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Insurance. Id th is catching fire on the campaign trail. We need to have medica medicare for all. I support medicare for all. Medicare for all. He should put billions ofs dollward medicare for all. But are some candidates rallying behind the catchy slogan without really embracing the policy . Who here would abolish their private Health Insurance in favor of a governmentrun plan . Just a show of hands to start out with. [ apause ] what does representative Pramila Jayapal say now . Firing linega with mart hoover is made possible by. Additional funding is provided by. Corporate funding is provided by. Representative Pramila Jayapal, welcome to firing line. Thank you, margaret. M happy to be here. Its a delight to have you here. You are now in your second term in the house of representatives, representing washingto 7th district. Correct. And im delighted youre here today so that we can talk about one of your key issues, which is medica for all. And it is also an idea that almost every single democratic candidate is rallying around an claiming part of, although to varying degrees. Ur yes, correct. That is a very ae description. So, i want to talk about that, but, first, in an issuet that is frauth distinctions and differences and entrched interests, it seems to me that the first point of agreement and maybe th point of agreement is that the status quo to almost everyone involved is insufficient. Ight. Ats absolutely i mean, i think if you look at our Healthcare System in the country today, you have 70 Million People who are either uninsured or underin and then you have tens of millions more o simply cannot afford healthcare, people whond are using go as their Insurance Plan, and it is an crisis iis country, and i think its one that every single working family across the country is dealing with in some way, shape, or form. Do you sense that, as you begin to look for reforms, especially on the democratic side but across the universe ofs stakeholn the healthcare environment, that most people believe that there is a way tohe reformealthcare system and are coming to the table in good faith . I do think that. I mean, it started with the Affordable Care act. I think the affordableare act covered tens of millions of more americans across the country and actually made it so that americans started to think, wait a second healthcare is a right and not a privilege. Since you mentioned the Affordable Care act, lete just play a clip of president obama talking about the Affordable Care act, cause it is shocking to think that it was just 10 years that demrats were pushing a major reform to healthcare that is quite r different than medicare l. Lets take a listen. Today, after over a year of debate. Day. After all the votes have been tallied. Healthinsurance reform becomes law in the United States of america. Ee [ and applause ] so, that was only 10 years ago. Ab but the affo care act has really fallen out of popularity in parts of the democratic party. . S that fa no, i think its not that it fell out of popularity. I think it is that the Affordable Care act was the firsstep. But the problem is it didnt edtually reform the whole system, so it expa healthcare for tens of millions of americans but did not and was not trying to be, i would say, in fairness, a system thatco red everybody. Do you believe that the system actually can be reformed, or do you believe it has to fundamentally be changed . To me, those two things are the same. You know, it can be reformed, and it has to fundamentally be we pay almost double the healthcare costs of any industrialized country, but, in fact, the United States today has the worst Maternal Mortality rates, the worst infant mortality rates, the worst rates of Life Expectancy of any peer country in the world. To be fair, there are a lot of reasons Life Expectancy isht low, r Life Expectancy is low because we have a lot of shootings, because we have a t of car crashes, because we have an obesity crisis. Sometimes thats not due directly to the healthcare. Most of it is, though. Most of the studies show that the United States is youre absolutely right. Theres lots of reasons for low Life Expectancy. But when you think about infant mortality and Maternal Mortality, those a some of the biggest reasons that you have low Life Expectancy. You have issues with diabetes. You have all these other crises that people are facing, and so its pretty clear, when you look dat the statistics and Public Health for 10 years before doing all of this work that the United States does not have a healthcare systt provides healthcare for everybody and doesnt do it athe the pointsit should. I mean, this isnt a new idea. Its not a radical idea. It is actually what teddy roosevelt, harry trun, lyndon johnson, all of them, actually tried to get to thate, plut at the time, the systems that were put in place, ether it was medicare or medicaid those werentti cr the same amount of profit that they are today. Mean, medicare for all, again, wasnt a catchphrase. It wasnt something everybody was running on until rather recently. F so, when was tst time you heard medicare for all . I would say bernie really popularized medicarall back in 2015. He used to talk about it all thi. It was part of his campaign. Lets look at a clip. We are gonna say loudly and clearly that every person in this country will have aalthcare. Were gonna do it costeffective way, and that is a medicare for all, singlepayer program. Re okay. So, tou go. That was back in 2015, just as you said, but now every single 2020 candidate has something toe say aboucare for all. Lets take a look. Healthcare is a right. I think the best way to get ere is medicare for all. I do believe medicare for all is the right solution for healthcare. I strongly believe that we need to have medicare for all. Dond we figure out how to medicare for all in a way that makes sure that were gonna get 100 coverage. Alright. So, just for the benefit of the audience, here evybodys talking about medicare for all. Most people know what medicare is. Can you just expla in plain terms the difference medicare versus medicare for all . Yeah. Absolutely. So, medicare for all is an expanded and improved medicare system medicare, the system which provides healthcare to those 65 and older. Exactly seniors 65 and older. And others with disabilities. But is somewhat limited. People love their medica, but they say it doesnt cover enough. So, what do you get from medicare for all . You get comprehensive ca you get medical, dental, vision, mental health, reproe health, longterm supports and rvices everything that you need to be healthy as an individual. N no copayprivate insurance premiums, no deductibles. The only thing that changes in medicare for all is who provides the insurance,f you will, right . So, the government would provide a guaranteed insance plan, but you would use the same doctors and hospitals. So, what if a doctor doesnt want to ben the system, a medicare for all system . Well, most doctors will want to be in it because when its covering everybody, that is the main marketplace. So they wont have a choice. Probably not. I mean, this would be doctors would be a part of it. So, in medicare for all, ich is actually a new system. Its an expanded and improvee care system, because were adding people to medicare all the time. Theres no reason to not expand it. But this would put in who . This would be everybody, so everybody would be covered. Everybody in and nobody o is the phrase we use. Okay. So, would it mean the elimination of priva insurance . So, what it would mean is that, just like medicare, you wouldnt be able to offer a private Insurance Plan thatse covers the samices and benefits that are covered under this plan. But private insurance wante to exist and cover something that isnt covered by this plan, ey would be free to do that. That is how Medicare Advantage came up, because no, but ihought you said everything will be covered. Not everything, but comprehensive care. What kind of things wouldn be covered . Well, you know, cosmetic surgery probably wouldnt be covered. There would be certain you know, certain other things. But it would be a limited set of things. So, private insurance wouldnt be able to compe with the offerings of the government. Exactly, which is the case now with medicare. Aits just that medicare narrower set of benefits right now. Medicare for all wld be an expanded set of benefits. In the end, it is cheaper forto everybodctually go to see the doctor when you first get sick versus to wait untithe very end, and thats separate from the moral imperative to actually provide healthcare for everyone. So, as you know, there are about approximations of between 150 million to 180 Million People who are currently on employerbased private insurance. Right. Would they lose their insurance . Well, they wouldnt lose by the way, 71 or so are ppy with that insurance. Right, absolutely, and they would stay what happento them . So, they would be covered by ene guaranteed Insurance Plan that the governmwould be providing. All it is is were cutut the Insurance Companies that are providing the insurance, but you get to see the same doctors and hospitals. But heres the question i have, because private insuranceu ultimately, asnow, in the Healthcare System, its actually paid for through rmbursements, and medicare is billed at a lower rate, and private insurance is billed at a higher rate. Right. And if prive insurance no longer exists. Right. Anis not able to overpay for services. Right. Will there be as much money in the system to provi as Many Services to the population of americans . Its such a great question. So, what we would do in our plan is we would actually have a rate, reimbursement rate, thatwe is somewhere b medicare and whats called an allpayer rate. So, the rate wou at least be as much as medicare and perhaps more. Are there some people who are gonna make less money . Well, certainly, the insurance c. E. O. S will make less money. Some of the specialty doctors at e very top of the scale may make a little bit less, but the majority of doctors and we have incredible support from the physicians because they are tired of spending 30 of theirni time on adrative costs, trying to convince Insurance Companies that they actually should provide the payment for treatment that the doctors know their patients need. In the first roun president ial debates. Right. Over two nights of debates, only four candidates have raised their hand for your version of medicare for all, the one that would eliminate private insurance and do what your bill outlines. Right. So, this question abo whether you keep private insurance or not is a debate in the democratic party. Lets roll the clip of de blasio and orourke. Would you replace privatein rance . No. I think the choice is fundamental to our ability to get everybody cared for. Private insurance is not working for tens of millions of americans when you talk aboutde the copays, thctibles, the premiums, the outofpocket expenses. Its not working. How can you defend a system thats not working . So, for those for whom its not working, they cachoose medicare. Congressman, you got to start op acknowledging the system is not working for. Theyre able to keep em. Why are you defending ivate insurance . Alright. And then what happened after that is you had representative delaney say the problehere is that were throwing the baby out with the bath water. Right. Rig . That if you keep private insurance, if people like it, let them keep it. And then why not provide for those who dont have the ability or the opportunity to buy in to private insurance a medicare for all . The average family whos buying insurance on the marketplace or is covered byem oyer insurance is paying anywhere from 18,000 to 20,00s a year in costs. So whats happening is private insuranccompanies are raising premiums even on employers, so employers either have to cover that cost on their own or they have to push it down to their eloyees. Employer healthcare sure, aof loeople like it, but there are a lot of people that are absorbing enormous amounts of costs, and its not just employees. Its also employers,hich is why we have this Great Coalition of small businesses, mediumsized businesses, and even now larger businesses who are saying, we cannot be competitive. Warren buffett called healthcare i think he called itm the tapew economic competitiveness, if i have that right. Ll basi what hes saying is it is killing our balance sheet. I mean, this is certainly one of the where all of us agree. It is too expensive, and there are ways to reform it. E i think there fferent competing ideas about how to reform it. I mean, there are dels within medicare itself that have proven successful at bending the cost curve. If you look at Medicare Part d, for example, it has kept prescriptiondrug prices lower than it would ha otherwise. The same is true for Medicare Advantage. But heres e thing about Medicare Advantage. Its an enormously expensive program. People like it because wouldnt you want to have vision and, yo knaring aids and dental . That is really important as you come older. I mean, its important anytime, but certainly when you become older, but youre paying a these multiple plans. People are tired of having to pay for five different. But that is whats kept the cost from growing,ecause theres competition between these multiple plans, isnt it . If you have a large enough system, you can negotiate a far lower rate. Americans should not be paying double the cost of prescription drugs than they do in canada. I mean, this is ridiculous. And the Insurance Companies can find another way to make money. God bless em. Find the other way. But dont make it off of the profits of people who t sperately need healthcare so that they can exd live and have a decent life. The only thing i feel like io cant leget away with is just saying that you know, the profit motive has generated benefits to the system, as well, in terms of innovation. What innovation . And in terms of all of the innovation in medical i mean, think about how, in the United States, we are leading in immunotherapies and in gene therapies. Immunotherapy the thing thate ha jimmy carter alive. But thats resear and that is with the profits from pharmaceutical cos. But okay. Most of those technologies were actually funded by governmt research, and theres lots of there is lots over 0 billion a year into research and development that is a hugemount of money. And if the price is drugs. Yeah. Theni mean, how you hear the saying that todays medicines pay for tomorrows research. Wel we should talk about pharmaceutical drugs and research as a whole separate topic. I know. We need another 30 minutes. But i will tell you that a lot and ive spent a lot ofoo timeng at this there are lots of research and innovation opportunities, including the federal government continuing to provid of that key funding, even more, perhaps, for pharmaceutical drugs, but thats a differt that has nothing to do with medicare for all. Healthcare is a basic human right. That is what i fundamentallye. Beli and these basic human rights should be provided by theve ment. Id like to talk about whether its a basic human right. I mean. When one thinks about rights, when i think about fundamental rights, i think about bill of rights. I think about the fact that we have the freedom of speech. We have the freedom to practice our religion. We have thfreedom to peaceably assemble. These are all fundamental freedoms that weve agreed in this country exist for us to protecus from government overreach. Ceen i think about healthcare, i think its a serhat somebody purchases and is provided. How is a service that is provided to somebody fundamental right in the way that freedom of speech is a fundamental right . Ig. If you get sick, you have no access to any of the her rights. This is a fundamental piece of who we are as human beings. You have to be able to Access Healthcare in a way that is affordable and doesnt drive you into bankrtcy. So, is that a responsibility of a civilized postindustrial country, or is it a fundamental right . O and i, i mean, i think i would be happy to pay more so that people dont fall through the cracks, so that they have basic healthcare, and i think of that as a responsibif a Civilized Society that is caring and compassionate and postindustrial. Thats because youre youre fu. But not amental right, because when you call it a fundamental right, doesntn that tply that theres a moral responsibility and imperative for the government to pay . If you want to call it a responsibility and i want to l ll it a right, the end g the same, and we could argue out that, and i do belie its a right, but i also believe that its fine if you think its a responsibility. The reality is neither one of us is getting our needs met with this system. 70 Million People in the riche country in the world cannot Access Healthcare. Ls talk about the cost. The major factor here, the elephant in the room that we havent discussed yet, is cost. Right. Cost to the system, cost to the economy overall, and cost to the individual. Yeah. The cost erall has been estimated roughly by rightwing think tanks and leftwing think tanks roughly at 32 trillion. O r 10 years. Over 10 years. So, 3. 2 trillion a year. And thats the Koch Brothers estimate, but lets take that as the estimate. Sure. I mean im just going to accept that estima 32 trillion over 10 years. Id3 of the cost of our Current System is already or by the federal government. Why . Because its medicare, medicaid, and public subsidies. Then you just need to come up with a little less than a trillion dollars in funds that the federal government is not already paying. The employer industry is paying about 700 billion a year in costs, but theyre paying it to private Insurance Companies, not to the government. So many of the businesses ive talked to have said, god, please, take Health Insurance off of my books. I will pay even a portion of that to the governmento cover that and to cover the cost ofth hensurance by the way, Health Insurance that people could have no matter what job h th. A big part of that would go to the federal government, and then you got to come up with, you know, depending on how yous, look at the conywhere from 300 to 400 billion a year,ul which be a cinch to do with a financialtransaction tax on the wealthiest, a tiny capitalgains tax. There are all kinds of ways to come up with that money very easily. So, explain to me one analysis said th could double doubling all currently projected federal, individual,at and corpincometax collections would actually be insufficient to finance the added federal cost of the plan. I dont know what study that is, but lot of its the cato institute, say. Well, i mean its a libertariank think, right. But, also, theyre not looking at the current cost, so theyre saying theyre saying all the federal costs. Os right. I mean, theyre saying that this is a new and what i want to make sure people understand is we are already paying this money. The federal governnt is already paying 2 3 of the healthcare costs in this country. It could cut administr waste out of the system immediately and save a tremendous amount of money on overall healthcare costs. I have heard thathere is a fallacy with this idea that the government would be more efficient, that, somehow, l of this would be administered in a very streamlined way, because ie is administhrough different departments, and so it is hard to get a cost of how this administration would work. It would be admi through hhs. It would be administered through the irs. It would be administered through so many different agenciesat t isnt just one. Medicare is the closest example to that. I mean, you can look at the dicare system, which the government administers today, and the cost of just pure medicare is 2 . The ea that government cant do this efficiently is just not borne out by experience. And so then, ultimately, you would raise taxes in some way on the wealthy or on corporationsn ordividuals to pay for that delta . For the final delta, yeah, you could make any number of, you know, small tax increases on the very wealthiest. A financialtransactions tax would bring you way more money than you need. T, ost importantly, what you get for it is the average family would probably pay 14 less in total costs because the costs of the Healthcare System out of pocket are getting absolutely unaffordable, and theyre breaking american families. This program was hosted originally byll wiiam f. Buckley jr. You wont be surprised that in 1974, he debated specifically this issue. Ohh he didnt call it medicare for all, but it was a w debah max fine, a member of jfks medicare tax force. Uhhuh. About governmentrunon na healthcare insurance program. Lets take a look. Okay. Well, i think the quality of care in england is very good. And the fact that they likes itst immaterial. [ laughs ] i love it what about the question of wait times . I think that england is a different system, right . England is a systewhere the government actually controls the hospitals and the doctors. Is a National Health service. Canada is not that. Germany is not that. T there are a places that have a system where the insurance is provided by the government but the actual system is privately administered. And ive heard you say that the system of medicare for all would be most like the canadian system. Is that accurate . Yes. I think thats probably the most similar. Well, its true, though, in canada that there are pretty extraordinary wait times for many, Many Services. Right. In general, if you look at canada, germany germanys sligly different to some of the other European Countries you find that people dont have enormous wait times that areyou know so, youre saying there wouldnt be wait times if we switch over to a medicare for all system . There is a sense in t United States that, you know, you have to go and you have to get something immediately, right . Half the time you go a find out that theres something ing on, and somebody say okay, you have to go get an mri today. Might you have to wait a day to get your mri . Maybe. The reality is today people are not getting care you want to talk about wait times . Lets talk about the fact that 70 Million People dont get re across a country. Thats a pretty significant wait ti for everybody that can never Access Healthcare in this country. Except that there are peoe that dont have the wait times, and so the question is how do you correct. The wealthiest 50ople today in this country not even theillion people that have private employerprovided Health Insurance they have very few wait times. I mean, it really is not a feature in our system. The reality is the vast majority opeople who get healthcare, you know, of the highest quality whenever they want it, as much of it as they wantare the wealthiest, and think we have to put ourselves in the place of reimagining a country where everyone can get the care that they need. An even if it waiting a little bit longer . You might have to wait a little b longer, but i think you will ultimately get the care you need. You have to reference it to the system we have now. What about the enormous numberss of people ache country that cannot get care . Its not about wait mes. Theyre dying. Theyre dying. So,hat youre saying is to cover everybody, if some people have to wait a little bit longer, its gonna be worth it . Thats the cost you have to pays a society. If its even true, but, sure. Yeah. How realistic, how achievable, do you believe your version ofedicare for all is . It is so achievable. How politically possible is it . Oh, look, politics is the art of the possible, and our job is to push the boundaries of whats possible. When people said, lets go to the moon, people said it wasnt possible. P whple said, lets give women the right to vote, people said it wasnt possible. If we sten to people who say things werent possible, we would never be the country we are. It requires some courage to take on the system that is profiting a very few today and leaving so Many Americans without this Critical Healthcare that they deserve. Its a right. Lets give healthcare to everybody. Pramila jayapal, thank you for coming to firing line. Thank you. Great to talk to you. Appreciate it. Firing linear with mret hoover is made possible by. Additional funding is provided by. Corporate funding is provided by. The people who give the money to make Mister Rogers neighborhood are the people who contrheute to this and. And. Captioning made possible by u. S. Department of education its a Beautiful Day in this neighborhood a Beautiful Day for a neighbor b would youmine . Could you be mine . Its a neighborly day in this beauty wood

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