THIS TIME ON CODE WACK!
Why do Americans live about four years less, on average, than people in similar European countries, despite spending far more on health care? And why are so many dying from illnesses we already know how to prevent or treat?
To help us unpack this, we spoke with Dr. Adam Gaffney — a pulmonary and critical care physician, public health researcher, and Assistant Professor of Medicine at Harvard Medical School. He’s a former president of Physicians for a National Health Program, and his research and advocacy focus on health care financing and national reform. He’s also the author of To Heal Humankind: The Right to Health in History. This is part one of a two-part series.
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
Tell us a little about yourself. Who are you, and what inspired you to become an advocate for healthcare reform?
Gaffney: I’m a practicing intensive care unit doctor. I practice in a community hospital system north of Boston — many disadvantaged patients and patients from immigrant backgrounds are part of our patient population.
I also conduct healthcare research on equity and access, as well as national healthcare reform. And finally, as you mentioned, I’ve been a longtime advocate for universal healthcare reform. I served for a couple of years as the president of Physicians for a National Health Program, which is a Medicare for all advocacy organization of physicians that was formed in the late 1980s.
So that’s the sort of three things I do. And what brought me to it was a desire to meld my career path and medicine with the cause of social justice that I’ve always been committed to.
The US spends more on health care than any other wealthy country, yet our health outcomes are worse and still falling behind. From your perspective, what explains this deepening paradox?
Gaffney: …the reason why we spend so much on health care in this country is not because we are sicker than other people in other countries. It’s not because we have more unhealthy habits. The reason why we spend so much on health care is because of the way that we have designed our healthcare system.
We have a fragmented, privatized healthcare financing system in which enormous amounts of resources go towards the administration and the profit of our health insurers. Meanwhile, on the provider side, huge amounts of resources go towards administration to deal with that welter of insurers, each with their own rules and regulations, prior authorizations, and so on and so forth. There are also huge amounts of profits that get siphoned out of the system and increasingly into the pockets of shareholders or even private equity firms. So that’s why we spend so much.
Now why are our outcomes worse? There are many things. It’s not only health care, of course, many things contribute to poor health other than health care, but health care matters…
Number 1, we leave more than 25 million Americans uninsured. They don’t get any care. We leave even more underinsured — copays, deductibles, and co-insurance are so high that they often avoid care even when they need to use it. I don’t think we invest enough in primary care. I think we’re a specialty-heavy healthcare system, and I can say that ’cause I’m a specialist, but I think that’s a problem as well. So, really, at the intersection of those two forces is the picture that you paint.
US life expectancy started falling behind peer countries in the eighties and still hasn’t recovered since the pandemic. What does that long-term trend tell us about the structural failures of our healthcare system?
Gaffney: …something is very amiss in American healthcare and American society. I think the health trends are complicated, but factors that contribute include some of the healthcare issues we’ve been discussing, but also rising economic inequality.
During the 1980s, obviously, there was a surge in economic inequality under the Reagan administration. There was also environmental deregulation and other policies that set us back in the increase in spending. What’s that about? You know, actually, researchers don’t really have a great answer for that. There’s no official answer to that question: ‘What happened that we seemed to really start going off in the wrong direction?’
But I do think part of the problem was the increasing corporatization of American health care, the entry of big managed care giants, the rise of privatized Medicare, the shift towards more for-profit provision. Colleagues and I did a study looking at the hundred years of … ownership and financing of health care and we found that, you know, there’s been a gradual ongoing shift towards for profit, corporate provision – even though the public is actually picking up more and more, and more of the tab. It’s just that the money is flowing to private interests.
Helpful Links
To Heal Humankind: The Right to Health in History, Adam Gaffney, MD, MPH
Physicians for a National Health Program (PNHP)
National Health Expenditure (NHE) Fact Sheet, CMS.gov
The Wealth-Health Connection: How Economic Status Shapes Well-Being
Milken Institute
What Could Be Done to Reduce Health Care Spending and Improve Health Outcomes?, GAO.gov (Government Accountability Office)
The Truth about Medicaid Work Requirements: Costly, Ineffective, and Harmful, Community Catalyst
Disenrollments of People With Medicaid Climb Past 16 Million, Nerd Wallet
Episode Transcript
Read the full Transcript.
Guest Biography: Adam Gaffney, MD, MPH
Dr. Adam Gaffney, M.D. M.P.H. is an Assistant Professor of Medicine at Harvard Medical School, a pulmonary and critical care physician at the Cambridge Health Alliance, a health policy researcher, and a writer and commentator on issues of medicine and policy.
His research focuses on national healthcare reform, healthcare equity, and disparities in lung health. He has authored or co-authored more than 60 journal articles, with first-author publications in such journals as the Lancet, Annals of Internal Medicine, British Medical Journal, JAMA Internal Medicine, Health Affairs, the American Journal of Public Health, and elsewhere. He is also the author of the book To Heal Humankind: The Right to Health in History, published in 2017 by Routledge.
A past-president of the nonprofit research and advocacy organization Physicians for a National Health Program (PNHP), Dr. Gaffney is also a frequent writer on matters of healthcare and policy, and has published articles in outlets including the New York Times, Washington Post, Atlantic, New Republic, USA Today, and the Boston Globe. He is also a frequent media guest, and has appeared on NPR, MSNBC, Fox Business News, the BBC, and elsewhere.
Dr. Gaffney received his MD from New York University and his MPH from the Harvard T.H. Chan School of Public Health. He completed his residency at the Columbia University Medical Center, where he served as chief resident, and his fellowship in pulmonary and critical care medicine at Massachusetts General Hospital, Brigham and Woman’s Hospital, and the Beth Israel Deaconess Medical Center.
Host Biography: Brenda Gazzar
Brenda Gazzar, the host and co-producer of Code WACK!, has produced over 300 weekly podcast episodes, topping 400,000 downloads. A skilled interviewer and storyteller, Brenda brings nuance, curiosity, and clarity to every conversation.
Brenda has worked as a multilingual and award-winning reporter with more than two decades of experience in California and the Middle East.
Her work has been published by Reuters, Ms. Magazine, USA Today, Los Angeles Daily News, the Orange County Register, The Wrap, The Jerusalem Post, Cairo Times, and numerous other publications. She speaks Spanish, Hebrew, and moderate Arabic and is the recipient of national, stat,e and regional awards.
Brenda also enjoys being a life coach, helping people align with their purpose so they feel fulfilled while achieving their boldest dreams.
Brenda’s work is grounded in a belief that systemic change and personal growth go hand in hand — and she’s here for both.
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Keywords:
Code WACK podcast, Adam Gaffney, Brenda Gazzar, Medicare for All, health equity, universal healthcare, healthcare reform, U.S. healthcare system, health disparities, primary care access, administrative waste, healthcare costs, underinsured Americans, uninsured population, healthcare inequality, single payer healthcare, public health policy, Physicians for a National Health Program, healthcare financing, health system design
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