tv Washington Journal Adam Gaffney Joseph Antos CSPAN March 5, 2019 1:31pm-2:16pm EST
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c-span's "the presidents" will be on shelves april 23rd. you can preorder your copy as a hard cover or ebook today at cspan.org/thepresidents or wherever books are sold. >> a conversation about the concept known as medicare for all with two guests joining us here in studio. joann tose of the american enterprise institute. also joining us from boston, dr. adam gaffney of the group physicians for a national health program. he serves as their president. to both of you gentlemen, thank you for joining us. >> thank you. >> dr. gaffney, let's start with you. when we hear this concept of medicare for all, what appears in your mind and what do you think has been introduced here in congress or at least some of the ideas connected to this concept introduced in congress? >> well, the concept of medicare for all is not an especially
complicated one. in the name itself, it's medicare so a universal program that's currently for seniors that we would apply for all, meaning everyone in the nation, but a key additional point i would make is that we think of this as improved medicare for all. this is a program that would expand medicare to everyone in the country but that would make it a much better program by, for instance, making the benefits comprehensive including things like dental care that medicare does not currently cover, as well as improving medicare by eliminating cost barriers to care, things like co-pays and deductibles. that's the basic concept of medicare for all. there is now, as you mentioned, a bill in both the house and the senate, that's the medicare for all bill, that would create the system in the united states. this is a measure referred to as single payer as well. it's essentially universal health care that would provide comprehensive benefits without financial barriers of care to
the american public. >> same question to you. >> i think this is an aspiration as opposed to a reality. i think that's the biggest problem. it sounds great for everybody to have complete coverage for absolutely everything at no direct out of pocket cost to themselves. that costs money. that costs a lot of money. the bill that was introduced last week isn't fleshed out enough to guess at a number but bernie sanders' bill which is somewhat similar comes in around $33 trillion over ten years. that's a lot of money. that means that we are going to have to tax the same people who are getting something that they believe is free. we are going to have to tax them very very heavily. in the real world, nothing is free. i think the real question is what can we do to improve health insurance for people and improve
coverage without breaking the bank. >> dr. gaffney, this idea of cost, especially as you see it as an expanded type of proposal, how do you pay for these kind of services? >> so we are already paying for this medicare for all. we are already paying for it. through premiums, taxes, co-pays and deductibles. i think the $30 trillion something figure that joe pointed to is from a think tank, libertarian think tank study which actually found that overall, though it would cost money, we would need new taxes, overall health care spending as a nation would fall by $2 trillion over ten years. so we are already spending this money. we are already spending it through premiums, co-pays and deductibles. we are not talking about increasing the amount of money we spend as a nation on health care. we are talking about financing it in a smarter way so that people pay into the system according to their need, their means, then they get the health care they need in terms of their
means. or needs, rather. long story short, we are already spending this money. don't forget, two-thirds, approximately two-thirds of american health care spending is already financed by taxes. we are talking about having to finance the remaining portion which is a much smaller number than many people think. we can't afford the status quo is the reality. >> if those streams do take place, what's wrong with the idea of expanding these kind of services if the money is already there, so to speak? >> well, the money isn't already there. let's take representative paul's bill. she adds something that even bernie sanders wouldn't do which is that she would cover all long-term care services at no cost to anyone. there was a provision not quite similar to this act, but a provision like that in the affordable care act. it was abandoned by the obama
administration. it was clear that except for a little budget trickery, this was going to cost a lot of money and that was a proposal that required people to pay for it. here's a proposal where you don't pay for it and so you are not only going to have expenditures that are already being made by people and by the medicaid program, but you rare also going to substitute a federal program with federal tax dollars for the kind of services that don't get paid for now. that might be a great thing if you can do it, but an awful lot of long-term care is provided by the family. it's not monetized. when you monetize that, you've got a huge fiscal problem. >> our guests will be with us until 9:00 if you want to ask questions about this medicare for all concept. if you support this idea, 202-748-8000. if you oppose, 202-748-8001.
dr. gaffney, when it comes to the legislative proposal, i think the idea is to automatically shift people into this medicare for all period for two years. what would that do to the existing system that already -- that we have in the united states? >> well, the existing system produces enormous waits and we need to do better. the administrative overhead of private health insurance plans are always cited as greater than 10%. the administrative overhead of medicare, traditional medicare is closer to 2%. the waits that our current sometime imposes is enormous and we can do much better. let's not forget there are 29 million people who remain uninsured in this country. there's 44 million people who are underinsured meaning they have insurance, but there are co-pays or dediktabuctibles so they can't afford to get the care they need. the other thing is it's been stated we cannot afford a single
payer system yet the united states has a uniquely expensive health care system and we don't have a single payer system. the systems that do have single payer systems spend much less than us. there's a real paradox that's confusing. it is true that health care is very expensive but the fact is we all need it. the reality is there is no long-term coverage in this country, essentially, except for medicaid which requires you to essentially become impoverished before you can have access to it. that is not a good system. so yes, health care is expensive but it is already expensive under the status quo. financing it publicly will, in fact, make it less expensive, will in fact increase the efficiency, not the reverse. >> i think it's kind of interesting that folks who support medicare for all like to talk about administrative expenses. administrative expenses are probably 10% of total national health spending. where is the real inefficiency, in the delivery of health care.
it's the way we use health care services. we have expectations that are far exceeding what i think citizens in britain and other countries have about what kind of health care should they get, how quickly should they get it, you know, can they go to any doctor, any hospital in the country. yeah, that's the general view in this country. we're not good at standing in line. and that's an issue. that's an issue. so you know, the fact is that our health care system, i agree with dr. gaffney, we are in a health care system that's going 90 miles an hour down the road and there's a brick wall in front of us, and the problem is that transition from 90 miles an hour to stop, there's a brick wall, is pretty painful. it's going to take a lot more than two years and a lot more effort and thought than i think has been presented in any of these bills. >> let me give you a specific to both. what happens then to private insurance if this system that
representative jayapal actually becomes reality? >> under her program, private insurance would essentially disappear. she does have a provision in there that says if you want to contract privately with a physician or anybody else for that matter for services that are not covered by the national plan, go ahead. but of course, virtually all services will be covered boy y national plan so that's pretty much the end of that system. i think the key here is again, it's that transition. it's saying to people you can't keep the health plan you now have even if you like it. you will move into this other thing. maybe it's better but maybe it won't be better. it will certainly be more expensive. >> dr. gaffney, because you are a physician and have other physicians you represent, what about this idea of private insurance going by the wayside? >> everyone i know cares about the doctors and hospitals they
can go to. they care about the drugs they can obtain that they need. very few people care about whether their health care company is cigna or aetna or united health. there's very little brand loyalty to private insurance companies in this country. what people care about is access to doctors, hospitals and medicine. that's what they care about. so this idea there's going to be this painful switch where people have to say good-bye to cigna or aetna, no one cares. they care about their health care, not their health insurance company. so yes, it is true to respond more directly to your question, it's true that for instance, representative jayapal's bill would cover basically all health care services, comprehensive benefits. there wouldn't be a significant need for private health insurance. again, that's a good thing. we don't need duplicative, wasteful private health insurance companies that simply take money out of the system and add nothing of value. what we need is to give people
choice. >> sorry, doctor. >> the painful transition wasn't insurance companies. it was doctors and hospitals. they have, the way their businesses operate, pharmaceutical companies basically everybody in the supply chain for health care is going to have their businesses disrupted. now, jayapal doesn't talk about how she's going to pay for it. but the sanders bill definitely talks about moving to medicare level payments which means that doctors get paid 40% less. hospitals get paid 40% less. maybe you can do that over a period of time but in the short term, that's very difficult duty. you can't accomplish that in two years. >> our guest with us, mr. antos represents the american enterprise institute in washington, d.c. joining us from boston is the president of physicians for a national health program, dr. adam gaffney. our first call comes from joe in michigan. good morning. go ahead.
caller: just a couple of quick things. i was born the year social security was passed as a law. that means i'm 83. in fact, i have a doctor's appointment at the v.a. this afternoon. without the v.a., i would not have any insurance. i'm old enough to know people who died, who passed away because they could not afford a doctor. i remember when doctors used to limit the number of physicians graduating from medical school to keep the costs up. the republicans kicked and screamed about the g.i. bill, oh, it will bankrupt the country. no, instead we have been bankrupted by people dying because they can't afford health care. i come from a farm. my grandparents couldn't even get social security. farmers weren't eligible. >> caller, your question then to our guests concerning medicare for all? >> i think it's a good idea. it will be paid for, it can be paid for. root out the fraud. root out the greed.
there's enough money in that alone to pay for it. >> thanks, joe. go ahead. >> well, there's a lot to be said for rooting out the fraud. greed is very hard to squeeze out of the human mind but fraud, yes. joe has a good point. we really ought to do better in our health care system to make sure people get the care that they need. but we also should do better about making sure that people don't get the services that they don't need that are in fact wasteful and could in fact damage their health. we're not very good at that. the health system is not good at that. the government probably doesn't have the magic formula to make that work. it really is up to physicians, hospitals and other providers, understanding more about the patient, understanding more about the science and then acting on it appropriately. we're not there. we are far from it. >> dr. gaffney? >> well, i agree with several points the caller made. every big program, every big
societal social policy has been called unaffordable. when medicare was passed in 1965, people said that it would be unaffordable, people said that there would be -- the hospitals would be overflowing, headlines from that era that hospitals couldn't handle the increased capacity. there's all these claims these sorts of social programs are unaffordable. i think history is informative in the sense it does show us these things can be done. i certainly agree that greed does explain a lot of the waste in the u.s. health care system. if you look at the profits of the pharmaceutical industry, enormous, far greater than other fortune 500 companies. there's a lot of fat in the system. and by moving towards a publicly financed medicare for all system, we can reduce a lot of that profit taking and make for a more sustainable system for everyone. >> illinois, brian, hello. caller: good morning. the reason i initially oppose it is because of the unlimited
nature of this thought. it just becomes, to be healthy you got to have decent food, have decent housing, got to be able to get to the doctor in a decent mode of transportation and it grows and grows and grows. we will have basically the left wants unlimited immigration so we will have everybody on the planet wants to come to the united states, then i'm sure dr. gaffney would be for giving them immediate health care. compliments of the united states taxpayer. then dr. gaffney, i have a little thought exercise for you. say you and i are identical twins and we are in the nursing home and we are 95 years old. how much should the government spend to keep us alive one more year? >> dr. gaffney, you start. >> the question of how we should be treated at end of life has nothing to do with the financing of the u.s. health care system. i work in the icu. we deal with these issues very commonly. it's not about money.
it's about the best way to treat people and about giving them the care they want when they have advanced illness. i'm not in favor of rationing on the basis of age and i don't think we need to. i think there's enough money in the system. i think there are times when people are so sick, where certain kinds of health care is not in their benefit and they make that clear, and that makes sense. but that's what's happening now and it's very different than some sort of rationing system based on some metric from the government. i'm not in favor of that. in terms of the unlimited nature of it, that's not what we are talking about. this is something that's been done in many countries. this isn't the pie in the sky utopian notion we sort of invented out of thin air and are expecting the money to materialize. we already have one of the most expensive health care systems in the world. we already have the money. other countries have done this sort of proposal and have done quite well, with better outcomes and less cost. so i don't think it's really this kind of unlimited funding scenario that the caller
described. >> dr. gaffney, a follow-up. if all these people come on to the current system, what makes, or make the case that quality of care won't be diminished. >> the united states already has serious problems in terms of the quality of health care and many metrics we fall behind our peer nations. in many respects, in fact, our health care system is lower performing than many of the universal health care systems for instance of europe. so there's no reason to think that publicly financed health care actually has worse quality. it's simply not true. look, we're not talking about changing every single thing about the u.s. health care system. we will maintain many of the things that work well now and change the way it's paid for. so i think in fact, single payer financing gives you ways of understanding the quality and actually improving it that is distinct from the status quo. >> well, again, i would -- i think we really ought to focus on the likely process that would occur, the financial process that would occur. we are talking about almost
certainly much lower payments to doctors and hospitals for their services. the jayapal proposal says nobody has to pay any co-payments, no deductibles, nothing out of pocket. that's the recipe for an explosion of utilization and that is not necessarily a good thing for patients. it's certainly not a good thing fiscally but it's often not a good thing for patients. there have been studies over many decades demonstrating what dr. gaffney is saying. we have a lot of waste and excess in this system. so removing all of the fiscal barriers, removing the caution signs and saying run through the intersection is probably going to cause more problems than less, and that will then lead to a reaction, inevitable reaction. this is one of the many problems with legislation. you think through the first step but what about the second through end of steps?
that's where the trouble comes. >> from south carolina, leon, hello. >> hello. yeah, i totally support medicare for all. i realize that we may have to do it in a slower method , but thi is ridiculous. i mean, we spend twice as much as everybody else. you can go fact check our low performance on so many things, even such as infant mortality and what we are currently doing for a great country, i think is a disgrace. and i don't see that any of the paychecks that insurance executives and stock holders of
insurance companies are getting don't even give any of the doctors a fair, you or me so much as an aspirin tablet. thank you so much. >> you start. >> well, there's a lot of money in the system, no question about it. there's a lot of money in the insurance industry, there's a lot of money in the hospital industry, there's a lot of money among providers, especially physicians. not so much nurses, not so much people who provide services in long-term care facilities. it's doctors and hospitals and insurance companies and drug companies. there's no question about that. but what's the practical way to edge off of this fiscal cliff? that's the question. the bill doesn't really address that. in fact, it doesn't say anything about financing. it says it will be okay, don't worry about it. i think a sensible person would worry about that.