Dr. Margaret Flowers on the Upcoming Supreme Court Decision and the Future of American Health Care

photo credit: Mark Almberg

Thank you for asking, Joan. My colleagues at PNHP [ Physicians for a National Health Program] have been focused on a number of fronts. While we all believe that the simplest and most just way to reach single payer is to create a national single payer health program, there are efforts in many places to pass single payer at the state level. Vermont is leading the way with its "Health care is a human right" campaign and its new health legislation. Other states, such as Maryland and Oregon, are following Vermont's lead and creating similar rights-based campaigns. There is also a strong campaign led by Dr. Rob Stone of Indiana to encourage socially responsible investing which includes divestment of stock in private for-profit health insurance corporations such as Wellpoint. 

 
At present, we are also focused on the Supreme Court case regarding the constitutionality of the individual mandate in the Affordable Care Act (ACA). Single Payer Action, ItsOurEconomy.us and 50 physicians filed an amicus brief with the Supreme Court arguing that the individual mandate is not necessary because it will not achieve the goal of universal, affordable and guaranteed health care and in fact, a single payer health program is the best and simplest way to achieve this goal.

Opposing the individual mandate in the Affordable Care Act is viewed by many as a controversial and perhaps counterintuitive move. Are you and your colleagues being unrealistic and hard-nosed? Isn't what ACA has accomplished, while perhaps not great, better than nothing?

What we are seeing on the right and the left is a lot of confusion about the ACA and partisanship rather than a focus on the actual policy. The individual mandate provision is an idea that came from the Heritage Foundation and was used to counter health reform during the Clinton years. Then, Governor Mitt Romney used the individual mandate as an anchor in the Massachusetts state health bill implemented in 2006. President Obama opposed the individual mandate initially during his campaign but ultimately came to embrace it. Now we find Democrats aggressively defending the individual mandate and Republicans opposing it. One can imagine in this environment that if McCain was president, the Democrats would be opposing the mandate and Republicans would be defending it.

So let's put partisanship aside and look at the individual mandate. It forces people who do not qualify for public health programs like Medicaid and Medicare to purchase private insurance under penalty if they fail to do so. This further entrenches the insurance industry as part of the health care system and further empowers private insurers with hundreds of millions in public dollar subsidies. If you believe that the solution to our health crisis is to have more people with private insurance, then one would support the individual mandate.

However, it is actually the private insurance part of our health care system that is the source of many of our problems. It is the part of our health care sector that is least efficient and that places obstacles to care because the private insurers' bottom line is profit, not health. The individual mandate puts us further down the road to a market-based health system and this is the opposite direction that we need to go. The argument that the ACA is an initial step and can be improved upon is a false argument and does not hold water from a health policy standpoint. The ACA is a step in the wrong direction.

What would be a first step towards a universal, guaranteed and affordable health care system would be to initially expand Medicare to cover everyone. This would move us away from a market-based system to a nonprofit, publicly-financed system. We would then need to tweak Medicare in many ways to improve it and would have to concurrently build a national health program that used health planning to utilize our health resources in the way that meets the needs of our population.

Are there beneficial parts of the ACA? Of course there are. Every health bill has beneficial aspects and they are used to divide people. If the bill is better for women and children, then groups that advocate on behalf of women and children fight to preserve it and ignore the fact that others are left out. Attempts have been made to patch together our current system at the state and federal level for decades. None of these attempts have addressed the fundamental problems and none have moved us forward - our health care costs continue to skyrocket, we continue to have tens of millions who are uninsured and our health outcomes are still poor compared to what they should be for the money we are spending on health care.

If we truly want to create a health care system that works for everyone, then we will have to be persistent and clear in our demand for a system that works for everyone and that's single payer. If we believe that health care is a human right, then we must believe that everybody should have health care. And if we continue to accept the crumbs that are handed out and not have the courage to insist on real reform, then we will not get real health reform. So, in my view, it is those who ally themselves with political agendas rather than focusing on the issue that hold our progress back.

What happens to our health care if the individual mandate is struck down by the Supreme Court? Are we back to square one? Many are concerned that we'll be even worse off than we are at the present. Congress is so beholden to the health care lobby that single payer seems more and more of a pipe dream.

If the individual mandate is struck down and the rest of the ACA is kept intact, we will see the true nature of the private health insurance industry - an industry that sells insurance to make a profit and that profits by denying and restricting care. We will see premiums skyrocket and more care denied.

If the individual mandate is struck down and the ACA is considered to be 'unseverable,' meaning that the whole legislation is struck down, then we will be at square one. This provides a real opportunity. The majority of the US favors single payer. All of the evidence points to single payer. The Occupy Movement is a manifestation of social unrest. All signs point to the fact that Congress and the White House are beginning to fear the people.

This is our opportunity to push for single payer. After the passage of the health bill, Ezra Klein and others started to admit that if the ACA fails, the US will have to seriously consider Medicare for All.

And the truth is that the ACA is going to fail. It will follow the same path of similar legislation that has been passed in the US previously. Either the cost of health care will become even more unbearable, or as has happened in Massachusetts, people or health benefits will be cut. Even those on the Deficit Commission who don't support single payer admitted that lack of control of our health care costs is the greatest problem for the US economy.

The longer we wait to pass the inevitable, the more people in the US suffer, die or go bankrupt. This is our opportunity to push for the inevitable.

In May 2009, you and a number of other health care providers were arrested at the Senate hearings on health care. You've been at this for a long time. Can you tell our readers a little about your background, Margaret? What makes you care so much about this issue?

I am a pediatrician. I went into pediatrics because I believe in the importance of providing children with a healthy start in life as one of the best ways to lead to a healthier population. My vision as a physician has always been that every person should have the same high standard of health care and that every person should have the opportunity to reach their full potential.

When I was in practice as a hospitalist at a rural hospital and then in private practice, I experienced the obstacles to delivering high quality care that are created by our current health system that relies on private insurers whose bottom line is profit, not health. I had to find ways to keep children in the hospital if they were not ready to go home but the insurer wanted them to be discharged. I was pushed to see more patients and spend less time with them. This was counter to the way I thought I could provide the best care for my patients.

I then became involved in health reform and the more I learned, the more my eyes were opened and I could not close them. The United States is the only industrialized nation that uses this market model for health care and it is failing us. Our health care costs are rising out of control and our health outcomes are relatively poor. I could go on and on, but the bottom line is that we have the resources in this country to provide high quality lifelong comprehensive health care to every person and the reason that we don't is because the corporations that profit off of the current system are writing the laws in their favor. This is unacceptable to me. I believe it is my professional responsibility as a physician to speak out about this and to do all that I can to change this situation.

Anything you'd like to add, Margaret?

Probably but I'm so swamped!

I bet.  Thanks so much for bringing us up to speed on the current health care debate.  Hope to talk to you again soon!