Stephanie and Ben discuss who developed the vaccine; who is profiting from it; and the fight for global vaccine equity on this episode with guests David Mitchell of Patients for Affordable Drugs and Andrew Goldstein, a public hospital primary care doctor, assistant professor of medicine at NYU, activist, and organizer with the Free the Vaccine and People's Vaccine campaigns.

Show Notes

Who paid to develop the COVID-19 vaccines? Primarily taxpayers. David gives us a history lesson: before the COVID-19 pandemic, the Federal government invested $17 billion in vaccine technology because drug companies weren't investing in this high-risk, low-return research. When the COVID-19 pandemic hit, these vaccine technologies were ready to be tested. Taxpayers invested another $20 billion in clinical trials, creating production capability, and pre-ordering the product. We took the risk out of the endeavor for the pharmaceutical companies. (We socialize the risk, and privatize the profit.)

Are there strings attached to taxpayer dollars for pharmaceutical development? Not really. David explains that the National Institutes of Health contributed to every new drug approved by the FDA in the US between 2010-2019. NIH is the single largest medical research agency in the world. When the drugs are ready for commercialization, they turn the intellectual property (IP) over to pharmaceutical companies with no strings attached. The drug companies can set any prices they want. (For an example, see the new Alzheimers drug from Biogen, that will cost $56,000 a year.)

In the case of the COVID-19 vaccines, the US government did negotiate, showing that it is possible to have life-saving innovation at reasonable prices for patients. The Pfizer vaccine is currently $19.50/dose. Pfizer has told their shareholders recently that they want to raise the price of a dose to $150-$175. Many Americans may still need a booster in the future, which will be an opportunity for the drug companies to raise prices if the government doesn't negotiate.

What is standing in the way of developing nations purchasing enough vaccine to inoculate their entire population? Andrew shares that so much of our response to this global pandemic has been approached differently nation-by-nation. Rich nations who gobble up all the available doses are also preventing maximum production of doses, creating false scarcity and "vaccine apartheid."

Trade deals with wealthy nations result in forced austerity for developing nations, keeping them impoverished. Most of them have a tiered healthcare system, with very frail public health mechanisms. Some might have a universal public system, but they tend to be low quality. A secondary private system exists for wealthy people who pay full price out of pocket. Even if wealthy countries donate vaccines, those countries may be selling them to cash-paying patients.

Patent rights are preventing developing nations from producing generic vaccines to save their own populations. In the fall of 2020, South Africa and India called on the World Trade Organization for a Trade Related Intellectual Property Rights (TRIPS) waiver, an emergency public health authority to waive patents on vaccines and the technology to produce them. Unfortunately, there are also a lot of trade secrets that aren't patented that companies are unwilling to share. The TRIPS waiver is a necessary but insufficient solution to free the vaccines.

Will the donations of vaccines from G7 countries be enough to meet global need? There are about 6 billion vaccine eligible people on earth who will need two doses = 12 billion doses. G7 countries are announcing a total of about 1 billion doses, but they're already backing away from that amount and they haven't tied them to a timeline. Philanthro-capitalism won't be enough to get 10 billion doses in the next year to meet the global need.

Every other developed country bargains for pharmaceutical prices.

62% of people now have a positive opinion of drug companies, up from 32% in 2020. What's responsible for the sudden shift, and do pharmaceutical companies deserve this newfound adoration? We're joined by Shannon Rotolo, co-founder of Pharmacists for Single Payer and a clinical pharmacy specialist at the University of Chicago Medicine, to debunk industry lies about research and development, innovation, the market, and more.

Show Notes

Public opinion seems to be driven by the belief that pharmaceutical companies mainly function to discover and manufacture important new drugs. While the big pharma companies do do some research and development, they primarily buy the intellectual property of smaller biotech research companies, and then mostly act as marketing and sales reps for the product. They actually spend a lot less on research and development, and much more on marketing and profits for shareholders.

Image description: Congresswoman Katie Porter, holding a whiteboard at a House Oversight Committee hearing about drug prices. The smallest circle on the whiteboard is labeled Litigation and Settlements, the next circle is labeled R&D, the next largest is labeled Marketing and Advertising. The largest circle, Stock Buybacks and Dividends, is more than 10 times the size of the next largest circle. https://www.businessinsider.com/video-katie-porter-tears-into-pharma-ceo-whose-company-inflated-its-prices-for-two-major-drugs-2021-5

The vast majority of breakthrough innovative pharmaceuticals are actually funded by taxpayers through the National Institute of Health. Some studies are funded through the Veteran's Administration. There are countless examples of pharmaceutical companies profiting off of publicly-funded research, making billions and denying any royalties to the government. Those royalties could be used to provide lower cost drugs to patients, but the pharmaceutical companies instead have driven prices up, making life-saving drugs unavailable to people who need them. A recent example is the drug Truvada, marketed by Gilead.

Shannon explains some of the games pharma plays to make more money regardless of patient needs. Patent extensions, me-too drugs and changes to delivery methods all allow drug companies to maximize profits and minimize research costs and risks, ultimately driving up costs for patients.

While drug companies argue that lowering prices will stifle innovation, the profit motive actually works against the innovation motive. If you can tweak a drug and profit from it, the incentive isn't there to take the risk and put in the work to develop something new. (Socialize the risk, privatize the profit, as they say.)

If you've always wondered what Pharmacy Benefit Managers (PBMs) add to healthcare, Shannon breaks it down. Insurance companies, large employers and Medicare Part D contract with PBMs to facilitate prescription drug benefits. They negotiate rebates with drug companies, ultimately setting the price the payer will pay for the prescription. Essentially, PBMs are yet another corporate middleman that skims profits off the system without adding any actual care for patients.

What would single payer mean for pharmaceutical prices? Removing insurance companies and PBMs, and negotiating prices would all help bring down costs. But the key benefit of single payer would be simplifying the process and eliminating out-of-pocket costs for drugs that patients need to live.

We sometimes hear concerns about a single payer system limiting the drugs that are covered. Shannon explains that there would be a formulary in the system, which would limit coverage of some of the duplicative me-too drugs; but that's already the case with the insurance plans that most Americans have now. The benefit of a single national formulary is that it's transparent. Your provider will know what's covered and you'll get it. There would be an exception process for patients with rare conditions,

In our inaugural mailbag episode, Rose Roach - Executive Director of the Minnesota Nurses - joins us to answer your questions about how Medicare for All would save money and impact rural hospitals, how to answer to pushback on cost, talking to conservatives about Medicare for All, the political landscape, petitions as a base-building tool, and more!

Show Notes

Ben and Stephanie are joined by Rose Roach, the Executive Director of the Minnesota Nurses Association (MNA), and answer questions from listeners.

First, we celebrate that Congresswoman Betty McCollum (D, MN-4), Rose's own representative, signed on as a co-sponsor of HR 1976 after a conversation with MNA nurses during Nurses Week (and years of advocacy by healthcare activists in her district).

On to the mailbag questions!

Q: Jordan asked: How does insurance work for the Indian Health Service? A: The Indian Health Service (IHS) is independent but not well funded. Earlier versions of Medicare for All absorbed IHS into the system, which concerned advocates for tribal sovereignty. Under HR 1976, though, IHS will stay independent of the Medicare for All system, but will be treated as a provider, so will receive financing like any other provider.

Q: Laurie asked: Why is it taking so long for Medicare for All? A: For one, our political system and elected officials are influenced by money. The for-profit health insurance industry has deep pockets and is willing to spend big to maintain the status quo. Until we have campaign finance reform, we will have to fight this fight against monied special interests. Another issue is that we haven't quite achieved the working class solidarity that it will take to create the grassroots demand that will force elected officials to pass Medicare for All.

Q: Heather asked: How would Medicare for All affect hospitals? How will they stay up and running, especially rural hospitals?A: Medicare for All would actually be transformative for hospitals, despite the misperception generated by the industry that it would hurt them. Medicare for All would fund hospitals equitably and fairly, based on their value to the community rather than their profitability. In a market-based system, hospitals that don't generate profits, like small rural and safety net hospitals, can go under, regardless of the benefit they provide for the community. Under the Medicare for All system, hospitals will be funded based on the care needed by people in the community. Medicare for All is actually what could save rural healthcare from closures and consolidation.

Q: Steve asked: How do we educate conservative rural communities at risk of losing their hospitals about the benefits of Medicare for All? A: We have to meet people where they are. Ask them how the system works for them now? Do you have to travel far for your routine care? For some it's an ideological difference and we'll never convince them, but there are conservatives who can be engaged about the care they and their community need.

Q: Many asked: How would we pay for Medicare for All? A: The two Medicare for All bills don't have financing language yet. The plan is to build the financing through the committee process. Several studies over the years have shown ways to pay for the program and generate savings, including the Political Economy Research Institute (PERI) Economic Analysis of Medicare for All.

The PERI study found the whole system would cost about $3 trillion, which is less than we're currently paying. We already pay for about two thirds of the healthcare in the US through tax dollars. The other third is currently coming out of people's pockets in the form of employer and employee premiums, deductibles, and co-payments that generate insurance company profits. Under Medicare for all, those dollars would go to a public system that would guarantee your healthcare. Some proposals also include taxes on the extremely wealthy.

We discuss Biden’s American Families Plan proposal, which Biden unveiled in his first State of the Union address last week (spoiler: it’s rather underwhelming) and the industry lobbying that made it happen. Then we discuss the proposal to expand Medicare that came from Reps and Senators - both progressives and moderates - and what it may signify in the fight for Medicare for All.

Show Notes

Today we celebrate Stephanie's first dose of vaccine and Biden's first 100 days.

(Spoiler alert: #underwhelming)

While Ben and Stephanie liked the President's non-healthcare progressive priorities like paid family and medical leave, subsidized childcare for low income families, and increasing taxes on the very wealthy, they're disappointed in the healthcare vision Biden laid out.

Ben and Stephanie first review the healthcare components of the American Rescue Plan, passed on March 10. This plan included $1,400 payments as well as 100% subsidy of COBRA (the very expensive program that allows employees who have lost their jobs to pay for their past employer's health insurance plan) premiums. It also removed the income limit on ACA premium subsidies for anyone whose health insurance premium costs more than 8.5% of their income, and increases subsidies for low income households. All of these policies will sunset, or die off later this year or in a few years.

During the State of the Union, President Biden also talked about proposals that aren't actually in the American Families Plan: a public option, lowering the Medicare eligibility age to 60, extending subsidies to low income people in states without Medicaid expansion, and letting Medicare negotiate drug prices.

The actual American Families Plan only has one healthcare proposal: the ACA subsidies from the Rescue Plan will be made permanent. This will affect about 9 million people, less than 3% of the population, at a time when 30 million have no insurance, and more than 60 million are seriously underinsured. While this expansion will help this small group, it sends more tax dollars to a private, profit-driven insurance industry. Not the big bold reform those of us who believe healthcare is a human right and a public good hoped for.

Coincidentally, back in December America's Health Insurance Plans (AHIP - the industry lobbying organization) and Blue Cross called on Congress to fully subsidize COBRA and expand subsidies for private ACA plans, as a response to the COVID-19 pandemic. Interesting that this is the exact proposal made by President Biden in the Rescue Plan and Families Plan. Hmm.

Ben and Stephanie also discuss the alternative proposal sent to Biden by members of Congress (Seventeen Democratic Senators and 80 Democratic Representatives), calling for the American Families Plan to include an expansion of Medicare eligibility to age 60, cover hearing, dental, and vision, and introduce a cap on out of pocket expenses. Interestingly, the letter signers include a lot of centerist leadership, not just the typical Medicare for All supporters.

This plan isn't a clear win for us: we assume Medicare Advantage, the private insurance alternative to traditional Medicare, will continue to siphon taxpayer dollars into private coffers. Also, bringing in 60-65 year olds, we won't get the cost savings we would get by bringing all Americans in. But bringing more people and some additional benefits into Medicare would help build confidence in public healthcare, potentially making it easier to build a case for Medicare for All.

Ben does some coalition math on this alternative plan: the insurance industry would probably like this plan, because it would take the most expensive people (those 60-65 years of age) out of the private employment-based insurance pool, leaving younger and cheaper policy holders for insurance companies to profit off of. The opposition will come from hospitals and providers, because Medicare pays them less than private insurance does...

We talk with Ben Palmquist from Partners for Dignity & Rights about a new anti-single payer bill in the Florida state legislature that would require a two-thirds supermajority to pass a single payer bill in the state. We segue into a larger conversation about the various opposition groups that have sprung up against Medicare for All and how the Florida bill is part of a trend of attacks on both healthcare and democracy.

Show Notes

Ben and Stephanie speak with guest Ben Palmquist, Program Director, Health Care and Economic Democracy, at Partners for Dignity and Rights (aka NESRI) to discuss the Koch Brothers' entry into the M4A debate at the state level.

Healthcare advocates are watching an anti-M4A bill working its way through the Florida State Senate which, if passed by the legislature and voters, would require a two-thirds supermajority to pass a state single payer bill. If this bill passes in the Florida legislature, it would go on the next statewide election ballot and would require 60% of the vote to pass and amend the state constitution.

It appears that Americans for Prosperity (the libertarian/conservative think tank funded by the Koch brothers) may be behind this bill, and are considering pushing it through other Republican-controlled legislatures if they're successful in Florida.

A single payer bill has not actually been introduced in Florida, so this anti-M4A bill is in anticipation of the introduction of one, should the state continue to trend purple and swing to the left.

Ben P sketches out broader right-wing policy campaigns, including attacks on voting rights and democracy. Healthcare industries are highly organized against M4A (and any legislation that changes the status quo). He notes that typically the insurance industry is in competition with hospitals and pharmaceutical companies because they bargain with each other over prices. But now we're seeing coalitions (Partnership for America's HealthCare Future, Realities of Single Payer, Affordable Coverage Coalition) bringing them together to attack any shift away from privatized insurance.

Stephanie puts the Florida bill singling out M4A for a two-thirds majority into the context of a larger attack on democracy. Ben P notes it's part of a strategy that the right-wing has used for decades, dating back to the California tax revolt in the 1970s. In California, Proposition 13 is still state law, requiring any tax hike to be passed by a two-thirds majority, making it hard to raise revenue, decimating public education and other public services. Conservatives are now using this model for a systematic attack on voting rights and democracy: even if the citizens of Florida elect a majority of legislators who want to pass single payer, they will preemptively prohibit the will of the people from being enacted.

They discuss the way conservatives have also dominated the framing of the healthcare debate in the media. Conservative groups of all stripes have found common cause in attacking government at all levels and sectors, most recently in a coordinated campaign to frame M4A as "government-run". On the other hand, rather than talking about the current system as "corporate-run," the conservative frame refers to it as "private," erasing corporate profiteers from the discussion about the system. Mainstream media has picked up this frame to discuss any attempts at healthcare reform.

Stephanie notes the recent effort by liberal philanthropy and think tanks to focus on countries with universal coverage with private insurance. Media stories have held up countries like Singapore and Switzerland to justify the role of private insurance in a universal healthcare system. These stories downplay the fact that these countries have different regulations on private insurance than we have: in some, their hospitals are public, or the government sets prices, and workers have seats on boards that govern the economy.

In January, the Campaign for New York Health made single payer history in the United States: the bill secured the support of a majority of co-sponsors in both chambers of the New York State legislature. Campaign organizers Ursula Rozum and YuLing Koh Hsu join us to discuss how NY got here and the very real chance to win Medicare for all at the state level!

Show Notes

The Campaign for New York Health recently achieved a huge majority of cosponsors of the New York Health Act in the State Assembly and a narrow majority in the State Senate, so this week Ben and Stephanie speak with co-directors YuLing Koh Hsu and Ursula Rozum about their work over the last several years leading to this milestone.

They discuss the early days of the work, the broad coalition they’ve assembled, and the story-based organizing and lobbying that has been key to their success.

In New York, the people who are impacted by the healthcare system the most are leading the movement, including patients, families, and small business owners who can’t afford healthcare coverage. Everyone is an expert on their own experience with the healthcare system, and New York’s story-driven strategy focuses on real people to build the grassroots demand that’s necessary to pass major legislation.

Predictably, the insurance industry is actively opposed to the New York Health Act, relying on the usual arguments that the legislation will raise their taxes. It’s important to remember that they are making billions on the status quo, and their arguments all need to be viewed through the lens that they will say anything – true or false – to maintain their control over care and ability to make profits.   

Even with a majority in the Assembly and Senate, the last step of passing the New York Health Act is going to be the hardest. The next step for New York is to organize legislative co-sponsors to become vocal supporters of the bill. The new legislators elected in 2020 are bringing a bold, progressive approach to the work, and the campaign will focus on moving more legislators from being passive co-sponsors to active champions of the bill who will demand a vote from the Speaker of the Assembly and Leader of the Senate.

YuLing discusses their campaign’s theory of change: to build a long term, mass movement that can not only pass legislation, including financing, but will also do the hard work to make sure the Act works for the people it was built for.  

Ursula stresses the importance of understanding that the American failure to pass a national health system has roots in systemic racism; white supremacist opposition to a desegregated health system killed early attempts to pass national healthcare, and compromises in the creation of Medicare and Medicaid allowed Southern states to discriminate against patients of color. Our current profit-driven healthcare system continues to reinforce racial hierarchies. The lesson today is that programs and policies intended to marginalize people of color end up hurting everyone, and a multi-racial, anti-racist healthcare movement is necessary to move the United States toward a just healthcare system.

(For more, see Healthcare NOW’s video, “The Politics of Race and Medicare for All: https://www.youtube.com/watch?v=_eN0KhJ3BoI.)

Ursula and YuLing urge other state healthcare movements to focus on the long-term fight, building leaders, and using stories as the foundation of the work. There are no shortcuts to organizing; building a base and a strong leadership has to happen before a bill can pass.  

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Rep. Pramila Jayapal re-introduced the Medicare for All bill last week with a record 112 original cosponsors - up now to 114. We talk about surprise sign-ons, powerful stories from the cosponsoring Reps, the first national endorsement of a hospital CEO, and the epic organizing effort that got us to this stage!

Show Notes

Representative Pramila Jayapal introduced H.R.1976 on March 17th, with a record number of original co-sponsors on the bill: 112. That represents a majority of the Democratic members of the House. Ben and Stephanie discuss how far our movement has come in just a few years, evidenced by the largest ever co-sponsor list.

Thanks to the hard work of advocates, we have gained two committee chairs as co-sponsors: Rep. Frank Pallone (D-NJ-6), the chair of Energy and Commerce, and Rep. Ted Deutch (D-FL-22), chair of the Ethics Committee.

Other new sign-ons include Rep. Mike Quigley (D-IL-5), Del. Gregorio Sablan (non-voting member, D-North Mariana Islands), and Rep. Tony Cardenas (D-CA-29).

A number of freshman members of Congress also signed on: Rep. Jamaal Bowman (D-NY-16), Rep. Mondaire Jones (D-NY-17), Rep. Ritchie Torres (D-NY-15), Rep. Cori Bush (D-MO-1), Rep. Teresa Leger Fernandez (D-NM-3), Rep. Nikema Williams (D-GA-5), Rep. Marie Newman (D-IL-3), and Rep. Sara Jacobs (D-CA-53).

The bill launch event, held virtually, wasn’t business as usual. Some representatives spoke about their own experiences living without health insurance. A business owner from Pennsylvania spoke about how hard it was to run a business and administer health insurance for his employees. The bill received its first endorsement from a hospital system CEO, Dr. Eric Dixon of UMass Memorial Hospital System. Also, for the first time, a leader for racial justice, Patrice Cullors, co-founder of Black Lives Matter, addressed healthcare as a racial justice issue.

Thanks to the work of constituents on the ground and allied organizations across the country, there has been extensive organizing in every district represented by those 112 co-sponsors.

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Please donate to the Healthcare-NOW Education Fund to support the podcast!

We’re joined by Stephanie Kang, Rep. Pramila Jayapal’s Health Policy Director, to discuss the upcoming 2021 Medicare for All bill, which will be shortly reintroduced in Congress. Kang also discusses changes made to the membership rules of the Progressive Caucus, and the most effective way to lobby your legislator during COVID!

Show Notes

We are excited to speak with Stephanie Kang, DrPH, MS, the Health Policy Director from the office of Representative Pramila Jayapal. Kang is one of the nation’s leading experts on Medicare for All and has been instrumental in Representative Jayapal’s work as chief author to reintroduce the Medicare for All Act.

The upcoming Medicare for All Act is the most comprehensive healthcare program proposed in decades. With the principles of the late Representative John Conyers’s H.R.676 as a foundation, Representative Jayapal’s bill does away with the unfair, fragmented, and inefficient system we have now and makes sure that every American resident has guaranteed access to full healthcare, with all medically necessary services covered, while lowering costs by eliminating all the waste from a profit-driven, inefficient system.

The current Medicare system has some major gaps. The upcoming Medicare for All Act would expand and improve coverage; eliminate out of pocket costs; and add dental, vision, reproductive care, and long-term care support for the elderly and disabled people. Medicare would be allowed to negotiate drug prices. Kang stated that the bill is “battle ready,” a comprehensive, 125 blueprint ready for implementation.

While offering comprehensive benefits to every American resident, countless studies show that Medicare for All will actually cost less, by cutting administrative waste, profits to shareholders, and lobbying and marketing expenses; allowing negotiation of drug prices; and streamlining the inefficiencies of our current system.

Nearly 90% of Democrats polled in April 2020 supported Medicare for All, but currently only about half of the Democratic members in the House support the bill. Kang discussed some of the objections she has heard from Democratic lawmakers who are reluctant to sign on to the bill, including the issues of choice and finance.

Choice in our current system usually means having the choice to keep your employer-provided plan if you would prefer. While opponents often claim that Americans like their employer-provided coverage and would not want it to change, that argument seems to be losing steam as millions of Americans lose their jobs and insurance in the pandemic-related downturn. The choice that actually matters – choice of healthcare providers, clinics, and hospitals – is hampered by insurance companies’ narrow networks, a cost cutting measure that prevents countless Americans from getting the care they need from the provider they want. Medicare for All is the only system that has no networks and allows patients to choose their providers. With no out-of-pocket costs, Medicare for All also allows patients to choose to seek medical care when they need it, not when they can afford it.

Kang also discussed what the transition to Medicare for All would look like. First, no American would go without coverage during the transition period. In the first year of the program, all Americans under 18 and over 55 would be transitioned into coverage under Medicare for All. In the second year, all other age groups would follow. In the meantime, there would be a public option available for the second group, in case private insurance companies decide to stop offering plans or collapse. Kang explained that because everyone would be eligible, the administrative setup of the new system will be much simpler than the current system, and should be able to be phased in quickly.

The Medicare for All Act will be re-introduced this spring, and Rep. Jayapal is already collecting an impressive list of co-authors for the legislation.

In the House, we have about half of the cosponsors we need to pass Medicare for All. Democrats who are not currently cosponsors (and constitute the other half we need to win) represent districts that are whiter and wealthier than the districts we’ve already won. What does this mean for our movement and how do we organize in this next phase?

Is the supposedly “private" Netherlands healthcare system a model for the US? And what would it take, politically and in terms of concrete policy, to transition to this system? Dr. Kieke Okma, an expert on healthcare systems around the world, joins us to discuss how exactly the Dutch healthcare system works (to start: its 80% publicly financed), the nature and extent of the privatization reforms made over the past 15 years, and the effect those reforms have had on the healthcare system. We discuss more broadly the role of government in any healthcare system and what the private sector can and can not deliver in the health insurance sphere.

You can find a copy of her upcoming book, Health Reforms Across the World: The Experience of Twelve Small and Medium-Sized Nations with Changing Their Healthcare Systems, by clicking the title.

Follow & Support the Pod!

You can listen to Medicare for All on Apple Podcasts, Google Podcasts, or visit our website here.

Please donate to the Healthcare-NOW Education Fund to support the podcast!