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Woolhandler calls for Medicare for all . . . continued

Huge CEO salaries also consume millions of dollars under the private healthcare insurance system. Woolhandler gave the example of one of her Harvard colleagues who became the head of Aetna healthcare insurance and made half a billion dollars during his 5-year tenure at Aetna, about $220,000 in salary each day, seven days a week, according to Woolhandler's calculations.

Yet this huge cost has not meant a higher quality of care and better health outcomes for Americans, said Woolhandler. Americans live about 2 to 2 1/2 years less on average than Canadians do, Woolhandler said. Infant mortality in the U.S. is more than twice as high as Sweden's, and maternal death in the U.S. is four times as high as Australia's, she noted. Americans do not get to see their doctors more, or stay in hospitals longer, than in other developed countries, despite paying nearly twice as much.

Woolhandler explained and critiqued one approach to healthcare after another, from for-profit HMOs, to so-called "consumer-directed" high deductible private insurance plans, to the "mandate model," where everyone is required to purchase or obtain health insurance, primarily from private health insurance companies. The mandate model was first proposed by then-president Richard Nixon in 1971, in order to block Senator Edward Kennedy's proposal for national health insurance, said Woolhandler. Ironically, the mandate model is now at the heart of the Democratic Party's House healthcare bill. "What was a Republican point of view has turned into a rallying cry for Democrats," Woolhandler dryly observed. "Absent cost-controls," and cost-controls are absent in these plans, said Woolhandler, "expanded coverage is unaffordable."

"The mandate model adds administrative complexity and cost, because it retains the private insurance [companies and] it actually rewards them," said Woolhandler. This approach may have "impeccable political logic -- don't fight with the insurance companies," she said, but it is "economic nonsense . . . [it doesn't] work economically."

Under Massachusetts' mandatory health insurance scheme -- often seen as the model for the House Democrats current plan -- roughly 5% were still uninsured, according to evidence Woolhandler offered, and costs were escalating. Woolhandler charted the number of uninsured remaining under one state mandate plan after another, in Tennessee, Oregon, Massachusetts, Washinton state, Vermont, and Maine, showing that there was "no durable improvement" in reducing the number of uninsured under these mandatory health insurance plans. Reductions in the number of uninsured under the Massachusetts plan are mostly attributable to the increase in Medicaid (the subsidized government health insurance plan for low-income persons) under the scheme, she said. These plans "haven't worked," asserted Woolhandler.

Woolhandler noted that the "public plan" component of the current House healthcare bill, according to Congressional Budget Office analysis, will actually involve higher health insurance premiums for participants, and will only be available to about 6 million Americans, or about 120,000 people in every state. This small size would mean that the House's public plan could not exert competitive pressure on the giant private health insurance companies, some of which can have millions of members in a given state, according to Woolhandler. House Democrats and, on occasion, the Obama administration, have suggested that a public plan's competitive pressure on the health insurance industry would bring down prices. The numbers Woolhandler offered clearly cast doubt on this suggestion.

Woolhandler highlighted the Canadian national single-payer healthcare plan. The Canadian program includes government health plan coverage for all Canadians, coverage of all medically necessary treatments, portability from province to province, and far less cost than under the American private insurance based healthcare system. Many provinces do not allow co-payments under the plan, she said. Costs are saved by far less money being spent in Canada for adminstration and overhead, and by less use of costly, often unnecessary, but highly-profitable, medical procedures, Dr. Woolhandler suggested. The average Canadian reports no greater unmet health needs than insured Americans, according to a recent study, she said, and reports far fewer unmet health needs than uninsured Americans.

In September of this year Dr. Woolhandler co-authored a study, "Health Insurance and Mortality in US Adults," published in the American Journal of Public Health, that found that nearly 45,000 Americans die each year from lack of adequate health insurance. Woolhandler noted that “Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives.” (Quoted in Harvard Science, "New study finds 45,000 deaths annually linked to lack of health coverage".) A September 18, 2009 Democracy Now interview with Dr. Woolhandler about this study is available through or via iTunes.

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