Margaret Flowers, MD, is a pediatrician whose exasperation with the American healthcare system turned her into a single-payer activist. In 2009 she was arrested at the Senate Round Table on Health Insurance for attempting to speak on behalf of a single-payer plan when single-payer had been cut out of the conversation.

“When Obama was elected I was optimistic, like many people, because he knew what single-payer was,” she told me when we talked. “He’d been on record saying that single-payer was the best solution. It was quickly very clear that that this was a predetermined course, that it was more like a marketing campaign.”

As the nation awaited the Supreme Court’s decision on the Affordable Care Act of 2010 (ACA), Flowers sounded more upbeat than aghast at the prospect of the Supreme Court ruling striking down part or more of the Obama law. For Flowers, a single-payer plan, like Medicare for all (which would fund medical care from a single insurance pool run by the state), was always the ideal way to provide universal, affordable, quality care, and contain soaring costs and waste in the process. As for the individual mandate—forcing the public to buy from a for-profit company—she’s called it “crony capitalism on steroids.”

It would be no small thing to move health reform through the legislature again, she agrees. Three years ago, Democratic leaders in Washington foreclosed on single-payer, and went on to betray their commitments to single-payer lite—the so-called public option. There’s no evidence there’s been a sea change in Washington. Around the country, though, Flowers believes single-payer supporters are in a stronger place now than they have ever been. (And during oral arguments on ACA this year, Justice Sotomayor was good enough to confirm the constitutionality of a public system.)

Regardless of how the court rules, we’ll still have healthcare woes and groups like Physicians for a National Healthcare Program, will continue to fight for single-payer. What follows is a partial transcript of my conversation with Flowers which took place last week, in New York City.

Laura Flanders: Margaret, a lot of media would have you believe that we are on the brink of the Apocalypse: Are we?

Margaret Flowers: Where we stand right now is that there are two things that we need to consider. One, of course is the decision around Medicaid and this is a very important decision, this is much more crucial. If the Supreme Court says that the federal government’s giving states money is tantamount to coercion, that’s a real problem because where does that end? If the federal government says you must meet minimum guidelines for education and we’ll give you money to help your schools, is that coercion? We really rely on government to provide a basic social infrastructure that takes care of people.

Now with the individual mandate, really no matter what happens—if it’s found to be constitutional or not constitutional—we know that the bill didn’t go far enough and the single-payer movement is going to be continuing to push for national Medicare for all. If it’s found to be unconstitutional that provides us with a better opportunity to make that argument; say okay you’ve done everything that you could do in the private insurance framework, it doesn’t work. Now can you really see the facts and see that we need to build a publicly financed system that’s accountable to all people and universal healthcare.

Let’s talk about the individual mandate. In one piece you co-wrote recently you referred to it as “crony capitalism on steroids.” What did you mean?

The individual mandate requiring people to purchase private insurance and using hundreds of millions of our public dollars that go directly to the private insurance companies is outrageous. If you look at it people having private insurance still doesn’t guarantee that you could see the doctor that you need to see, get the treatment that you need to seek; [it doesn’t guarantee] that you can afford the healthcare because of co-pays and deductibles… many people are foregoing necessary care even though they have insurance.

And then you look at does private insurance protect you if you have a serious illness? The greatest cause of bankruptcy is medical [costs] and 80 percent of those people that went bankrupt from medical cost had health insurance. So, we’re forcing people to purchase a defective product, we’re putting our private dollars into a private corporation that’s just going to take that money as profit and not give it out to the people for care.

So the Supreme Court should vote it down?

I believe that the Supreme Court should vote down the individual mandate. It’s not a solution, it’s not working in Massachusetts very well, very clearly they are failing. People are still facing serious barriers there. They say they’re worse off than they were five years ago so that should be the answer right there: it doesn’t work.

Howard Dean was speaking recently in Washington said that “did didn’t give a damn” about the individual mandate, but he did think that there were things to preserve in the act. He talked about 30 million previously uninsured Americans’ getting coverage. He talked about 17 million being added to Medicaid if the Act survives a couple of years; tax credits for people who can’t afford it, (again, kicking in in 2014 if the Act as a whole survives.) Do you agree that there are parts of ACA worth saving?

Well, this is the dilemma that we are always placed in where there is a little bit of good for some people, but [let’s] step back and look at the big picture. For one thing, the 30 million people that would gain insurance, what are they actually gaining? About half of those will be given Medicaid. Medicaid is a system that doesn’t work very well, it’s hard to find providers and people are not treated well when they have Medicaid. In many cases they are kind of shifted out of the hospital quickly. The other half is going to be getting private insurance and with the co-pays and the deductibles. They’ll still face serious financial barriers to getting the care that they need, they’ll still face bankruptcy if they have a serious accident or illness. And 20 or so million will still be left out. We are expecting under this legislation—the recent data shows—that maybe 20 million employees will lose their employee benefits under the Affordable Care Act.

We’re not really moving in the right direction and so there’s always something good in there which causes people to defend it without looking at the big picture that too many people are going to be left out.

When Obama was elected I was optimistic, like many people, because he knew what single-payer was, he’d been on record saying what single-payer was the best solution. We thought we would at least have a discussion, a debate of looking at what were the possibilities. It was quickly very clear that that this was a predetermined course, that it was more like a marketing campaign—it was very scripted toward a predetermined end, and that was what was very upsetting to those of us who advocate for real health reform, you know: evidence-based reform, Medicare for all.

Nonetheless a lot of people got very involved in the campaign. What’s your message to them today as they wonder what’s going to happen and many of them feel that they’ve worked very hard for something that they don’t want to see thrown out, far less told it was all useless?

I know it’s difficult for people that worked really hard to get the Affordable Care Act and for me personally, I think it’s really important, to be honest. And the truth is that the Affordable Care Act was something was heavily influenced by the industries that profit off of our current situation, that doesn’t address the problems that we have, and now we have an opportunity (if the bill is brought down or the individual mandate is found unconstitutional), we have an opportunity to push for real health reform; to come together and stand independent of a political party. One sign that I thought was beautiful was “Get your politics out of my healthcare.” That’s what it has really got to be about. Let’s all come together and fight for a really top-notch healthcare system in the United States that serves everybody. 

So, who would be the“we” in this case?

Well, it’s interesting because in the same conference where Howard Dean said he didn’t care about the individual mandate, Representative Keith Ellison said, if the bill goes down we immediately must “pounce on this opportunity” to go out there with &lsdquo;Medicare for All” and say this is what we want to have. And the majority of Americans already support that approach—the majority of the physicians do—so this is a real opportunity to clearly define what we as a nation would like to see happen.

Has the movement around [single-payer] healthcare changed in these years?

The one positive that came out of the 2009, 2010 health reform process was that the movement for real health reform, for single-payer, Medicare for all, became much more organized and much larger, with groups all around the country and most states who were advocating for this. I think that they’ll be ready to mobilize when this opportunity arises.

What do you think you’ll be up against in the form of the lobbyists and the corporations that put a $100 million dollars into trying to stop this act, that you think didn’t go far enough.

If we’re pushing for single-payer we’re always up against the big dogs –the ones that are profiting off of the current situation, but one thing that’s happened with the advent of the Occupy movement is that people are more and more looking at the truth behind this, seeing the corruption of money in our political system, seeing the corruption of our corporate media and how they really serve the political interest of the people and there has been a growth of independent media, we need much more growth in that area, but I think that all those are real positives towards pushing, exposing the truths and pushing for what we really want this time.

A lot of the media discussion is about the political implications of this decision; I want you to talk about the personal implications for a minute. For the people you would like to be caring for as a doctor. Where are we right now in terms of giving them care and what hangs in the balance?

The politics of the healthcare decision are something that I’ve never really paid attention to. That’s not important to me. What’s important to me are the patients that we see every day, that I saw when I was practicing, that my colleagues continue to see. We don’t want to turn anybody away. We don’t want to have to ask them if they have insurance first or if they can afford their co-pay before we see them.

What we see in the United States, we’re ranked thirty-seventh in the world [in quality of care, according to the World Health Organization], which is ridiculous because we spend twice as much per person on healthcare than other industrialized nation and those nations cover everybody and they have better health outcomes. We see that tens of thousands of people are dying every year of preventable causes simply because they don’t have access to care. The number-one cause of bankruptcy in the United States is due to medical costs. That doesn’t happen in any other industrialized nation. They think it’s crazy that people are facing that. What we really need to do is talk about that, talk about the patients.

The bill, the Affordable Care Act does help some people. It doesn’t help them as much as it should and what those kind of politics does is that it takes those kind of people [and pits them against each other]. When we saw the Supreme Court was hearing the decision, there were all these signs saying fight for women’s healthcare, fight for children’s healthcare —they pit people against each other, saying well, we have to say this because it’s going to help this group.

We want every person to be helped and that’s what a national improved Medicare for all would be: every single person would be “in.” Nobody would be left out. That’s a system that we could build on. We’re hoping that could develop a campaign (if the law’s found not to be constitutional), that’s very simple: drop two words. If we just took “over 65” out of the Medicare bill, then it’s there for everybody.  Now we have something that we can tweak and make better.

What can people do after they wake up after the Supreme Court decision and want to get involved in this movement?

It’s very important to contact your members in Congress right away and demand Medicare for all. Very simply, drop those two words, expand the Medicare program—that’s the fastest way to do this. There are a lot of educational materials at Physicians for a National Health Plan, that’s PNHP.org. Health Care Now is really the grassroots kind of sister organization, and there are Health Care Now chapters all around the country. It’s Healthcare-Now.org.

Thank you.