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Feature
Story |
Bill
Bradley's
Unjust Heath Care
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©1999
Jennifer Warburg, Impact Visuals |
In October, a new
poll came out on how Americans feel about our health care
system. They didn’t like it very much. One out of three
people described the system as "critically or terminally
ill." They were very upset about the high cost of health
care, and 85 percent said insurance companies were to blame.
Some 79 percent said health care should be a right. The poll,
commissioned by the W.K. Kellogg Foundation’s Community
Voices project, only echoes what previous surveys have found
and what many of us experience on a daily basis.
Along comes the 2000
presidential election. All the candidates know they have to do
or say something to address public rage about health care.
Recently, former New Jersey Senator Bill Bradley, a Democrat,
came out with the most thorough plan yet proposed in this
election campaign. "Good health care is a right," he
told an audience in Los Angeles in late September. "And
it is up to us to ensure that right to every American."
Bradley then spun out a proposal that involved providing
federal subsidies to the uninsured, among other things.
So how does the Bradley
plan really measure up? If Americans are fed up with insurance
companies and think health care is a right, is Bill Bradley
the man for us? We recently asked Dr. Steffie Woolhandler
about the Bradley plan. Woolhandler, an associate professor of
Medicine at Harvard University and a founder of Physicians for
a National Health Program, supports the Labor Party’s Just
Health Care Campaign.
It seems like previous efforts to win
substantive health care reform have failed partly because
there’s so much confusion about the different proposals.
Language is used so loosely. For instance, almost everyone
offering up a plan, including Bradley, says the aim is
"universal coverage." Is there a litmus test — a
basic minimum — people should be looking for if they think
our health care system should provide universal, high-quality
care?
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Presidential
hopeful Bill Bradley
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I think there are two fundamental things a
program has to have. One, unless you guarantee that everybody
is in the health insurance program and nobody’s out of it,
then you can be sure that millions of people will get left
out. More incremental approaches — the idea that we’re
going to add in some people over here and then add some from
over there . . . well, people have been doing that for the
last twenty years. And it hasn’t worked — because we have
more uninsured people now than ever before.
Two, if you aren’t going to abolish the
private health insurance industry, you aren’t going to be
able to afford universal care. Because those insurance
companies waste billions of dollars, and that’s the money
that you actually need in order to extend care to everyone.
That’s where the money’s got to come from — cutting the
waste involved in the insurance industry.
Bill Bradley recently came out with a
proposal for health care reform which he says is an effort to
"move to universal coverage." How does his plan
measure up to your standards?
I think Bradley’s plan is worse than
nothing. It doesn’t include everyone, and it certainly doesn’t
eliminate the private insurance companies.
In fact, what it does is hand over billions of
tax dollars to the insurance companies and HMOs. The U.S. will
spend about a trillion dollars on health care this year —
which is more than any other country. And $250 billion of that
money will go to health care bureaucracy — the paperwork for
profit-making insurance companies, HMOs, hospitals. Bradley’s
plan does nothing to challenge this situation.
It tells you something that Chip Kahn,
president of the Health Insurance Association of America [a
major industry lobbying group] has endorsed Bradley’s
proposal. It’s very similar to a plan that has been pushed
by the right-wing Heritage Foundation.
Of course, there’s no reason to single out
Bradley for having a bad policy on health care. Gore’s
proposal is pretty bad, too, and so is his record. Since the
Clinton-Gore administration took office, six million more
people have become uninsured. The only candidate who’s
really come out for a reasonable plan for universal health
care coverage is Senator Bulworth. Unfortunately, he’s just
a character in a movie.
What’s the basic idea
behind Bradley’s plan?
Bradley wants uninsured people to buy private
insurance through a plan used by federal workers called the
Federal Employees Health Benefits Program. The government
would provide financial help — tax subsidies and skimpy
vouchers — to purchase insurance, but not nearly enough help
to ensure that everyone would be covered. Bradley would
privatize Medicaid by rolling it into his plan, but Medicare
would stay separate.
Explain what Bradley’s plan would mean
for the 44 million people who are currently uninsured.
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"What's
not feasible is incremental change [of the health care
system]. We've tried that over and over, and we're only
falling further behind when it comes to providing good
care to everyone.
—
Dr. Steffie Woolhandler |
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Basically, Bradley would have them ante up for
their own coverage. The parents of uninsured children would be
required to buy private health insurance. The government would
provide a voucher to help low-income people pay for the
insurance, but only enough to cover the cheapest plans. For
instance, a family of four would have to have an annual income
of under $16,400 to qualify. And they’d receive a voucher
worth $1800 per adult. Even Bradley admits that millions of
people would still fall through the cracks.
What’s more, there’s good reason to
believe that the existence of this federal program will tempt
employers who do provide health insurance to dump their
coverage. That’s exactly what’s happened with the Children’s
Health Insurance Plan, which Clinton and Congress passed in
1997. The number of uninsured kids actually rose after that
bill was passed, partly because employers responded by
dropping their health insurance.
What would happen to Medicaid
recipients under Bradley’s proposal?
He totally abolishes part of Medicaid and
privatizes the rest. Medicaid is a joint state-federal
entitlement that covers not only the poor but also disabled
people and low-income elderly, mostly people in nursing homes.
The piece of Medicaid that covers the disabled and low-income
elderly would be abolished by Bradley. He’d hand the money
over to the states and say, "Here, solve this
problem." This includes government support for nursing
home care. Bradley would turn that over to the states, ending
a 35-year-old federal guarantee.
Bradley would privatize the part of Medicaid
that goes to poor women and children. He proposes taking the
money out of the joint federal-state program and giving it to
people in the form of vouchers so they can buy coverage in the
private insurance market. That would be a disaster. Basically,
the $193 billion we now spend for Medicaid — plus $65
billion in new tax dollars — would go to private insurers.
The current Medicaid system
does have a lot of problems.
It’s true that traditional Medicaid has a
mixed record on delivering quality health care, but it
definitely does better than for-profit HMOs in treating
Medicaid patients. We have a lot of experience with people in
private Medicaid HMOs, and it’s not good. HMOs function by
placing subtle barriers in the way of care — you have to get
approval and stay on the phone thirty minutes to get an
appointment. And many people, especially poor people, can’t
jump those barriers.
It’s well documented that patient care
suffers under Medicaid HMOs. In Oregon, they found that when
poor women on Medicaid got pushed into HMOs, they got worse
prenatal care and had more low birthweight babies.
There have been lots of cases of Medicaid HMO
fraud, like when HMOs tell poor people they’ll lose their
Medicaid if they don’t enroll. There’s a lot of
profiteering that goes on because many poor people don’t
know how to get the care they need. So it’s that much easier
for the insurance plan to collect their premium and not
provide the care.
What’s more, these HMOs spend up to 70
percent of their program costs on overhead and profits, while
traditional Medicaid only spends about 3.5 percent on
overhead. So turning over the entire Medicaid system to HMOs
would be a disaster.
Does Bradley propose
any changes in Medicare?
Not any major ones. He’s proposing a small
prescription drug program, which would cover medication costs
of over $500 annually. Seniors would have to pay an extra
premium to get the benefit.
What we really ought to be doing is forcing
drug companies to bring down their prices, the way the
Canadians are doing. Drug companies have the biggest profits
of any industry, and the U.S. has the world’s highest drug
prices. Two scholars at Boston University recently did a study
that found that if the U.S. government used its bargaining
power to negotiate drug prices down to Canadian levels, we’d
save enough money to give drug coverage to everyone who
currently doesn’t have it — about 70 million people.
Bradley says under his plan, everyone will
be able to exclude the cost of insurance premiums from their
federal taxes. What do you think of that?
It’s awful! Basically, Bradley’s going to
pump more money into health care, but in such a way that
affluent people get more than poor people. The tax break for
private insurance is worth a lot more for a rich person than a
poor person, because someone who’s taxed at a rate of 28
percent is going to get a lot more out of the tax break than
someone who only pays 15 percent. It’s regressive.
If Bradley’s health care proposal is so
skimpy, why is Gore saying it’ll blow the federal budget?
Well, it is expensive in the sense that it
would waste billions of taxpayer dollars on HMOs and insurance
companies. Both the Congressional Budget Office and the U.S.
General Accounting Office have found that if we had a
single-payer health care plan [like the Labor Party’s Just
Health Care proposal], we’d save enough money to cover
all 44 million uninsured Americans.
That’s because if you eliminate the private
health insurance companies and have the federal government as
the single insurer [a "single payer" system], you
get rid of billions of dollars of waste by the insurance
companies — profit-making and paperwork. Health care should
not be a profit-making business, but a human service that puts
people’s needs first. But none of the candidates are even
raising these issues.
What has Gore said
about health care reform?
He’s talking up the Patients Bill of Rights
[a proposal that would make it easier for people to sue HMOs,
among other things]. He would also propose putting more money
into the Child Health Insurance Plan, which we see as
fundamentally flawed. And he’s proposed a 25 percent tax
credit for some 55-65-year-olds who buy Medicare. But he’s
not talking about the right to health care.
No one is talking about the fact that the U.S.
spends more money on health care than any other nation in the
world, and yet is the only one that doesn’t guarantee
universal coverage.
The bottom line is that none of the Democratic
or Republican presidential candidates are willing to confront
the major corporations that control the health insurance
industry, the hospitals, and the whole for-profit health care
system.
What do you say to people who maintain that
a plan like the Labor Party’s Just Health Care is a good
idea but just isn’t politically feasible right now, and so
we should put our energies into incremental changes instead?
What’s not feasible is incremental change.
We’ve tried that over and over, and we’re only falling
further behind when it comes to providing good care to
everyone.
You’ve been heavily involved with the
health care reform fight for years. How do you feel about our
prospects these days for building a real movement for
something like the Just Health Care plan?
We’re doing better in some ways and worse in
others. The single-payer idea has much more support within the
medical profession — particularly the academic medical
profession — than ever before. One survey showed that 56
percent of all medical students, residents, and medical school
faculty supported single payer. So it’s become a much more
majoritarian view in a lot of quarters.
And I think the level of popular discontent
with the health care business is incredibly high. People
really think the health care system is broken.
But we’re really stymied by the fact that
the candidates have been so quiet on it. It’s hard for us to
mobilize when not one of them is raising the issue. And that’s
obviously part of the Labor Party’s raison d’être: to
raise these issues, to give people a focus for this work. And
that helps make it start to feel real and important. |
