Remarks of PNHP President Dr. Andrew Coates at single-payer summit

The following is an unofficial transcript of the remarks of Dr. Andrew D. Coates, president of Physicians for a National Health Program, at a summit on single-payer health care convened by Sen. Bernie Sanders, I-Vt., on May 21, 2014, at the Dirksen Senate Office Building in Washington.

Sen. Bernie Sanders: Dr. Andrew Coates is president of Physicians for a National Health Program. He is assistant professor of medicine and psychiatry at Albany Medical College, and practices hospital medicine at a community hospital in Upstate New York. Dr. Coates, thanks for being with us.

Dr. Andrew D. Coates: Thank you, Senator Sanders. It’s a great honor.

I’m representing Physicians for a National Health Program, 19,000 physicians who have been advocating for national health insurance for over 25 years.

Physicians have a special relationship with society. As the profession has evolved, our relationship with society has become profound, but also tangled with business. And what I has happened is almost bewildering to my colleagues many times.

We know from studies, very good research, that the majority of American physicians want national health insurance. And we know that from our daily practice because patients should have access to all necessary care when they need it. I think that question is absolutely settled in this country.

Right now there’s a scandal in the Veterans Administration, and there’s a scandal because those patients should have everything they need. And the entire country knows it. And we should all make it our responsibility to make that happen. That’s the starting point for the dialogue in our nation, and it’s the same starting point among the physicians.

What’s happened lately is that costs have been completely out of control in terms of aggregate, but the plan about what to do about those costs has been to shift them onto individuals.

So in our hospital I understand that emergency room visits are down, they’re falling. The administrators think it’s because of the co-pays, the co-insurance, the deductibles – the new forms of insurance that the patients have. But as the visits to the emergency room are going down, the number of admissions to the hospital are climbing. So the patients who are coming to the hospital are much sicker.

We practice near the southern Vermont border. Many of our staff and some of our patients come from Vermont. We know this community well. It’s a community with a heroin epidemic. The needs are colossal. The poverty is severe. And we see the presentation of very advanced disease from people who have not had access to adequate primary care every day.

Patients don’t have the choice of where they can go. This system shunts them and schleps them wherever. My own doctor, several years ago, cancelled my health insurance, wouldn’t take my health insurance, because she couldn’t come to terms with the company that my employer had chosen.

And so, when you lay out the evidence, like Rob [Weissman] did, the system actually indicts itself. It doesn’t make any sense at all. If the goal were to provide all necessary care for everyone in the United States, the system we have is a failure. Way too many people are left out, there are hideous disparities, African Americans do not get the same care that white patients get, immigrants are actually left out in all kinds of different ways -- the most hideous violations of human rights in our country are the medical deportations of undocumented patients who are sick and who are sent back by air ambulance to their home country by the hospital.

And through this, it’s clear to me that physicians want to do their best as caregivers. We want to do what we learned to do. We want to apply the medical science and the human arts at the bedside in the best and exemplary way, and yet our society doesn’t organize to give us those resources.

The farther I go in this advocacy for national health insurance, I think, Why is it that the mainstream of our society is so interested in single payer? Why is it that we’re in The New York Times every week, or The Washington Post, or the U.S. Senate? And I know that the wonderful educational efforts of senators like yourself and representatives are crucial to keep the discussion going, but it’s also the simple fact that this would work.

Single payer would work. We could do this. It would be completely feasible. It could happen rather quickly. We have what it takes. We have the excellent caregivers, we have the infrastructure, and we have the know-how. So it’s something we could do.

There’s one more piece, which is that in a modern democracy, it seems to me that it’s the responsibility of the government to guarantee all necessary care to everyone in the democracy and also to protect the privacy, the decision-making, between the patient and his or her caregiver.

And if you think about that a little further: What would it mean if we had national health insurance? What would it mean if we had access to all necessary care, if we wouldn’t have to worry when our mother needed to make a transition to a nursing home, if wouldn’t have to worry when our child got leukemia, if we didn’t have to worry, like all of my patients – every case I have in the hospital is worried – about the money problem that is going to follow their illness, and it is an absolute national disgrace.

Yes, we can indict that. But let’s think about it the other way. What kind of freedom would we have if we could travel anywhere we wanted and know that there would be an adequate health care infrastructure? If the Adirondacks, where there are underserved populations of my own state, had the hospital and the support staff that they needed?

This would be liberating, and it would change the political culture of our nation to the idea that we can do this together, we all deserve basic human dignity, and we should all be free. And I think that health care is such a modern necessity that that can take our democracy to that place.

Thank you, senator.


Later, in the context of a panel discussion about the relationship between state-based and national efforts for single payer, Dr. Coates made these remarks:

Dr. Coates: I think there’s an event that recently happened in Madrid, Spain, [that might be instructive]. The right-wing party in power in Madrid wanted to privatize the public health system. Sell out pieces and parts, close public clinics, lease out hospitals – the whole scheme of privatization.

And the nurses and the doctors had for years educated about the villainy of privatization: that privatization ends up costing a society more of our money, privatization ends up delivering inferior care. They did that for years. And they were very much like we are now – “We don’t have a chance of stopping privatization,” that would be the feeling two or three years ago. “Here it comes, they keep trying, keep trying.”

Well, the movement blossomed. Their time came. Everyone worked together, and they completely stopped the effort to privatize the Madrid health system.

I think that in this country, the single-payer movement is an incipient mass movement. I think Vermont is the best example, perhaps with California, but Vermont because if its size and the dedicated activism of Dr. Deb Richter, of some really tenacious labor leaders, county by county, village by village, the education about single payer is there. Everyone knows that it would work.

Everyone knows. Sen. Sanders started way back, going to Canada and saying this would work for Burlington. And this education, for many, many years, is what is carrying us forward.

So whether it takes place at the county level, or the state level, or the national level, it’s that education that we’re doing that will win the day.

And other thing is that the income inequality, all by itself, creates its own crisis. Richard Wilkinson and Kate Pickett argue that income inequality by itself causes ill health, I wonder if it isn’t just the poverty, but it creates its own crisis and at some point something’s got to give. And the establishment will reach for a good idea that will work. They’re not going to try to invent something brand new, and our day will come.

You can watch a video of the entire proceedings of the summit here.