Rep. Dennis Kucinich speaks with Truthdig contributor Joshua Scheer* about the state of healthcare in America, his bill with Rep. John Conyers to provide universal coverage and why progress is inevitable.
What kind of healthcare [do] congressmen get—what kind of healthcare do you have?
Well, we pay for our healthcare. I mean, our healthcare is deducted from our salary. You know, we can opt for what kind of plan we want. The more comprehensive coverage you have, the more you pay. The solution to the nation’s healthcare problem is not to deny members of Congress healthcare coverage. It’s to make sure every American has the access to quality healthcare, and the only way to do that is for Congress to pass a bill that would provide for universal not-for-profit healthcare for all Americans. There’s a bill called “Medicare for all,” and this bill in this current Congress is HR 676—the Conyers/Kucinich bill.
That bill—it’s Conyers and you? Do you think it’s going to pass?
There are 75 members of Congress signed on in support of the bill. We recognize that there are 46 million Americans who don’t have health insurance, and there are another 50 million Americans who are under-insured; that the cost of healthcare has gone out of the reach of a large number of Americans, and so there’s only one real solution, and that is to make healthcare not-for-profit. I mean healthcare should be established as a basic right in a democratic society. Every industrialized democracy has healthcare for its people. ... You know, when I traveled the country as a candidate for president, the two issues that came up most consistently were healthcare and the integrity of the election process. Healthcare is one issue that unites Americans across party lines, across income lines. Because every person realizes that a single illness in a family can wipe out that family financially. So healthcare and the accessibility and affordability of healthcare is central to the government’s responsibility to provide—to promote the general welfare.
When you look at the fact that there are 46 million Americans without health insurance—another 50 million under-insured—when you see that businesses are cutting back sharply on healthcare benefits—at the bargaining table, labor is faced with giving up their hard-fought healthcare benefits—when you see that trade, meaning in this case jobs that move out of our country—there is an acceleration of jobs going out of the country because workers are not paid benefits in a number of countries where the jobs move to. Chief among those benefits is healthcare. Healthcare is central—it’s a central question— and it defines who we are as a nation and what we can become as a nation. We are already paying for a universal system of care, we’re just not getting it. ... Close to $2 trillion a year is spent for healthcare in America, but one out of every four dollars goes for the activities of the for-profit system: corporate profits, executive salaries, advertising, marketing, the cost of paperwork—anywhere from 15 to 30 percent, as compared to Medicare’s 3 percent. And so a for-profit healthcare system is crushing everyone, except the insurance companies. It’s crushing workers, who may actually be working 40 hours a week and not have healthcare coverage. It’s crushing businesses, particularly small businesses, who are finding that they cannot afford healthcare for their employees. It’s causing major manufacturers to renege on commitments they made to their workers years ago and to retirees years ago for healthcare.
The high cost of healthcare and healthcare for profit has transformed American society and has been a powerful engine for accelerating the wealth of the nation upwards. And so what I’ve advocated with John Conyers is HR 676: universal single-payer not-for-profit healthcare, which provides that everyone’s covered for everything. And we’re already paying for a universal standard of care—we’re just not getting it because—if you took that almost $500 billion a year and put it into healthcare in the form of a universal system, we would have enough money for all basic medical care, plus dental care, vision care, mental healthcare, long-term care, prescription drugs and even broader coverage. We’re already paying for this. We’re not getting it. We need to have the end of healthcare for profit in the United States and the beginning of a healthcare system which helps those who don’t work or can’t work, which helps workers, small businesses, manufacturers. This could be—this single move towards healthcare for all can bring about a dramatic shift in the American economy and in the lives of every man, woman and child in the United States.
If I’m interested in the plan and I want to know more and make my voice heard, how do you suggest going about that?
You have to start by talking to people in your family and your neighbors, because everybody is affected by this. I mean, this is a moral question. Martin Luther King says of all the forms of inequality, injustice in healthcare is the most shocking and inhumane. And when you have—I think it was 82 million people spent part of 2002 and 2003 without health insurance, and when you understand that the uninsured include—half of the uninsured are people who are employed ... certainly people have to talk to their congressman, but already there are over 14,000 physicians for national healthcare who are advocating this plan. The American manufacturers are starting to take a more careful look at how healthcare can benefit their industries. When you see that Canada, for example, has long maintained a competitive advantage in various manufacturing sectors vis-a-vis the United States because they provide healthcare. And all of Europe has had a competitive advantage against the United States because they provide healthcare. When you understand that, for example, you remember General Motors? They had a big, big debate a few years ago about their healthcare costs—they spent $5 billion in 2003 for healthcare—that was like $1,200 per car—and when you see how GM has gotten into financial trouble, one of the reasons is their healthcare costs. And all these Americans ... don’t have health insurance because their employer either dropped their coverage or people can’t afford the insurance.
And you look at medical bankruptcies, Josh, there are millions of bankruptcies in America now and about half of them are related to the cost of medical care. And people are filing bankruptcy—I think it was in 2001, there was a study that three-quarters of those who filed [for] medical bankruptcy had health insurance at the start of—at the onset of the illness. This is a huge problem for middle-class families because people are postponing needed care, they’re having trouble paying their bills, they aren’t getting the drugs they need, the collection agencies are on top of people. ... A lack of access to healthcare is one of the reasons why the United States has had higher infant mortality rates as compared to Germany and Australia, Norway, Sweden and Canada. You know, lower life expectancy, less continuity of care.
People are having difficulty getting needed care. I mean, think about this: Life expectancy in Sweden and Italy and Canada and France and Germany and the UK—it’s all higher than the U.S. And this despite the fact that we spend over $2 trillion a year. So ... throughout my district, I’ve been holding town hall meetings on the issue of healthcare and discussing this with people, my constituents. ... As a candidate, I was promoting this, and we had some real challenges that have to be overcome in the Congress in order to make it possible for people to get the care that they need. ... This really is the single most important economic issue confronting the United States right now.
You’ve said the money’s already there ... there’s not going to be a problem paying for this ....
Well, yes. Now here, a woman whose name is Dr. Marcia Angell ... a few years ago ... when Conyers and I introduced our bill, she said that—and this is a woman who was the editor of the New England Journal of Medicine—she said that she’d estimate that no more than 50 cents of the healthcare dollar actually reaches the providers. So if you’re talking about a little more than $2 trillion, where does the rest of the money go? And where it goes is to, you know, you look at some of the executive compensation where people running these healthcare companies are making tens of millions of dollars a year; when you look at the fraud that’s involved in the system, the drug company profits, how people are paying so much more for drugs than they should be—look at the crooked deal that resulted in ... Medicare being strapped with a law that forces them to pay whatever the drug companies ask for drugs ... the Medicare Part D drug plan forbids the government from negotiating lower prices with the drug companies, and it banned the Canadian import of drugs, and it paid only 30% of that first $5,100—the so-called “doughnut hole”—and forced coverage through private plans.
It resulted in windfalls, subsidies and profits for private plans and managers and—I mean, there are so many things wrong with it, but [the worst] part of it was it guaranteed $150 billion in drug company profits. And, of course, it was not a surprise that the drug companies turned around and rewarded Congress handsomely with big contributions during election cycles. And, you know, any time you’re talking about a for-profit system, the costs are higher. There’s fraud, there’s higher overhead, there’s fewer nurses, the quality is worse, death rates are higher. You get more citations on poor quality and, as far as the doctors—more and more doctors are favoring the approach that I’m talking about because they don’t want the insurance companies to be making the decisions—about the doctors, about the tests, about procedure, about length of stay, about medication—and what we’ve seen in healthcare has been a tremendous increase in administrators as opposed to physicians over a period of about 20 years. So, I see this change coming. It is going to happen, because there is an awareness that government has failed the American people in this regard, and it’s an economic issue, it’s a moral issue and it’s central to who we are as a nation.
So for-profit medical companies have as much bureaucracy as ... the government-run [program]?
It’s not just the bureaucracy, Josh, it’s the amount of profits they make with their product. The VA negotiates a price for drugs with the drug companies. Under the Conyers/Kucinich bill, the government can negotiate for all the people in this country with the drug companies and benefit from high volume. I mean, if the drug companies don’t want to negotiate, the government could start making its own generic brands if it wants to, but we shouldn’t have to do that. The drug companies already negotiate with the VA, but in Medicare Part D, in order to protect over $100 million in drug company profits, the administration saw to it that cost controls were taken off. So you have to go back to—what is it the people want with healthcare? They want guaranteed access. They want freedom of choice as far as their doctor. They want high quality and affordability. They want to be able to trust the system. And that’s not what they’re getting right now. So what I’ve been doing—John Conyers is the senior member whose name is first on the bill, but John and I have been working together and I’ve been organizing members of Congress on this, to get people to be involved in supporting this universal single-payer not-for-profit healthcare system, and this is really an idea whose time has come and one for which there’s broad support.
I’ve got one more thing to say about it, if I may, and that is—I went to the Democratic platform committee in 2000 with Lila Garrett, Tom Hayden [and Gloria Allred] where I offered a presentation that the Democratic Party take a strong stand on universal healthcare. My proposal, unfortunately, was rejected. I brought the same proposal embodied in the Conyers/Kucinich bill to the Democratic platform committee in 2004. Once again, the plan was rejected. Both times the plan was rejected because of the unfortunate influence of corporate interests upon the Democratic Party hierarchy. And so it is urgent that the American people are aware that our political system has frustrated the emergence of healthcare for all because of the tremendous influence which the insurance companies and the drug companies have on our political process. It doesn’t mean that this influence is fatal, but people need to know that it exists.
You’ve just said it’s not fatal, but do you think this is going to hinder the Conyers/Kucinich plan this time? Or do you think you have enough support now that the Democrats are in power and they won on these kinds of issues like healthcare, the minimum wage and the war?
I see healthcare as being the defining domestic issue in 2008. It transcends every other issue. It relates to quality of life, it relates to economic productivity, it relates to wages, it relates to trade, it relates to our ability to have a government we can call our own. It relates to the foundational purposes of the United States of America as outlined in the very preamble to the Constitution. This really is a great cause that we should all be involved in. And so my commitment on this has been very strong, and I think that when you go out across the country as I have, and you hear from the people and you see the amount of economic jeopardy which exists because of a lack of—either a lack of access to or affordability—then you know that one must take a stand, that healthcare is a right, and that the current healthcare system is not adequate, and that we have to fulfill the purpose of our nation to promote the general welfare.
*Interviewer Scheer worked as an entry-level staffer on Kucinich’s state Senate campaign and was later a summer associate in his congressional office. In this weekly interview series, Rep. Kucinich gives his take on the goings-on in Congress in the wake of the Democrats’ victory.