Republican political leaders have long treated the Affordable Care Act, or Obamacare, as a devilish plot and used it to stir up voters across the country. Now they have released their own plan to reverse the “cursed’ ACA and the response has not been positive. I recently sat down with Dr. Adam Gaffney, an instructor in medicine at Harvard Medical School and a pulmonary and critical care physician, to discuss the state of healthcare in the United States. This interview was edited for length and clarity.
1/ Republicans promised to end Obamacare and despite some divisions seem prepared to do so. What’s the political climate around health care in this country and why do you think, given the grim outlook, universal healthcare is a viable option?
The conversation around healthcare in this country has changed. My sense is that it is becoming increasingly untenable, from a political and certainly moral perspective, to oppose the idea of universal healthcare. A Gallup poll last year found that 58% of Americans wanted a federally-funded healthcare program that provided insurance for everybody (i.e. single payer). So what is a right-winger supposed to do in such an adverse environment? “Go die in the street” simply doesn’t work.
2/ There seems to be a general misconception about the access to health insurance vs. the access to adequate healthcare. As a provider, can you explain the difference?
What I believe is happening is that those who oppose universal healthcare are employing creative rhetoric in order to give their ideas the veneer of universalism. From this you get the idea of “universal access”—which means access to purchase private health insurance plans.
This came up in the recent Sanders-Cruz healthcare debate when Sanders asked Cruz how he felt about the idea of a right to healthcare. Cruz responded with some nonsense about how everybody should have access to buy health insurance. Sanders had the right reply, which was ridicule. There is a massive difference between having access to purchase a commodity and the realization of a universal social right to a particular good or service. In any system in which healthcare is not treated as a universal social right and instead as a commodity (even if partially subsidized), almost by definition many will be excluded from needed care.
3/ Have you ever not been able to give someone a specific treatment because it is not included in their insurance plan?
I currently work in a safety-net institution that provides equitable care for everyone who comes to it. However, every day in this country, people are not taking medications, skipping doctor’s visits, and delaying going to the emergency room either because they are uninsured or because of inadequate coverage.
4/ Many people argue that health care is not a right? What is your opinion as a doctor?
We should create a right to healthcare in the country, which has been done to varying extents in other countries. If we want to be philosophical, I would say that a right to healthcare can easily be defended on the basis of human equality; from that understanding of equality comes the idea that we should have access, on an equitable basis, to a number of social and economic goods. And as a doctor, I find it abhorrent that people live and die—which they certainly do—on the basis of whether they are insured or not. I find it abhorrent that people may use a twice a day medication once a day in order to save money on copayments. I find it terrible that, as one study shows, the uninsured or those with financial worries delay seeking care when having a heart attack. And as a critical care doctor, I am horrified by the notion that somebody could go bankrupt because of a catastrophic illness, which is unfortunately what I often have to deal with.
5/ Paul Ryan has hinted for a while now that he would like to see our Medicare system privatized. However, with the introduction of Medicare Advantage plans by Humana, Cigna HealthSpring and others, hasn’t Medicare already become partly privatized?
Yes, that is a very good point. We talk a great deal about Medicare-for-All, but the truth is that Medicare currently has a number of significant deficiencies. First, there is too much “cost-sharing”: many seniors still have to pay a significant amount out-of-pocket for healthcare, unless they have secondary “Medigap” plans that cover these expenses. Additionally, Medicare doesn’t cover some important forms of healthcare, for instance, dental care or long term care. Second, there is the issue you bring up, which is Medicare privatization. The biggest problem with these plans is that they waste more money on administration and overhead, while also having a long tradition of gaming the system to increase profits. So when we say “Medicare-for-All”, we mean a better, broader, and fully public Medicare-for-all system.
6/ What would be the main benefits of universal healthcare?
The benefits are multifold. One, you eliminate un-insured Even if the Republicans don’t touch the ACA, between 25-30 million are going to remain uninsured in this country moving forward. This is unacceptable. Second, you eliminate underinsurance. We envision the end of copayments and deductibles, which other countries, including the UK and Canada, have already achieved (with some exceptions). Third, you save enormous sums of money—hundreds of billions in administrative waste and in excessive pharmaceutical spending. Fourth, you create “one big network” of doctors and providers. No more in- and out-of-network, you can go to the doctors and hospitals you please. Fifth, you create a single tier of access for all, bringing us closer to the goal of health equity.