The US Health Care Crisis: Corporate Masters Cannot Solve Public Problems

This January, Jeff Bezos, Warren Buffett and Jamie Dimon announced they were partnering together to form a new health care entity. The executives from Amazon, Berkshire Hathaway and JP Morgan — three experts when it comes to making profits — claimed that this entity would be “free from profit-making incentives and constraints.”

Meanwhile, Congress embroils itself further in the partisan health care quagmire, and Bernie Sanders’s Medicare for All bill is nowhere near becoming law — it seems that monopoly businesses might offer an alternative. But should we really be looking to corporate masters for a solution to public problems?

In this interview, Ben Palmquist and Dr. Steffie Woolhandler unpack all this and more. Ben is the campaign director for NESRI’s “Healthcare Is a Human Right campaign” and Dr. Woolhandler is a spokesperson for Physicians for a National Health Program, who have long advocated for universal health care.

Laura Flanders: US health care is still in crisis. Over 30 million Americans remain uninsured, and even more of us are sickened by sky-high insurance costs. We’ve got a lot to unpack here. Let’s just start with the top facts. Still in crisis, right?

Steffie Woolhandler: Absolutely. We have very high health care costs. They’re going up rapidly again. We’ve got 30 million uninsured, and another 20 million who have insurance but still can’t afford care, so quite a crisis.

Still a crisis. The Republicans still out to kill the Affordable Care Act, or have they given up?

Ben Palmquist: They’re still going after things. It’s week by week now to see what they’re going to do next.

The Sanders bill has more support, but got a long way to go.

Woolhandler: It’s got support by a third of all the Democrats in the Senate, including every major presidential contender among the Senators. It’s got support of half of the Democratic caucus in the House. More importantly, it’s got tremendous support with the electorate, with polls showing two-thirds of Americans now endorsing the idea. I think that’s an idea with legs. We’re not going to see anything happen until we have some different people in Congress and probably in the White House, but that could be very soon, if we’re lucky.

Jeff Bezos, Warren Buffett — these are people who a lot of people think, “They’ve made all this money. They’ve made these big companies. Maybe they can solve our health care crisis.” What do you think?

Palmquist: These are not health care companies. These are employers, and they are profit-driven. What they’re looking to do is cut their costs that they’re spending on their employees’ health insurance. This does nothing to address the health care needs of the 50 million people who are being denied care. It does nothing to address the corporate profiteering that’s driving hospitals and drug companies and insurance companies to inflate health care costs. It’s really missing the point.

Physicians for National Healthcare actually wrote a letter to these guys. What did you say?

Woolhandler: We said, “If you want to fix the health care system, go for a simple, single-payer system, and an expanded and improved Medicare for All.” I think we’ve seen business, including very big business, trying to involve themselves in controlling health care costs many times over the past few decades. They occasionally can get a little lower price for their own corporations, but they’ve never had a durable impact on the health care crisis in this country.

How would you define their interest? Is it fair to say they might have reason enough to try to figure this out?

Woolhandler: Let’s look at Jeff Bezos, who owns a lot of Amazon. It’s in his interest to lower the health care costs for his workers, but frankly, it’s in his business interest to see those costs go up for everybody else’s workers. If he gets cheap health care and has lower labor costs, and other people have expensive health care and higher labor costs, that’s a competitive advantage for Amazon. Yes, he has every interest in lowering the prices he has to pay, but no interest whatsoever in lowering health care costs overall, because that would help his competitors just as much as it helps him.

Palmquist: It doesn’t seem like they’re actually going to have their own hospitals or their own delivery system. What they’re really trying to do is establish market power so that they can bargain with possibly insurance companies, possibly directly with drug companies or others, to really just bargain down those costs. They may introduce some technical things to cut out some of the middlemen involved, but fundamentally, neither of those models are able to offer a guarantee of health care to everybody. Private companies are simply unable to do that.

Woolhandler: Decades ago, many decades ago, there were companies that went out and set up their own hospitals and clinics. Actually, Kaiser grew out of that. Kaiser Steel set up hospitals for their own dam workers that were building dams out West, but that has not occurred in any recent decades. Recently, the role of business has just been to try to step in and use their buying power. I think we’re more likely to see that. I guess the insurance industry has reacted and thinks, “Maybe these guys will come and demand that we lower our prices, cut some of our profits.”

You can see why people are desperate for some kind of deus ex machina, maybe deus ex Wall Street, to come and save us. Where do we stand when it comes to the kind of change that both of you advocate for that’s rights-based, that’s more forward-looking to an economy where people are less permanently employed? Where are we in making the shift that’s obviously going to be needed for a new economy and a new era?

Woolhandler: The thing we’ve got going for us now that we haven’t had for a while is a majority of the American people endorsing the idea of an expanded Medicare for All program. Moving to Medicare for All means developing a political movement. That’s going to mean the electorate organizing. It’s going to mean physicians organizing, as we do in Physicians for a National Health Program, nurses organizing, as they do their unions. It’s going to require people who see the need for the single-payer program.

Palmquist: We are in this extraordinary moment where energy is bubbling up all over. People are pushing for universal, publicly financed, single-payer in Washington [State], but also in a bunch of states. It’s up to all of us now to really stand up and hold elected officials accountable, and also to hold private actors accountable. We need to be holding hospital companies and drug companies and insurance companies accountable. When they’re not delivering care to people, we need to be demonstrating, getting out there, writing letters to the editor and speaking up.

Where are you most excited? There [were] some interesting results in the elections of last November that pushed this issue forward. There are some models out there in different parts of the states. Who wants to take a whack at that?

Woolhandler: I think we’re going to need a national movement. The state movements are great for people who are in states where they have a lot of momentum for single-payer. But we are going to need a national movement. We’ve got some people who are real leaders at this point, recognized leaders, the way Sanders has become recognized, the way Keith Ellison has become recognized, who are out there saying, “Now’s the time to push these single-payer ideas.” People were taking a “wait and see” attitude toward Obamacare. Obamacare and the Affordable Care Act have played themselves out. We’ve covered half of the uninsured, but we’ve left half uninsured, and people are still pretty unhappy about their private coverage, even people with coverage.

Every day in our own practices, physicians see people who have disabling conditions that could have been prevented by early attention to diabetes or hypertension. We see people who come in and we need to get them specialty care, and we can’t get it, because they don’t have the right insurance. As we try to take care of patients, we’re finding we really can’t do it. We found that the Affordable Care Act, whatever its strengths, did not get us where we need to be in terms of universal health care.

Palmquist: Healthy California and the Campaign for New York Health have both passed a bill for universal health care through one of their state houses. Those campaigns are going strong. People in Maine just went around their reactionary governor and passed a Medicaid expansion in November. Then there’s all sorts of local efforts to protect community clinics and hospitals. What’s really important is keeping our eyes on the long-term goal of really guaranteeing health care as a human right and a public good for everyone.

You co-authored a piece in Jacobin that is totally dedicated to the question of health care, raising concerns or anticipating problems if the Medicare for All proposal isn’t implemented in a certain way. The biggest one being you really can’t have two parallel systems, private and public. Is there any way around that?

Woolhandler: I think we need a single system with everybody in, nobody out. That’s what they have in Canada. You’re in the system, and the richest person and the poorest person in the country have the same type of health insurance. Illness doesn’t care how much money you make. Illness can strike if you’re rich or you’re poor.

So Jamie, Jeff, Warren, come on over. What do you think are the chances?

Palmquist: I’m not holding my breath.

Woolhandler: Yeah.

I guess me neither. What can other people do if they want to try to get involved?

Woolhandler: People should look at the website of Physicians for a National Health Program. Full membership open to any health professional. There’s also lots of links to the community groups and coalitions that we work with. Certainly National Nurses United has websites that help people plug in, Progressive Democrats of America, and people should find local groups that are working on this issue, and show up.