Blending Research & Advocacy

Interview With Dr. David Himmelstein

Review of Systems Podcast, July 11, 2017

EXCERPT (full interview above):

REVIEW OF SYSTEMS: For me, one of the appeals of a single-payer system is a better opportunity for cost control and reducing administrative waste. But at the same time, when you do that, it feels like one man's waste may be another man's job, and there may be a reduction in physician salaries [as well]. How do you account for these types of trade-offs? Does a single-payer system result in lost administrative jobs?

DAVID HIMMELSTEIN, M.D.: Well, I hope it does and I think it does, and we would need to make plans for re-training, and re-placing in new jobs, the roughly million people who are doing useless work.

In legislation that we've worked on helping to draw up, and in in proposals for reform that we've made, we've always included a provision that says we need to set aside several tens of billions of dollars to help transition those people to new jobs.

Now, most of the people who are going to be displaced are relatively low-wage clerical [workers] and they could be readily re-trained for the expanded workforce that we need to deliver more care in our society.

Our long-term care is terribly understaffed. Our nursing homes are hugely understaffed. We're not doing the smoking prevention programs or hypertension or cholesterol screening that we ought to do. But we shouldn't be employing people to do useless things in our health care system.

You know, the automobile put horseshoe makers out of work, and there had to be a transition there, but we didn't say, "We can't move forward into a new age because people who make horseshoes might lose their jobs." Similarly, with health care, I think we need to use the resources we have in a rational way.

Now, there are some people who are not going to be able to find comparable jobs. The CEO of Aetna, for several years, was making $225,000 a day. We're not going to be able to find him a comparable job, but luckily those folks have saved up enough that they probably don't need to work anymore.

[Regarding physician pay], in countries that have implemented national health insurance, like Canada, doctors' incomes don't go down. They may equalize a little bit - the plastic surgeons may make a little less - but on average, doctors' incomes in Canada have actually gone up faster than wages in the society as a whole.

But the doctors haven't just benefited from having good incomes, they've benefited because their work lives are better. They don't spend their lives filling out billing forms and checking boxes that have no use other than to support billing.

I think the vast majority of doctors would be much happier, not just financially but in everyday life, under a national health insurance system.