Supports cspan as a Public Service along these other Television Providers giving you a front row seat to democracy. On our landmark legislation series we are going to look at the creation of medicare and medicaid. Two guests joining us, james morone from Brown University and Laurence Kotlifkoff of Boston University will join us. He is the author of the health care fix. Thank you for joining us, gentlemen. In looking at this legislation, there are a couple of things that happened before. It was before the 1960 bill we know it was in 1935 that fdrs Social Security act was passed creating ace creating a security net. With that as the backdrop, how does this lead up to us getting medicare and medicaid. Roosevelt had wanted at the end of world war ii, he looked for another cause and he lighted on National SecurityNational Health insurance. He died before his plan had been written. That plan went to harry truman who embraced it like nothing else. It was the passion of his life. G else. It was the passion of his life. He never got anywhere close to getting it through congress precongress was not interested in the plan. He fought and fought. Finally, blue cross official said this is a pretty big g ulf, National Health insurance. Why dont you start with the elderly and show National Health insurance for all woodwork by making it work for one portion of the population . The advisors went to harry truman and talked him into reducing the National Health care plan. That became the plan. National Health Insurance got boiled down to National Health insurance for the elderly. Eisenhower wins the next election in 1953. They pushed and pushed through their time out of office. By the time kennedy wins, it is maybe the great legacy of the roosevelt era of the new deal that had not passed. Kennedys father has a stroke while kennedy is in office. It makes him acutely aware of how difficult it is for older people to manage their health care. That becomes candidates cause kennedys cause. Johnson takes all the martyred president s causes and pushes them with the kind of flare only Lyndon Johnson had. This might have been the most difficult to pass. He pushed and pushed. That is how this package came to be. Host he spoke about president truman. Did you want to add to that on how we got to its creation . Guest even back to teddy roosevelt, the initiative for National Health insurance, we have a long history in this country of people pushing for it and it being blocked. The American Medical Association plays a big role in blocking National Health insurance along the way. There is private industry that tries to buy off the unions during this period to obstruct trumans initiative because they figure, why not just take care of our own people and not have the attacks on workers in general . Whatever reason. There is also the communist red scare of the 1930s. The idea of socialized medicine was for many people frightening because they thought it was connected to communism. We have a troubled history of having issues not directly related to health care for the public getting in the way of universal care. Now we ended up with this vulcanized system. I think truman should have stood firm and not said we will do it for this group and then this group. I think that was the wrong direction and continues to be a terrible path for the country because we now have five or so different programs. I would say the most important thing about Medicare Medicaid legislation is that it does not coverage full coverage. And for the poor, medicaid, . 70 out of every numeral 1 of medicaid is being spent on the poor elderly. We have a system of means testing locking the poor into poverty. That is a very big issue with what we have in place now. Host we will go on with our guest looking at the legislation and where medicaid and medicare are today. If you want to ask questions about her guests, 2027488000. Lets hear from president truman himself. He was recognized at the signing ceremony in 1965. Here are some of the remarks at the celebration. [video clip] [laughter] thank you very much. I am glad you like the president. I like him, too. [laughter] one of the finest i ever ran across. President johnson, distinguished guests, you have done me a great honor in coming here today and have made me a very happy man. This is an important hour for the nation. For those of our citizens who have continued their tour of duty, these other days we are trying to celebrate for them. They are entitled among other benefits to the best medical protection available. Not one of our citizens should ever be abandoned or absent from the dignity of charity. Charity is dignity. We have to have it. We dont want dignity to have anything to do with charity. We dont want them to have the idea of hopeless despair. Mr. President , im glad to have this law. [applause] with us today, the signing of the medicaid bill. Your inspired leadership and responsiveness, forwardlooking and responsive congress, have made it possible for this day. I think you all for coming here. It is an honor i have not had done for me in quite a while. [laughter] host those were the words of former president truman. He spoke of those finishing their tour of duty, those put on the sidelines, his care for them. Pick up on that in light of the president s words. Guest im not sure the Veterans Administration was authorized for that. Certainly, that was the group that would be helped by this medicaid medicare legislation which was joint legislation, part of the Great Society bill passed in 1965. Truman tried and failed to get National Health insurance pass ed, so this was a partial victory for him. The basic problem is the whole thing was set up the wrong way from the getgo. You had medicare providing only partial coverage to the elderly. They still had to buy supplemental policies. That is still the case today. You have medicare being quite expensive. You also have premiums not fully indexed to inflation so we will see people facing very high Medicare Part b bills that will go much higher through time as inflation makes that happen. For medicaid, we have this program for the poor that says if you have too much turning and too much assets, if you have done what we think you should do, which is work hard and save a lot, guess what . You lose medicaid for yourself, your spouse, for your kids. It is all different in each state. We have 51 street Medicaid Programs including the district of columbia we have 51 state Medicaid Programs including the district of columbia. Welfare, food stamps, the earne incomed tax credit, all of these have means testing. Medicaid is among the worst. You could earn an extra 100 and lose your benefits or those for your kids. All of these things together, if you take a cohort like 30 euros and look at the poorest 20 , about 1 4 of these people are in marginal tax brackets. Benefits are lost. If you save more than a couple of thousand dollars, you will lose benefits. Medicaid and obamacare and all these other welfare programs, obamacare, you earn too much money, you start losing your subsidy. The system is byzantine. It needs to be entirely scrapped. We need to get rid of employerbased health care, medicaid, medicare, obamacare, and move to a Single National system like we have been discussing. Host mr. Morone, you heard mr. Kotlifkoff talk about whos pushing back against these ideas. If you go back to 1964, there were those protesting at the dnc in favor of medicare. Supporters of l. B. J. Had that kind of support as well. Who was supporting it in the United States at that time . Guest let me back up a second and say who was opposing it. Then i will get to who was supporting. When truman first proposed the bill, the American Medical Association hired a law firm. This was the First Time Ever a single bill created politics of people pro and con. We take that for granted today. They did not used to happen. This was the first bill that did it. This lobbying firm created all the tropes and arguments like this is socialized medicine, an extraordinary thing to say in the middle of the red scare. That defined the terms of our Health Care Debate to this very day. The kinds of stuff that they made up like lenin said socialized medicine is the keystone arch to socialism. We defined our Health Care Debate positive and negative in 1948. They are all variations on the theme whether it be death panels, socialized medicine, or democracy run amok. It has run through our history to this very day. On the pro side, medicare was an item of faith for democrats, liberals, labor unions, very strong for health care. But to be a democrat in the 1950s and 1960s was to be pushing for medicare. One other thing to say about the passage of this program, very dramatic. Laurence is absolutely right to say it was a very narrow package. It was only Medicare Part a. In the ways and Means Committee, i dont know how any people are interested in this level of historical detail, but in the ways and Means Committee, the congressman from arkansas who had fought medicare tooth and nail all of a sudden says we have three bills before this committee. One pays for hospital costs, part eight. One pays for doctors bills, part b. One pays for poor people. Lets pass them all. They work competing bills. In the last hour, congressman mills with a secret backing of Lyndon Johnson who pretended he did not even know about this, made the bill three times larger than it would have been. Absolutely right. Should we have tried to get everybody under the system . Laurence is right. It would have been great. If you studied the politics of the day, what they got was something extraordinary, the tripling of the size of the program in the Historical Context of 1965. And get it through the Senate Finance committee where the finance chair was absolutely opposed was nothing less than legislative genius by Lyndon Johnson. This was a very difficult package to pass and they managed to do it because of the landslide and because Lyndon Johnson helped spear this thing through the ways and Means Committee and Senate Finance committee, something many other president s, including kennedy, could never have managed. Host our guests are with us to talk about the creation of medicare and medicaid. Our first call is from homer in louisiana. Caller it is very confusing. I am 80 years old and a vietnam era veteran. Right now, i am in pretty good shape with medicare and the v. A. It has been a confusing thing all of my life. We send people up there. You think youre going to get something good. They fight it. It has been a confusing mess. Thank you for taking my call. Host mr. Morone, you hinted at the widespread expansion. Do you think that led in part to the confusion the viewer talk about . Guest no, i think what leads to the confusion is a constant war over our Health Care System set up in 1948 that continues to this day. If you could imagine an ultimate universe where democrats and republicans agreed on the principle of government provided Health Insurance, a principal every other nation endorses, if they agreed on that, it would not be such a political football which has had enormous consequences for the running of the program, for the definition of the program, for the simplicity of the program. We have had changes in medicare that were designed by people who clearly did not like medicare because they sought as part of the government, medicare and medicaid. I think the kinds of troubles homer is talking about are a consequence of partisan warfare that pushed Government Health care in the middle of the political scrum, partisan political scrum. That goes right back to the 1980s and the reagan era with conservative congressmen who would have liked to rollback medicare. The consequence is a patchwork of fixes and complications that need not have been. Host mr. Kotlifkoff, go ahead. Guest going back to the issue of whether i agree with james, john, right . I agree something is better than nothing. Medicaid and medicare have delivered enormous good. Obamacare as well. On balance, as opposed to not having them for millions of people over the years. The problem is when you give something to a certain set of people, all they want to do is protect it. That is the balkanization. That is where you lose support for fixing an entire system from scratch. We need to scrap all of these programs and have medicare for all. Senator sanders from vermont has been pushing that. I think he has been pushing the wrong version. He has been pushing it as part of his socialist agenda. He uses the term socialism. We have a great aversion in this country to that word. We get hung up on words. I actually love Bernie Sanders. I think he is a terrific senator, one of the best we have got ever. I think what we really need is Medicare Part c for all, the republican version. That is the idea that everybody signs up for a health plan once a year. The key problem underlying Health Insurance which is the reason we dont have a private sector that provides Health Insurance and we have so many uninsured people is the fact that if you have a preexisting condition, nobody wants to ensure me. That goes under Medicare Part c taking care of by telling the company this person has diabetes, so you will get a bigger premium for this person. When that happens, then we can have a complete plan. We can have an even Playing Field where the companies are competing. About half of new medicare enrollees are enrolled in Medicare Part c. We need to move in that direction and maintain employerbased Health Insurance to the extent those plans are willing to take in people who are not employees. Gm has a plan. They would be offering a Medicare Part c plan like everybody else to their employees. But if i dont work for gm, i should be able to join it. That is part of what would be a feature of the system. That is what we need. Highly competitive. If you look at france, germany, switzerland, japan, israel, they have a version of Medicare Part c for all at play. They are Getting BetterHealth Outcomes for 12 of gdp. We are getting Terrible Health care outcomes for 18 of gdp, and we are going broke in the process. Host gerrit in virginia, go ahead. Caller glad to have supporters of medicaid and medicare on the show. I want to making comments. I want to make a comment. I think president truman should have done all he could to pass whole medicare and not just for adults 65 and over. I have medicare and it works. I have had private insurance. There are good things about private insurance for dara good things about medicare. Medicare only covers you for 60 days. After that, you have to keep spending 1500 every time you go to the hospital. That is one bad thing about it. It only pays 80 of the doctors fees. They should revamp medicare, get rid of the deductibles, put more money into it, get rid of Medicare Part c which is a scam anyway. It is not providing care to people. It is like private insurance in the private market. It is just to make money. Host that is jerry in virginia. He mentioned some technicalities. The Social Security amendment of 1965 created medicare in two parts. It created medicaid for low income families in federal matching funds involved. Mr. Kotlifkoff, to the callers point . Guest james may differ with me. I dont think Medicare Part c is a scam. I think in the early stages when it was first introduced, there were some entities trying to scam the system. Things have improved dramatically. You have the ability to walk with your feet. If you feel you are being scammed by a particular hmo, you leave after a year. This is a pretty clear system. You just sign up. The government is basically paying the bill. They are paying more if you have a preexisting condition. There is competition. You leave if you are not happy with it. New participants are above 40 . There is a reason these people are signing up for Medicare Part c. It is not to be scammed. It is to have some peace of mind that there will not be extra bills coming at the end of the day, which is what the caller just described. Medicare traditional does not cover all of your bills. In effect, you are partly uninsured. If you have a long stay in a hospital, you could lose coverage. You could hit a maximum. We need a single system for everybody that is highly competitive and will operate like other markets. They go between different apple cellar ifsame thing here. The reason this works in all these other countries is because it works. It is designed well, and it can be designed. And personally, every Health Economist i know, the top Health Economists in this area come advocates for Medicare Part c for all. Host sorry. Did not mean to interrupt, mr. Kotlikoff. Go ahead. Guest i just wanted to clarify a couple of things that people who do not know a lot about health care be confused about. The debate that laurence is responding to is the debate about whether we should inject competition into the Medicare Program. The original medicare is a basic oldstyle Great Society program paid for by the government. And after that, over time, particularly republicans pressed to have competition in the framework of medicare, so this is really a debate between jerry and laurence. Jerry is saying i do not like these principles, and there are people who dont for various reasons. But what we are all agreeing on is one basic first principle, and that is this, that when someone is sick, they should be able to assess care without all kinds of barriers to their care having to do with their income. It should be easy and simple as it is in every advanced democracy in the world but isnt here. Laurence is giving some specifics about how economists can see a better function system, all of which i agree with, but the way viewers can see this is first, just think of the first principle. What we want to get to if we can just get agreement on the principle is when you are sick you get care. We have to figure out a way to finance it, but when you are sick, you get care. Then there is a secondary question we have basically been debating over the last decades, and that is, how much do we want competition to discipline the Medicare Program itself . Most economists say that is really helpful. It creates all kinds of good effects as long as people can easily access the program and make their choices. Not everybody agrees with that. We just had a caller who said it is too confusing for me. Some people would just like to go back to the Big Government program, which has been beggared over the years because republicans are eager to push people into a more Competitive Program but that is the big principle. Big government versus a little government frame where people, different committees can compete. Maybe that will help our listeners and viewers sort out what we are talking about here. Host the amendment i just mentioned, it passed the house 307116. That was on july 27. It passed the senate 7024 on july 28 and was signed into law on july 30. Our just joining us to talk about the medicare and medicaid bill. In illinois, thank you, go ahead. Caller good morning. My perspective has been in private Practice Medicine for 50 years but also been at the v. A. For 50 years. What i would say now, i would never have thought of 50 years ago, but to have a National Health system, i am for it 100 . The only problem is it has the facilities. The hospitals have to be owned by the plan. Right now, we are headed to health care owned by 150 entities in the United States. That is what is going to be in 10 years, but that is not National Health. National health is where the hospitals are actually owned by the entity. The physicians are paid by the entity. And i would make my last point, you need to have it so that everybody at point of service doesnt pay. It is the same, regardless of income. How we raise the money is obviously going to depend on your income. And how we raise the money for this is a totally different problem. I have totally changed over the last 50 years based on that perspective. I think the v. A. Is a fantastic entity. I do not think this is craziness. I am telling you, medicare and medicaid is craziness. It is a nightmare and i am glad i am about ready for the exit. Host thank you for giving us your time, your input. Mr. Marone, go ahead. Guest there is a lot to what the doctor has said. It is one of the great irony is the American Medical Association fought so hard against a Government Intervention in the Health Care System back in 1965 only to discover that capitalism is a much harsher driver than government would have been. So there is a great many physicians who if they could go back to 1965 would take a very different stance. He touches on something, and laurence is far more expert than me, but we have seen hedge funds moving into the Health Care System. Capitalism is constantly remaking American Health care now driven by financiers trying to squeeze an extra dollar out of the finance system. The caller is absolutely right. That is not really a development that is going to enhance health care generally or make it easier to get to the kind of universal system that laurence has most effectively been playing out over the course of this program. The great irony of that 50 years the caller refers to is we have gone from a system where the physicians fought like crazy against government sponsored Health Insurance. Not a health system, but Health Insurance, 21 now where the positions are the most impressive forces in the health or system. That is a great irony i think the caller has lived through over the last couple years. Host mr. Kotlikoff . Guest we need one system. We dont need 5, 6 different systems where the sharks are coming in to try to set up something. Originally with Medicare Part c, when the caller was talking about scamming, they were setting up these hmos for healthy Medicare Participants. As soon as they got sick, they were switched back to traditional medicare. We cannot have this backandforth. We need to have this one system. Bernie sanderss traditional medicare for all improvements that fully covers everything, i would much prefer that over what we now have, ok . But more relative to that and what is politically more acceptable to the public is explaining that if we just went to Medicare Part c for all and bernie would have come out and publicly endorsed that, that would happen. Public and would be trapped and they would be forced to say, ok, we will do it. It is our part of medicare. And we can maintain it, but you have to open yourself up. You cannot restrict yourself to just your employees. Now we have an apples market. Now we have competition. The cost of financing, you save the country, our children from a fiscal nightmare that is coming down the road because we cannot pay all these bills. But you generate these efficiency gains. I think it can be done with traditional medicare too. It would put the kebabs on paint when he thousand dollars per infusion, per drug, which is insane. It costs 10 abroad. Whatever we need, we need to do one thing. Imagine you had 535 members of congress designing the Brooklyn Bridge from scratch with no engineering degree. They would make a mess and it would collapse in a few years. That is what we have done. That is the history of National Health insurance in our country. It is people that dont know what they are doing engineering the Brooklyn Bridge and watching it fall apart bit by bit. Host we are showing the viewers at home a photo of president truman, actually president johnson signing the legislation of the law. President truman and his wife receiving the first medicare cards. What is the sign up like for the country or the response of the country once it becomes law . Guest johnson told them dont go out to independent missouri independence, missouri, because he is associated with socialism. He said, no, we are here and i am going to do it. At first, the physicians struggled against the legislation. But here is something most people dont know. As they were implementing the law, the rules and implementation said you may not segregate the hospitals you want to get medicare from. Overnight, american hospitals throughout the south went from absolutely segregated to desegregated. So medicare is what desegregated the hospitals in many cities in the north but throughout the south. Within a year, there were 30 small segregated hospitals left that could not get medicare funds. The signup was extorted every. People thought part b was voluntary. Part a, hospital care, you were already signed up with, but part b was voluntary. No one dreamed that would be that much demand. It awed everybody involved in the program to see people rushing forward to participate in this program. So the early years of the program are a triumph of participation, of desire. People wanted those apples, to use laurences metaphor. And you had the desegregation of the hospitals. But it all came with a kicker, and it was an important one. Back before medicare, hospital inflation and healthcare care costs were rising, but they were spread out through private insurance so people did not really pay that much attention. Once the medicare was signed, all those costs directly go to the federal government so people could see that Health Care Inflation that had really been rising since the 1930s. And that created what many people consider a crisis on Rising Health care costs. Richard nixon takes over in 1969, becomes president , and he immediately, first republican now, democrats have passed over republican objections, and now the republicans are in power, but Richard Nixon defends medicare but worries about the cost prices. So the immediate first decade of medicare is triumph of enrollment, triumph of desegregation of american hospitals, and great worry about costs, which are now visible because they are immediately confronted by the federal government rather than less visible because they are in a thousand different insurance programs. So that is the trio of things. Host james marone of Brown University joining us. Laurence kotlikoff also joining us from Boston University, here to talk about the creation of medicare and medicaid. Mary in new mexico, hello. You are next up. Caller hi there. I am hoping one of you can answer a question i have had about original medicare and going into the Medicare Part c. If i am an original in original medicare and i think i want to try part c and i go there and discover it is not working for me and i go back to original medicare, why do i pay a penalty for the rest of my life for going back into original medicare . Host mr. Kotlikoff . Guest im not i dont believe you are going to pay a penalty. I never heard that. Maybe james caller i read it in medicare books. I went through them. We all know it is a fine mess. It just perplexed me. Guest hang on a second. If you dont sign up for Medicare Part b, there is a penalty for signing up late. Maybe you are referring to that. Even under Medicare Part c, you have to pay the premium for Medicare Part b. I just dont know what you are referring to. I dont think you are correct. I dont think there is any party for switching from one program to the other from one year to the next. Not that i heard of. Caller i hope. Host caller, go ahead. Finish your thought. Caller i hope you are right about that because, you know, folks are only trying to go along with all the multitude. Guest we can figure this out together. Host ok. Color, thank you for the input. Mr. Marone, do you want to add anything . Guest no. I think laurence is right. I dont know about that. You can get in touch with us for the security office. They are usually helpful about medicare. Give them a try. You will have to make an appointment and wait for a while, but they will walk you through it. I think this is probably a glitch that will not trouble you as much as you are worried. I think this will be ok. Host here is lois in iowa. Hello. Caller hello. I have some comments to make too. My understanding, and i dont have this officially from anyone at medicare, but a friend of mine who had had the regular medicare, i am calling it, and switched to part c finds that her original carrier for a supplement was under no obligation. They do not need to take you back. And if they do, there could be a change in your price. It would not be less. It would be more. I think this is something people should check very carefully before they switch. I can see where the Medicare Part c sounds marvelous with these commercials. And i think Insurance Companies like them obviously a lot because they put lots of commercials on for them. But i dont think in the long run they are the best deal. I am 89 now. I took out the regular medicare back when you can have plan f. I have a supplement that goes up every year. I pay quite a bit of a supplement now. But it has paid every bit. I have had lots of scans because of some cancer problems. I have had lots of scans, cat scans, every kind of scan you can mention. Everything has been paid by my supplement. I just have one bill paid out of my pocket other than what i paid for my medicare. Host ok. Thank you for your example, caller. Gentlemen, who wants to start . Guest let me jump in and just say very briefly that, and good luck to the caller with the Health Issues she mentioned, this is basically a fundamental debate about whether markets work for this population. Markets have made a very elegant case for yes, this is how we ought to go. People ought to have a choice. Others say keep it simple, stupid. Architect complicated. They are treacherous, but particularly for people who are not as nimble about shopping as maybe they once were. So that is a basic debate. We need to have explicitly i agree that all the economists would tend to be for markets, but the basic choice we are talking about is, do we just keep a simple Government Program . It sounds like heresy to say onesizefitsall, but sometimes that kind of simplicity for something as complicated as Health Insurance really does work. Or do we want to get people lots of choices . Not about doctors and hospitals. We want those kinds of choices. But in terms of insurance products. That is a fundamental choice we have about how to run medicare and hopefully someday an entire National Health system. Host mr. Kotlikoff. Guest you know, i think if we really had traditional medicare for all and put the clamps on the suspending and went down from 18 to 12 , that would be better than what we now have. We need to go to one system, whether traditional medicare for all that covers everything, does not leave a supplemental payments to be made by this lady, or whether we go to Medicare Part c for all, which eliminates the information problem, compensate Insurance Companies for your preexisting conditions. It does not complicate the Playing Field and let one system into the old system and Start Playing games with that, which is the big problem under the current system. Let me respond to the caller. The problem she is having is not with traditional medicare. She leaves her traditional medicare, goes to part c, comes back to traditional medicare, gets back on traditional medicare, but to up a mental insurance she had before but the supplemental insurance she had before which was privately provided, they are the ones telling her because of her preexisting condition she can no longer rejoin. So it is a problem with the way competitive systems work. If you did Medicare Part c for all, you would not let anybody turn you down, deny you coverage for supplemental insurance to the extent that that was part of, you know, the landscape here. We have to make sure that in the competitive system nobody can be turned down for preexisting conditions. That is the only way we can get Health Insurance competition to really work here. That is the core reason why you had back in 1965 98 of the people signing onto medicare. They did not have anything before that. The whole system the old system, the private provisions did not work. They did not insure me because i thought i might have cancer. That is why the whole system broke. There was no provision of coverage of which to speak of except employers. Because they are hiring people who basically are coming them to work with preexisting cancer. That is why there is a tool that could be used by the employer, the Insurance Company they are hiring. You have to understand the problem here, an economic problem. The Health Insurance market does not work like the apples market. Fix that so the issues the caller is calling about disappear under a competitive system. We go from 18 to 12 of gdp. Am i ideologically stuck . Politically, the only way we get to is if Bernie Sanders traditional medicare for all made improvements. It is a problem the way it is operating and driving us broke, so we have to fix it fundamentally. Would i prefer that over what we now have . Absolutely. No question. I have written that in public. I am not strong left or strong right. Lets get something that makes some economic sense. Both of these can work. But one can work a lot better and faster. Host here is allen in indiana. Hello. Caller yes, hello. Good morning. Thank you for taking my call. Huge fan of the washington journal. Really appreciate this show. Thank you for being here. I had about four comments or thoughts i wanted to ask you. One, i was very fortunate i work for a company that was unionized. It was through our union we were able to get Health Care Even through retirement. I pay way less than other people do for, say, private Health Insurance. That is a thing that has disappeared i guess with unions not being able to provide that for people. But i also learned that big businesses stopped competing a long time ago. They learned competition is bad. I think about five major health insurers, they dont compete with each other. Host i am going to have to apologize because we are running short on time. What would you like our guests to focus on . Caller ok. One, was it true back in 1948 with eisenhower, the main people against the southern politicians because they did not want black people showing up at white hospitals . And two, did Richard Nixon come up with a plan but it was blocked by ted kennedy . We all remember Hillary Clinton had Health Insurance, but that was also knocked down by the republicans because they did not like hillary. Host ok, thank you, color. Mr. Marone . Guest yes, the caller is absolutely right. Segregation was the big issue in the debate. The debates were very passionate, and no one mentioned segregation, but it was there. It was the passage of medicare, as i said earlier, that really desegregated the hospitals. And , its and had a plan. It passed and yes, nixon had a plan. It passed through. Nixon was the one that got us to where laurence has been criticizing, which as he said, lets create a system where employers pay their part of it, medicare pays their part of it, and he cut the system up into different pieces but wanted everyone covered each in their own track. And ever since then, whether it was the clinton plan or obama plan, we have had a very divided mosaic of Health Insurance, which makes it a very complicated system. So that really comes as the caller rightly implies out of the era. Kennedy did impose it. He was working secretly with nixon. His union backers and said, no, we do not like this plan. We want something much closer to what laurence has been advocating for, so kennedy backed off but later lamented the fact that he backed off. But nixon really pushed us further down this road of each segment of the country employed into their own health care piece. That is part of why we have such troubles with the Healthcare System today. Host mr. Kotlikoff, the centers for medicare and Medicaid Services tell us in 2022 that the total income of the program for medicare was 373. 4 billion. The expensive, 329. 9 billion. What do those figures tell us . Guest medicare and medicaid is paid by general revenues so if you look at this situation by the congressional budget office, all the spending by medicare, obamacare, medicaid, and florida, medicare has a huge subsidy because people are not paying taxes on the premium. That cannot be added to the equation either. 18 , a huge chunk of that, the majority of the federal money. So we already have socialized health care. If you look at these projections, it is a major component. We are already kind of broke given where we are in terms of saying if things continue the way they are, but the cbo is projecting increases in medicare, medicaid, obamacare, and this employerbased subsidy as a share of gdp going forward, which will make us further broke. So we have to have a president and congress that starts addressing more than who won the last election, which is quite obvious. We have to Start Talking about our real problems. And our real problem is making sure our kids are not bankrupt, bankrupted by what we are doing here. Not everybody is covered. Our real problem is we have a vulcanized system put together idiotically for reasons that had nothing to do with for racist reasons and other reasons. The union was trying to cover its own skin in the game. We have to discuss where we are, where we are going, why we cannot start from scratch, and why the Brooklyn Bridge cannot have this part built by these southern democrats and this part built by northern minnesota republicans, neither of which have engineering degrees. Host two just joining us to talk about the legislation that created medicare and medicaid. Laurence kotlikoff it is from Boston University. He serves as an economics professor and is the author of a book. Also joining us, james marone of Brown University, Political Sciences and urban studies professor. He has a book, the heart of power. To both of you gentlemen, thank the director of the cdc, dr. Rochelle walensky, will talk about the Agency Second role in preparing for the pandemic, posted by the center for strategic and international studies. Life tuesday at 4 p. M. Eastern on cspan. You can also watch an hour free cspan mobile app, cspan now app. Cspan is your unfiltered view of government. We are funded by these Television Companies and more. Including cox. Homework can be hard, but exporting in a diner for internetwork is even harder. That is why we are providing low income students access to affordable internet so homework can just be homework. Kept connect and compete. Cox along with these other Television Providers, giving you a frontrow seat to democracy. Gop senator and potential 2024 president ial candidate tim scott urged voters in iowa to vote for republicans in this years midterm