The Covid-19 pandemic has exposed gaping holes in the United States’ medical system, and the lack of access to tests and treatment has many wondering if fundamental reforms to the system might be necessary after all. CNN commentator and public health care expert Dr. Abdul El-Sayed joins Mehdi Hasan to discuss whether universal health care — Medicare for All — could be the cure for the ills of our ailing system.
Dr. Abdul El-Sayed: We have just deconstructed our public services, public health being chief among them. On top of that we are now facing a pandemic at one of the most vulnerable moments of our economic and political existence.
Mehdi Hasan: Welcome to Deconstructed. I’m Mehdi Hasan. As millions of Americans are laid off and lose their healthcare, is there an obvious and readily available solution that a lot of the political and media elite are missing?
AES: Bernie’s put this issue on the map and I think people will continue to fight for it. Regardless, it’s not going anywhere. I think this is the moment where we continue to drive, because COVID-19 has made the case for us.
MH: That’s my guest today, Abdul El-Sayed — physician, politician, author, and advocate of single payer healthcare. Nearly 50,000 Coronavirus deaths and 22 million unemployed Americans later, is it now, finally, time to guarantee Medicare for all?
Remember how over the past year we were told again and again, even by top Democrats during the presidential primaries, how Americans love their private health insurance, love their employer-sponsored plan, and it shouldn’t be taken away from them?
Senator Amy Klobuchar: 149 million Americans will no longer be able to have their current insurance. I don’t think that’s a bold idea. I think it’s a bad idea.
Joe Biden: If you go the route of my two friends on my right and my left, you have to give up your private insurance. 160 million people like their private insurance.
John Delaney: We should deal with the tragedy of the uninsured and give everyone healthcare as a right. But why do we got to be the party of taking something away from people?
Mayor Pete Buttigieg: I don’t understand why you believe the only way to deliver affordable coverage to everybody is to obliterate private plans, kicking 150 million Americans off of their insurance.
MH: Well, it turns out that it’s not Bernie Sanders or Elizabeth Warren or Medicare for All that’s getting Americans kicked off their beloved private healthcare plans. It’s the Coronavirus — or at least the mass unemployment that’s been caused by this pandemic, and the federal government’s mishandling of the pandemic.
To be clear, more than 22 million Americans — 22 million — have filed for unemployment since President Trump announced a national emergency just over a month ago, and social distancing measures and stay at home orders kicked in. Some economists suggest unemployment could reach 40 or even 50 million people within a few months. That’s tens of millions of Americans losing not only their jobs, but their healthcare, too — a reminder, if you really needed one, that it is dumb, extremely dumb to tie your healthcare to your employment status, to whether or not you have a job.
Which is not just a uniquely dumb thing to do, but a uniquely American thing to do. Other countries don’t do this. They don’t. Healthcare is treated as a right, not as a perk or benefit of employment. As an immigrant to the United States, I’ve got to say to the American listeners right now, the two craziest things about your country that most of us immigrants notice straight away are the batshit crazy gun laws and the batshit crazy healthcare system. You have too many guns and not enough healthcare.
Now, guns is a topic for another show. But healthcare — as I say, I’m from the UK, where we have cradle-to-grave universal healthcare free at the point of use, defended and promoted not just by the Labour Party, but even by the Conservative Party, the current Conservative government that dares not question the social democratic, progressive principles behind the hugely popular National Health Service, the NHS.
Here’s Prime Minister Boris Johnson praising the NHS after recovering from his own recent bout of COVID-19:
Prime Minister Boris Johnson: The NHS has saved my life. No question. We’re making progress in this national battle because the British public formed a human shield around this country’s greatest national asset: our National Health Service.
MH: The NHS in the UK provides free universal healthcare paid for out of taxation, with a government that not only pays for services, but also owns the hospitals and employs the doctors. Now, even crazy, Cuba-loving socialist, Marxist Bernie Sanders isn’t calling for that. Under his plan, the US government won’t own the hospitals or employ the doctors, but they will pay for all the treatment for everybody. The government will be the single payer in the system — hence the name — using your tax dollars to guarantee actual universal healthcare. So taxes go up — yes!
But as Bernie repeatedly points out:
Senator Bernie Sanders: Let us be clear what Medicare for All does. It ends all premiums. It ends all co-payments, it ends the absurdity of deductibles, it ends out of pocket expenses.
MH: Finally, people are waking up to the advantages of Medicare for all, the necessity of a single-payer system. I mean, it’s sad that it took a global pandemic of tragic proportions to open people’s eyes. But that’s life, I guess. A recent Morning Consult poll found support for Medicare for All surging to a nine-month high, with the majority of registered voters, including a majority of independents, now saying they back it.
But not everyone backs it. Joe Biden being Joe Biden, he’s not budging. He doesn’t think anything’s changed. Here’s what the former Vice President and presumptive Democratic presidential nominee said about the Coronavirus and the case for Medicare for All at the last debate he had with Bernie Sanders:
Joe Biden: With all due respect to Medicare for All, you have a single-payer system in Italy. It doesn’t work there. It has nothing to do with Medicare for All.
MH: But hold on, Joe. In Italy, nobody has to worry about paying for healthcare. There aren’t millions of people who don’t have insurance and don’t have access to a primary healthcare provider. People aren’t staying at home in Italy because they’re worried about the cost of going to a hospital.
And it’s not just about costs or expenses. In a pandemic, like this one, a lack of universal coverage makes things worse. Listen to Stephen Shortell, distinguished professor of health policy and Dean emeritus at Berkeley School of Public Health, who says, and I quote, “The degree of financial coverage for healthcare is not an issue with regard to the initial outbreak of infectious diseases, but it can accelerate the spread to the extent that the initial people affected delay getting tested and getting their symptoms diagnosed, because they lack insurance coverage or have no regular source of care.”
“This is the added complication and challenge we have in the US,” he says.
Listen to the New York Times, which noted in its big deep dive into how South Korea flattened the curve, that quote, “officials also credit the country’s nationalized healthcare system as giving even people with no symptoms greater incentive to get tested.”
What’s kind of amusing, and ironic, is that deep down even Republicans know that Medicare for All makes sense. They do.
I just want to read to you from the Wall Street Journal, April 3, quote, “The Trump administration will use a federal stimulus package to pay hospitals that treat uninsured people with the new Coronavirus as long as they agree not to build a patient or issue unexpected charges.” The story goes on to add, “both would be barred under the administration plan and hospitals would be reimbursed at current Medicare rates.”
Free treatment reimbursed at current Medicare rates — sounds kinda like Medicare for All? Right?
The problem, of course, is in a crisis, people want to have Coronavirus testing and Coronavirus treatment done for free — no payments, no deductibles. But if you say “Well, why not extend that to cancer treatment, too? Why not extend that principle across the board?” They recoil from it. They think that’s mad, extreme beyond the realms of possibility or practicality or affordability.
And so, there are so many myths, even in liberal circles, associated with the idea of Medicare for all of single payer healthcare. And today, especially as the pandemic rages on, and the death toll mounts, I wanted to try and debunk some of them on this show, deconstruct this issue from every angle, and have on a guest who really knows this subject inside out.
I’m delighted, therefore, to be joined by my good friend, Dr. Abdul El-Sayed, who ran an inspiring, but ultimately unsuccessful, progressive insurgent campaign for the Democratic gubernatorial nomination in Michigan in 2018.
He’s now a CNN contributor and author of the new book “Healing Politics.” But Abdul isn’t just a respected, progressive voice — he’s a respected medical one, too. He’s a former Rhodes scholar, a former assistant professor in the Department of epidemiology at Columbia University, and the former executive director of Detroit’s health department. He joins me now from his home in Michigan. Abdul, thanks for coming on Deconstructed.
AES: Yeah, thanks for having me, Mehdi. Always good to chat with you and Ramadan Mubarak to you and your family.
MH: To you, too. You are author of the new book, “Healing Politics: A Doctor’s Journey Into the Heart of Our Political Epidemic.” And in there you write about, obviously pre the Coronavirus, an “epidemic of insecurity,” you say, which makes healthcare crises worse in this country. What do you mean by that, “epidemic of insecurity”?
AES: So what I mean by an epidemic of insecurity is what I experienced in traveling across the state of Michigan for 18 months and meeting people in their homes, their VFW halls, their union halls. And no matter where I went, people were talking about the same set of questions, and I didn’t expect this considering you’re talking about different places, different demographics, places as diverse as Flint and Detroit versus, versus Petoskey in the Upper Peninsula, asking, you know, “Why do I not have healthcare in the richest, most powerful country in the world? Why does my kid’s school look like it did 30 years ago? Why is it that in a state defined by its freshwater, that we can can’t offer fresh water to folks for $400 a month, sometimes, when Nestle can bottle unlimited amounts for $400 a year?”
And, and what I came to appreciate is that we have an interlocking set of systems that have blocked people out, whether it’s lack of access to healthcare, lack of access to quality housing, an economy more focused on providing capital for the very top rather than access to a good job with a living wage at the bottom. And that epidemic of insecurity has left us battling over crumbs, for fear of loss rather than coming together to build out and reconstruct those systems so that they actually empower real people. And so I speak to both the subjective experience of this—this disintegration of the systems of our lives and then also how it makes us feel and the political consequences thereof.
MH: And, of course, the Coronavirus crisis exposes all of those interlocking systems of insecurity.
AES: That’s absolutely right. So you know, Mehdi, I rebuilt the health department that had been shut down when the state imposed austerity on the city of Detroit. You think about the fact that Detroit is now battling this pandemic with a health department that’s functionally five years old, in a city that’s been around for centuries, and it’s emblematic of the fact that we have just deconstructed our public services, public health being chief among them, at least the one that we talked about so much right now. But it’s not just public health.
And then on top of that, right, it’s not just the fact that, you know, we are now facing a pandemic that could have been contained. It’s that we are doing so at one of the most vulnerable moments of our economic and political existence. You have people who are on the slippery edge of economic viability before this pandemic, who have just been knocked off — being forced to choose between saving their lives and staying home or saving their livelihoods and going out and working. And this is the circumstance that millions of Americans find themselves in as a function of the system that has created this epidemic of insecurity.
MH: Bernie Sanders, who you backed in the primaries, he may be out of the presidential race for the second time in four years, but he’s signature policy proposal, Medicare for All, single-payer universal healthcare, is now very much mainstream inside the Democratic Party. You have majority support, I think, in almost every Super Tuesday state where there was an exit poll done.
AES: That’s right.
MH: Public support for Medicare for All post the Coronavirus is at a nine-month high. Do you think this is the moment it goes mainstream?
AES: I think it’s been mainstream. I think, you know, one of the signatures and hallmarks of Bernie Sanders’ run, as you said, was Medicare for All, but one of his lasting legacies will be that he also took this idea that had been seen, as you know, too far-left before he ran on it, and just infused it into our national psyche. It is the standard to which all other healthcare proposals are held, and rightly so.
It takes on a lot of the source of the rot in our healthcare system, a healthcare system that locks out 10 percent of our population as it stands, and then has left us fundamentally incapable of dealing with this pandemic at scale, whether it’s the fact that you’re watching hospitals have to fight both COVID-19 on one hand, and then bankruptcy on the other, because they had to cancel all of their most lucrative elective procedures. And in this for-profit system, they cannot stay open without that, that money flow.
The fact that you know, just-in-time supply chain may be great if you run a Starbucks, it’s not so great if you’re stocking masks and PPE for healthcare workers, and it’s left our healthcare workers almost naked on the frontlines. It’s not so great when you think about the fact that we only spend about 2.5 percent of our healthcare budget on prevention in the first place, because of course, in a for-profit system, the way that money is made is after people get sick. And so Bernie’s put this issue on the map, and I think people will continue to fight for it. Regardless, it’s not going anywhere. I think this is the moment where we continue to drive, because COVID-19 has made the case for us.
MH: So as you say, this is the moment to carry on fighting for it. In a fight, there’s two sides, there’ll be people fighting back. There were already a lot of myths and misinformation that surround Medicare for All. But there are also some legitimate, good-faith objections to it, queries about it, concerns with it.
You’re a physician; you’re also a progressive politician. This is your subject in so many ways. So I was hoping today that you could make the case for our listeners, explain to them what the best answers are to the most common questions, the most common objections to Medicare for All, which come not just from Republicans, but from top Democrats, too, from the presumptive Democratic presidential nominee Joe Biden.
So right now, I want to throw some questions at you, just as a devil’s advocate, for the sake of argument.
AES: Let’s do it.
MH: For you to try and address and rebut. And just, I know there’s going to be people saying, “Why is Mehdi Hasan echoing right-wing tropes?” That’s the point we’re doing — it’s an exercise to see what the answers are, see what the best responses are. I think it’ll be useful.
So let’s start with the classic question, Abdul, which drives me up the wall. But again, for the sake of argument, I’ll ask it. How are we going to pay for it? Medicare for All isn’t cheap. Some studies suggests Medicare for All could cost, could cost between $32 and $34 trillion over the next decade.
AES: Yeah, well, I’ll tell you, the, the simple answer is that we have corporations. And we have extremely rich people, billionaires in our society, who pay lower effective taxes than you and I do. And in asking them to pay their fair share, part of that is paying into a Medicare for All system.
But part of that is also that we will pay for it. And this is a good that we’re asking government to provide for us, the traditional way that we pay for government goods is through taxes. But I want to flip that question on its head just because I think the premise tends to assume that nothing is taken off the table.
Well, we’re gonna, we’re already paying for our healthcare system as it stands. In fact, we are paying more per capita —
AES: — than any other country in the world for healthcare in America, and we’re paying for it in ways that leave us deeply insecure. It’s not just that we pay premiums, but the average person doesn’t pay down their deductible, that amount of money that you have to pay for before the insurance you already paid for kicked in, until May 19. That means that functionally the healthcare you paid for is behind a paywall for half the year.
And so we’re already paying for it. We pay for it in co-pays, we pay for it in deductibles, and of course we pay for it in premiums. And on top of that, we end up getting care that is substandard, if you get it at all, because of course 10 percent of people are locked out.
So every dollar in the healthcare system, no matter what system you’re talking about, comes out of somebody’s pocket. The question is whether or not we want all to pay for it equitably, or we want to continue to allow some of it to go to corporate CEOs and allowing those who profiteer off of it to continue to take too much off the top.
MH: So just to be clear, obviously corporations, billionaires should pay more. I think Bernie talked about a financial transaction tax on speculation as well. But you’re saying as well, like Bernie did, the average voter’s taxes will go up as well. Elizabeth Warren struggled to say that during the primaries, she would only ever say that your costs overall will go down. Bernie said they will go up, he’s not quite sure the exact figure, but they are going to go up for average people.
AES: Yeah, your taxes would go up, but your healthcare costs overall would go down. The amount that you pay out of pocket for healthcare and in premiums is substantially higher than what the taxes would be.
In response to that, right, the overall cost of healthcare also goes down. And I just want to be really clear about that. Right now, we have for-profit insurance companies who take 15 percent off the top of every dollar we pay for in healthcare. If they’re not run for-profit, those 15 percent, that is their profit margin, the CEO salary, the advertising costs, they go away. So the overall pot of money is lower, which means that our costs go down and it’s divided more equitably, because it’s shared across, in a more progressive way, between those who make the most and and the rest of us.
MH: OK. That’s the costs. What about the politics? How do you get Medicare for all through Congress? Because forget Republicans, most Democrats in the Senate are not on board with it, less than one in three of them signed onto Bernie’s Medicare for All bill last year, and you’re never ever going to get people like Joe Manchin or Kyrsten Sinema onboard, are you?
AES: Well, I’ll tell you this: It can’t just be the policy, it has to be the policy and the politics. And there’s a reason why Bernie, who ran on Medicare for All, also called himself the presumptive Organizer in Chief, not just the Commander in Chief. And the reason for that is because it is almost impossible to take on the money people, who have a vested interest in our healthcare system as it stands.
Remember Mehdi, the single biggest lobbyist per sector is the pharmaceutical industry. And then, after them, is the insurance industry. These folks spend a lot of money to keep the status quo. But the only way to take them on is if you have a coalition of people who come together across their various interests and drive it forward. It is the coalition of nurses and doctors who—
MH: I know, but that’s not going to get you, that’s not going to get you 50 senators.
AES: I mean, it could, if you put enough people pressure on them, right? I mean, I’m just saying that like it is not — if you get enough people calling a Senate switchboard there’s a real possibility to move votes. And you’re right, probably with this Senate, it’s not going to get you 50 senators, but part of the goal here is also to help elect 50 senators who are already there. And in that respect, this is a long game project.
And I do want to be clear about this, right? The idea that somehow we were going to get Medicare for All the day Bernie Sanders took office — you know, even Bernie would never say that.
MH: Hold on, hold on, hold on, hold on a moment. Before we go, before we go off on a tangent, I just got a call — I just got to pick up — a lot of people did suggest it would happen right at the start. And, in fact, they attacked Elizabeth Warren for saying it would take a couple of years, Kamala Harris saying would take a decade, that some Bernie supporters, and Bernie did imply, that this could be done right at the very start of a Bernie term.
AES: I will say that there’s a lot that you could do in terms of teeing it up, by executive order. But to actually pass the legislation that you would need to get it done, it would have been exceedingly hard to do with the senate the way it looks. That being said again, right, our job is to push the politics that elect the politicians that are willing to finally be accountable to the people rather than the corporations who have dominated this system for so long.
MH: So you talk about the people, the polls show, don’t they, that Medicare for All has majority support with the public. But when you tell voters they won’t be able to keep their private insurance, and when you tell them that their taxes will go up, even if you say costs will go down, polls show that support then starts to fall.
AES: But then polls also show that it goes right back up when you tell them that they can keep their doctor. And here’s the challenge with healthcare generally, is that it’s exceedingly complex, right? The doctor that you go see is paid in reimbursements from the insurance company that you may or may not have. And the hard part is that a lot of folks don’t appreciate where one institution starts and the other one ends.
And so, when you tell people, you’re right, that they might lose their current health insurance, support goes down. You tell those same people, that they’re going to be able to keep their doctor which is true in Medicare for All, and I’ll explain why in a second, their support actually goes up beyond where it was at baseline.
And the reason why you get to keep your doctor under Medicare for All is because you don’t have some insurance company gatekeeping what doctor you can and can’t see because they’re in-network versus out-of-network. How often have you had the circumstance, Mehdi, I know you’re from the UK, right where you walk in any doctor’s office, you see the doctor. Where, you know, you try and go see a doctor who is recommended to you by a friend, you realize that they’re out-of-network, which means that your co-pay goes through the roof, which means that they can’t really refer you to some other doctor that you need to see for follow-up. And this is the labyrinth that people live with all the time.
And so people get afraid when you say they’re going to lose anything, again, because of this epidemic of insecurity, that they just say, OK, fine, no reform. But when you clarify and you say, “Listen, you get to see the doctor, you want to see, even if you may lose your insurance,” I think people get a lot more secure with that proposition.
MH: OK. So we’ve talked about the politics and economics of it a bit, let’s talk about the actual healthcare implications. People say, “OK, access goes up under Medicare for all, but quality goes down.” Single-payer systems like those in the UK, where I’m from, or in Canada, they hold down costs, by limiting the availability of doctors and treatments, even for serious, life-threatening diseases like cancer, heart disease, you have very long waiting times in the UK. It’s a huge problem there, as you know, a huge controversy. How do you stop that from happening here?
AES: Yeah, I’ll say, I’ll say two things. Number one, the ultimate outcome of whether or not a healthcare system works is in length and quality of life. And, if you look at Canada, for example, which is really close to where I am right now, they have a single-payer healthcare system. They live on average two years longer than we do. They’re happier with their system, and they pay 60 percent as much for it. And so if this is a system that you’re happy with, it keeps you alive two years longer, it’s a good healthcare system.
I’ll also say this: One of the challenges that we have is that traditionally, conservatives always like to throttle the amount of funding that goes into public systems and then blame public systems for failing. That’s been the experience that you’ve seen both in Canada and in the UK.
AES: And so they’ll point to the systems and say, “Well, look, see, the public system doesn’t work.” And I think it behooves us to point back and say, “Yes, a public system that has been choked off from the resources that it needs to function, so that you could make the argument for privatization, may not function as well as it ought to. But that’s like choking me and saying, ‘Well, he doesn’t talk so well.’”
MH: Yeah, no, and you’re, you’re completely right on that. But on the other hand, I think even, you know, even quote-unquote, bipartisan, neutral health economists would point out a simple reality, which is the UK rations by limiting availability with waiting times, with not getting instant access. The US you have quicker access, but it rations by basically cutting off loads of people from the system, but there’s always gonna be rationing and we have to acknowledge that.
AES: Yeah, healthcare is a limited resource, it is impossible to provide all the possible healthcare to everyone at the same time, it’s impossible. That being said, the question that we have to ask ourselves is: How do we make decisions, the best decisions, that meet our values about how we allocate this scarce resource? And I would rather live in a society where everyone who has a heart attack gets a heart attack care, everyone who has diabetes gets diabetes care, then in a society where some people just don’t get any healthcare no matter what, but maybe I get to cut to the front of the line if I need to, you know, get my ACL repaired or I want a dermatologic procedure.
I’ll just also say one last thing on this point: The hard part about our system is that it’s always with reference to what, to the worst stories we hear about everywhere else.
AES: And so you’ll talk to folks and they’ll say, “Well, I had a cousin, and that doesn’t have to wait in line. And I don’t want to have to wait in line.” The fact is, is that, sometimes in doing that, we discount our own experience. The average wait time to see a cardiologist, Mehdi, a cardiologist in America, is over a month. If you’re, if you’re a new patient — a cardiologist, I mean, this is somebody who is treating your heart, like, basically the two most important organs in your body are your heart and your brain, right? And if you can’t see a heart doctor in time, that’s a real challenge.
And on top of that, there have been studies that have shown that the consequences of having to worry about whether or not you can pay down a deductible or a copay, actually limit — or extend the time at which women who have breast cancer will get their breast cancer diagnosed and treated and that has long term consequences for their mortality in that experience.
And deductibles in America are just going up and up and up. And so functionally, what that means is that in our system, even if you have private health insurance, you’re behind a paywall. That paywall has consequences for your waiting in line, and it means that Americans are waiting in line, too.
AES: But the question is for what. And so in America, no matter what, you’re waiting in line for whatever it is that you need, if you can’t pay, rather than waiting in line for those things that are less urgent.
MH: But critics would say you’re waiting in line, you said “for what?” They would say, “You’re waiting in line for better care.” You know, cancer outcomes, for example, are better in the United States than they are in the UK. That’s a fact.
AES: That is a fact. And it’s conditional on getting cancer care. And so what are we missing in terms of all of the undiagnosed disease because people just don’t go see a doctor.
If you have access to healthcare, which is a big if, and it’s dwindling every day, then yes, you’ll get great care in America. The problem, though, is that on average, right, you don’t really have the same kind of access as you might in the UK or Canada. And so that’s why they live two years longer.
MH: Yes, which goes to —
AES: Again, you know the backstop —
MH: — your point about anecdotes taking on the worst-case scenarios, rather than, as you point out, the averages. People don’t like averages.
OK, let’s deal with the next objection, the next concern. What about the fact that, according to a big New York Times investigation last year, if Medicare for All abolishing private insurance, as Bernie Sanders said it would, and reduced all rates to Medicare levels, which are often less than half of what private insurers currently pay for treatments, “Some hospitals, especially struggling rural centers, would close virtually overnight. And others,” said the Times, would, “try to offset the steep cuts by laying off hundreds of thousands of workers.”
That would be really bad, wouldn’t it?
AES: Yeah, it’s a bit of a misnomer that the reimbursement rates are going to be exactly what they are for Medicare.
MH: But you would accept that Medicare reimbursement rates are much lower than what we have right now.
AES: Oh, no doubt. And that’s actually a really big problem. I mean, a big part of the problem that we have, again, with public insurance programs, no matter what, is that they tend to be underfunded. And so, under Medicare for all, the choice of what we reimburse, is not fixed. And so this, this notion that somehow we’re going to go to Medicare reimbursement rates automatically, because the program is called Medicare for All, just seems to lack a bit of an imagination about what you can do when you’re the only payer.
In fact, I’ve got a book coming out on Medicare for All in February, and we make a lot of arguments about the fact that actually you should not have fixed reimbursement rates. Reimbursement rates in rural communities, for example, or underserved urban communities, should actually be higher, right, because the rate of serious illness and a lot of those communities because they’ve been so underserved is so high. And second, because you want to get doctors and hospitals and clinics to locate there to take care of those folks. And so you can do a lot in terms of changing reimbursement rates.
Here’s the other problem with reimbursement rates as they’re set. They tend to be highest for the kinds of elective procedures that we’re seeing got cancelled in the middle of this pandemic leaving hospitals facing bankruptcy. And so why is it that we are reimbursing things like dermatologic procedure, which some may be necessary, but others may not be at substantially higher rates than we’re reimbursing other really critical services, like just —
MH: You’re saying, and you’re saying, change the whole reimbursement system, don’t just assume that’s gonna stay the same.
AES: Exactly. Right? And any responsible Medicare for All system would change the reimbursement system. It has to.
MH: Next up, what about private insurance? What is the reason for getting rid of it completely?
During the debates, we saw some Democratic presidential candidates, who say they support Medicare for All, saying no, but we don’t want to get rid of all private insurance. Even in the UK, the NHS exists alongside supplemental private insurance for those who can afford it, for those who want it. And right now, the majority of seniors on Medicare, I believe, also have some form of private insurance, too. So if you’re growing Medicare for All, if you’re following a UK single-payer model, why get rid of private insurance? It’s not necessary, is it?
AES: Yeah, so a couple of points. There are a lot of different ways to think about how private insurance may or may not operate. The bills that have been proposed, they would actually do away with only that private insurance that competes with the public system. And the reason why is because you end up creating a two-tiered system. Right?
For those who have the means they end up going to the private system, which tends to shunt the lower income, and usually, because of all kinds of bad things in our society, the sicker people into the public system. And when you do that, it raises the cost of the public system, because of course, an insurance system is really just a balancing act — you want enough of the less sick, less expensive people in the system to be able to balance out the more sick more expensive people and you start siphoning off those who are richer, who tend to be less sick and less expensive, you end up leaving the public system more sick and more expensive. And of course, we know, what are Republicans going to do with that information? They’re going to point to that public system and say, “See, it’s bloated, it’s inefficient.”
Well, no, actually, it’s that the private system has cherry picked all of the least expensive, least sick patients.
MH: What about the — last question on Medicare for All. What about the argument that says, and Joe Biden said a version of this, too, the argument says, if not having Medicare for all has supposedly made the Coronavirus crisis here in the US worse than elsewhere, say the critics, how do you explain the massive crises and death tolls from the virus in countries like the UK, Italy, Spain, which do have some form of single-payer?
AES: Again, I just think this is a cherry picked argument, right? Because then I can also point to South Korea and say, “Well, look, they were one of the world’s best response, and look what they have. They have a very similar system. And they were able to do what they did because the public system kicked in and saw —“
MH: But the critics would say, “That’s fine, but it didn’t help the Italians, or the Brits, or the Spanish.” That’s their argument.
AES: Right. But like my, my other point is also, like, since when did we start comparing ourselves to Italy, right? Like, the only time I’ve ever compared ourselves to Italy is, is, you know, when it comes to, like, quality of food, and yes, Italy wins.
But this is just a cherry-picked comparison, to pick one example that tends to fit an argument that you wanted to make in the first place and that held us accountable. We are the richest, most powerful country in the world. We are not Italy. And nothing against the Italians, they just don’t have the means that we have, they don’t have the size that we have, and they don’t have the relative governing functionality that we have.
Like let’s say we were to compare our military to Italy’s. Right? And we’ll say, well look, let’s just, let’s just, let’s just say, “Look, we want to be just like Italy, let’s scale down our military so that it works like Italy’s.” And I think the same folks who are making that other argument would be up in arms and say, “No, we’re the United States of America, we have to be a strong, a strong military on the world front.”
MH: You’ve just reminded me of another argument often raised, and I’ll throw it at you now as a kind of P.S., you said we’re the “biggest, strongest, most powerful country” in the United States.
There’s an argument that says, OK, single-payer — fine. It works in countries like the UK, or Italy, or South Korea with small populations; it can’t work in a country with so many people.
AES: The point that I’ll make is that what we have right now isn’t working in a country with so many people. And it’s not working because it systematically excludes the poorest and the most marginalized. It fails us in moments like this when we’re facing a real pandemic because everything’s focused on a profit margin. And we waste a huge amount of money paying CEOs major salaries. And so my point is, is that look, what we have right now isn’t working. And as the richest most powerful country in the world, shouldn’t we be doing something about it?
We’re watching as every other high-income country in the world, every single one has some system of government health insurance. What would ours look like? Right? What would the American system look like? Because I know I’m from a country where we take pride in doing what we do better than anyone else. And so what would it look like if we finally decided that our collective will should mean that we surpass the profit motives of CEOs of major corporations and decide that we’re going to do this for our people?
MH: OK. Just before we finish, let’s talk Bernie Sanders. You were a big Bernie supporter, you’re close to him in his campaign, you were on CNN as a surrogate for him. How disappointed were you when Bernie Sanders announced he was suspending his campaign?
AES: I mean, deeply disappointed. And I think it’s not just disappointment, it’s also just pain and frustration. Especially considering the fact that we’re in the middle of a global pandemic and you look at all of Bernie’s policies, and they map pretty damn closely to all of the things that we either are doing or should be doing to take care of people in this moment.
And you ask, “What would a Bernie Sanders presidency mean for the future that we built around protecting us from something like this in the future?” And so that, that’s hard. And I come to my politics not out of ideology. You know, a lot of folks will point to me and say, “Well, you know, you, you, you say specifically that you’re not a socialist.” I’m not a socialist, because I just don’t, I don’t think ideological tags matter.
I come to my policy by thinking about what it would mean for the people I got to serve when I was health director in the city of Detroit, low income people all over our country who have been marginalized into those situations of poverty. And so, you know, that’s why I’m so devastated. That’s why I’m so frustrated.
MH: But unfortunately, a lot of, a lot of low-income working class voters, in the primaries at least, didn’t vote for Bernie Sanders. They voted for Joe Biden. In your state. I think he lost every county in Michigan. Why do you think he lost? Where did it all go wrong for Bernie Sanders?
AES: Yeah, I’ll say a couple things.
Number one, you know, we started our conversation today talking about an epidemic of insecurity. If my hypothesis is correct, that we are approaching our politics from a place of deep anxiety about the future, Joe Biden is the political equivalent of a security blanket, right? You remember him eating ice cream, wearing his aviators in the eight years with Barack Obama. And he seemed like a safe choice. And I think for a lot of reasons, to voters, he was. And so I’m never going to be in a situation where I’m blaming voters for what happened. But I do understand the anxiety of this moment. And, you know, I know that when I’m really anxious, sometimes I just, I want to sit under my blanket in my bed. And I think, in some respects, Joe Biden was that choice.
The second point I’ll make, though, is that I think that we take for granted how quickly we’ve gotten where we are with Bernie Sanders’ leadership. And real change takes time. And so, you know, I hate to tell folks who are, who are suffering and struggling right now that we have to be patient. But we do have to be patient — that these ideas have exploded onto the, onto the scene and they’ve made such incredible headway, but there’s more work to do.
MH: I can’t help but note that you didn’t say he has done anything wrong. You basically said people voted for Biden as a security blanket and things take time. So you don’t think that the Bernie campaign got anything wrong? You wouldn’t, you wouldn’t go back and do something differently.
AES: I ran for governor in Michigan, and the experience of running a campaign is like perpetual failing. If you’re doing well, you’re just failing a little bit better tomorrow than you did today.
And so, you know, every campaign could do a better job. I think the interval change that we have made in our society, around critical issues like climate change, around healthcare, around the firewall that’s deeply broken between corporations and our government, that interval change has been incredible. And so while there are a lot of things that you could point to and say this could have been done better, and that could have been done better, of course — I think we take for granted just how far we’ve come over the five years of Bernie Sanders in, in, on the national political stage.
MH: And will you be voting for Joe “security blanket” Biden in the general election?
AES: I will, and look, you and I both come from a community that has been deeply marginalized by this president.
AES: And for me, it’s not even just only about the experience of being Muslim in America, and what it means to raise my ethnically half-Egyptian, ethnically half-Indian daughter in this country. But it’s also about low income folks in a community like Detroit where the rate of COVID-19 deaths has far surpassed any other community in Michigan.
Those folks deserve that we will spend the next four years arguing and fighting for Medicare for all rather than arguing and fighting so that the ACA doesn’t get repealed. And so, you know, I would rather spend the next four years working to drive progress, even if that President doesn’t perceive or engage progress the same way I would have liked with Bernie Sanders, rather than fighting to keep what we have against a bigot, a xenophobe, and an incompetent man who has leveraged government for his own well being and the wellbeing of his cronies, rather than for the wellbeing of all of us.
I mean, we’re sitting in the middle of this global pandemic because of government incompetence, because of Donald Trump. And so I just think it would be selfish of me to say, “Well, you know what, I didn’t get my way. So I’m gonna take my ball and go home.” And like I told you, I come to my politics not because of my ideology, I come to my politics because of the people I feel I have responsibility to serve. And for them, they are well better off under a President Joe Biden than a President Donald Trump for another four years.
MH: Abdul El-Sayed, we’ll have to leave it there. Thank you so much for joining me on Deconstructed.
AES: Hey, I really appreciate you having me.
MH: That was Abdul El-Sayed, progressive politician, doctor, cable news pundit, and the author of the new book “Healing Politics.” Abdul’s right: There’s an epidemic of insecurity, and it’d be tragic if that insecurity continues to be exploited for right-wing, not left-wing causes.
I mean, you have Americans dying who shouldn’t be dying. You have Americans from minority communities dying at higher rates than the rest from COVID-19. You have millions of people losing their jobs and with those jobs, their healthcare. If there was ever a better time for Medicare for All, or when the argument for it was obvious and staring us all in the face, I can’t think of one. To borrow from that famous saying, “If not now, when?”
MH: That’s our show! Deconstructed is a production of First Look Media and The Intercept. Our producer is Zach Young. The show was mixed by Bryan Pugh. Our theme music was composed by Bart Warshaw. Betsy Reed is The Intercept’s editor in chief.
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To those of you who are Muslim and listening, Ramadan Mubarak! To all of you listening, see you next week, and stay safe.