Above Photo: President Joe Biden gives remarks on the status of COVID-19 in the United States from the South Court Auditorium at the White House campus on Oct. 25, 2022, in Washington, DC. Anna Moneymaker/Getty Images.
When the national emergency for COVID-19 ends on May 11, between 5 to 14 million Americans will lose Medicaid coverage.
The Biden administration is poised to allow the national emergency on COVID-19 to expire on May 11, 2023. Once that occurs, between 5 to 14 million Americans previously covered under Medicaid will lose their insurance. Although the pandemic continues to rage, killing thousands and infecting hundreds of thousands each week, a bipartisan consensus has settled in Washington to simply pretend COVID-19 is “over.” What meager safety net was extended at the start of the pandemic is now being rolled back—leaving Americans to shoulder the risks and expenses of illness and death entirely on their own.
Dr. Margaret Flowers joins The Chris Hedges Report to discuss the toll that COVID denialism will have on our society, and the generally outrageous state of US healthcare.
Dr. Margaret Flowers is a pediatrician and activist for single payer healthcare. She served as co-chair of the Green Party of the United States until 2020, and is currently an adviser to the board of Physicians for a National Health Program.
Studio Production: Adam Coley, David Hebden, Cameron Granadino
Post-Production: Adam Coley, Cameron Granadino
The following is a rushed transcript and may contain errors. A proofread version will be made available as soon as possible.
Chris Hedges: The National Emergency and Public Health Emergency declarations related to the COVID-19 pandemic will terminate on May 11th, 2023. These emergency declarations in place since 2020, waived or modified requirements in a range of areas, including in the Medicare, Medicaid, and chip programs, as well as in private health insurance. The end of these special measures will see between five and 14 million Americans lose their Medicaid coverage according to the Kaiser Family Foundation, more than 30 million Americans already don’t have health insurance, and millions more are under insured. Even with insurance, medical costs are so high, the medical bills are the cause of bankruptcy for half a million people a year, the number one cause of bankruptcy in the United States. The average American spends more than $12,500 per year on personal healthcare, some $4 trillion annually. A citizen in France spends $5,468, in Canada, $5,905, in Germany, $7,382 for Universal Care.
The organization for Economic Cooperation and Development found that despite the high cost of US healthcare and nearly every critical ranking from life expectancy at birth and deaths from avoidable conditions, the US consistently ranks at the bottom. 68,000 Americans die every year because they are uninsured or underinsured. This is because the US healthcare system does not serve the public, it serves the medical insurance and drug companies whose lobbyists gut regulations and block healthcare reform.
In 2020, the CEOs of 178 major healthcare companies collectively made 3.2 billion in total compensation, that was up 31% from 2019, all in the midst of the pandemic. According to Axios, in 2020, the CEO of Cigna took home $9 million, the CEO of Centene made $59 million, the CEO of United Health Group received $42 million in total compensation. The CEO of Moderna got a $926 million golden parachute after his company received $2.5 billion in taxpayer dollars from the Trump administration to develop its COVID vaccine.
These huge profits were being made when over 330,000 Americans died during the pandemic because they could not afford to go to a doctor on time. Joining me to discuss the debacle that is the US Healthcare System is Dr. Margaret Flowers, an advisor to the board of Physicians for a national health program, and one of the country’s most prominent advocates for single payer health insurance. Margaret, let’s begin with how we got here, there was a proposal several decades ago, I believe it was under the Trump administration, I can’t remember, for single payer that got stopped, and then bring us up to where we are today.
Margaret Flowers: There’s actually been a movement for a national health insurance for more than a hundred years now in the United States. And David Barton Smith writes beautifully about this, the movement keeps compromising just as it did in 2010 under the Affordable Care Act. But profiting off of healthcare was not legal in the United States until the 1970s under the Nixon administration with the Health Maintenance Organization Act, and there’s a tape of Nixon saying, the companies can make a lot of money off of this.
But Reagan really took it to another level when he brought investment firms into the Department of Health and Human Services and trained them on how to take over healthcare, is what they called a fertile field for making profits. And so since that time, not only have we seen the consolidation and privatization of our healthcare system, but the public portion of our healthcare system, Medicaid and Medicare are also majority privatized now to the point where for the top five major health insurance corporations, more than half of their revenue just comes from being paid by the government for running Medicaid and Medicare. So it’s eating into those public systems that we were trying to preserve to at least have some space in our healthcare system that was about taking care of people and not making profits.
Chris Hedges: Let’s go back to Obamacare. You were very involved in fighting for single payer, Obama promised that single payer universal healthcare would be an option, which under pressure from the insurance and pharmaceutical industry, he removed, it never was. But you called out, I think in retrospect you’ve been proven right, you, Kevin Zeese, and other activists. But talk about that seminal moment because it’s an important moment, and I remember hearing you speak, you knew what was coming.
Margaret Flowers: It was an important moment for me personally as well. Physicians for National Health Program is based in Chicago where Obama lived, one of the leading members, he’s deceased now, but Dr. Quentin Young was in the practice that treated Obama for healthcare. And as a state Senator, Obama used to go around with Quentin Young and others saying, healthcare’s a human right, and somewhat, he was trying to give that message during the campaign.
But then we have to recognize, I think he was one of the first presidents that received such huge amounts of money from the health insurance corporations, the pharmaceutical corporations. And so we thought we might have some seat, but it was very clear from March of that year, 2009, when he came into office, he was holding a summit at the White House and he was inviting the health insurance corporations and the pharmaceutical companies and no proponents of a single payer system. And we protested that, and finally they did let a few in, but it was really for show not substance.
And so at every bit of that fight, we were excluded. In fact, they designed and supported alternative organizations to convince people who would otherwise support a universal single payer healthcare system that, that was not achievable, that this is what you can have and this is what you should be fighting for, and so divided the movement from the get-go. And I was a congressional fellow for Physicians for National Health Program, we met with members of Congress beginning in December of 2008 saying, just compare our proposal to yours. And as soon as the hearings began, it was clear that they were not going to include us in any way. The business round table was there, the chamber of Commerce was there, the CEOs were there, but we weren’t there. And so that’s when we had to step up and say, people need to know what’s going on here, this is being written by the corporations and not in the interest of people.
Chris Hedges: Well, it was Liz Fowler is that her name?
Margaret Flowers: Liz Fowler was the architect, former vice president of WellPoint, one of the large insurance corporations. And she wrote the white paper and she with Max Baucus, who was the chair of the Senate Finance Committee, they really shepherded and oversaw that whole process. And then Obama appointed her to write the regulations at department of Health and Human Services, and now she’s wreaking havoc in Medicare, fully privatizing Medicare through this new center for Medicaid and Medicare innovation.
Chris Hedges: I remember the time you saying the American public was being forced to buy what you call this defective product. And you talked about how there would be no control over so called copays, which of course, is proven to be correct. Take us from that point to where we are now, and we’ve seen all horrible moves by the pharmaceutical industry like insulin. Talk a little bit about how people are being priced out of medication which they depend on for their very survival.
Margaret Flowers: Let’s look at the environment at that time where about 50 million people in the United States didn’t have health insurance, and so there was a demand to do something. And the health insurance corporations were panicking too because they wanted those people to be buying their product, and so the solution to them was force everyone to buy it or pay a penalty. And this was a new level of, not only was the government saying you have to purchase private health insurance, but we’re going to set up a market and we’re going to sell it for the insurance companies and we’re going to give people money to help them pay the premiums to the health insurance companies.
The health insurance corporations get hundreds of billions of dollars of subsidies every year. And there was this message, they were trying to say, well, this is going to bring prices down because the health insurance companies are going to compete with each other and they’re going to have to lower their prices. No, they carved up the market and so most people have very little choice of which health insurance companies they can buy a plan from in their area. And while they said that people can’t be denied on the basis of a preexisting condition, what the insurance companies did, is they look at the regions and if they’re not making money in a certain region, they could just pull out. And so that’s how they get around having to actually pay for care.
Since then, health insurance premiums continue to rise, the out-of-pocket costs continue to rise. And what’s really interesting, again, a new level of atrocity is that, because now these mergers that have happened where the hospital corporations have their own insurance, they own the labs, they own the practices, if a doctor actually is trying to provide too much care to their patients, they can just pull their health insurance, kick them out, and then they lose all of those patients.
Also, if a certain department pediatrics, OBGYN, psychiatry, if it’s not making money for the hospital, they just shut the entire department down. That’s happened in Maryland through our nonprofit MedStar. They gave two days notice at one hospital that serves a majority Medicaid population, they were shutting down the entire pediatric department, including the pediatric emergency room, the Center for children who’ve been abused, shut it down.
Chris Hedges: Let’s talk about drug prices.
Margaret Flowers: And drug prices-
Chris Hedges: And also the way they’ve closed, those in rural populations are even being served?
Margaret Flowers: … Well, when it comes to drug prices, what people need to know in the United States, is that there is no rational basis for the pricing of any of our healthcare services, it’s basically what they can get away with. And so that’s what we see in the pharmaceutical corporations, not only charging as much as they can for medications that people’s lives depend on, so what choice do you have? You have to pay that price, but also, for certain medications that are not expensive to make, but they can’t make as much of a profit off of it, they just stop making. So it’s not about health or what we need, it’s about what that market can get away with.
And people should know that when they bring these new drugs on the market, most of the time they’re just tweaking a chemistry from the previous one, but they patented, they give it a new name, they don’t have to prove that it’s better than what they had before. So they pay their whole army of drug pushers to go out into the practices and strong arm the doctors to sell their products, so that’s not in the interest of people at all.
And then we talked about our hospital supply, particularly in the rural areas, but also in low income urban areas, these corporations come in, they buy up the hospitals, they run them into the ground, and then they just sell them off to be developed in the cities. They become luxury condominiums in the rural areas, they just shut them down. And this really destroys some of these small communities because in some places that local hospital’s a big provider of jobs, but also might be the provider of services like an ATM machine or the other things that they couldn’t get in their town.
And so in the United States in 1975, we had about 1.5 million hospital beds and a population of about 216 million people. Now, with a population of over 330 million people, we have around 925,000 beds, so we’ve lost a significant number of beds. And that hurt us during the pandemic when we saw our hospitals getting overwhelmed and we just didn’t have the facilities to handle these patients.
Chris Hedges: It is racialized in a sense that it’s poor people of color who pay the worst price in terms of mortality statistics, especially. There was an article in the New York Times that poor people on insulin are trying to ration their insulin, they’re not taking the full dose, but this, of course is, if not ineffective, it’s certainly harmful. But let’s talk about that racial component.
Margaret Flowers: Well, in the United States healthcare system, let’s be honest, it’s been a racist system from its very onset. And that continues today and I think there’s starting to be a little bit of a reckoning that, we do have a racist healthcare system. But look at the COVID-19 pandemic, because that really exposed this problem, and part of it was not prioritizing communities of color and getting masks and vaccines and things that they needed and education out to them.
Part of it was that, there is a justified distrust of the US healthcare system by a lot of people who live in Black communities because they haven’t been treated fairly and have been actually experimented upon, let’s be honest, with no regard for their health or their lives. And then look at who are the essential workers and how were they treated and not being forced to work in conditions where they knew that they were facing risks of getting sick or dying and weren’t protected? So the number of OSHA complaints skyrocketed early in the pandemic.
And so now we see that, when you look at who gets sick with COVID and who dies, is it’s three to four times more likely that a person of color is going to be infected, is going to die. And what’s interesting is though, if a person of color gets infected and gets into the hospital, for some reason, they have a better outcome than someone who’s White. I can’t explain that, there’s no biological basis to race, but that’s the experience that we’re seeing. But still, their life expectancy has fallen much faster than life expectancy for white populations and I think that much higher proportion of people who are Black are in medical bankruptcy.
Chris Hedges: Well, we see, life expectancy is falling-
Margaret Flowers: Consistently.
Chris Hedges: … In terms of maternal deaths and births.
Margaret Flowers: Much higher.
Chris Hedges: It’s going up, especially of course if you’re black or brown. Let’s talk about how the medical system is endangering the health of a public which doesn’t go for preventative care because they can’t afford it. And then even when they are sick, they won’t go. You’ll periodically read these stories about people, they may be injured or sick, but they don’t want to get in an ambulance because they can’t afford the thousands of dollars you’re charged from being driven to an emergency room.
Margaret Flowers: Getting sick or injured in the United States is scary, not just because you’re sick or injured, but because you could ruin your whole life and your family financially, people go bankrupt, they lose their houses. So whereas in other wealthy countries, we’re the only wealthy country that doesn’t have a universal system. People make the decision about whether to go see a doctor based on what they’re feeling in the United States. First is, you recognize I might need to see a doctor, the next conversation you have is, can I afford to go see that doctor? Can I afford to be diagnosed with a life-threatening condition? And so people make really difficult choices.
And it’s interesting because there was a RAND study that showed that no matter what your socioeconomic status, your level of education, people without a medical background are not able to make a good decision about whether they should go or not. So having this incentive to not go, people are not good at making that decision about when it’s life-threatening or not, is the point I’m trying to make. But to me, people talk about their concerns of having a universal system because there might be some rationing. In the United States, we ration healthcare in the cruelest way possible based on a person’s ability to pay. And I know of people who’ve made decisions not to get cancer treatment because they wanted to keep their house, people who committed suicide because they didn’t want to bankrupt their family, this doesn’t happen in other wealthy nations.
Chris Hedges: Let’s talk about what is done to the medical profession. You have huge shortages of nurses, doctors, the privatization of every aspect is essentially driving people out of the medical field.
Margaret Flowers: This is really a very sad thing because I remember years ago talking to physicians who said, we think most of the doctors in the United States are in some stage of grief, denial, anger, because of the way you do this training, you want to get out there and take care of your patients and then you just start running into obstacles everywhere. And now medicine has become so corporatized that even those little family doc practices or pediatric practices, they’re going extinct because the insurance companies will drop you and you are forced into a corporate system so that you can still be in that insurance so that you could still see your patient and then you don’t have any autonomy.
And I remember meeting with some doctors at their lunch break in a big practice, and they were all worried that day because their numbers were coming out and were their numbers going to be, and that’s not what doctors should be thinking about. And so it’s really demoralizing to physicians, and it’s one of the reasons why I left practice, is because you can’t, all the incentives are against doing what you need to do for your patient, you have to fight for every little thing, and that has to change.
Chris Hedges: But also because it’s profit driven, they strip staff down in hospitals.
Margaret Flowers: Nursing staff, physician staff, the nurses are completely overworked, and you can’t provide good care in that environment. The nurse is really the eyes and ears and the direct caregiver, and you can’t give the necessary care if you have way too many patients to take care of. And so it takes a toll on everyone within our healthcare system because it’s about profit. And here are people who actually want to do some good things and you’re prevented from that.
Chris Hedges: Let’s talk about what the trajectory is. As I mentioned in the opening, these profits are obscene, these bonuses are obscene, but they’re carnivores. Where are they taking us? What are they doing at the moment?
Margaret Flowers: Well, they’ll stop at nothing, as we saw Maryland, where they’re stripping essential services from hospitals that have served communities in order to build these huge surgical centers that do cardiovascular and orthopedic, because that’s a big moneymaker. So where are we going to go for our OBGYN care? Where are we going to go for our pediatric care with this type of trajectory and shutting down the hospitals?
I remember it used to be that Black people were turned away from hospitals and they had to drive miles and miles and miles to try to find a hospital that would take them in. Now, this is everybody in the rural community, the hospitals just aren’t there, and you’re driving. And that has impacted higher mortality in these communities from preventable causes if they had healthcare. So this is not sustainable, it’s not sustainable based on the way that we’re treating the health professions. At some point, because this is an issue that touches on every single person, this is going to have to change.
Chris Hedges: And yet they’re disempowering those segments, veterans, the VA, or medic people who actually have a system that functions, they’re destroying it.
Margaret Flowers: They’re privatizing the VA, and of course, they cloak it under, this is better for our veterans, they’re going to have more choice. Where have we heard these words before? People in Moscow are not even aware of what’s happening to Medicare, but the goal, as stated by Liz Fowler’s Center for Innovation, is to have it fully privatized by the year 2030. And what does this mean for seniors? It means that you’re going to be in the same boat as people who have private health insurance, where you have high out-of-pocket costs, you’re denied care. We see through these Medicare so-called Advantage Plans, people who need rehab, they’re kicked out early, they can’t get the necessary rehab that they need, this is devastating. This was a program that was meant to serve our senior and our chronically ill population and it’s another profit making center now for the private corporations.
And same with Medicaid, the vast majority of people in Medicaid are in these private, they’re in MCOs called a managed care organization. These managed care organizations can take 40 to 50% of the money they receive from the government for their administrative, their pay, their salary. Whereas traditional Medicaid, it’s 2% that goes into administrative costs. So that’s robbing money that could be used to pay for care for people.
Chris Hedges: Well, let’s talk about where we’re headed. You mentioned earlier that it’s not a sustainable system, certainly in terms of public health, it may be sustainable for corporate profit, but where are they driving us? Where are we going to go?
Margaret Flowers: Well, where we’re going right now, and Congress is aiding and abetting this, they just continue to find ways to give people the illusion that they’re doing something about the problem, but every time it means either throwing more money at the corporations or giving them more tax breaks or protecting their profits, their interests. But I think this is not going to be sustainable for the American public. And we see that the polling data shows that people support having a healthcare system. And it’s interesting because what’s been even people who consider themselves to be conservative and traditionally, we support the market, are more and more beginning to understand and say, no, I like my traditional Medicare. I like being able to choose my doctor and be able to get the care that I need. So I think public sentiment is going to continue to grow.
And also, I just see so many organizations and groupings within the United States who advocate on other issues, but who also understand that we need a universal healthcare system. So this is really becoming part of their demands as well. So the trajectory we’re on is not a good one and it depends on how much Congress can get away with continuing to funnel public dollars into these private corporations. But I think from a popular level, more and more people, as they continue to see that nothing is done and they can’t afford their healthcare and their loved ones are dying, they’re going to do something about it.
Chris Hedges: But it’s even worse than not being able to afford it, it’s increasingly more expensive. It’s not just that it prices out a large segment of the population, but year after year, a larger and larger segment is priced out.
Margaret Flowers: And it’s eating up more and more of our GDP, so nobody is safe in this. I know of people who were fairly well off prior to an important illness and ended up losing everything anyway, so nobody is-
Chris Hedges: And we should be clear that a lot of these people have insurance.
Margaret Flowers: … If you look at, so as you mentioned, medical bankruptcy is the leading cause of personal bankruptcy in the United States, medical illness. And more than around 80% of people who went bankrupt due to medical illness had health insurance at the onset. But we have a system that ties health insurance to employment and that’s another situation that makes no sense at all, not only because it gives the employers a lot of control over their workers, and that’s why every worker should be opposed to that. But because as soon as you become ill, you risk losing your health insurance at the time that you need it the most, it makes absolutely no sense.
Chris Hedges: And yet the Democratic Party is completely complicit in all of this, that they sometimes mouth, like Obama, the right words, but they’re captive to the healthcare industry.
Margaret Flowers: And then they wonder why people don’t want to vote for them. Because if they make these promises and they absolutely work against it in every way. And what’s interesting, is the few champions I knew in Congress that tried to hold strong and push, in some way, they were pushed out. And Dennis Kucinich was the last stalwart, and I remember that just before the vote on the Affordable Care Act, and he was the last one voicing opposition, President Obama flew him on an airplane to his district and held a big rally and got out there and said, we’re going to do healthcare and it’s going to be great and then he pushed Dennis out there and said, so what are you going to do, Dennis? And he told him on the way back in the plane, if this goes down, I’m blaming you. It was a tremendous arm twisting and manipulation.
Chris Hedges: I think Dennis voted for it, didn’t he?
Margaret Flowers: I can’t remember if he did or not-
Chris Hedges: I think he did.
Margaret Flowers: … He may not have needed to have his vote for it, but anyway, if it had gone down, it was all going to be placed. And then he ended up being redistricted and pushed out right after that anyway, they punished him for daring to speak.
Chris Hedges: How do we break the back of a healthcare industry whose lobbyists control the legislative process? And I would also ask you just in the closing minutes to talk about the coverage because if networks like CNN rely on their advertising, the voices like yours are essentially not only at the best at margins and usually shut out.
Margaret Flowers: We are, and that was the interesting thing during the Affordable Care Act, Obama’s personal physician was invited to the White House as part of an ABC thing, and I think it was April of 2009. And then he was quoted in an article saying he thought we should have a universal healthcare system and he was dis-invited. We had Dr. Quentin Young who served as Dr. Martin Luther King’s personal physician and Obama’s personal physician asking the Washington Post to let them write an op-ed, and they wouldn’t even talk to them.
This was the collusion and it all has to do with what we call interlocking directorates, where the CEOs of these corporations are also on the boards of these media outlets and the advertising dollars as well, so they wield tremendous power. So people need to understand that a lot of the information that they’re getting is not accurate information, they package these things, they make them sound really good. But right now, Congress is aligned with these corporations and they donate equally to Republicans and Democrats, and especially if they see that one party is likely to take over and they’re going to be in charge of the committees, then they really pump a lot of money into that party.
We win this the same way that we’ve won every other battle, we have to educate ourselves and others, we have to speak out about it, we need to connect. We need to understand that health is fundamental, it’s connected to everything, and that there is no incremental way that we can do this. We cannot work within the for-profit system to fix this problem, we have to nationalize our healthcare system. And that means getting the profit out completely, and that’s unfortunately in the bills that are in Congress right now, they don’t take that step. They continue to try to allow the for-profits to operate within the system, but they’re parasites and they’re always going to push it and take as much as they can. And every dollar they take means a dollar less of somebody getting the care that they need.
It’s the fundamental, it’s education organizing, connecting this to other issues and putting pressure and taking action on our own communities. There are a lot of efforts that people can take locally to try to save their hospitals to set up alternative formations. We saw that during the pandemic, Black doctors going into communities and taking care of people there. These are the things we need to, at every level, be doing in our country.
Chris Hedges: One of the little pieces of trivia I learned covering the campaign was that they sponsored the candidate’s debates, that’s why they lock Kucinich out. The Debate Commission is a private corporation, and it had pharmaceutical and insurance money to run.
Margaret Flowers: That’s the whole other thing, it’s called the Commission on Presidential Debates, but it’s a completely private entity. And that’s one of the main reasons we don’t have democracy in this country, is because all the other voices, if you’re not part of the Democratic or Republican Party, is shut out of the debates.
Chris Hedges: Great. That was Dr. Margaret Flowers, advisor to the Board of Physicians for National Health Program. I want to thank the Real News Network and its production team, Cameron Granadino, Adam Coley, David Hebden, and Kayla Rivara. You can find me @chrishedges.subsdeck.com.