U.S. Health Care is Profiteered to Death

Interview with Susan Rogers, M.D.
Black Agenda Report, May 23, 2017

The following is an unofficial, lightly edited transcript of an interview that Dr. Susan Rogers, PNHP national board member, gave to Glen Ford, executive editor of the Black Agenda Report, on May 23. You can listen to the interview above.

Glen Ford: Obamacare remains in a kind of limbo in the U.S. Congress, having been repealed in the House but with no action pending in the Senate. On the single-payer health care front, a majority of House Democrats have finally signed on to Congressman John Conyers’ Medicare for All bill. However, Democratic Party leaders have not gotten behind the measure. And Bernie Sanders has not introduced a single-payer bill in the Senate. In Chicago we spoke with Dr. Susan Rogers, a board member of Physicians for a National Health Program.

Dr. Susan Rogers: I think that it’s just politically difficult for a lot of these congressmen to take a stand for single payer, although, clearly, they cannot support the Republican bill that has been passed in the House. And even the Affordable Care Act: many people know that there are some significant issues with that. There are some positives in the ACA, of course: the fact that people can get coverage for preexisting conditions, that kids can stay on their parents policy till they’re 26. But the Affordable Care Act doesn’t eliminate the whole issue of private-insurance-sponsored health care, which is – that’s the biggest problem. That’s where all the high deductibles are coming from, the copays, the tiered drugs and all of the expenses that are being shifted onto patients. That, the Affordable Care Act does not fix.

GF: I was surprised to see even a Republican seem to admit that single payer’s time has come. That person was defending the Republican bill that would allow states to opt-out or opt-into plans, as this congressman mentioned, “so they could have their single payer or they could have our plan,” which seemed to be an admission that single payer is on the horizon anyway.

SR: That is true. I think a lot of people will say that. However, to have just a small segment of the population in a single-payer system won’t work. That’s been the problem with the public option: the people who would end up being in the public option are people who couldn’t get affordable insurance elsewhere. So here you end up with a pool of people who have a lot of medical issues at high cost. And that’s why that public option or small single-payer systems would not work. I mean, if you look at Medicare, it covers everybody over 65. We all know that’s a very heterogeneous group, in terms of some people who are very, very healthy, and some people who are high utilizers of health care. The pool works because you’ve diluted the risk: you have healthy people and sick people in the same large pool. And that’s the way a single-payer system would work. Everybody has to be in it.

GF: Single payer seems to work in every industrialized country in the world. But folks in the United States, Democrats as well as Republicans, act as if the U.S., the richest country in the world, can’t afford it.

SR: Well, we still have this assumption that health care is a commodity and that the markets dictate how it functions. Buying health care isn’t like buying a car. Everybody needs the same coverage and health care. Everybody doesn’t need the same kind of car. Everybody doesn’t need the same kind of house. So that’s where the market comes in, it’s when people have choices with things. But people talk about choice of health care, which really, when you think about it, makes no sense. Do you know what your health care needs are going to be next week? You have no clue. You assume they’re going to be what they are today, but you don’t know. That’s the whole point of insurance, is to cover you for the unexpected. So to make buying health insurance a matter of choosing what’s best for you – the whole basis of that argument is false. It’s not applicable, because you don’t know what you’re going to need. So you have to be covered for everything. And that’s why people who buy private insurance often end up being exposed to the phenomenal bills, these high deductibles these co-pays, that send them into bankruptcy.

GF: And the net result is that the United States pays more per capita for health care than anybody else in the world – without assuring insurance for everybody

SR: Yes we do. And an interesting part of that number, too, is that the majority of those dollars are already government dollars. So the government is already paying the majority of that per capita expense. Not just Medicaid, not just Medicare, but in terms of the premiums for government employees – all teachers, all policemen, all firemen. All these people get their health premiums paid for in large part with government dollars. And then when you look at the tax write-off by employers for what they spend on employees’ premiums – that’s an additional cost to the government. So the government is already spending more than other countries, and that’s without the additional cost of the costs they’re putting on patients so they have so-called skin in the game. So the government is already paying more than everybody else, so the whole idea that there isn’t money is not true. We would save so much money by eliminating all the administrative costs. It’s ridiculous the amount of time and money that gets spent in administering a system like this that is so complex and so tedious. It’s difficult even for me as a physician who had some medical issues this last year. I found it difficult to navigate the system. So I can’t even imagine how someone who does not understand health care can figure a way through it. It’s impossible.

GF: So it’s not a question of expense which is already exorbitant, but who gets paid and who profits.

SR: That is exactly true. And the ones who are going to get paid are the health insurance companies. There’s no question about that. And if you look at a large hospital, I bet they’ve got more billing clerks than they do nurses per patient. That just tells you where the money is going. It’s not going to health care, it’s going to billing. And if you look at the electronic medical record, which was supposed to be developed to make health care better – so that if you go to a hospital in New York and then see somebody in California, the two doctors should be able to talk, but they often can’t or don’t. The drive for electronic health records, EHRs, was really driven by billing. It was not driven by the need to improve health care or clinical care. It was driven by a way to bill, and that’s the whole concept. So it really isn’t helping health care. It may be a little bit because we can read the notes now of physicians with poor penmanship, but it’s not lowering medical costs. In fact it’s driving costs up.

GF: As a physician, as a person as an activist medical person, what would you like to see happen to get the Congress off the dime on single payer?

SR: I would like to see Congress get educated about this. I have talked with many people who have gone to town hall meetings and had firsthand discussions with representatives across the country. I can speak mostly to people I know who have done so in Illinois. One thing that’s clear. They talk about is just how the congresspeople are so – they don’t know what the system is. They’re actually ignorant about the problems. I hate to use that word because it’s a strong word, but some of the comments that have been made, like “Nobody has died because they didn’t have access.” I mean, where does this person live? What bubble are they living in? And that’s part of the problem – these congressmen are living in bubbles and have no idea of what everyday people go through just to get their health care needs met. And then there is this other assumption too, that the biggest driver of costs in health care are the unhealthy lifestyles of people. That may be true in the sense that some behaviors do lead to more cardiovascular disease, for example, but we have to remember we are all mortal. We are all going to get sick whether we lead a perfectly healthy lifestyle or not. So we all are going to need health care.

GF: That’s right. Almost all of us will die of disease at some point.

SR: Exactly. And even if we die of trauma, there’s still health care in that issue. So the whole idea that staying healthy will prevent you from using health care dollars is a falsehood, because we will all eventually need health care. I know very healthy people who have gotten cancer. I know very healthy people who have gotten heart disease. I know very healthy people who unfortunately lived in an area with bad air and ended up with lung disease. So it’s not just because of poor lifestyles, because obesity is a big problem. Clearly that’s a factor. I’m not denying that. But that’s not what’s necessarily driving up health care costs.

GF: That sounds like the ever-present factor of prejudice in American political thought.

SR: Well, yes, if you look at the health care industry lobby, it’s a huge lobby that has poured billions and billions into congressional races and stuff. And so that’s who people are beholden to. And unfortunately it’s been clearly shown that the congressmen are voting for their donors, not for their constituents.

GF: That was Dr. Susan Rogers of Physicians for a National Health Program.