut in Medicaid and Medicare, more physicians leave practice or stop seeing patients that they have been committed to. So I think what we need to do is to educate people about what this means for them not just the poor, not just for minorities, but what does this mean for employers, major payers who would like to provide care for their employees, but are finding it very difficult to do so. So this strategy, I think, is to really put a proposal on the table, a very simple proposal, not complicated. I was involved in the Clinton proposal. I helped put it together. I know in retrospect that it was far too complicated and in some ways maybe too political. I think what this proposal is, is a very simple proposal, that will allow us to cover everybody and to provide for the health needs of the American people and to do so without increased costs. And I find it very difficult to see how we can say no to that if we really care about the health of our people.

AMY GOODMAN: Senator Lieberman has accused Congressman Gephardt of putting forth a "break the bank proposal" for national healthcare. I think Dennis Kucinich, the congress member from Ohio, Cleveland, has talked about universal healthcare.

DAVID SATCHER: I think Congressman Kucinich's proposal to probably closest to this. Clearly this proposal has been evaluated by the congressional budget office and the G.A.O. and it is clear that this proposal is affordable. We can cover all of the American people using...and we can add those who are uninsured now, based on the savings that we will acquire from the decrease in administrative costs. And it's not just administrative costs in dollars. It's all of the time that physicians spend filling out forms. All of the people that hospitals have to hire to fill out the various forms that are involved in this system. The overhead is just tremendous. Probably 13 to 15% of costs now related to that. And we know we can do better because in Medicare, for example, it's only 3%. So we know that we can do much better in terms of administrative costs of running the system. So we can answer that question, I think we have in this proposal, about the affordability. This proposal is affordable. The $1.6 trillion that we're now paying for the health system can provide for all of the people in this country and it will include long term care, mental health coverage, dental coverage and all of the things that people need to maintain optimal health.

AMY GOODMAN: Well Dr. David Satcher, I want to thank you for being with us. If people want to get a hold of the plan where can they go on the web?

DAVID SATCHER: Well, JAMA is publishing it today. You can access it through...JAMA's publication is coming out today, and it can be accessed.

AMY GOODMAN: That's the Journal of the American Medical Association.

DAVID SATCHER: Right.

AMY GOODMAN: Dr. David Satcher thanks for joining us. You are listening to Democracy Now When we come back some say it was Supreme Court that stole the 2000 election. What will happen in this one? Will it be stolen by electronic voting machines or those who can hack them. Stay with us.

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* Video Link: Unveiling of the National Health Insurance Proposal: Physicians for a National Health Program present a National Health Insurance Plan. CSPAN, August 14, 2003. Note: You have to scroll down a couple of pages to find and click on the appropriate link.

* Physicians for a National Health Program