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Obamacare Debate

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Economist Dean Baker and Dr. Margaret Flowers debate the merits of the Affordable Care Act.

Jessica Desvarieux, TRNN Producer: Welcome to The Real News Network. I’m Jessica Desvarieux in Baltimore.

Open enrollment for insurance plans under the Affordable Care Act will open on Tuesday, October 1. That means those 48 million Americans who are uninsured can pick a plan according to their income.

With us to discuss the Affordable Care Act are Dean Baker and Dr. Margaret Flowers.

Dr. Flowers joins us in-studio. She’s a pediatrician in the Baltimore area and the Maryland chapter of Physicians for a National Health Program cochair, and she’s the secretary of health for the Green Shadow Cabinet.

Thank you for joining us.

Dr. Margaret Flowers, Co-Chair, PNHP: Thank you for having me.

Desvarieux: And joining us from Washington, D.C., is Dean Baker. He’s the codirector of the Center for Economic and Policy Research.

Thanks for joining us, Dean.

Dean Baker, Co-Director, CEPR: Thanks for having me on.

Desvarieux: So, Dean, let’s start off with you. You’re a proponent for the single-payer health care system, but you recently wrote an article, “Obamacare: It’s Better Than You Think”. Can you briefly explain the state-based health care exchanges? And why are you considering the Affordable Care Act an enormous step forward?

Baker: Well, the point here is that we’re for the first time going to have people able to buy insurance without regard to their condition, their health condition. And that’s obviously a huge issue, because basically insurers do not want to insure people who are sick. And beginning 2014, regardless of your condition you can sign up and pay the same rate. There’s age ratings, so you pay up to three times as much if you’re in the oldest group, 55 to 64, pre-Medicare age, as people in the youngest group.

But still what that’s going to mean is for the first time people with serious health conditions are going to be able to get affordable insurance. So that’s a huge, huge difference. And what it means is really that people have insurance, real insurance for the first time, because most of us get insurance through our job, and we’re in a situation where if we were to get a serious illness, after a point we’re likely to lose our job and we will also lose our insurance, and then we’re suddenly in a situation of looking for insurance in the individual market, which is clearly not going to be affordable. So this puts an end to that.

So we will have people being able in most cases—not in all cases. We’re still going to have a lot of people uncovered. There’s lots of grounds for criticizing the ACA. But this is a huge step forward. We’re going to have tens of millions of people that will be able to get insurance who haven’t had it previously. And, again, for the 100-plus million who are now insured, they will actually have real insurance, because if they do get sick, lose their job, they’ll still in most cases be able to get affordable insurance through the exchanges. So I have to see that as a big step forward.

Desvarieux: Okay. Let’s have Dr. Flowers respond to that. Do you see that as a step forward?

Flowers: No, I actually see the Affordable Care Act as a step backwards. It takes us farther in the direction of privatized health care. And the way that we really need to go is towards greater—a publicly financed universal health care system. That’s the most efficient and most equitable way to provide health care.

What the Affordable Care Act does is it 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. And so they’re still going to find ways to deny payment for care. And people are going to find that while they’ve paid out hundreds of dollars for health insurance, they won’t have the money to actually pay for health services, because a lot of that cost is going to be coming up front first for the patients before their insurance even kicks in.

Desvarieux: But what about Dean’s point about serious health conditions and those being covered?

Flowers: Well, that’s another concern is that what we’re seeing from the large private insurers is that because they’re being required to accept people with pre-existing conditions, they’re severely cutting back their networks. So hospitals that provide care to people with serious health problems are not included in their networks. They’ve restricted the number of physicians that are in their networks. And so people are going to find it more difficult to actually go to the places they need to go to to get care. And so if you’re getting care outside of the network, that means 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.

Desvarieux: Dean, what’s your response to what Margaret just said?

Baker: Well, it’d be great to have, you know, universal Medicare, but that wasn’t about to be coming. So basically our choice is having health care provided through private insurers or not having it at all. And the fact is, we have 100-plus million people who get most of their health care through private insurers now. And yeah, they do lots of bad things, but the alternative is not getting it all. So I can’t somehow tell people they’re better off not getting health care than having it provided through private insurers, as much as I may not like them.

Desvarieux: But is that true? Is that really the alternative? We only have two choices here?

Flowers: No. And, actually, during the health reform debate, a point that we were making, especially towards the end when it looked like the Affordable Care Act was going to go through, was don’t give hundreds of millions of dollars in subsidies to private insurance companies where they’re going to hang on to a lot of that and still deny people care. We should be giving that to our public programs to expand them more and really shift us in the direction we need to go, towards a greater publicly financed health care system.

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

Desvarieux: Okay. And we had actually—Senator Reed, he came out and he said that this is a step in the direction of eventually getting a single-payer system. Margaret, do you buy into that? Do you see that as being—?

Flowers: I don’t see how giving more money to the very industries that are influencing this legislation in their favor is actually moving us towards a real health care system. What we see down the road and what’s starting to happen is further privatization of our health care. So we see large employers are moving their retirees into the insurance exchanges. Medicaid is going into the exchanges. We heard Jonathan Gruber, whose—you know, he’s an economist from MIT that talks a lot about health care—saying that Medicare—within five years he expected that Medicare would be put into the exchanges. So we’re going to be seeing an erosion of our public health systems and further privatization. And that just really takes us in the wrong direction.

Desvarieux: And, Dean, you’re actually in favor of a single-payer system. But, as Margaret pointed out, is this just going to privatize the industry even further?

Baker: Well, there’s an ongoing struggle. We had a chance to test what happens when health care reform goes down, ’cause we lived through it. Nineteen ninety-four it went down. I don’t see single-payer in ’95, ’96, ’97, ’98, I didn’t see it anywhere close, and I talked to people on the Hill. I can tell you, in 2010 I doubt you had 20 members of Congress 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 ’cause we don’t like them. I don’t like them, but, you know, that’s the reality.

Now, in terms of what Jonathan Gruber’s plan might be for five years out, that’s wonderful, but last time I looked, Jonathan Gruber isn’t running the country. So, yes, if we all lie down and die, there’s a lot of people who want to privatize Medicare. I suppose Jonathan Gruber’s one of them. I can’t really say, but I’m willing to take Margaret’s word on that. But, yeah, if we lie down and die, yes, they will privatize Medicare. But it’s an ongoing struggle. And I think we’re much better having that struggle from the standpoint where we have a lot more people insured and that 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. So I don’t really see a downside here.

Flowers: Well, that’s the real question is, you know, do they actually have real insurance, because we were fighting for so long to say that insurance companies should cover 80 percent of needed services. And what the Affordable Care Act has done is it’s put into law that 60 percent and 70 percent coverage are just fine. And those are really bankrupting coverage. People who have plans that are 60 or 70 percent—and you can only get a 70 percent plan if you take a subsidy. It only subsidizes those plans. Those are really plans that mean that people, if they have a serious accident or a serious illness, are either not going to be able to afford to get the care they need or they’re going to go bankrupt. The top cause of personal bankruptcies in this country is medical costs and illness. And we haven’t seen that decline in Massachusetts that has the same plan. I don’t think we’re going to see it decline here. We’re going to continue to have—the latest estimate by Congressional Budget Office is still 31 million people without insurance in this country when it’s all said and done. And I think that’s a low estimate. I imagine it will be higher. People who have insurance are going to have really very skimpy coverage that’s not there when they need it.

So we’re pouring money into this industry and a lot of bureaucracy and added cost with no cost controls, and we’re not going to be seeing—I don’t think we’re going to see good health outcomes out of it or see people getting the care they need.

Desvarieux: But Dean raises—.

Baker: Thirty-one million’s down from 50 million, which—it looks, to me, pretty good. And if you look at the case in Massachusetts, it looks on the whole like a pretty good story. They have almost universal coverage. They have better health outcomes.

Again, it’s not 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 in this. So there’s lots of things to complain about. But I still have a very hard time seeing it 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, but 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 if somehow we were to make this go away, it’s very hard for me to see how we get to universal Medicare anytime soon.

Desvarieux: That’s a good question, Margaret. How would you move forward? Because obviously it’s been passed in both the House and the Senate. The president has approved it, Supreme Court has deemed it constitutional. Where do we go from here?

Flowers: Well, first off I think we should look at what happened during the health reform process, because tens of millions of dollars were poured into foundations and organizations to push for not single-payer. And the majority, particularly of Democrats, 80 percent of Democrats, wanted a single-payer plan in terms of the public, the voters, and two-thirds of the total public support a single-payer plan. But the messaging that came down through all the media and these scripted house parties that were held and these progressive groups was you can’t have that; you’re asking for too much; you could maybe ask for a public option, which was never meant to be in the final legislation anyway. So you had—you know, if you’re telling the public you can’t have it, what you want, and that this is a solution when it clearly isn’t a solution, right, that takes us further away from our goal of getting a single-payer plan.

This is not going to happen without a struggle, but we need real leadership. We need people to tell the public that that’s what it’s about, that 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. Look, the public stopped an attack on Syria. That’s unheard of. When have we in the United States ever stopped a president who’s declared that he wanted to attack another country? And that was because Congress was flooded with public comments saying, don’t do it.

Desvarieux: Dean, what’s your response to that?

Baker: I’d love to see more public pressure. But, again, I am just saying what realistically is out there. I mean, sure, everything could change tomorrow, but it didn’t change yesterday. So if you want to tell me some story that things are going to be radically different in 2014, I’d love to see it. I just don’t see it now.

So what I’m saying is we have an enormous advance here. There’s tens of millions of people that don’t have insurance who will get it through this plan. And, again, I think the most important thing is that you have a lot of people that are struggling with medical conditions, particularly older people, people in their late 50s, early 60s, pre-Medicare age, that are working at jobs, they’re struggling with bad health because that’s the only way they can get insurance. This is going to mean a world of difference for those people because they’re going to have affordable insurance through the exchanges. They could quit their jobs. That’s going to make a world of difference in those people’s lives. I have to see that as a huge step forward.

Desvarieux: Okay. Margaret, I’m going to let you have the final word.

Flowers: Well, I think we’ll have to have this discussion again a year from now, ’cause I think what we’re going to find is that the American public is going to see that they were forced to buy a product that didn’t actually work for them and that we’re going to continue to have people going bankrupt for medical costs and not able to afford the care that they need. And I think that 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 goal of a universal, publicly financed health care system.

Desvarieux: Of course we’ll certainly be tracking this story at The Real News. Thank you so much for joining us in-studio, Margaret.

Flowers: Thank you.

Desvarieux: And, Dean, thank you for joining us there remotely from Washington, D.C.

Baker: Sure. Thanks a lot for having me on.

Desvarieux: And thank you for joining us on The Real News Network.

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