Transcripts For CSPAN Washington Journal Margaret Flowers And Michael Tanner Discuss Single... 20170711

Of a singlepayer Health Care System in the u. S. This is just under one hour. [no audio] definitions. Doctor, how would you define washington journal continues. Host were going to engage in a discussion look at the topic of singlepayer health care. Two guest joining us, Michael Tanner with the cato institute. He serves as a senior fellow. And dr. Margaret flowers is a National Board advisor for the physicians for a National Health program. Of you, good morning. Lets start with definitions. Doctor, how would you define singlepayer as a working definition as far as health care is concerned . The easiest way is to call it National Improved Medicare for all. National, every person living in the country, and of the Health Professional in the country, is in the system. It is more comprehensive and there are no upfront outofpocket costs like copays or deductibles. Then medicare for all, everybody pays into it through a preventive tax, and everybody is covered for the care they need. That is certainly an expansive definition, and it gives us some to work with, but it is much more expansive than National Health Insurance Programs in other countries, which do include outofpocket expenses which often have secondary payers working alongside the governmentrun market. This would be much more expansive than perhaps anywhere in the world. Host lets look at the idea of pros and cons for such a system. Michael tanner, the idea of singlepayer what are the pros and cons as far as that program is concerned . Guest it would certainly give everybody a piece of paper saying they have Health Insurance, more than what some people have today. But it would be enormously expensive here at look at the california proposals, 400 billion more than the entire state budget for a year. There is the Bernie Sanders proposal, medicare for all, which have caused 30 trillion over 10 years. We are not willing to make the sort of tradeoffs that other countries are willing to make an terms of access and outofpocket expenses in order to expand coverage. What we would end up with is a hugely expensive program that tries to do something and when alls does, which is provide everyone with unlimited care. Guest a National Improved Medicare for all system is the only way to save money on health the costs and start to bend cost curve. If you look at the other industrialized nations, most are spending less than half of what we spent per person for health care, causing High Satisfaction raise, much better outcomes, improving where the u. S. Is declining. Numerous studies show when we do a National Medicare for all system, it will save us money and we can cover every Single Person with comprehensive coverage for the amount of money we are currently spending. I do not think this can be done at a state level. There are too many federal barriers. No state has achieved a true singlepayer state system. That, you cannot do the cost savings you need to cover everybody. Host he mentioned the california example and the expected price tag. It came up in legislation. That is on a state system. How do you make it work on a National System . Guest the problem with a state system as we have a lot of pieces to the Healthcare System, multiple payers, and you cannot create a state system that puts those all in a single risk pool. With national law, just like we in 1965, wherere we set on this certain day every person over 65 in the country is included on the medicare system, date, say, ok, on this every Single Person is in the system. That is how it has been done and other countries, and it has been a smooth system. They have been able to control costs. Host medicare is 58 trillion in the red going forward. You have the titanic going under, suggesting everybody is a passenger. This is a program that is unaffordable as it stands now. Adding every american would raise the cost of the program. This program already has deductibles and copayments that people have to pay out. On longer you are sick medicare, the less it actually reimburses you, which is why people in Nursing Homes going medicaid. Medicare is an example of everything wrong with health care in this country, simply trying to cram more people onto it would be a bad idea. What is the closest example to singlepayer . What we callf National Healthcare systems and other countries are actually multipayer systems with private insurance and so on your there are very few systems in which a government is the only payer. Medicare is a good example. Has beendicare consistently under attack for decades now. When we brought in the Medicare Advantage plans come a private insurance plans that seniors choose, those act like private Insurance Companies. They choose the healthiest seniors, and when the sinews get sick, they and send buys them to leave and go into a traditional medicare plan. So it is a more expensive server more expensive medicare. The reason people going to medicaid is because medicare does not cover longterm care. Only medicaid covers that. Under a National Improved Medicare for all system, if you look at legislation we have, it is comprehensive and includes longterm care. We know that by doing that and being able to incentivize communitybased care, homebased care, some countries are looking at reimbursing family members for staying home to take care of their sick people in a family, we can save money that way. So the best way to protect and preserve medicare, which people in this country do love, is to expand it to everyone and improve it so it is not operating in the current toxic and expensive environment. Host you have heard our two guests this morning, dr. Margaret flowers and Michael Tanner. If you want to ask questions about this idea of singlepayer, we divided the lines differently. If you support the program, 2027488000. If you oppose it, 2027488001. Mr. Tanner . Guest look, 58 trillion in medical debt in medicare debt. The average couple will pay hundreds of thousands of dollars into it, and they will take out about 450,000 and benefits. What dr. Flowers is talking about is losing money in every transaction and trying to make it up in value. Guest i say what we are doing right now is losing a lot of money in every transaction. We have the most complex Health Care System because we have hundreds of different payers spirit we are paying onethird of our Health Care Dollars just on paperwork. That adds up to almost 500 billion a year that we are wasting on paperwork that could be going to health care. In fort collins, colorado, you support this idea of singlepayer. Caller thank you, and i would have to agree with ms. Flowers. If somebody gets sick, the hospitals should not turn them away. Time i checked with a think tank, they said it would cost each american 6,000 a year just to take care of people who do not have health care insurance. Aca is onent on the of the big issues is that not makeh kids are in this to the actuarial pool large enough for affordability. Singlepayer would spread the actuarial pool against everyone. Is charles in colorado. Mr. Tanner, what about the idea that people will ultimately be in the hospital anyway . Guest youre right. It does get passed on to the on toers or gets passed people with private insurance and pay higher premiums. But what takes place in Government Programs like medicare and medicaid exceeds the costs from uncompensated care. Those programs under reimburse physicians significantly. Onicare is around 70 cents the dollar of actual cost. What you are actually doing is those costs are passed on to people with private insurance, as well. Guest the caller makes a good point, that the basic idea of insurance is sharing the risk, spreading the risk around. The bigger you have the group of people in the pool, the more that risk gets spread. When you look at population dynamics, you know about 20 of the population uses about 80 of our Health Care Dollars, but any one of us could be in that 20 at any time and our life if you have an accident or illness. 50 of our population use very healthcaree dollars. But you had that security that when you get sick, the money is there to cover the care. That is what is experienced in other countries. Other countries have private insurance on top of the public system, adding an extra is the public system may not cover. That is fine. Efficient want an system where everyone is covered, you need to have comprehensive provided through a singlepayer system. Guest in medicare, basically everyone under 65 is paying into the system and taking nothing out, and the program is still 58 trillion in the red. So if there were taking out in addition to paying an, that would only make medicare work. To thein addition problems with Medicare Advantage, medicare is operating in a toxic environment. In the u. S. , we pay the highest prices for Health Services and for pharmaceuticals because we do not have a Natural Health system designed to lift up our health. So we do not have the ability to negotiate. There is no rational basis for the prices we have for pharmaceuticals or Health Services. In the system, you can bring some saturday sanity to our pricing. Guest about what that half of all pharmaceutical products are patented in the United States because that is where the research and development is done. 80 of nonpharmaceutical s, wehroughs, such as mri would not want to have price control to limit medical availability. Imagine if you put price 1900,ls on health care in so we have no advances in Health Care Quality since that time, no new products, no new drugs it would be terrible. Guest the majority of our Research Done on health in the u. S. Is sent to the National Institutes of health, the ones who do the upfront research with the breakthroughs, and that then goes on to pharmaceutical companies. A lot of our innovation in the United States when it comes to pharmaceuticals, because it is a forprofit model, it is taking the medication, tweaking it, giving it a new name, patenting and making a lot of money. We can prioritize what our health needs are and direct research towards areas with needs. Taylor from kansas city, missouri, opposes this idea. Say that i am to opposed to the singlepayer system because i have seen what happens in england. In england, they have a baby there that is sick, and yes, it life is but that babys being taken short because the doctors there in the government feel that that they be should just go ahead and die. They want to take it off of life support. To brings. , we want the baby here and give that baby some life with its parents as long as it can. If we do a singlepayer system, were going to end up with a system or the government and whoever is in charge is going to die a situation of you because you dont have qualityoflife. You are healthy and you have qualityoflife. I do not want to see that in the United States. I want to see that everybody has qualityoflife. Host dr. Flowers . Guest it is sad that the situation in the u. K. Has been politicized the way it has to in the u. S. , we have tens of millions of families with no Health Insurance at all, so they cannot access the care they need. Death rates from others and for infants are many times higher than they are and other countries. A lot of people in the u. S. Do not have the ability to get health care they need, including children. Families will go into debt because they have an unexpected complication with a child. The united in states, if we do a national approved medicare for all system, it is a different thing from the u. K. , a truly government owned and operated system. Taking a private Health Insurance industry out of the picture, because they are the and that want to deny care, were putting the decisions back in the hands of the patients and physicians. Guest i will say, in fairness, that this, as tragic as it is in the u. K. , has more to do with the u. K. Court system and the legal right to parents of than it does with the National Health service, although the doctors did make a costbenefit analysis originally. Then it had to do a lot with the legal system in britain after that. But it does set up the fact that every Health Care System in the world rations health care in some way. Lists. Ssian by waiting some ration by waiting lists. Unlimited care is unaffordable. Host this is a recent headline from the guardian about the National Health service. Longer delays for operations cut onee nhs decided to of its most important requirements, relaxing the requirement for hospitals to treat with an 18 weeks. Mean that there are problems with the Current System that they are making these kind of decisions . Guest the u. K. Has been under severe austerity for a long time now, so we are seeing cuts to the National Service there appeared people and physicians are fighting to restore that because they are in the system together. They fight together to make it a better system. That is what we need in the u. S. Here it when were all in, it is social solidarity, and it raises at the bar in the system, and that is what we see around the world. When we are all in it, we have an incentive, including the members of congress being in the same system. Guest it is called the magic money tree system of health care. Health care is a commodity like any other. There is a finite amount of money and a finite amount of hospitals and doctors. There will have to be allocation decisions and we can retain there is a unicorn farm and we can give everything to everybody, but the reality is we have to allocate decisions. The American People want to make those decisions for themselves, not let an arbitrary body make those decisions about who gets karen who does not care. Agree thatlutely people want the choice of the doctors. In our Current System, we do not have those choices. The private Insurance Companies dictate who we can say, where we can go, what treatment we get. Their incentive is to charge premiums as high as they can get away with, shift the costs onto the people. Since the Affordable Care act became law, Insurance Company stocks are booming. United health care is up almost 500 . No reason we should have that element in our Health Care System. What national approved medicare for all, that puts health care back into the hands of patients and their health care professionals. Host joseph in florida, hi. Caller ok, so have a little spiel, as my friends in new york would say, regarding health care. I am a veteran. My three brothers are all veterans. We served during three different wars. After world war ii, we did not destroy the powers, we build them up into great economies, and we also help them rewrite the constitutions. Rewrite the constitutions. In those, health care for systems in those countries guaranteed some type of Health Insurance program. Hello why have we not done the same thing for our own people . Guest a very good reason why we have not done it for our own people, we have an industry here in the United States that is making tremendous amounts of money off of the system the way it is. Theyre the same ones who have lobbyists on capitol hill. This is really a democracy issue if you think about it. In the u. S. , the majority of people support a medicare for all system. We know that these systems work and we can spend less and have Better Health outcomes. But our members of congress, because of the financial interest, locations, are not going in this direction. That is why it is so important that we continue to build this movement to fight for National Health care for all system. Gett i disagree that you Better Health outcomes from some of these interNational Systems. Can alwayslook, we give people a piece of paper that says they have Health Insurance. Goingality is we are not to provide unlimited care for everyone. No Health Care System in the world does that. Many of these countries that say you have a right to health care, the reality is it you do not. Example, in britain, they have the National Institute for clinical effectiveness that looks at the price ratio, makes a costbenefit termination, and they say that the treatment that might save your life costs too much, so you do not get the treatment unless you can supply the market and provided for yourself. If you look at the studies, it is very consistent, International Studies looking at Health Outcomes in this country compared to other countries, looking at the and we have in our country. We arecent studies show failing and serious areas of chronic disease, problems from medical errors am a because we have a system that is not about care. I disagree, health care is not a commodity. Health care is something every Single Person needs. We need roads to drive on, schools, health care. When we get sick, if we make it a commodity, a gets more expensive and more unequal. Guest but it is a commodity and we have so many hospitals, so many doctors, so much money it physically is a commodity. It is the same laws of economics as any other commodity. Guest the problem with that is you cannot put health care and to the marketplace. People do not have the same choice that they have when buying something on the market that i would consider a commodity, like a telephone or Television Set where you can save up and shop around and choose the one they want. And they say, if i dont find what i want, i will not buy it because i do not ultimately needed it with health care, you do not have that ability to shop around when you need it. Once you get into that hospital system, you have very little control. The Health Professionals are making the decision. There is no way to even predict when some of comes into the hospital how much that hospitalization is going to cost. This is something that we know from experience. Nationalprogram is the website. Not everybody really wants to go get help. People are not knocking on the doors saying that i want to go to the doctor all the time. People want to go to the doctor when they get sick. From population of studies, we know most people and our country are healthy. We know were spinning twice as much as other countries. Money is not the problem. Guest we know we have an overdue utilization of Health Care Problems in this country. You are right, if you get hit by a truck, you are not negotiating prices. Chronic care or routine care, and those type of things you do have choices. You cant choose or ask around you can choose or us ground about physicians. There are Health Advisors and so on to help you navigate the Healthcare System and get the best care at the lowest price. Guest it is really sad that people have to hire able to navigate our system. Are creatingpanies altra Narrow Networks that excludes 70 of the Health Professionals so they can drive people out of network and then they have to pay more to her the system we have right now does not make sense. Host clarksburg, west virginia, this is lou. Caller my name is frank. Host sorry about that, frank. Good morning. Caller good morning. Things here ny mr. Tanner, dr. Flowers is eating you up, ok . I will start there and go on to insurance around health care. People, you literally put off going to see a doctor because of costs. Not only that, but if it is catastrophic e, lots of themnd up lots of them end up losing their assets, their savings, homes. On an insurancerain Health Care System mr. Tanner, i really sorry, but host we will let him start. Mr. Tanner, go ahead. Guest the fact is i am not a fan of the current Health Care System, and insurance governmentrun, sort of, combined system. About half of all health care in the u. S. Is actually run by the government. 37 has been subsidized by the government. Individuals have very little control over their own health care. I favor a system under which the money being given to Insurance Companies through employers actually given to individuals who can then use that to make more decisions. In the end, i might if light my entrance committee, but i can ultimately fire them and choose another one. Host as far as funding mechanisms are concerned, what is the ultimate word and on the u. S. . Other countries use similar tax systems to pay for their health care. What does that suggest for if we put something into place like that in the u. S. . Reasonshere are several for the Lower Health Care costs. They do a free write off in terms of research at development from the u. S. And consumption increases along with income. The fact were a wealthier country allows us to spend more. We also want to live forever. And then it is a third Payment System the blocks individuals from the health care decisionmaking process. We have to look at the types of proposals being made. The Bernie Sanders proposal was going to cost 30 trillion over 10 years. The california proposal was 400 billion a year. A singlepayer system, 7 billion here these are in or was the costly. It will bring down economic growth, and nothing does more to help health and poverty than a growing economy. If we slow economic growth, that will cost lives. Host you mentioned the Bernie Sanders plan. We have a graphic that shows some of the structures. There was an incomebased premium another tax rates. Is this something the American People would accept . Guest i see the golden standard bill. 676, the conyers we do have studies of how we would finance the type of system, and we are talking about a progressive taxation. The u. S. Is one of the most regressive countries on a comes to Financing Health care, so people at the lower end of the Healthcare System they much higher proportion of their income on health care than people at the top tiered we need to create a system that is more just and warfare and would serve as a stimulus, an economic stimulus. We have people in this country look at the poverty rates. People are choosing between buying their medication or buying food for the families or paying rent on their house. Utilization that is driving our high prices right now. The United States under utilizes health care per capita compared to other countries. People go to the doctor more and go into the hospital more. Is expensive because of the paperwork and high prices of health care and pharmaceuticals because it is all marketdriven. The corporations are profiting, getting as much as they can off of it. An example, hypertension, high Blood Pressure in this country, if we had a Health Care System based on health, we would make sure that people who have high Blood Pressure would see the doctor regularly and get the medications and education to manage the hypertension. We do not do that, so we have people in their 40s and 50s having strokes or kidney failure. After that, we will pay for it, pay for your dialysis or your treatment for strokes. That is ridiculous. We should remove the barriers to care and make sure people are being kept healthy. Host lets go to chris in cedarville, tennessee. Caller yes, a couple of points. She says this singlepayer system will save there is not a Government Program out there that saves money. Second point is she said a poll suggested that the majority of americans want singlepayer. The polls also said Hillary Clinton would win president. Thank you. Host to the first point, not a Government Program that saves money . Guest even though medicare is operating in what i consider a toxic environment of high prices and being undercut by the private Medicare Advantage plans that keeps the administration at 3 of the money that it has, private Insurance Companys admit they are spending 17 to 20 administration. And when you add the hospitals and Health Professionals, one doctor spends 82,000 a year on billing in the practice. Medicare actually is the most efficient part of our health there our Health Care System. The cost of medicare underestimates the actual cost of medicare, because many costs associated with private entrance would be carried out by other agencies of government. Billinginsurance is a arm, and then there is the irs, and we do not count that into the administrative costs. It is still less than private Health Insurance, but it is much higher. Rateare is a huge baud because part medicare has a huge fraud rate. Guest the medicare 3 includes the federal agencies, the buildings, the contractors, the fraud and abuse unit that does look at fraud, and with medicare, we have the ability, because we have a system that is transparent, to look and find where there is fraud. In the private insurance system, those Companies Keep that information proprietary. So it keeps us from seeing how they are spending the money, where it is going, but also if there is fraud going on there. Recently, Medicare Advantage, the cms is supposed to be releasing the data on the private Medicare Advantage plan. For some reason, those private Medicare Advantage lands are not allowing them to release that data, and that is because they do not want them to see how they are wasting money. Who enroll inns it voluntarily seemed to enjoy it and like it because it often has benefits that traditional medicare do not offer. To blame all problems and medicare on Medicare Advantage were talking 58 trillion in medicare debt, and that is not all due to the fact that Medicare Advantage are seeking healthier people out of the pool. Medicare basically under charges in terms of what it costs to provide health care. Lets go to jesse from maryland. Caller good morning. Guy. Wondering about this i think he is talking for the lobbyists. I agree with ms. Flowers about the singlepayer. Host what is your question . Caller what is wrong with singlepayer . Guest what is wrong with singlepayer . Host i think the line was dropped. A call from north carolina, hi. Caller government has already had a system of singlepayer for over 70 years. It is called the v. A. System, and now congress is a voting to let people get out of the singlepayer system. How come that is the situation, as opposed to going to the singlepayer system . I have proposed in the past that if they want to have a singlepayer system, give everybody free access to the v. A. For one year and let them see if that is the way they want their medicine . Host v. A. As a model, how would you respond . Has advantages and disadvantages. It does manage to hold down costs, but it doesnt restrict choice and access. On pharmaceutical costs, the v. A. Offers one drug in each therapeutic class. If it is not right for you, you might be out of luck. There are studies that show that a limited formulary is costing if not months, of lives if they are truly sick. Havee provide care, if you a good if your congressmen is on the right committee, you get a lot of v. A. Hospitals both in your area. If not, despite overutilization, you will be out of luck. The v. A. Does a great job on some things but does a very poor job in Mental Health care, see veteran suicides. Model is nota. What were proposing, that is government owned. We are proposing a model that is fine its publicly, and then private providers and public providers are paid in the system. The v. A. Has been underfunded. We have been in wars now for 17 years and are generating a lot of veterans, injured soldiers, coming back, and it is a huge burden on the system because of that and it is not being kept up with. And a National Medicare for all system, every Single Person is in the system, and you do not get people buying against each other for care. We will fight for it to be the best system that it can be. It is the only way to set as on the path to start improving quality of care in the United States. The Current System is eroding quality. It is why i left practice and why so many physicians are leaving practice, because the system undermines our ability to take care of our patients, spend time with them, talk with them, order what they need. We are constantly fighting with private entrance companies. Host dr. Margaret flowers with physicians for a National Health program, National Board advisor. What is the group . Guest it has been around now for almost 30 years, and it is made up of Health Professionals, medical student, and Health Advocates around the country who educate and advocate for National Improved Medicare for all Health Care System. We put out a lot of research. Org. Pnhp host cato institute, mr. Tanner. Guest we believe the government really should stay out of your life, libertarian. It does not belong in your wallets, your business, your medicine cabinet, or your bedroom. Host if such a program were in place, what happens to physicians as far as what they might make her not make . Guest we have to recognize that under the Current System, physicians have very little say when it comes to what we get reimbursed by private Insurance Companies. Every year i would get a contract from various interest telling me what they would pay me, no negotiating ability. But under this system, we would have an negotiating ability to we could negotiate for better prices and better pay for primary care physicians. Other countries that have a singlepayer Health Care System, doctors are paid very well. In canada, the doctors are the highest paid in the country. There would be some redistribution where we would have to shift some more resources towards primary care, because were losing the sector of our physicians viewed may be a little bit less from the very high end, people making millions of dollars per year. We see a little bit of a redistribution, but people would still be doing quite well. Host mr. Tanner . Guest we see examples now of medicare medicaid, the villa, and so on and so on in which physicians are under reimbursed. We have governments that have price controls essentially in isicare, were the government determining what physicians will be reimbursed arbitrarily. There is very little negotiating power. The idea that physicians and the government will be an equal negotiations, the government ultimately will decide one way or the other. They do not decide very well. Guest in north carolina, a geriatrician, she rents or practice off of medicare, does not take other type seven sharons, and she had a problem where she was delayed on an address change, and they said they were not going to pay her for that time, she called her members of congress, they cant medicare, she got her payment. She had some want to turn to. With a private Insurance Company, you are out of luck in that situation. Host don, go ahead. Caller i am in chicago. I have two quick points. , all of the clinton republicans hate her so bad, but she is not a russian spy, as our president is. Second question is, if we can put a man on the moon, i think we can figure out ways to buy health care for the American People. Host ok, lets hear from bob in virginia. Caller yes, i want to share contrast between the debate tactics of dr. Flowers versus mr. Tanner. I feel like dr. Flowers is very knowledgeable on topics and brings up points that are sending you can absorb, whereas you have dr. Tanner talking about unicorns earlier and throwing a very large numbers red, 50 trillion in the which does not support that. I just feel like host specifically, what would you like to hear . Caller i would like to hear them talk about that exact 58 trillion number. Guest that comes from the medicare trustees. It is in the latest Trustees Report they came out in may, i believe. It is essentially the discounted present value of medicares unfunded liability going forward. 58 trillion today would pay the shortfall in medicare going forward. It is an official government number. Guest but over what time period . Guest discounted, infinite horizon, forever. That you discount it into the future. I like to deal with the here and now. We know that were spending twice as much per person on health care each year in the United States than most other industrialized nations. It is not that were not spending enough on health care. , weway we have our fragment have a lot of excess paperwork, very high prices, so the best and preserve the medicare system is to expand it to everyone, and then we are all paying into a single system that is paying out for care when it is needed. It ready to accept that volume of people coming in . Guest absolutely to what you see is a shift. In countries where they have gone to a singlepayer Health Care System, you see people who are maybe over utilizing the system will get a little bit less care. People with Unmet Health Care Needs will get a share they need. But we do have work to do. In the u. S. , we have been shutting down hospitals, primarily in rural areas, because they do not make enough money. Under this system, every hospital would get a Global Operating budget, so people will not be losing hospitals when they need them. We have a lot of Health Professionals who have left practice because of frustrations with the Current Systems and have gone into the administrative positions. , and thereome back are a lot of healthcare jobs we need in this country. Good infrastructure accept that . Guest we will be short giving the aging population. We will have to get those positions in some way. More autonomy and more pay would be good for them. In countries like germany, i believe the average physician income is around 55,000 a year, so they have much lower physician incomes, which will not bring people back into the market. Guest autonomy is an important point, because we do not have autonomy as Health Professionals in the Current System. That is the beauty, we would have autonomy. All we have to do is build a government. I have a friend who is a surgeon in france, he does not even have much of an office staff because someone comes in, swipes the card, puts the bill into the computer, five days a waiter gets paid. In the u. S. , we can fight for years with an Insurance Company to get pay for a single patient. Doctors in the u. S. Are spending two hours of paperwork for every hour of patients time. That is not a good highquality system. Guest physicians i know talk about problems with medicare. They miscoded a number by the time they get through the bureaucracy or the cost for the repayment is not even meeting their costs. Host lets go to a call. Whenr i shudder to think i hear dr. Flowers say, well, someone in washington is going to have a global budget do you know what that means . Elitess they decide, the remember Jonathan Gruber said American Voters were too stupid so we lie to them about keeping their doctors and their health care plan. And talking about keeping every hospital open, who are you giving that flim flam to . We have dozens of hospitals in california that want 450 billion on the Health Care Bill that they did not even want to discuss. It is a political ploy. The radical left talks the way dr. Flowers does when she says, well, a little bit of distribution here, a little bit of distribution there. It does not matter. It does matter. Guest we know that these types of Health Care Systems work. They work around the world. We know the United States is an outlier for using a marketbased system, and that is why we have such a high cost system with poor Health Outcomes. When every Single Person is in that system, including our members of congress, there is an incentive to make it a highquality system. Right now, were all fighting in the system to get our little piece. That does not make sense. Guest actually, the foreign systems that are doing best our marketbased systems, like switzerland, the netherlands, and singapore. They have market aspects to them. Switzerland has no government Health Care System, no medicaid or thefor the poor elderly, and it is entirely private insurance. Is where, basically the Health Savings account started. These are all marketbased foreign systems this into doing well. Guest i would not really count them as marketbased because the private insurance is completely different in those countries than in this country. In the u. S. , ours is a financial instrument that is designed to make profit for the investors who invest in it. They do that by charging high premiums, shifting the cost of care onto the patients, and denying payment for care. This was system is heavily regulated it but it is designed to pay for care and not pay profits for investors. They have much less wealth inequality than we do here. You do not have the same situation in switzerland. In switzerland, theyre one of the most expensive, as well as the netherlands, two of the most extensive Health Care Systems and the world. We want to use our dollars efficiently. With one single system, it is one set of rules, one payer, symbol for patients and for Health Professionals. We can do it at a low administrative cost and focus on health care. U. S. about onethird of Insurance Companies or nonprofit. All mutual ones or nonprofit. Are of the blues nonprofit. Guest but they operate like a forprofit Health Care System. Even though they are required by the government to pay some of it because the excess of money, to pay that back into community programs, they are refusing to do that. , theyfit or forprofit are all operating under the same model. Host matthew is in washington state, and he is on our support line. Caller i wanted to mention that when i was in the philippines, i had to go to the emergency room for but four hours, and i was concerned the bill would be about 5,000 like it is here in america, but when i went to pay, it was only 16. When asked why, they said because they limit how much the government delivers, how much doctors and hospitals cant urge, and that includes pharmaceuticals. I wonder why we dont address the problem in such a way and we just look at how we are going to pay this huge bill that we are going to charge. Guest price controls have never worked for anything in Human History review can go back to the roman empire, and they enforced price controls with the death penalty. And there are shortages, essentially. We would not want to eliminate the research and developments, the new innovation, technology that brings so much improvement to the lives of people in this country. We would not want to tell Drug Companies not to invest in new drugs. There is a great deal of work when it is in terms of prior application. We would not want to eliminate it can go back to drugs we had 10, 20, 30 years ago. Is somethingation that has been used throughout time. We do not negotiation right now for reasonable prices for Health Care Services or pharmaceuticals, and that is why we get Companies Like mylan charging hundreds of dollars for Something Like an epipen, something children need to keep them from dying of they have an allergic reaction. Innovation does happen in other countries that have National Health systems, ct scanners, laparoscopic surgeries, groundbreaking juvenile diabetes treatment these happened in other countries with singlepayer Health Care Systems. I would argue that the kind of innovation we have in this country, just profitseeking, is not always good for our health. A lot of times the companies are making new drugs based off of old drugs to them and they do not have to prove their clinically better. They just have to prove their better than nothing. We see medical devices being pushed out without really being proven their safe for patients. Just because a family can market it and make it sound good, they have people going to the hospitals saying use this, it is great. We need to have health as the bottom line. Guest Profit Margins in the Health Care History are about the same as any under other history. You talk about the abbey 10, a great example of how the government got involved in caused the problem. You talk about the epipen. The fda was slowing competitors from entering the market. There was a much government bureaucracy to prevent new products from coming into the market, which created the situation. There are three epipen companies andurope, but the fda bureaucracy here is blocking them. Guest it is most often pharmaceutical ceos making decisions about charging outrageous amounts, because they can get away with it. Raised pricesn that way, other companies would undercut it. Host elena in illinois, go ahead. Caller good morning. Illinois illinois, and headlines are reading taxation problems. The state is looking for more money so they can produce more spending. Banking officials and investment firms, stockbrokers, hedge funds, they have all plummeted. Aese are educated men with low rate of consciousness, and you are asking them to get involved in our medical care . Helpe government wanted to the citizens that they rule over, they would have provided more medical centers for people that are working minimumwage and those that are underemployed or not employed at all. Host dr. Flowers . Guest there are a lot of problems with our economy right now, and we have kind of a predatory economy where we are seeing privatization of ulcers of services across the board, muchhat is creating too costs and people not being able to get what they need and workers not being able to make a lot of money. That could be of the conversation. A medicare for all system is a nobrainer. We have medicare workers and maryland where i live, people who care about making sure that people can get access to the care they need. What this National Improved Medicare for all does is it really opens up a system that is about health. 2010, when negotiating the Affordable Care act, i went to a lot of this stakeholder meetings. We would have hundreds of people and the room from various parts of the health field. The insurance always wanted people to be forced to buy the products. Others did not want to have to pay more money. When they left the room, that is in the best conversations started. People started saying, hey, you know what, we have this idea that could really improve care for our patients. When we discharge them, why dont we make sure they can get the medications and see the doctors for followups . There are a lot of ideas, but those are stifled right now because we do not have a system that is actually about health. Guest remember that utopia is a place that does not actually exist. I want to talk about costs. The caller alludes to a problem, nothing will do more to improve peoples health, wellbeing than economic growth. If we have texas supporting and 30 trillion program like bernie the taxess proposed, and regulation that will go with that will drive down economic growth, and that will leave people worse off. If their health is worse off, that will ease more people in poverty. If we want to grow the economy, we will have to reduce the burden of health care, not add to it. Some of the wealthiest people in our country get it. Health care costs keep us from being competitive in the international market. The system we have is the most expensive in the world. Wouldrecognized that this decouple health care from employment. It would really give businesses a way to predict whether expenses are going to be over time. I do not know what bernies bill is, but we do have hr 676, and economic studies show the savings we would get from negotiating prices, global budgets, streamlined administration when more than offset the increase we would need to cover everybody with comprehensive care. It is not utopia. It is all around the world and works well. Host there is a debate on capitol hill about the future of the aca. If it continues on, we have heard some arguments that the aca could lead to some type of singlepayer health care if it is not sustainable. Have you heard that argument . What we arenk seeing is that more and more people recognize that the United States is an outlier when it comes to other countries, that more people have an expertise in the government should make sure that everybody has access to health care. So we are really seeing much more of a groundswell than i have ever seen in my time of advocating for this. I do not see the Affordable Care act as any kind of backdoor to singlepayer. I think it will say, ok, we have tried every fixed that we could to try to make the system worked and it does not work, so now we have to do the right thing and go to medicare for all. Guest i dont know if the aca will devolve into a medicare for all system. Aca is unsustainable, and it is going to collapse quicker if congress does not figure out what to do about it. That said, i do not advocate for more government involvement. I think we need to have a more marketbased system. We have never really had a marketbased Health Care System in this country. We have had a system and which we have had insurance cartels protected by regulation and which the government subsidizes the purchase of insurance. About 87 cents out of every dollar is paid by the government. And physicians, nonphysician professionals,titian is, and so on, it is all regulated. We constrained supply and then subsidize demand, and were surprised we have problems in the system. Host this is from illinois, pam. Hi. Caller hi. Host go ahead. Caller can you hear me . Host yes, go ahead. Caller i am a physician and a supporter of singlepayer. I know that medicare works. Can controlk if we health costs. Currently, the u. S. Government supports 67 of healthcare costs and does a good job. We know that there is a published fee schedule every year that we accept, and it is not modified, and that does not pick the patient against the provider by changing the reimbursement fee. There are many, many physicians, 63 of physicians support medicare for all, so i think that is what we need to do. Essentially, look, government price controls do not work. Thecare has a fee schedule sets price controls, and you cannot get out from under them. We know what the result is from price controls, they ultimately result in limiting supply. Of physicians15 will not accept medicare patients right now because they are tired of being under reimbursed. About onethird of physicians are not taking new medicare patients. Underially, medicare reimbursement is driving physicians out of the market. Guest it is interesting, when i hear you talk about price controls and the government, because i think about my experience as a practicing physician and what went on with the private Insurance Companies when my colleagues and friends were practicing. Host what area were you in . Guest pediatrics. The Insurance Companies tell you what youre going to be reimbursed. It is a take it or leave it situation. They can decide to cut if they are going to reimburse you. Even when we passed regulation and our state to say that every Health Insurance company has to make sure its network has enough providers in it, my friend was the only psychiatrist in her area and they offered her some thing below what she could handle. She was not making a huge amount of money by any means. They said take it or leaving, and she said that you have to negotiate or you will not have any psychiatrist in your system, and they said no. Ithave this situation, but is run by corporations whose bottom line is not the health of people. We know when we have a government system, we have a voice and can call our legislators and we can see what the Different Things are as opposed to the private Insurance Companies that keep the information private. It is something physicians are yearning for in the United States. We have a situation here that is very serious. Problemer two health identified last year was physician burnout, because we are in a system that does not allow physicians to take care of their patients, spend time and give the care they need. Guest you have to look at international Health Care Systems in the amount of time physicians spend with patients. In many, this been far less time with patients. For example, japan. Guest in japan, they see them 10 to 13 times per year, so they have a very good relationship. Guest the simple fact is profit is not a dirty word. Profit is an incentive to produce more. We produce more innovation and more health care in this because of profit, a return on investment. You are limiting return on investment, you do not get that investment. That means less innovation and worse health care and the future than we have today. We will not get the breakthroughs of tomorrow. To leave it there. Dr. Margaret flowers, physicians for a National Health program, pnhp. Org. Michael tanner of the cato institute, the house and Senate Return this week from the july 4 recess. They discuss it on policies for next year. We spoke with a capitol Hill Reporter to learn more. Joe gould is congressional reporter with defense news. What does the Defense Authorization bill, and what is in the version, the 2018 version approved by the House Armed Services committee