Transcripts For CSPAN Heritage Foundation Discussion On Medicare For All 20240714

They have reduced choices and they dont feel they are in charged of their health care. They want to know when they or their loved ones get sick, they will be able to see a doctor and tell us they are afraid. These are real concerns and they deserve Real Solutions so today, we will liberal proposals that say they speak to this concern. One is called medicare for all. We will liberal proposals that say they speak to this concern. One is called medicare for all. It would outlaw private coverage and put almost all of us on a government run plan. It is a bill that would we will liberal proposals implement it is supported by almost all House Democrat members, four senators including four running for president. Another proposal, i will call medicare for all lite for ease of reference gives all americans the ability to enroll in a new government run plan. On the surface, these look like easy solutions, and depending on what poll you look at, you get the georges of americans interested. We will learn more about what they would do, whether they deliver on hopes for Americans Health care and we will focus on the impact on patients. Will they have the coverage they want, see the doctors they need, and in time they find valuable to them . I am pleased to introduce senator braun from indiana, and a former ceo and founder of companies that employ hundreds of americans. He led work to see that his employees got what they wanted in health care. Lower costs, the ability to see doctors they wanted and choices they found valuable. Today, he sits on the Senate Committee responsible for health care. He cares about improving americans ability to get the care they want. With that, please welcome me in and join me in welcoming the senator. Sen. Braun this is a big topic and i will try to get it covered in seven or eight minutes. I have been spending my entire entrepreneurial career trying to figure out health care as i am running a logistics and distributions company. Never wanted to do it but as i said earlier in the panel, did it out of necessity. Weve got a limited window to get this done correctly. You heard it last night on tv, the discussion of medicare for all. How you could talk about something that would be 32 trillion estimated over 10 years, 3. 2 trillion a year and by the way, that is about what we raise in revenues currently, 3. 3 trillion to 3. 4 trillion, so it is fantasy talk but i warn everybody on our side, not getting government, a broken institution, even more responsibility in a sector as important as health care. How do we avoid it . Health care has evolved from the time i had my business in the early 1980s when i didnt care about it because i didnt have enough employees and you didnt have to worry about it because it didnt cost you much. As it evolved into the 1990s, it started becoming a nagging issue because you knew it was creeping up. It was such a small part of our gdp. By the 1990s, it is going from 5 or 6 up to 7 , 8 , 9 and now it is 18 to 19 . How does that happen . It happens when you have no competition, no transparency, and a consumer that is totally disengaged with his or her own wellbeing. You know how you all shop when it comes to almost anything you buy. You know the tools you have with transparency reminds me of the last time i was at the grocery store. Cell phones out, saving and shopping to save a buck on a five dollar item. We dont do any of that. And i got to the point when enough was enough in 2008 and i had Little Company of 15 employees for 17 years, hardscrabble, i learned how to compete. I learned how to keep low overheads. The things you do in all other sectors because youve got competition at every level, and youve got engaged consumers. So here i am. What am i going to do . Well, i radically changed our Health Care Plan and i want to tell you about it because i think it is a solution if weve got enough time, whether it is government, paid for health care, medicaid and medicare, or it is insurance through an employer. They are both going to have providers that have hidden behind no transparency, have not been weaned and called out in their own industry with competition because that is what needs to happen. We need to shrink health care from 19 down to not 9 or 10 like it is in other one payer systems across the world or to where they actually employ providers, which is a whole other step. We will get there with the providers we have now. They just need to get with it. What i did, because this is what i have control over, is took the atrophied Health Care Consumer and said hey, we cant keep doing this. Your premiums are going to go up. I cant raise deductibles anymore to moderate those premiums. Im going to need your help. After getting through with a two to threehour meeting with my agent and underwriters that normally was 15 minutes and id walk out of the room disgusted and just pay the price each year, i had enough back then. I made mine consumer driven. My employees are engaged in their own wellbeing, not remediation, wellbeing now because they have changed their point of view and when i made that tough decision to get rid of copays, one of the three legs to any Health Care Plan. Health care copays and deductibles. I had a 5,000 deductible in 2008 and even though i never had a layoff in 27 years and paid the highest wage in town, people were starting to squirm because health care was becoming more important than your wage and your job. Had a couple of employees quit back then. They got it was too out there, and others explained what am i up to . Ill tell you what im up to. I want you, down the road, to have Health Insurance that is affordable. It is not going to be based on paying for everything, but when you get critically ill or have a bad accident, im going to be there. I believe it is a right in this country. I covered preexisting kiss conditions and no cap on coverage before the law required it. Still, there was not much appreciation for it because at a relatively young census, they werent at the point where they were engaging health care in a critical way. Four to 5 of employees engaged in health care in a critical way. 11 years later, it is 44 of my employees. They now know it is what what it is like to where they dont use the Health Care System as much as others because i stress wellness, not remediation. When you need it, i created the tools to where it is not going to break the bank. Never forget, we went live, one of the employees with me had a medication. Told it earlier in a panel. 200 a month. If you dont have it, you use more of it and youve got an industry that is not competitive and transparent, it is like fuel on the fire of inefficiency and high prices. He said mike, this is going to hurt with that 10 copay that was costing 9,800 a year, that plan i had in place that was no longer sustainable and i had a young profile. Now cadillac plans are 20,000 to 30,000. Thats how bad it has gotten. I said have you ever shopped around for your medication . He said, why would i with a 10 copay . Great counterpoint. Humor me. Lets see if we can find it without going to canada. 15 seconds and he found a 200 medication for 99. I said this is in 2008. It was on an online pharmacy. That needs to happen every time you engage the Health Care System. When you do it, good things happen. You save 30 to 70 , the tools have grown a little bit and when you throw things in like telemedicine, health shavings accounts savings accounts come all the tools to take it to the next level, you dont pay anymore in my company now than you did in 2008 because i lowered Family Health care premiums by 200 a month actually, it was about 1400 a year. Unheard of in any company because i made it consumer driven and i found the best of what the industry has to offer, which is not very good. Whether it is medicare for all which will break the bank, health care has got to change. The Industry Needs to lead by being competitive and transparent or they will regret it. Theyll have a business partner, his name is Bernie Sanders. That would be a travesty. Thank you for having me. [applause] thank you, senator. Today, we have the honor of welcoming the administrator of medicaid services. She administers programs today that cover more than 100 Million People including one that might be abolished if proposals like medicare for all or to become law. Her track record is one of innovation. She has put forward reforms that have allowed people to have more control over their health care and that has led to Lower Health Care costs and better choices for individuals. Government affects nearly 80 of all Health Care Spending today and the administrator oversees a lot of that. She often talks to medical patients and providers so shes in a great spot to help us understand what would change under proposals like medicare for all. With that, please welcome her. [applause] thank you. Welcome. Thanks for having me. Great to be here. Medicare for all and the puzzles like it would fundamentally change who is in charge of Health Care Decisions today. And like coverage, benefits, access to care. Is that the right way to go . What would change for people under those proposals . For starters, i will say no, it is not the right way to go and as head of the Medicare Program, i am uniquely positioned to understand some of the daytoday challenges of the Medicaid Program and why it would be a bad solution for the American People. What we are talking about is taking 180 Million People and taking away their private coverage. Im going to ask of the audience, how many of you have private coverage . How many of you like your private coverage . How many of you want to keep your private coverage . [laughter] pretty much everyone. Yeah, so that is what we are seeing when we talk to people. Most people like their private coverage and want to keep it. This would lead everyone into the Medicaid Program and there have been estimates of 32 trillion. That would mean increased taxes and it puts us in a situation where as taxes go up, it puts the government in a situation where they have to make tough choices and that is where you see rationing of care, long wait times. This is the experience other countries have had when they have created these types of programs. We see people coming from all over the world, whether it is canada maybe not for medications, but people come to these countries because they know they can access some of the most innovative treatment in the world. I think that is one of the things we should all be concerned about, the access and the wait times. It is also the most important point, it is putting washington in charge of our health care. If we look at where Government Run Health Care or washingtons track record, that is something that should give us all pause. Lets think of obamacare and what happened there. This was a large takeover of the individual market and the impact whether you like obamacare or not, the facts are that rates went up by 100 . In some areas of the country, 200 so premiums went up. Choices went down. We saw insurers leave the market, flee the market and in some parts of the country, there is only one issuer and when youve got one issuer, you are creating a virtual monopoly. Studies have shown when there is only one issuer, of course they will be increasing rates because they can. That hasnt worked and there is wide acknowledgment from both sides of the aisle that obamacare hasnt worked. That is our latest example of where the government has not stepped up to the plate. If we look at the Medicaid Program, Medicaid Program that started out i would say not a huge portion of the states budget and now it is the number one or two budget item for every state. States are struggling to pay for the program and if we look at this large investment we have made, where are the outcomes . We dont actually know because the government hasnt collected data and hasnt helped states accountable for what they have produced in the program. It is costing more. Doctors wont even see patients on the Medicaid Program and outcomes are unclear. There has been a lot to be said about the Medicare Program. We do have a lot of High Satisfaction but the Medicare Trustees report is telling us the Medicare Program is not sustainable and that in seven years, it is going to run out of money. While people are calling for medicare for all, that program in and of itself is not sustainable. Our administration wants to strengthen the program, protect the program, make sure it is sustainable over the long term so we need to work toward that instead of forcing so many more people on the program. Those are some serious facts to consider. Help us unpack it a little more. When we at heritage talk to people about some of their hopes and fears for health care, one thing that comes up over and over again, i want to know i want to know my loved one can see a doctor when they need care. We talked about what my shift for people under proposals like medicare for all. Can you help us a bit . Seema sure, and when it comes to provider, it impacts them significantly because we are talking about washington, d. C. Setting reimbursement rates for providers. That is concerning because in many cases, medicare reimbursement is below what they can get in the commercial market and providers make it work because they do have commercial reimbursement. What we are seeing, though, is a lot of providers dont want to see people on public programs. Medicaid is a great example but even in medicare, we are seeing a lot of providers moving toward direct primary care. They dont want to have the government in the way and they want to be able to see patients directly. If you create this government run system where everybody is forced to participate in this government run program, there is going to be doctors that are not going to participate, so you will have less doctors in the system that are willing to accept this reimbursement and because of that, that is where you get into access issues, longer wait times. I look at this not only as a policy maker but as a patient. The experience i have had just within my own family. My husband has a serious cardiac condition and we found out about this in a surprise way where he was running through the airport and essentially collapsed, had a seizure, went into cardiac arrest. He had to be shocked six times, and this was completely out of the blue. There were no symptoms, nothing. When he was treated, it was the widow maker and it was a 99 blockage. It was a miracle he survived and there was a lot of anxiety for me and for even the doctors, saying this came out of the blue. They treated him for that but they decided to give him a defibrillator. That means if he ever went into cardiac arrest, this would revive him right away and they felt they needed that because he was so young and there was nothing that led up to this. Our Insurance Company did pay for it, but come to find out when i left as the administrator, medicare would not have paid for that defibrillator. I think that is a great example of what patients might go through. There is the government making decisions. My husband needed that service, the doctors were recommending, but the government run program would not have paid for that. I think that is something we all need to think about as patients. You might not be a patients now but when you are going to be a patient, we want to make sure people have access to innovative treatment and as the administrator, i can tell you we struggle with that because of how the law is set up. We have very narrow requirements that are set up by that say when or when we can cover it. The government is a bureaucratic beast that has to go through a long process. You have cases where people cannot get services that are paid for. I did not know that about your husband. He is ok now . Seema all good at the ranch. Marie that is why people care so much about this conversation. Im glad to hear that things turned out well. You touched a little bit not to go right back to policy wonkiness you talked about what is a relatively Innovative Care treatment for your husband. If we look at where health care is going and these Incredible Health care innovations, even care is getting to a stage where it can be so personalized to individuals, like you can get a genetic test and find out with the care is for you as an individual, and yet we see this call at a policy level to go in this onesizefitsall benefit model. What do you think would happen to innovation and the kinds of treatments that kept your husband alive and so many other people . Seema that is one of the main concerns we should all have as americans. What does it do to innovation . As the administrator, one of the things the agency struggles with is when new, innovative treatments come to market. A lot of the problem is that Congress Says you can cover durable medical equipment, supplies, and drugs. Sounded great when they wrote that law 30, 40 years ago, but it does not make sense in todays environment. All of these new technologies and treatments do not fit nicely into what how the law has been constructed. It creates problems for the agency. If you examples. One of them was insulin cons for diabetics. Four years, they have some very creative pumps people can use. When they got on to the Medicare Program, medicare was not covering them. So the private sector not like it was brandnew, this was going on for many years and we figured out a way to move forward,. To have medicare pay for those things i think the Trump Administration has been focused on strengthening the program, protecting it, making sure seniors have the best possible experience. That took years for us to be able to provide that treatment. The other thing we are struggling with now, there are new treatments in that case, we had to figure out whether it was a supplier device we are now getting into a new era of treatment where there is nothing even close to it and it creates access problems. A couple of examples. One of them is in antimicrobials. This is a Serious Public Health issue. You have probably heard about superbugs. People get infections and there is no antibiotic to treat them. The federal government has recognized this. This could be a significant Public Health issue for the country. They had created some opportunities for investors to get companies to develop these antibiotics. That part of the system worked. What would happen is they would come to cms, and the way cms regulations in the law are set up we have to say, is this comparable to something out there . Antibiotics are relatively cheap. We are like, we already have one, we are already paying for this, so you can get paid the same. That has completely thwarted innovation in the development of antimicrobials. So, companies, we can get this to market, but the government does not going to pay for it adequately or appropriately. What that has done is all of the innovation in that particular space is drying up. That creates a problem. Many of us could get an infection and there would not be a treatment. The point here is that the government is already struggling in the Medicare Program with how we support innovation. We need to reform some rules and regulations and the law to make it work. The other area is the development of a very innovative cancer treatment. Many of you heard about this. In some cases, people have been on the verge of death and they have gotten this cancer treatment. It uses the bodys own t cells to fight the cancer. Very innovative treatment. When this treatment was approved by the fda, cms did not know how to pay for it. We did not have the data. We were not sure, is this a drug . Is this a process . The way that our system works as we have to see what it costs, what hospitals are paying it takes us years to figure out how to even pay for something. In the meantime, that means patients are not getting access to these innovative treatments. Now, these treatments are available in the private sector. Somebody is paying for them. Which is great. If we put the entire country into the medicare system, so they can come to my office to go through this convoluted process to be able to get coverage, we are not going to see the type of innovation that we have seen in our country. Innovators, when they get something approved by fda, they have to come to cms. There are three separate tracks. They have to figure out whether this is going to be covered. If it is covered, we have to give them a code. We have some temporary measures that they go through the process. The government has only handed out these codes once he year. We are changing some of those things. Then we have to figure out how they are going to get paid. There is already a lot of burdens. We are trying to streamline the process. The president is focused on supporting innovation, so we can make sure our seniors have it. Can you imagine if we started treating all of innovation in the country in this way . I think it would bring innovation to a standstill. Marie none of that sounds im glad you are working on improving it, but it does sound like a serious thing to think about, having one center chokepoint or bottleneck, trying to make all these decisions for us, when today the innovations that you talked about that successfully come to market are coming to market because there is a strong private element still in our Health Care System. You touched a little bit on the challenges reforming the current system. A lot of people, when we talk about medicare for all, there is this sort of assumption that it is an expanded Medicare Program. What would happen for people currently getting their coverage through medicare today . Are they better off . Seema im very concerned about the negative impact it would have on beneficiaries and seniors. This is a program that people have paid into their entire life. Now, we are saying, we are going to force everybody into the program. Some of the issues we talk about in terms of rationing of care, long wait times, providers may say, im not going to participate, so there are fewer providers. We put our seniors in a position where they are waiting in line. We are now deprioritizing them. We are not going to be focused on seniors and i dont think that is fair or moral, considering the promise we made to them. I think the other issue people talk about is our focus should be on protecting and strengthening the program. The fact that the program is going to run out of money and evan years should in seven years should because for alarm. Policymakers should be focusing on that. One of the things i hear all the time is we should have medicare because medicare has low administrative rates. That is an argument i hear time and time again. When they are doing those calculations, some of the pieces that would happen in a normal program, in terms of enrollment, that does not even happen in the Medicare Program. It happens with the Social Security administration. You would have to look at some of their costs that are not computed. In some areas, we are not spending enough. When you look at Program Integrity and fraud and abuse and the program is fraught with fraud and abuse and we are wasting taxpayer money. Taxpayers have not given the agency the type of authority you would have in the private sector. The private sector is way better at detecting fraud and abuse. They are accountable to their beneficiaries. With the government, they are not accountable, so we do see large examples of fraud and abuse. We are not taking advantage of some of the new technology out there. Artificial intelligence. The way the law is structured as a gives limited tools for the government to go after fraudsters. Marie my mother is of the age to go on medicare. Listening to this and hearing those concerns, that is something that is very powerful to me. Im encouraged to hear you have your eye on the problem. I certainly think there sounds like a lot of things to Pay Attention to in the near future. You have touched a little bit on a couple of things that i want to tease out. Medical providers. The other side of this equation. The doctors, the nurses. We hear a lot when you look at the research, you talk to people at heritage, they are really frustrated with the current approach they have to deal with. They dont like the red tape. They dont like dealing with government payment structures. They report feeling a lot of burnout. Sometimes, when you ask, why are you feeling burned out . They talk a lot about government regulations. Medicare for all is sold as something that is going to make that better because you dont have to deal with so many different payers. Is that really going to improve their life . Seema no. [laughter] seema let me start with kind of a broad stroke. Im very sympathetic to what has happened to the practice of medicine. Medicine has typically attracted some of the best and brightest in our country. The go to college. Then med school. In residency. It is years and years of training. If you look at their daytoday, they are trying to deliver patient care. They are also managing complex teams that are involved in some of this care. On top of that now because of the government regulations and paperwork, at the end of the day, they are doing all this type of paperwork. It is alarming. We are hearing about the suicide rate for doctors going up. We are hearing about burnout, we are hearing about people leaving the profession. Because there has been so much regulation, and a lot of them are giving up their independent practices. Doctors have typically had solo practices. Part of that is because of Government Policies. If i look back at the last 10 years and i hear that doctors are frustrated, but what i hope they will understand is the source of their frustration is washington dc and the government. Lets look at the problems that they face. Number one, the competition issue where they cannot compete, so a lot of them are selling practices to big hospital systems. That is because the government, the Medicare Program decided that it was ok that we pay hospitals more for the same services that doctors could give. A patient would see a normal physician visit in an outpatient setting in a hospital and we pay them more than we pay the doctor in their office. There is a differential, so they cannot compete. That is not the only place we do it. The 340d program is an example where hospitals were able to take advantage of the pricing, where they get more money through the program. They bought out a of oncology practices. It is Government Policies that have created an unlevel Playing Field for doctors and they have not been able to compete and they have given up practices, so they have given up a lot of the autonomy they have had in the past. I think that is directly related to Government Policies. Our administration has done work on site neutral payments, the Accountable Care organizations. That is the way it was set up, to favor large hospital systems. We try to create more competition, so physician led practices can be on a level Playing Field. They have done a great job in saving dollars. The government put them in a situation where they could not compete. The other thing is if we look at some of the major problems that doctors are complaining about, they are complaining about their Electronic Health records. They do not like them because they were built for billing systems. Guess what . It was the government, washington, d. C. , that forced them to use Electronic Health records. We told doctors, your reimbursement is going to be tied to other you are using these electronic records. We created this whole industry. The systems dont work for them. They work as a billing system. They are very frustrated. Many of you going to the Doctors Office and you see her doctor is not looking at you and they are staring at a screen. They are frustrated by these. The other piece that washington, d. C. Has created is a macro program. I think everybody is relieved that we fixed the sgr. That was clearly a problem. What we have now created is a New Washington program, where providers are having to report all of these metrics and the way that d. C. Created all of these metrics were a lot of process measures. Did you do a history and physical with the patient. The government created all of these Quality Metrics and that basically meant that providers after hours and late at night are having to find and report all of these measures to the government. In addition to daytoday seeing patient, trying to keep up on the latest innovations, they have to come home at night and do all of this. It is washington dc that has created problems for the doctors. I recently gave a speech about this and we got a standing ovation because they understand it is government that has done this. There are a lot of doctors note that are moving in a different direction. The vote was pretty close. It is one of the things i hope the rest of the industry fears that other private insurance companies, that we all need to be working together to ease the burdens for doctors. Marie the frustration is real and we need to make sure we are diagnosing the right cause of that. I have this vision in my head of doctors having the worlds worst boss in the form of the government. We have all had a bad boss. We want to make sure that that gets better, not worse. One of the things that we saw last night, if anybody watched the democrat primary debate, there was a lot of talk about, lets do something not quite as interventionist as medicare for all might be lets just have a new government run option for everyone. You have done a lot speaking out that you have real concerns about that medicare for all lite. Why is that . It sounds kind of reasonable. More choice. Dont we all want choice . Seema sure. I think the public option, is some folks are calling it, it is just another version of medicare for all, so we should call a spade a spade. The concern is with a public option is that you are having the government compete against private insurers. The way that the government has saved money or is able to offer what people would say is a lower cost plan is because they pay the doctors far less than what they can get in the commercial market. These are the reasons why we have access problems in the Medicaid Program and there are still providers that will take public programs. Now, if you have a public option, presumably, if people start using that program, i in think they could face access problems, where a lot of providers would not accept this type of low reimbursement. The people signing up for those public option programs could face a lot of difficulty in access, but i think the more important point is the impact it would have on everybody else. Because those providers are getting lower reimbursement, they are going to increase rates to other private payers. That is where you see that means higher premiums. All of you that raised your hands that i have private insurance, if you are not in the public option, that would mean your rates could potentially go up because you are almost subsidizing with the private option public option is not paying. The other pieces that the government does not have incentives to compete for quality and value. There is no competition, essentially. If we look at issues like fraud and abuse, the government does not have an incentive to go after fraudsters because they can go to the federal government and they will keep paying. A great example of this is what happened with the obamacare coops. The idea is that in lieu of a public option, we created these nonprofit plans and the government invested in developing them. Essentially, they could not compete. The vast majority went belly up. They cost taxpayers over 2 billion for this investment. In the world of a public option, there would be no belly up. He government would step in again and give them more money so they could continue, whether they were competitive or not. So, these are some of the issues that we all need to think about with a public option, because it is not just choice. It could have a terrible impact on the rest of the market. Marie wow. We are going to wrap up here because a want to be respectful of your time. We started this by saying that americans do have some really genuine frustrations that need to be addressed. We cannot just keep letting costs go up and choices go down. We cannot let this deep disempowerment for doctors and patients continue. In your leadership role in the administration, you have done a lot to start to address these things. You have pursued innovation to lower cost, protect people with preexisting conditions, and they are leading to good results. Do you want to share briefly what youre thinking is, so we can go out on a note that says there are some solutions we think would work. Seema i think one of the things that is sad about the discussions we are having is all we are talking about is who pays for things, lets have the government pay for everything. That is not a solution. What we need to come together on is how we address Health Care Costs. One of the things that has not happened with the legislation over the past 10 years is we have done nothing to bend of the cost growth curve in our country. Until we address that issue, we will always be having these conversations. Whatever administration is focusing on is exactly that. How do we get to the underlying cost drivers . That is lazy the president so engaged on drug pricing, an area that is why the president is so engaged on drug pricing, an area where we have seen a lot of growth. We want to create a lot more competition in the marketplace. The governments controlling him was 47 of the health care market. We have never had a marketplace in health care. That is what we are trying to create. We want to empower patients to make decisions that are best for them. We want to make sure they have cost information. Cost, quality, transparency. And so they have access to medical records. We want to create an environment where patients are shopping around for the best deal and providers are competing for patients on the basis of cost and quality, so all of our policies are geared toward creating that type of environment. So people can pick up their thio major announcements coming out of hhs. Cms, we announced a broad effort to require hospitals to post all of their rates. That is just the beginning of what we are doing. This is in response to the president s executive order on price and quality transparency. This morning, they talked about reimportation. Take on some of these cost bribery issues headon. Cost driver issues headon. Some responses different than what we spent the bulk of the conversation on. Think you for your time. Thank you. [applause] [general chatter] well, good morning. Im a Senior Research fellow at the Heritage Foundation. Im glad you all are here to continue the conversation we are having on medicare for all. Today, we are joined by a distinguished panel of Health Policy experts who will share their insights on medicare for all, what it might look like in practice, and how such a clan might influence how americans will get their health care today. I will do brief introductions. I will allow speakers to offer their comments and open it up to the audience. Gracemarie turner is president of the galen institute. We will then hear from sally pipes, the president of the Pacific Research institute. And Merrill Matthews is that a free policy think tank focused on issues of economic growth, innovation, limited government, and individual liberties. Merrill, i will turn it over to you. Which one do i click . Very good. Thank you, nina. Thank the Heritage Foundation for having this timely event. Did any of you see the debates last night . One of the things ive noticed from the democrats when they talk about health care, two things they agree on. The current Health Care System is an absolute mess. Nobody seems to point out that that is obamacare. The media seem to be very generous in just not saying, isnt that the system you past 10 years ago . The second thing is they all agreed that the goal is a singlepayer Health Care System. Some want to keep employerbased Health Insurance for a little while before they get there. Ive been tracking Health Policy issues for more than 30 years now. I used to get over to england and canada a fair amount. When i did, i often looked at the newspapers and saw the stories in the newspapers that were running in the media and i thought, this is a different story than what you hear in the media here. So, ive been carrying some of these things around with me for a long time. We did not have the internet back them, but i have kept a lot of the stories, so i thought it would bring you some of the stories from the major media from the United Kingdom and canada. This is not breitbart london reporting the stories. These are major media stories, where they talk about the Health Care Systems in those countries. So, this is the media you can believe. We will start with the first one year. First one here. Kidney patient s diet as dialysis machines lay idle. The chart over there is the machines and the dialysis machines in london with the number of people using it versus how many they could actually use. Because what is happening is the government decided where the dialysis machines would go. They put more in london, which have more political power, then they get out in the country. As a result, people out in the country were not able to get in to get the dialysis machines, they were passed out in the hinterlands, so people were in the midst of weight. You cannot wait for a kidney dialysis machine. You have to have it three times a week. One of the administrators says, i dont know what is happening in the lines, i assume they die, but in london, there is plenty of space because that is where they put the machine. So, you have the issue of the government misallocated resources in places that are more politically powerful, but it creates shortages in other places. [chimes sound] am i too old to be treated . This comes out from the early 1990s. The story has got several people that it mentions. They have turned 65 and can no longer get certain types of care. Whether it is assistance from other people. One man is 75, he needs a pacemaker, and they said, sorry, you are too old. Now, he raised enough of a fuss that he finally got one, but they were not the arbitrary age was 65. If you were over 65, a lot of the things you can no longer get. I dont know that this is still the case because these are political decisions, rather than market decisions. When you get enough pressure, they may change it with more money here or more money there. There were several stories at the time that came out. Too old to be treated for cancer, from about the same time. Person was over 65, they did not want to treat him. Rationing to balance the books. Bernie sanders last night pointed out, he said canada, this country just north of us, they have great care, universal coverage, they spent half of what we do on health care. What they never mention is those are government decisions. They make it sound like they spend less because they are much more efficient. It is not because they are more efficient. It is because the government says, we are going to spend this much on health care and no more. Sometimes, they run out of money on that. Virtually every time they are struggling for money. It is just like education. How many liberals think we are spending enough on education . It comes from the government. They have to sometimes balance the books because the needs exceed the money that they have allocated and, as a result, they have to do some rationing and here they said what they decided to do was that they were just not going to people who smoked or were obese, you would not get hip replacements, knee surgery, there were several things they decided you would not get, because we dont have the money to go around. We have to ration it somehow. Dying because of shortages. They had the system there where the article argues that there are people dying of starvation and malnutrition, starvation, dehydration in the hospitals on a regular basis ive got it right down here. I dont see it right here. What is happening is hospitals are overcrowded, they cannot get the care that they need, there are not enough nurses to go around, so people who need help with eating, feeding, drinking, they are not getting it. They estimate roughly two or three people a day die in the u. K. System because they are not being treated they are dying of starvation and dehydration. Last one for United Kingdom. There is the dehydration thing. Last one for the United Kingdom. This was taken in 2016. Before brexit. Once brexit happens, that swamps everything. It is a survey of what they think are the Biggest Issues. Notice the nhs is the second Biggest Issue. If the system is that great, why would it be the second Biggest Issue for the population . We will move to canada. U. S. Medics bill ontario Health Insurance plan. This was about 1990. Canadians were jumping the queue and go into america to get care. The ontario Health Insurance plan would pay for the care if they went to america. There are waiting lines in canada. Some people increasingly start jumping that line in order to be able to get the care they need. Especially surgery. The point of the argument, the article is that they were spending so much on health care, they had to do something about it. I tracked to this for a little while and a few years later, they came up with the story, ontario his payments to u. S. In bid to cut crossborder care. They said, we cant afford this, people are jumping the line. You cannot escape the socialist health care paradise. We are going to make you stay here. That is one of the problems they have had for years. I used to joke about this when we first ran across this back in the mid1990s. Am i pressing that one . Humans weight in pain, dogs dont. This is the story of a guy named gray greg, who is in the midst of a three have an month wait for a brain scan. He needs to get a cat scan. The cat scan is at the hospital. There is a waiting list. He cannot get in. At night, it closes down to humans, and it opens up to pets. If you are a veterinarian, you can take it at and have a cat scan done that night for 300. Greg is quoted as saying, i could go anytime to get a cat scan so the doctor could find out the cause of my headache, but he cannot, because in canada, you cannot jump out of the system. If you are a human, you have to stay in the system. You cant do something else. So, Bernie Sanders says we need a system that puts people before profits. What canada has is a system in which pet are put before peoples. [laughter] editorial from the toronto sun. Canadas medical wait times are unacceptable. This is citing two studies. One from the fraser institute. Another from one of the systems there, health information. It cites the waiting lists that go on in canada. The press wants to imply that does not go on. It absolutely does go on in canada. It tends to go on more for elective surgery. A lot of things are elective that we might deem necessary here, but the wait times absolutely do happen and they can be extensive. Woops. Did i go too far . I wanted the this is the one where prescriptions are too expensive. This is done by a survey of the largest Nurses Association in canada, which came up and said prescriptions are so expensive here that people cannot afford them and they are dying because they cannot get their prescriptions. Wait a minute . I thought they heard that prescriptions were really affordable up there apparently, they may not be. Finally, this is a survey coming from the Canadian Broadcasting Corporation about what canadians are worried about. In 2012, health care is the second issue. Come down to 2018 and health care is the number one issue that they are concerned about. If it is good, as good as Bernie Sanders tells us, why is that the number one issue they are concerned about . With that, i will stop. [laughter] [applause] sally i want to thank nina for organizing this with my longtime friends, gracemarie and merrill. We have been fighting this fight for many years. I received any mail from a professor at pasadena City Community college. She said, sanders and warren, onetwo punch, they won the case and the debate. I do not feel that way. I am canadian and they grew up under i grew up under singlepayer health care. Bernie sanders, in his response to mr. Delaney, who was saying i dont think the American People are ready for the government takeover of health care bernie said there is a country five minutes away from here called canada, they have no copays, no deductibles, no premiums, health care is a human right, they get everything they want. I was like, woah. They never talked about how much it would cost, how it would be paid for, and what really happens in a country like canada. Im going to add on to what merrill has said with a few examples because ive been involved with this for so many years. Canada is one of only three countries in the world that has a true singlepayer system. This is what Elizabeth Warren and sanders want. Private Health Care Coverage is outlawed in these countries. The only things that can be paid for privately are things that are considered not medically necessary. Cosmetic surgery, things like that. The government took over our Health Care System fully in 1984. Canada spends about 11 of gdp on health care. We spend about 18 here. In canada, the government sets a global budget. That is what they are going to spend on health care. The demand for health care is much greater than the supply. As a result, long waiting lists for care. The average weight last year in canada for seeing a primary care doctor for treatment by a specialist, just under five months. Back in 1993, that we time was only 9. 3 weeks. Bernie sanders never talks about the 217,000 canadians out of a population of only 37 million, fewer than the state of california 217,000 canadians left canada and went to broader came to the u. S. To they felt the waiting time was too long for their health. A study was just released showing 1. 1 million canadians lost 2. 1 billion in wages and salary waiting for treatments. Meanwhile, there are scores of empty operating rooms. My cousin who graduated as an Orthopedic Surgeon waited 2. 5 years to get a job as an Orthopedic Surgeon east of toronto. Why couldnt she get a job . The government cannot afford to make more jobs available. There are real costs. Physical pain, mental anguish, loss of wages, and people die on these waiting lists in many cases. When bernie talks about everybody in canada gets care right away, my own mother died from colon cancer in 2005 because as a senior, there were too many other people on the waiting list for a colonoscopy, who had more serious symptoms. So, my mother did not get her colonoscopy, but by december, she was hemorrhaging, she had lost 35 pounds, she went to the emergency room, spent two days in the emergency room, two days in the transit lounge waiting for a bed in a ward, she got her colonoscopy, and died two weeks later from metastasized colon cancer. Rationing care will happen under what Bernie Sanders is talking about. There are a few stories pertinent. Merrill gave great examples. Michael blueblood bubl i love his cde, his son was diagnosed with liver cancer. Did he stick around in canada trying to get treatment, the best in the latest . No, he went to Childrens Hospital ucla and today, his son is in remission and cured from liver cancer. If the canadian system is so great, why wouldnt a crooner like him stay home . He was concerned about the longevity and life of his son. Mick jagger, the rolling stone, i remember mick jagger when he was a young buck [laughter] a young rock, a young rolling stone. He had a heart condition. He was in florida. Did he rushed back to england to take part in the National Health service, even though britain actually allows health care in private to run concurrent . No, he went to new york presbyterian and had his heart replacement surgery there. His young brother said, it is a good thing he did not have to go to the nhs and stand in a waiting line. These are true examples of things that are happening in countries like canada that Bernie Sanders and Elizabeth Warren never talk about. Canada has a system where, when you book your appointment with your doctor, you can only talk about one issue. You are allowed 15 minutes. If you have two or three issues you want to talk about, you have to book separate appointments. Of course, the waiting times are very long and can be harmful to your health. So, when madame chief Justice Beverly maclachlan, who just retired from the court, was ruling in the province of quebec on denial of care, she said that access to a waiting list is not access to health care. Having a care card does not mean you can get a doctor. When Bernie Sanders tells you everybody has a care card and everybody has care, they do have a care card, but they do not have access to care. What Bernie Sanders and Elizabeth Warren want for the American People is unfortunate because it is not free. The average canadian family pays 13,000 in hidden taxes to pay for a system where care is rationed and the weights are long waits are long. If we get a singlepayer system, the United States will be on the road to serfdom and there will be no offramp because the systems are hard to get rid of even when they are not working. We will have long waits, new taxes, higher taxes, rates for doctors being paid 40 lower, a lot of doctors will retire early from medicine, we have seen this under obamacare, and it is a huge concern of mine, the best and brightest young people will not pursue a career in medicine. We all want affordable, accessible, quality care, putting doctors and patients in charge of their care. It will lead to universal coverage. If you think health care is expensive now, just wait until it is free. Thank you. [laughter] [applause] why are we even talking about medicare for all in this country . It is because the American People are angry and frustrated. Their care costs too much, they can afford their premiums. Surprise billing, they are angry and willing to listen to anybody that promises them a way out. The tales that we have heard here will absolutely be where we will be headed in the United States. The description of what it is like running the Medicare Program, imagine putting another 240 Million People onto the existing Medicare Program. It would absolutely collapsed the economy. This is something that the Congressional Budget Office found when the democrats asked cbo to give them parameters of what would be involved in setting up the singlepayer system. Cbo found it would be a major undertaking that would be complicated, challenging, and potentially disruptive, that the changes could significantly affect payments to doctors and hospitals that could lead to a shortage of providers, longer wait times, changes in the quality of care, and especially if patient demand increased substantially. This is the cbo writing a report that democrats requested that they believed and they released as part of a roadmap to a singlepayer system in this country. We have actually seen several states trying to move to a singlepayer system already. Colorado had a Ballot Initiative in 2016 that would have moved the state of colorado to a singlepayer system. It failed 41 when people found out that im going to lose my employer coverage. Im going to lose my current coverage that i have now. I have taxes so high that it is going to drive businesses out of colorado. Vermont, with a population the size of a mediumsized American City tried to figure out how to create a singlepayer system in Bernie Sanders home state. It was a political disaster. They were not able to figure out how to do this in any way that would not also kill the vermont economy. And it would also provide people with a modicum of care that they are receiving now. And anything that would be remotely affordable. Yes, people are feeling powerless against the system. Yes, they are angry. The average American Family now is paying in one way or another 28,000 a year toward our Health Care System. The government is controlling, directly or indirectly, most of that spending. A study was recently published that showed that 80 of all spending in the Health Sector is under the influence of the federal government. The other side believes that if we have more government control if they could just get control of all of it then they could just fix it. Well, vermont, colorado, california would like to do this, but they cannot figure out how to make the dollars work sally is going to say california is going in that direction california is tough. I also want to talk about what this would mean for americans if we were go to a government run system. The sanders plan would take us much more quickly. Within two years, they would set up a medicare for all system. That would mean that 173 million americans, including millions of union members, would lose employerbased coverage. 60 million seniors, who administrator verma said, have paid in all their lives would lose the Medicare Coverage they had and would have to compete with another 250 million americans for access to the same underpaid providers. 20 million seniors would lose Medicare Advantage plans that they highly value, plans people are choosing on their own. To move into private plans that provide the better care than medicare. In the Medicare Prescription Drug program, the chip program, medicaid, obamacare, all that would go away. Some of the other proposals say it is a little too extreme, so why dont we just have a public option . Or allow a medicare buyin . Even some conservatives say, that is fine, people like this, why cant we let people under age 65 by into the Medicare Program . My colleagues did it analysis. If people were to pay the full premium for current medicare, without any subsidies, it would be about 1100 a month. The average policy on the exchange for full payment is about 700 or 800 a month. It is not clear what problem that would solve. The current coverage would go away. You have to ask yourself come a what problem are they trying to solve . The Kaiser Foundation recently did a study of who are the 28 million uninsured . So that we can figure out, why are we doing this . 15 million of them are already eligible for either Medicaid Expansion or aca coverage, just not signed up. Another 4 million are eligible for employersponsored coverage, but are not signed up. Another 2 million or 3 million have incomes that are high enough, maybe over 400,000 400 of poverty they would buy coverage if it were affordable, but it has become so unaffordable premiums would be 4000 a month. A man said that in fredericksburg, virginia, if he were to buy the only policy available to his family. Then the rest of the uninsured are undocumented immigrants. That is not a health care problem, that is an immigration problem. We were almost at full coverage, so we need to think about what really is the problem they are trying to solve . They are saying medicare for all they know the issue has moved to cost. That cost of care, the cost of coverage are the issue. Government is not going to solve this problem. Whether it is the public option, whether it is medicare buyin, or whether or not it is medicare for all, we need to move to the kind of market that allows the innovations that senator was talking about. Allows some of the innovation that some states are beginning to use. To do a better job of taking care of 5 of americans who consume 50 of Health Care Costs because they are sicker and more vulnerable and they need more attention. A medicare for all system will which drove them into the same pool just like obamacare did, driving up premiums, cost, making it more difficult for them to get the care they need and making it more difficult for providers and hospitals to say stay in business because of the low payment rates that they are currently providing. Are consensus, our Health Policy consensus group, which is has been meeting for decades to talk about freemarket ideas, moving power and control down to individuals, to give them more choices, more control, the only way we are going to make this is by giving consumers the incentive to be able to have more control and have more control over their Health Spending and their health choices. The market will respond better. Right now, the market is not functional, because it is responding to bureaucrats, either in the private sector or public sector. To respond to consumers. The only way they will do that is to have more control and power over the money. We have a website called s2020. Org. Choice more information about our solutions. It is about evolving control to the individual, resetting incentives, giving people more options and more choice, and most importantly, giving the Health Sector the incentive to respond to consumers and their demands for more choices of more affordable coverage. The federal government has proven it is not capable of delivering that. Thank you. [applause] thank you all. The panelists did a great job in offering us a window into what a singlepayer Government Run Health Care program would look like in our country and the concerns and risks of taking that path. With the time left, why dont we take a few questions for the panel and we will start over here. Please wait for the microphone and introduce yourselves so we know who you are. Im aname is sharon, moderate. I am also a woman after 19 years of marriage, my has been asked for a divorce. I was more upset about losing my Health Care Coverage. [laughter] 400,the divorce that was then up to 600. I went to the exchange and for me to keep my doctors, the premium was 1786 a month. When you go to get any procedure done, if you get someone out of network, sometimes it accidentally happens that outofnetwork was up to 12,500. I make about less than 70,000. Pocket ised out of half my income. I did find an association plan. Month is almost 1200 a but it is only a 3000 deductible. Im grateful for my association plan. But to pay for it, can i take money out of my 401 k tax, and i just think, im juggling in real estate. Cant go bankrupt. I dont want to go bankrupt. Im not the kind of person that wants anything for free. Im just tired of feeling like i am being raped by the system. 50,ow it is medicaid over now i think that is i think that sucks. Would really like more opportunity, more associations. I do not need birth control, i have been through menopause. Thank you. The administration is trying to do several things to provide you more options. Im glad to see you were able to find an association. Shortterm limited duration plans, people being able to buy a plan that can be renewed for up to three years, to be able to buy a plan that does not have to comply with all of the expensive obamacare rules and mandates which is what has driven up the costs of premiums to the point where you cannot afford coverage. That allow employers to provide a stipend a stipend to purchase coverage outside of their employer or find other plans that are good for the administration. The administration is trying to do things in the interim, but ultimately, Congress Needs to tackle this and needs to pout needs to move power away from washington to the states, to the individuals, so there can be many more choices and a competitive market. You are faced with a monopoly provider and they are following obamacare rules, and it has made it prohibitively expensive for you. Just to add, many of the people like nancy pelosi, Bernie Sanders, dont like people having more options. They say that shortterm limit plans, they are sabotaging the health market, they are all junk Health Coverage. And they are not. We want competition in this country in every industry that drives the price down. To have another question do we have another question . Either one. Wilson, from Howard University in boston, massachusetts. I wanted to ask, what do you think as a forecast, who is going to win this fight in the long run . [laughter] if we knew, we would all be very wealthy, making bets on this. I would say the new kaiser poll that came out yesterday showed the support for medicare for all had fallen from 56 in april down to 51 . Im hoping people are finally getting the message. I think the American People are going to come to the realization that medicare for all or the steppingstone approaches like the public option, medicare buyin are not going to be the answer to their health care. Who wins the democratic nomination . I just dont know who it is going to be. We also realize that the more people learn about it, it sounds like a great bumper sticker, who wouldnt like that . The more they learn, the more people realize that it is not what i thought it was. Im less optimistic than sally. I think you have a lot of people who are expressing the same problems this young lady had. And are ready to throw up their hands. To be clear, we had narrow networks, we had networks and other things before obamacare. It exacerbated all of the problems. It increase to those problems. Even though we were kept us we kept saying dont do thi, and the democrats say, it will not happen. I think a good portion of the public is getting ready to throw up their hands and say, im tired of all of this stuff. Just give me something that i can depend on and that may open the door for the singlepayer system. Which is why our job is to educate people so they do not leap off of this cliff, so they understand what will happen before they do it, understanding where this leads, as sally and merrill explained earlier. And price, student at Northeastern University across the river. Just to follow up a little bit on that, i think there is a lot of willingness from the public as we have seen to throw up their hands as you were saying. A lot of frustration with the cost of the system. You see all of the money being raised on gofundme, and they see the face of people struggling with these high costs. There is a lot of willingness to be more charitable and offer up money for their communities. Minded market individuals, how do you take community andt to that desire to help people out . Energy,ou take that without calling it socialism, because as we have seen, that is not really scaring the Younger Generation as much as it does the older generation by giving it that label, how do you take that energy and focus it into something that is not medicare for all, that has all of these other implications we are seeing and channel it into something that can provide Better Outcomes that people are striving for . Great question. It is never going to be one solution. It is always going to be a beautiful mosaic that is only american. Doctors would love to give their time to Charity Clinics that many of them, despite the charitystill do that to clinics. People providing help for their communities through gofundme, and through Church Efforts that are so important in this country, but the foundation needs to be a better functioning market, so that health care and Health Coverage are more affordable. I believe that Technology Actually can be a solution to this, as gofundme has created through technology. 200 differenteast companies that are developing apps to allow people to do a better job of tracking their own health care. We have already seen it with apple watches and fit bits. There is an explosion of that. There are so Many Companies out there seeing the problems in the Health Sector and getting rid of the individual mandate penalty. It was important because now people can buy other kinds of coverage from direct primary care to other kinds of plans, a lot of Different Companies are out there. If we can just begin to nourish and cultivate that. Itwe have medicare for all, is going to kill innovation. We are right at that casper right now. Whatdministration is doing soil. To fertilize that but ultimately, there needs to be legislation from the congress to truly enable a much more robust private market that is consumer centric to come about. I will just add this one thing. I think you mentioned about how soil. But ultimately, there needs to you energize younger people to get involved in this. You know who will pay for all of this . It is not going to be us. It is going to be you and your generation. That has been a mystery to me on Social Security, medicare, and other things. They keep expanding these things and they are passing the bill onto the younger people to pay for it rather than us they are trying to get the votes now but you will have to pay for it. Another question at the end of that row. Right there. I agree, health care sorry, my name is stephanie. I agree, Health Care Costs are out of control. At the same time, when im sick or god forbid, one of my parents get sick, the last thing i want to do is shop around. Is there a way that other strategies to control costs besides put placing the burden on the patients . That is why you need insurance on that is why you need insurance that you pick and make decisions about what deductible you can afford, how narrow you want the networks or not. You need insurance coverage. Announcer and we will take you live now here on cspan. President trump speaking at a rally in cincinnati, ohio at the u. S. Bank arena. Governor of ohio, mike to wine first appear. You are watching liveam