The American healthcare system is riddled with fraud.

But even more significant might be the embedded structural wrongdoing that sends billions in profits to powerful insurance and hospital interests at the expense of the health of the American people.

Joshua Freeman is chairman of the Department of Family Medicine at the University of Kansas Medical Center in Kansas City, Kansas.

And he’s just written a new book — Health Medicine and Justice: Designing a Fair and Equitable Healthcare System. (Copernicus Healthcare, 2015)

In it, Freeman calls for a universal healthcare single payer system.

This would be different from Obamacare, in that it would effectively push aside the health insurance corporations in favor of one public single payer.

“Embedded structural wrongdoing is the biggest challenge,” Freeman told Corporate Crime Reporter in an interview last week. “If somebody goes into a gas station and holds a gun on somebody and steals $100, that’s easy to identify. But there is structural wrongdoing that costs the American consumers huge amounts of money — such as subsidizing profits for the oil companies that provide that gasoline.”

“Structural wrongdoing is the most difficult to identify. Structural wrongdoing is the most difficult to understand. Corporate criminality is the most dangerous. It’s the most evil because those in charge know what they are doing. They are not doing it because they need the $100 to feed their family or their drug habit. They are doing it because they can. And we end up with things like the banks being too big to fail and having to be bailed out.”

“In the case of healthcare, we build the stealing into the whole structure of the system.”

At the beginning of the book Freeman quotes from Paul Batalden — every system is perfectly designed to get the results that it gets.

“And in some ways, that’s obvious. If you are getting certain results, then your system must be designed to get them,” Freeman says.

“We are getting profits for large corporations and individuals and not the health of the American people. And that is a result of the way the system is designed.”

“It is successful in generating profits for people. It is not successful in providing optimal health for the American people.”

“I’m not saying the system was designed to attain profits for health insurance companies,” Freeman says. “I’m saying the system is perfectly designed to do what it does — whether that was the intent or not. I don’t know what the intent was. But the result is that the system is designed to make large profits for many corporations and some individuals and not to improve health. And the health status of the American people by measure after measure is at the bottom when it comes to the seventeen wealthiest nations.”

“My proposal is that we move to a single payer system. That doesn’t address all of the social determinants of health. The single payer system doesn’t make poor people not poor any more. It doesn’t create sidewalks in neighborhoods that don’t have sidewalks. It doesn’t reduce crime in neighborhoods with high crime. It doesn’t build grocery stores that are convenient to people, or parks where people can exercise. But it does make healthcare available to everyone.”

Freeman admits up front that Obamacare was a bandaid approach, but he supported it.

“People got covered who previously weren’t covered,” Freeman said. “Several million people who didn’t have health insurance before were now covered by expanded Medicaid in the states that have it. Those people were suffering. This decreases their suffering. I know that is a liberal half baked sentiment, but it’s a real thing when you see real people’s suffering.”

“I work a lot in a student run free clinic. We can do what we as individual doctors can do. But we can’t pay for their hospitalization. If they need surgery, we can’t pay for their surgery. If they need expensive drugs, we can’t pay for their drugs. If they need imaging, we can’t pay for that. I know a lot of those people, who were covered in the exchanges. If we had expanded Medicaid, a lot more people would be able to get the care they need. I don’t have the heartlessness to say — we can’t do that because it slows down the pressure for a true single payer reform.”

“They are weak bandaids,” Freeman said. “We do it because if you put a bandaid on something, maybe it stops the bleeding for a while.”

Politics can be counterintuitive. Nebraska last week banned the death penalty, for example. Freeman is in Kansas, a red state. What kind of support is there for single payer in Kansas?

“I don’t know of any polls on single payer here in Kansas or even of doctors in Kansas,” Freeman says. “There are many doctors I know who are supportive of single payer. And some people in specialized medicine that I wouldn’t have expected would support single payer — and they do. That’s because the system is so irrational now. Individual hospitals and physicians or groups of physicians have to spend an enormous amount of money on staff to be able to file insurance claims, to appeal their insurance claims, to figure out which policy of the same company you have and how many co-insurances you have, whether you have met your deductible for the year. You have the administrative costs for both hospitals and doctors. They have to figure out what your insurance coverage is, how to get paid by them and how to appeal denials. Those costs are phenomenally high. And many doctors believe that single payer would be a better way.”

“I would guess that in the Kansas legislature, there is not a lot of support for single payer or any other program that is about social justice.”

[For the complete q/a format Interview with Joshua Freeman, see 29 Corporate Crime Reporter 23(12), June 8, 2015, print edition only.]