trump single payer healthcare

paul jay: welcome to the real news network.i'm paul jay in baltimore. the debate about health care is continuing.supreme court has found what people call obamacare constitutional. it will come into full forcein 2014. but proponents of what's called single-payer health care or government-run health insuranceplans are continuing to fight, and the evidence seems to be on their side. those countriesthat have government health insurance plans, people live longer and the cost of the healthcare is less. now the fight in the united states seems to be moving to the state level,because there doesn't seem to be much that's going to happen at the national level, atleast in the foreseeable future. and one of those states is maryland. and a recent studylooks at what would single-payer health care

look like in the state of maryland. and now joining us is the author of that study,gerald friedman. he's a professor of economics at the university of massachusetts in amherst,and he did this study for health care for all maryland. thanks for joining us, gerald. gerald friedman: thank you for having me. jay: so before we dig into some of your research,just sort of give us the bigger picture of why this would make sense for maryland. friedman: well, the big picture is that healthinsurance provided by competing private companies is inherently inefficient and destructiveof people's health. i mean, that's a strong

statement, but i think it is well founded. the problem with private health insuranceis that it's not like selling shoes. if you're a shoe company, you want to sell more shoes,you want to make a better quality shoe at a better price to attract more business. healthinsurers don't want more business. they want to get rid of sick people. eighty percentof your costs as a health insurer are incurred for about 20 percent of your people. you know,in some places it's 90-10--90 percent of your costs go to 10 percent of the people. if youcan find those people, identify those people, and figure out a way to get them to go away,go to a different company, then you will be in a position to lower your prices and increaseyour profits. that is what health insurers

try to do. jay: let me interject for a second. therekind of is that in maryland, is there not, where the state actually takes people thata lot of the private insurance companies don't want and puts them through this maryland plan. friedman: yes, exactly, exactly. one aspectof--the president's law, obamacare, the affordable care act, has provisions to try to restrictthis behavior by companies. until those provisions, the ban on preexisting conditions, until thatkicks in, states have been subsidized from the federal government to set up these carepools for special insurance for people who can't get insurance otherwise.

overall throughout the united states about100 million people have some condition that an insurance company would look twice at orthree times at before giving you insurance. certainly if you've ever had cancer, insurancecompanies don't want you. if you have hiv, insurance companies don't want you. if youhave an obsessive-compulsive disorder, a history of chronic depression, if you're overweight,if you have heart disease, if you have high blood pressure--. jay: or if you're pregnant. friedman: or if you're pregnant, that's right,or if you're pregnant, insurance companies don't want you.

jay: unless they already have you. like, ifyou haven't been insured--and i happen to know this through personal experience recently--ifyou haven't been insured, you can't go out and get new insurance if you're pregnant,except through this pool that the state creates. so isn't this some form of indirect subsidyto the insurance companies? like, we'll take the most serious conditions, publicly financethem one way or the other, and you can keep your pool nice and profitable. friedman: exactly. exactly. the high-riskpool is a subsidy to the insurance companies during this interregnum until 2014 when thewhole law kicks in, and then they are supposed to take everybody. but in fact they'll stillfind ways. they'll--the fastest-growing cost

center in american health care is administrationof the health insurance industry. that has risen in cost eightfold since the 1970s. andthat--if you compare the united states and canada, two-thirds of the extra increase incost for health care in the united states is accounted for by rising administrativeburden in the united states compared to canada. jay: now, i know in one of the papers youwrote, there's a cartoon, and it's kind of ironic, that one of the arguments againsta government insurance plan is it would be too bureaucratic. but the facts don't leadyou there, do they? friedman: no, they don't. they don't. justto give you the raw number, the cost of administering the existing medicare system, the traditionalfee-for-service medicare, is 2 percent--that

is, $0.98 out of every dollar that goes intomedicare goes out to pay for services, health care services. by contrast, the mandate inthe affordable care act is that insurance companies get up to 80 percent. so the health insurance industry admits thatit is ten times less efficient than medicare. they have ten times as high an administrativeburden in the private insurance system. and the reason they do that is not because theylike to waste money; it's that they use their bureaucratic apparatus to screen out sickpeople. they make it hard for you, they try to identify you, they try to scare you awayfrom procedures that you need, in the hope that you will leave after a while.

jay: i'll give it a--i can give a--now letme just explain the parameters of all of this interview we're doing for our viewers. we'regoing to do a series one after the other where we're going to dig into this proposal formaryland and talk about this health care issue. so this is part one. and i won't know howmany parts it is until we get to the end. i'll give you one example recently. we'vejust had two little twins, and they're in the neonatal unit, and the decision to movethem from the neonatal unit to a lesser-care facility is essentially going to be made bythe insurance companies. the insurance companies have people that are micromanaging these files,and they're looking at exact--studying individual care of people and then deciding what thenext step should be. i mean, they won't fight

it based on a hospital saying the hospitalmust keep the kid here, but they've created the criteria when the kid should move, notthe hospitals. friedman: yeah, yeah, as if they have a licenseto practice medicine. i mean, this is standard practice in america these days, that healthinsurers are practicing medicine, they're dictating which drugs are approved on theirlist, so that if your doctor wants to prescribe a different--give you a different prescription,well, sure they can prescribe, but the insurance company won't necessarily cover it. they say,no, you should take this other drug. they want to prescribe how long you're going tostay in the hospital, which second opinion, which specialist opinions are needed, whichprocedures are appropriate. i mean, this is

all done by insurance companies. jay: and let me add, 'cause people that watchthe real news know i'm a dual citizen, and i still get health care in canada as well,and you don't get the micromanaging that--like this in the ontario health care system, forexample. there's very broad parameters that are established by the insurance system, butthen all the decisions are really made by doctors after that, not, you know, gettingphone calls from the insurance company. friedman: and we see the difference. the unitedstates and canada had about the same life expectancy in 1971 when medicare, canada'shealth insurance, was enacted. you know, about the same life expectancy, and we were bothpaying about 7.5 percent of our gross domestic

product to pay for health care. so we havevery similar situations. now, since then, canada has added 6.5 yearsof life expectancy, compared to five years of life expectancy added in the united states.so canadians now live longer than people in united states, a year longer, and canada'sexpenses have gone up to 10 percent of gross domestic product while we've gone up to 17percent. so we're spending a lot lot more to get lessthan canada's doing. the difference is the cost of administering these health insurancecompanies, all those people supervising the doctors, and all the time that the doctorshave to spend dealing with the health insurers. jay: so i'm going to jump in. so we're goingto pick this up in part two of this series

of interviews and we're going to dig intothis proposal for maryland and just see where these cost savings would be and compare whata single-payer plan in maryland would look like compared to the existing for-profit insuranceplans. so join us for the next in this series of interviews with gerald friedman on thereal news network.