Health Care for All

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This week, Incorruptible Mass takes on what state politicians in Boston keep promising but failing to deliver on: health care for all. We'll have a conversation with UMass Amherst economics professor Gerald Friedman about what the proposal is, why it'd be such a game-changer, and what we can do to make it a reality.

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Transcript

ANNA

Hello and welcome to Incorruptible Mass. Our mission here is to help us all transform state politics because we know that we could have a legislature that truly supports the needs of the 7 million of us who live here. And that's what we're going for. So today we have an exciting conversation about universal health care here in Massachusetts. We have a fantastic guest, Gerald Friedman, who is going to help us talk about that. We're going to, we will talk a lot about the history including about the ACA and where it came from. We will talk about Trump's views on universal healthcare. We will talk about what has changed in the last 20 years since the ACA was passed and the profit motive. Of course we're going to get into that because how can you not? And we'll talk a little bit about the politics of getting this passed here in Massachusetts. But before we do, I am going to have my illustrious co-hosts— I should come up with more adjectives. I'm always like illustrious, fantastic and amazing. But I will have you guys introduce yourselves starting with Jordan.

JORDAN

These are all great. I like all of them. Jordan Brooke Powers, he/him, and I have worked in, I've worked in politics for many years now in Massachusetts politics for many years now. And fun fact, when I was a legislative aide in Congress I had health care as one of my portfolio issues.

JONATHAN

And Jonathan, before I start Anna, to your point there'd be funny for you to show up with like a big thesaurus on screen one time.

ANNA

A fishbowl with like adjectives.

JONATHAN

That would be fun. Jonathan Cohen, he/him/his, live in Boston in the South End, I’ve been an active and progressive issue in electoral campaigns for well over a decade now here in here in Massachusetts and always excited to be here.

ANNA

And I am Anna Callahan, she/her, coming at you from Medford where I am a city councilor, done a lot of work in local politics across the country and state politics fortunately with these guys and my mom is British and I just grew up my whole life with the understanding that our system is totally dumb. Why on earth we would not have universal healthcare is mind boggling. So I'm always happy. Anytime we can talk about universal healthcare, I'm happy to talk about it. So on that note, I would love to introduce our very special guest, Gerald Friedman who is also here with Mass Care, an organization doing a university healthcare here in Massachusetts. And Gerald, if you want to just give us a little bit of lowdown about like the bill that you guys have and what it does and if it has changed for the last Few terms that would be fantastic, as well as anything about yourself and how you got into this.

GERALD

Well, I'll start with the bill. And yes, Anna, it has not changed significantly. I've been working, doing economic impact studies for Mass Care since, I believe, 2007. You know, it's in the mists of time right now, and every two years I've updated it. This year, I passed the responsibility onto Auden, who did an excellent job. He's a really smart guy. But over that time, I've done these economic impact studies for, I don't know, like, 15 states. I've done it for the United States a couple times, and the results are always very similar. There are variations. Like Massachusetts, we have a relatively low share of the population without any health insurance. So when we establish a universal program, extending coverage to those who are uninsured is a relatively small cost. In other states, it's a larger cost, but there's a, you know, fiddling around the edges. The big things are that we could lower the administrative waste in the health care system. We can lower the waste to people of spending so much on overpriced, monopolized pharmaceuticals and medical devices and. And here's the thing that, you know, gets into, into trouble. The biggest single savings from a universal system would be by driving down the price paid for hospital services to elite hospitals like Mass. General, and balance against those savings, which amount to like, 40% of our healthcare spending. In Massachusetts and similar in other places, establishing universal coverage would cost more for covering the uninsured and eliminating co pays and deductibles so that you just walk into the doctor's office and get care that people would use. You know, go to the doctor more, which costs more. They would use the prescriptions. I've been told by doctors of patients who walk out of their office, look at the prescription form, and drop it in the wastebasket because they know they'll never be able to pay for it. So that would not happen. And that would cost money. We'd be filling prescriptions that people are not filling. Now. Balance against that, people would be healthier Americans. Life expectancy is like four years below the average for the oecd, four years below Canada. Even Massachusetts, which has just about the best health care system in the country. We have people who, more than a third of the population of Massachusetts, report that they did not get health care at some point because of cost. If everybody had the health care they need, we'd have a healthier population. People would feel more comfortable emotionally, and people would be able to go to work more consistently. And if we did away with the employer based system, people would be able to quit jobs that don't work for them and go someplace else or start out on their own. All of these things would make us a more prosperous as well as a happier country. If we could be more like Denmark, which does not need a US Hospital ship that we couldn't even send them, then we'd be a more prosperous country as well as a happier one. So that's what the Mass Care bill is all about. That's what the national efforts. Ideally we would do this on the national level so that everybody would be get the benefits in Mississippi, whatever. But you know, I've been one for, you know, forever thinking that we should do it wherever we can and if we can do it in Massachusetts, then let's go ahead and if nothing else, we'll set a good example for everybody else.

ANNA

Fantastic. Any commentary from my fellow?

JORDAN

I was thinking about, I was listening to Anand Giridas last night and he said something that really hit me, which is that Americans struggle with things that no one else takes for that other people take for granted. So like, you know, France is a much poorer country than ours. Like we don't take that for granted, but it's much, significantly poorer than America. Most of these countries are much poorer than America. But their citizens don't worry about the things that we worry about. They, they, they, because their government takes care of those things. And so we have stresses and we have things that poorer countries, places that have less money than we do take care of their citizens so that they don't have to worry. Like Belgians are not, it's not a rich country, it's not a big country, but they can manage to care for their people in such a way that their people can retire without having to like, you know, like there's these reports that Americans will need like $3 million to retire. Then most Americans have a, don't have $50 in their bank accounts I think is the median.

GERALD

Right.

JORDAN

Like it's just, it's, it's bizarre that we as a country and our elected officials and nominally the party that's supposed to represent the majority of us just thinks it's fine that corporations run roughshot over us and most of us and the government does not do basic things even though we have so much money, like just way more money than other places.

GERALD

Absolutely right. We need to think about the health care system we have in this country is not about health care. It's about profit making profits and health care is kind of an accidental byproduct of the for profit system, you know. So we give companies the chance to make a profit in the hope that they will sees that you'll produce health care as a way to advance their profit. The problem of course is there are a lot of ways to make profit in health care without providing care. The best way for an insurance company to increase its profit is to find the people who are going to be sick and get them out of the pool. You see this all the time with whenever the so called medical loss ratio goes up for a private health insurance company that the medical loss ratio is the proportion of premiums that go to paying for health care. That's a good thing. We want that to be a big number. We don't want to be spending a lot of money on on insure on insurance administration advertisement but whenever that ratio goes up, the stock price goes down and maybe they'll bring in a new CEO who will work hard to drive down that ratio. Ideally they would love it if the ratio was zero. If they could get all the money coming in as premiums and walk away within his profits or advertising for the. Yeah but that be nice about. They would love it. They would love it. You know, hospitals are a little different because they do want patients to come in. But even there which patients do they want? They want the patients who will give them profit. They want the patients who come with good insurance. They want the patients who will give them a good outcome so they can advertise that. Yeah. So that's what the system's about. And we've moved further in this direction since it's not my fault but since I first got involved.

ANNA

Yeah.

GERALD

Well okay.

JONATHAN

In the 1970s the one thing that we were talking about before there that I think is such a fascinating thing in this speaks to the issue of time is realizing both let's say in Massachusetts how far we are now from like the the kind of the premier as a health care reform bill and how far we are from the Affordable Care act because we are Massachusetts is the 2000 that we're about like we're 20 years past the big like health care reform law. I'm trying to find the exact date the the big health care reform bill known as Romney Care even though I think it gives the Romney false credit for things that he like down and it's more like cell demasi care if you will. It's going to be 20 years old this April and then in a few years the Affordable Care act will become 20 years. Like the. Like that's only a few years away as well, with that having been a very recent memory from the time that the Affordable Care act was debated and ultimately signed in 2010. So if you think about like this year as well in 2026, that the Affordable Care act will be old enough to drive a car if it were a person, just like, just like the Massachusetts healthcare reform reform bill, old enough to vote and next year it can drink, which it shouldn't do.

GERALD

If it's.

ANNA

No, I think it should

GERALD

be drinking given the condition of our country. Exactly.

JONATHAN

Given the condition of the healthcare system. Next year the Massachusetts health care reform law might take up drinking, which it can legally then do. But I think that what's, what's so interesting in thinking about both of those in terms of time is I feel like both of those have very strong holds over the political imagination in general policy landscape and health care. And I feel like that's in a way that wasn't the same, like didn't feel like it was the same case at the time that they were passed, that things 15, 20 years prior, like obviously all the stuff from the clan, like kind of the, like kind of Bill and Hillary's attempt at putting together something in the early 90s lingered over the Affordable Care act, but not in the same, like obviously in part because it failed. But we were kind of stuck in a certain paradigm of healthcare that we'd been for so long and would love, you know, kind of kind of opine some about as we're now like close to two decades past, that how timely it is then to actually start thinking about what, what the next phase of the U. S Kind of the evolution of healthcare in the US Especially as we then have like a presidential election coming up again in a few years where that will be big as well as how increasingly broken it has become since then.

GERALD

Yeah, yeah. If you look at, you know, there are two measures, two ways you could look at the success or failure of the ACA or Romneycare. The first is controlling course. And that's been a. Yeah, Jordan, you got it. It's been a complete failure. Since the Affordable Care act was enact was signed in 2010, premiums for private health insurance have just about doubled.

JORDAN

More than doubled. More than doubled. They've more than doubled, to be clear.

GERALD

Yeah, yeah.

JORDAN

2, 212%. So more than doubled.

ANNA

And let's not forget that premiums are the things that the, that's the money you fork over when you have literally gotten nothing, nothing out of it. Nothing. Not one thing.

GERALD

The share of our national income that goes to health care has continued to increase so that now we're close to, you know, we, we're. It's kind of leveling off between 17 and 18%. But the reason it hasn't continued, it hasn't increased even further. And this gets to the failure of Romneycare as well, is that we are more and more deferring needed healthcare.

JORDAN

I was about to say that. Yeah.

GERALD

Showing up in our declining life expectancy. And yeah, life expectancy is one piece of this. I, I once, as I mentioned to you guys, debated Zeke Emanuel and he said, oh, life expectancy. But you got to look at other things. Well, let's look at maternal mortality. Let's look at infant mortality. Yeah. Now these are still very good numbers for people like me in Amherst, Massachusetts, tenured professors. But there are parts of this country where the numbers for maternal mortality and infant mortality, both of which nationwide, are worse than almost any other advanced country in the world for maternal mortality. I believe we're 44th in the world. Wow. But there are places.

ANNA

But who cares about women?

GERALD

Those are women or babies. You would better off giving birth in Lagos, Nigeria.

ANNA

Oh my God, really?

JORDAN

Yes.

GERALD

In, in a city, New York or Cleveland or Detroit.

ANNA

I'm, I'm glad I went to birth center.

JORDAN

This is, I mean it's just like by every metric, right? So I just want to like put it in real dollars for people. So if you had $100 when the ACA, if you spent a hundred dollars when the ACA was, was passed, if you tried to spend that, it would, the same dollars would be 200 plus dollars right in for, for healthcare. If you just everything else, you're like, well, everything else got more expensive. It would actually only be. No, sorry. It would be, it would be three, it would be $300. So it would be $300 and then. And everything. But everything else would be 150. So it's going three times. The rate of increase for insurance is going three times as high. And the other thing that's happening at the same time is like, it's not just that it's like astronomically getting more expensive just to get insurance. You also like all of us know, right? What else has happened? It's covering less, it's requiring the plans are worse. Like so also like the plans were better. They were covering more things. Your co pays were less. Your, the amount of money it took to like hit your deductible was less. So like not only like we're just talking the price out of your pocket.

GERALD

But the thing you're getting is worse. The annual report by the center for Medicare Medicaid statistics on employer provided health plans did not ask about deductibles and not ask about co pays in the late 1990s. That question for deductibles was added, I believe, in 2001. CO pays in 2012. Because what we've done with Romneycare and especially the ACA is we've accepted the premise that the problem with American healthcare is that it's too expensive because we use too much health care. There's a committee coming out in the Massachusetts legislature, yet another one of these committees. How can we control health care costs?

JORDAN

Oh boy.

GERALD

Put in the commonwealth. Come. You know, forget the name of the.

JONATHAN

Yeah, come on, come on.

GERALD

That's it, that's it. You know, they talk about the things they're going to be looking at. How can we control course by getting people to be more efficient so they don't use as much health care. And that's what the deductibles and co pays have been about. The strategy of raising deductibles and co pays is to get people to pay for the health care on the margin. So they won't, you won't do it. And it works. People, more and more people are opting out of getting health care with one other result that more and more people are looking for alternatives. And that's part of what's behind the Maha movement. Oh, let's not trust the doctors. Let's just do it ourselves by drinking whole milk or whatever it is.

JORDAN

Because that's what it forces you to do. It forces you to say to make rational, to try to rationalize away how to do things that like, you know, and on top of that, like if you think about from the doctor's perspective, because the doc. Because the system isn't putting just pressure on us, right? It's putting pressures on the doctors themselves. So they went from being able to spend on average 16 minutes per person in a meeting even before that you're talking 30 minutes to now, if they spend more than six minutes with you, some administrator is calling them up and yelling at them for spending more, like it's not like they don't want to spend time. It's that they get yelled at saying we can't build, like we can't afford it. We have to build. We have to do these things. So you get this thing. So then if you, so if you're a regular person, real Quickly, if you're a regular person. Well, your experience of the healthcare system is a doctor who rushes in, who doesn't know you, who then who that who then who, who that who doesn't really hit all the things. And because you've been waited to get care, probably isn't giving you all the care you need. And so now you're distrusting that system and you're looking for alternatives. Right. So it's just a replica. It's just a system in decline in every possible way. Fewer people are going to become doctors. Doctors are leaving in droves. Like everything about this system is in decline. And people are just trying to figure out how to manage the decline in a way that we can save as many healthy white men as possible.

GERALD

Yes. Really, you hit it on the nose, Jordan. Now, a part of this is also that the profession of medicine has become proletarianized. When I was a child, back in antediluvian times, our doctor, a family doctor, had his own practice, made his own hours, made his own decisions. That is really uncommon nowadays. Something like 15% of doctors run their own practices, and most of those are specialists, family practice, and is almost entirely owned. Our doctor, and I've got to say, our family doctor, my wife and I see the same woman. It's wonderful. Love her. But she is owned by Mass General, as are a great many doctors. Now, Mass General will say, and they did this a few years ago, that when we lose $70,000 on every doctor we, you know, whose practice we purchase. Well, why are they doing it? I mean, this is just. They buy the doctors so they can steer patients away from other hospital systems towards their own. So that means, I mean, that may be fine. I really, I've been, I've gone to Mass General and Dana Far, but I'm very, very happy with the care that I've received. But, you know, it's not that it's right for me. It's not necessarily right for other people. So if you want to have many procedures in western Massachusetts, you can't do it locally anymore. You have to go to Boston, where they charge more because they're an urban teaching hospital. Yeah. So they get higher rates for Medicare and they get higher rates from the insurance companies.

ANNA

I was going to jump in because you guys are talking about Maha, and I think it's really important that we talk about Trump's opinion of universal health care. And you read this aloud. And I was so excited.

GERALD

Yeah. Read it again for the studio audience

JORDAN

of Trump's 2000 book. 2000 book the America We Deserve 2015.

ANNA

Didn't you say 2015.

JORDAN

Trump wrote it was. It's, it's. No, the book is from 2000. Sorry. It is, it's. He was, when he was thinking about running for president and it's, and the article came out in 2015, so that was my mistake. He said we should not hear he

JONATHAN

was going to run on like the Ross Perot party line. That's wild.

JORDAN

Yeah. So we should not hear so many stories of families ruined by health care expenses. I'm a conservative on most issues, but a liberal on 1. On 1. We need as a nation to reexamine the single payer plan. That's what Trump wrote. And I like many a times, if you've heard him talk, I have some other quotes of him basically back ending into this place over and over again about like, this system's really dumb. What are these insurance companies doing? They're ripping you off. Right. He's literally currently, just recently this year has made the case that like, you know, like the reason that we should, the reason that we, he should, that we should, that we should give, instead of giving money to insurance companies, they should give it directly to us.

GERALD

Yeah.

JORDAN

Because insurance companies are ripping you off. And I just keep thinking like, you're almost there. Like you've just even like, just like you just don't understand that like none of us are going to like if we get a $500 off our, like our MRI that costs $8,000. That's not actually helping us. But like there is a system where we are paying health insurance companies to do literally nothing. There is that system out there and you wrote about it like, you just need to back into that place. But it is.

GERALD

And those systems are very popular everywhere else in the world. I, I don't watch the Olympics, but in, what was it, 2006? The London Olympics.

JORDAN

Yeah.

GERALD

It opened with London recurrent valve.

JORDAN

Oh, 2012.

GERALD

2012. Okay. It opened with a tribute to the National Health Service. You have Britain's universal coverage system, which is also government run every. You know, in Canada, the national health system is enormously popular. The US stands out as the 1 country in the Organization of Economic Cooperation and Development, the one country where people don't like the health care system. They like their doctors, they like their hospitals, but they don't like the health care finance.

JORDAN

And Canada is the only country. So people always, you know, one of the things is Americans love to rag on Canada's system. Canada's system is the second worst, the only one worst Is us.

GERALD

Yes, yes.

JORDAN

People love it. Like just to be clear, like people in Canada love it and it has. The only place that has worse health care is us. And they love it. That's much better. Their system is.

GERALD

Well, thank you.

JORDAN

Can't find an American who loves our system. There's not one.

GERALD

Except the health insurance executives who average over $20 million a year in compensation.

JONATHAN

Do not have like bumper stickers of like I love my Blue Cross Blue Shield or Worcester.

ANNA

You stepped on something though, Gerald. What's the average compensation for these, for

GERALD

these health insurance a few years ago? I haven't checked it the last two or three years, but a few years ago, the top seven health insurance companies, the average compensation for the CEO is 23 million. UnitedHealthcare back then was 28 million. I doubt that it's going down.

ANNA

23, 20, 23 million. 28 million. And how much for security guards?

JORDAN

And it's like.

GERALD

But also not enough.

ANNA

Apparently not enough.

JORDAN

The other piece of that is just to remember that that's our money. That's actually meant to give us care. Like every single, that every single penny of that executive's pay is your money that was meant to go to make you better.

GERALD

All goes into that medical loss ratio that they want to drive down. So there's more money for them. And mind you, the high, the high compensation, it extends to the more worthy people running our hospitals. The heads at Mass General, the heads at Dana. And it, you know, it, you know, there's a certain amount that's spread around.

JONATHAN

It's always shocking.

JORDAN

There's a class of people who all agree with each other.

JONATHAN

It is shocking whenever you look at the hospitals and health insurance companies, particularly when some of like the ones like hospitals are largely not for profits that do not act like, not for like

GERALD

nonprofit just means they don't pay taxes.

JONATHAN

Exactly. Taxes. And they don't have, they don't have investors.

GERALD

Yeah.

JONATHAN

They don't have to pay anybody dividends and they don't have to pay anybody taxes. And that's. And that even when you have some of the like certain health insurance companies too are technically like not for profit but like they don't act like, they don't like act like that either. And it's always, it's always kind of shocking like how much market logic just exists across, across the system, regardless of tax status.

GERALD

And all this was intentional. This was policy going back to the HMO act of 1971. We went in the direction of establishing a for profit health care system with the idea that if it's for profit, they will try, they will provide better health care. Now, of course there were those who just wanted more money, you know, but, but I think there also were people like Richard Zekhauser at Harvard who worked with Nixon and Carter. You know, they were the people who, they really thought this was the way to do it. You know, we have for profit car companies, why shouldn't we have for profit in health care companies? So back in 1970, the health insurance companies were all not for profit, the hospitals were all not for profit, all tightly regulated. And we did away with all those so that they could go out there and be innovative and you know, search out efficiency. And the result has been they've searched out a lot of efficiency and to screen patients to find exciting ways to reduce care and to make profit by making life worse for average Americans.

JORDAN

And every part, and I just want to say that every part of the system is, is, is profit seeking. So it's not just the insurance companies, the prescription drug companies are profit seeking. The hospital systems are consolidating so that they can figure out how to profit seek and they profit seek within their own system. So, you know, the six minutes with the person, that's a profit seeking, that's not a health care decision, that's a profit seeking decision by health care executives to try to force doctors into being like Starbucks, you know, baristas for health insurance. Right. So just to push to get people to move in quickly. So it's not about your care, it's about the how much generating profit that doctor is making for the psm. And so this whole system is geared towards figuring out how to steal money from you that should be going to actually making you healthier. And, and so the reason for single payer is not just that insurance companies serve literally no purpose, but which they do, but also like that they that like it would force decisions from the only thing big enough to force hospitals and all these things to actually, actually work on care for us. And one of the things that's interesting to me is to see the labor government and the Conservative government in England force its country into our system and having worse outcomes for its population. Like you, like we're seeing in real time in the uk, what happened to a system which is dismantling and becoming more American and how much that's actually affecting people's real time health. So we're also seeing, you can see what happens when you sort of take it. And they're still way better than us, to be clear. They're still paying less than us. They're still less rich than us and getting much better care and everything else. But like there is just not, there's not a metric. You literally can't find a metric that doesn't say that this system is failing. Everything about it is failing. And so that's what I think is so frustrating for those of us who are serious about solving this issue of just trying to keep people healthy that the state won't, that our legislators won't even consider seriously a rethink of this system, which was created in 1995 to be in the platform for Bob Dole. By the, by the people who brought you Project 2025 like these, these same people are the. Are the, are the, are the. This is their system they've envisioned. This is their dream come true. The project 2025 people. The people brought you, that have brought you this system. And it's just, it's just shameful and frustrating that both parties have bought into the corporate executives lies about this as the best we can dream of and the best that we can hope for because it's just ridiculous. Nothing about this is working for anybody. For the workers, for the nurses, for the doctors, for us. Nobody. Sorry.

JONATHAN

And all of this is discussion of how, of let's say, good or bad uses of money. Reminds me of a good use for people's money.

ANNA

Jonathan, you're so good about this. There's a link below. You can donate to the show. I should come up with a little rap so I can say it all, you know, in rhyme and everything. But yeah, we'll, we'll take your, we'll take your, your co pays. You know, we'll do a system where people have to pass premiums.

GERALD

Exactly.

ANNA

People have co pay space for every episode and all that. We, we won't do that to you. We'll never do that.

JONATHAN

Current donation as a premium. You feel good about paying.

ANNA

That's right. Exactly.

JORDAN

Yes. I love that. Nowhere else are you getting this discussion.

ANNA

Nowhere else are you getting this discussion. And so we would love, Gerald, if you can wrap us up by just telling us what can people do to support the legislation here in Massachusetts.

GERALD

Oh, well, the best thing you can do is contact your legislator and urge them to support the Mass Care legislation. They can also reach out to Mass Care. I believe it's masscare.org and from there you can get lots of suggestions on ways to help organize with your community and donate money.

ANNA

Thank you so much. I'm going to do last minute words. We got any last statements? From the Pinot Gallery. Jordan, I think you. You said your piece, man, that was beautiful.

JONATHAN

I feel like my main thing going back my previous point is like, the need for us to have like a better political imagination of even so much as just looking at what happens in other countries. 1 When the point about, like comparing us to other places in the oecd. One of my talking points lately is that that Massachusetts has a higher GDP than Sweden, but we have a much worse welfare state and we should think about why.

GERALD

Yep.

ANNA

My final word is just. Honestly, I think it is a disgrace that in Massachusetts, where we have like 90% Democrats in the Senate and 80 or 85% Democrats in the House, and it's on the platform, the Democratic Party platform, year after year after year. Do you do universal healthcare? It is a disgrace that they. The history of healthcare. Universal healthcare legislation in Massachusetts is a disgrace. Sorry.

JORDAN

It's a total disgrace. Yeah, it's a disgrace.

JONATHAN

No, it's the thing I would underscore with that is when people see a platform, they typically understand a platform to mean what a. What a party in power will actually want to achieve. And I think that that speaks to such like a disconnect that exists between, let's say, like a party base and the party elected. So where a party basically wants the electeds to achieve something and the party elected never care.

JORDAN

Yeah. Yeah.

GERALD

Well, we know what should be done.

JONATHAN

Yep.

GERALD

The question is politics, not economics and not health care policy.

ANNA

Yeah.

JONATHAN

Well said.

JORDAN

Amen.

ANNA

All right, thank you so much to everyone listening. Pass this along to your friends, donate to the show, and we will see you all again next week.

GERALD

Thank you.

ANNA

Thank you.

JONATHAN

Awesome.