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tv   Medicare for All House Hearing - Part 2  CSPAN  May 3, 2019 7:08am-9:01am EDT

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we will take a little bit of a break and we will come back and a few more people to ask questions, closing remarks and bring this to conclusions which i think the witness, you are entitled to it now. >> the committee will come back to order. before i yield i want to have a statement from congresswoman torres who wanted to be here but was on a fact-finding mission to south america and encountered some unseen problems leaving the country so
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she can't be here. this is a strong advocate for universal healthcare. where we left off i will yield again to miss debbie lesko. >> hopefully she's not being held against her will or something. okay. i just wanted to say we have a long discussion here and members on both sides of the aisle, i can speak for myself on the republican side, we want to solve the healthcare problem. we do believe there are problems in the healthcare now and if improvements can be made, we should do this in a bipartisan fashion because really big issues like this need to be done in a bipartisan fashion. when i was in state legislature in state senate i worked on legislation to address medical
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bills that were brought up before and i got everybody together in the room and we hashed it out. it was controversial but we got it done. if we did work in a bipartisan fashion we could get things done even though we disagree on certain issues. i believe it can be worked out but this bill is not a bipartisan, this is a very partisan bill and i am sure you know that most if not all republicans in the house will vote against it if it is up for a vote and certainly the senate is not going to hear it. g i don't know why we are doing this but here we are. as we discussed in several hours here several reputable studies put an extra price pegged to the government of a
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1-size-fits-all healthcare system north of $30 trillion over ten years. as was said before some states have tried to implement government controlled healthcare but the price pegged is too high in vermont as stated, they said no because the payroll taxes will increase by 11% and income taxes by 9%. that was enough for even the bernie sanders constituents to say no thank you to this government controlled healthcare. given his history and that the federal government is already running massive deficits in the medicare program is reaching insolvency it is unclear that this new bill will solve any of our problems and it is not clear how it will be paid for. i would like to spend some time
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talking about one of the most successful innovations in medicare, the medicare advantage plan. this bill would take that all away. on medicare advantage plans would be gone. medicare advantage enrollment has almost tripled from 7 million people in 1999, 20 billion people that want medicare advantage in 2018. the 2019 annual report of the medicare trustees released last week indicates 37% of medicare beneficiaries are in a medicare advantage plan and this percentage, 40% over the next ten years. according to the kaiser family
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foundation, 88% of medicare advantage enrollees have plans that include prescription drug coverage, half of them pay no premium at all. on medicare advantage plan, she doesn't pay anything extra for drugs and i can tell you if i took this away from her she would not be happy and if we forced her to another plane she would be confused because it is difficult to navigate the healthcare system. i wanted to point out, i got some numbers of how many members are present today have their constituents on medicare advantage that would lose it under this bill. the first is thehe one that ha the most people under medicare
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advantage, representative morelli, you have 360 of your constituents or 66.4% from all medicare populations have medicare advantage in your district as you have 60.3% of all the people on medicare. i come in third, 75,887 of my constituents currently on medicare advantage, 44% of all the people in medicare in my district and i could go on and on but my point is medicare for all would take all of this from everyone. my question is to miss turner,
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what do you think about that? do you think seniors will be happy there medicare advantage plans are taken away? allows care advantage seniors to voluntarily enroll and provide better coordinated care, integrated care so they can have one plan, hospital coverage, and additional benefits, seeing years gravitate to these plans because they give them more resources to deal with than ever more complex healthcare system and highly value it and 20 million seniors overall are on medicare advantage, because it provides coordinated ic integrated benefits. >> my next question has to do with how the bureaucracy would work under this program. i would like to walk through the process a hospital would need to go through to fix a
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leaking roof under this bill. let's start with a simple example of what happens under the current system. the roof is leaking, hospital maintenance division called somebody to inspect it. may be they get a couple of this, decide on a contractor and the leak gets fixed, pretty simple. since the hospital has a provider agreement it needs to get funding from the government's capital expenditure budget to fix its roots. to get those bonds they have to submit application to the regional director, once they submit the application they have to wait until the regional administrator decides to review the application. how long will that take? what happens to the roof in the
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meantime. that's not the end of the process. after he goes through the regional director, the secretary of health and human services has to review the application and decide whether to approve the ea application how much money should be provided? the secretary of health and human services has many more important things to do than go through applications for funding of a leaking roof. this bill doesn't set any limits on these review processes. hospitals could be sitting for months in line waiting for their application to be reviewed. we know howng painful it can b going to the department of motor vehicles, sitting in that line waiting for your number to be called. imagine having to go to a federal department of motor vehicle for every little thing you need. a new ten x-ray machine, new application, need a software upgrade for your electric health records system, new application and wait and a
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single medicare for all provider across the country is going to be forced through this one system. everyone will be doing a lot of waiting, that last bureaucracy in the system, not more. that is a problem i see. miss turner, you have spoken about wait times in your testimony in other countries who have government run healthcare. is there anything in this bill protect the american people from astronomical wait times? >> there is not and i do believe the promises being made invokes for me that your health insurance premiums will go down by $2500, a year for a typical family, everybody can keep their doctor, keep their plan. it is easy to say these things but when you wind up with a system promising free access to
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the system without any checks, it is impossible to imagine the current system being able to meet that demand without having ever lengthening cues and that is what we see in other countries and why the fraser institute keeps track of how long the waiting times are and why in the uk people are waiting for a year for surgery in canada, the hospital may run out, the region may run out of money and if you have surgery canceled in late november the hospital is not doing any more surgery this year, get back in line. >> speaking of wait times it wasn't that long ago that phoenix va medical center was in the news, in the spotlight because of really long wait times for our veterans at the hospital and some of the claims were that veterans died when
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waiting and one of the im solutions that has been worked on and was supported by late senator john mccain was there be more freedom of choice for veterans outside the government run healthcare plan so they could see a private doctor if the wait time was too long. to me, miss turner, does this seem like the opposite approach, like we are going to more government run healthcare instead of allowing patient choice? >> this plan is more comprehensive in bringing everybody and virtually all systems under the federal government control. even the uk, you can buy private insurance. in canada you can come to the mayo clinic in rochester and ay lot of patients i canadian coming into the united states. the fact that people would have
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a difficult time finding a private option in this country would concern a lot of people. >> it certainly concerns me. >> may i make a comment about medicare advantage? >> can i ask a question first? will this bill provide free healthcare for illegal immigrants? >> the bill i analyzed indicates it would be, the benefit would be provided for every resident of the united states and the secretary may promulgate regulations to define who a resident is. nothing excludes the undocumented immigrants from receiving benefits was my assumption is they would be eligible for benefits, yes.. >> as members, you already know i come from a district where
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the number one concern is border security and illegal immigration. we all come from different districts and i can tell you my constituents and i would guess the majority of citizens of the united states would not feel happy that they are going to be forced to pay for illegals that aren't citizens free healthcare. with my t, i am done questions and you had a comment. >> medicare for all would deliver all the benefits currently provided with medicare advantage, seniors wouldn't lose the choice of paying for medicare advantage, they would receive better coverage for no cost. >> thank you for your comment but i can tell you firsthand experience my mother is on medicare advantage. it took some time to figure out
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which program was the correct one fore. her and now she like the doctor she has, she is happy with that, doesn't like changes and my understanding is this bill would take away that program and require everyone, r no matter what they are on if they are in medicare advantage or not they would have to take this government run program. i find that unacceptable.an it is not patient choice, but government mandated healthcare and i yield back my time. >> trying to be recognized. >> i will be real quick. one thing worth pointing out is regarding undocumented immigrants already providing care for them for free in the most expensive way possible, they are coming to the er because of the 1986 law signed by ronald reagan and getting care, the most expensive place to get it. medicare for all would provide
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such thatey r a these patients getting care in a more fiscally responsible way at the primary care's office. >> i thank you for your testimony but most people in the united states are not going to voluntarily want to be paying for illegal immigrants free healthcare so there is a difference between people coming here illegally and showing up in the er and we have a huge crisis at the border and i hope to introduce several pieces of legislation and i hope republicans and democrats will get on board and realize we have a crisis at the border and we have to mitigate it but i can tell you i gori ta lot of different meetings in my district and throughout the state and is not d going to be anybody happy about paying taxes for free healthcare for
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illegal immigrants. >> it's not about ideology. we are already doing that. we save money and doing the same thing we are doing now. >> we can debate this but obviously we disagree. i can tell you i have heard loud and clear from people consistently they do not want their taxes to pay for free healthcare for illegal immigrants. >> thank you. let me -- a couple requests. i would like to insert a letter from the washington state largest grassroots committee amortization with 44,000 members and insert a letter from the labor campaign for single-payer health care with 15 national unions and a large number of local regional organizations and insert a letter from social security works organization that seems to protect and approve economic security of disadvantaged he populations. doctor john all this from west
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virginia, they all support the congressman's medicare for all legislation and charlie right there was born prematurely before the age of 3. i mentioned at the beginning of my testimony she suffered through more infections, surgery, then most of us deal with in our lifetime, medical costs that up quickly and much of that was paid out of pocket. financial devastation forced her family to make tough choices highlighting the need for adequate long-term care. without objection i would like to insert to the record this story by rebecca would. in this story she says long-term support and services included in this bill are crucial to families like mine, the bill would provide mandatory coverage of community-based services people need a lot and services are equal across geographic areas and that is in the record as well.
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i want to thank charles blahous. when talking about the issue of immigrants leverage a group of people as undocumented immigrants. i much prefer that than illegals, a personal thing with me. i don't think anybody in this world is illegal. i will say to debbie lesko why we are doing this hearing, manj of us, not just democrats but republicans as well are concerned that we have 29 million people who do not have insurance, 40 million are underinsured, afraid to get sick because we are afraid of going bankrupt. we need to do better. is system we have in place deeply flawed, usually expensive. we think we can do better. i think medicare for all is the way to go. others have different opinions but that is why we are here.ex i would love to come up with a
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bipartisan solution but i w wod remind my colleague, i have been in the minority for eight years and every time there was a bill to repeal the affordable care act i don't remember being consulted or asked to be part of any discussion how we should move forward. you had an additional comment to make. >> you said you are not sure we are doing this hearing, the republican controlled senate won't pass medicare for all. first of all if you don't remember i want to remind you we last ran into each other in arizona during your election.tr at that time i asked about paul ryan's plans to cut social security, you had no idea what i was talking about. it seems you have chosen not to get your facts straight today. why are we having this hearing? to keep people alive.
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>> mister chairman if i could respond, the reason i said that statement is because we are going through the rules committee, this bill is not being heard in regular committee and also i would like, this is a big issue and i do believe we need to have hig quality healthcare at a reasonable cost for a patient. i concede we can improve on our healthcare system but something this big, my point is something this big, this major i think both parties need to work on together and we are not going to agree on everything. i did pension reform in my state, did surprise medical bill, i did contentious things
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but we worked through it. i know representative paul has said that in the past he has worked on big issues in bipartisan fashion and that is what we should do. you must concede you don't think this is going to pass because you didn't ask for input from republicans and even though we are in the minority here, the senate is still republican and you still have a republican president. that is my comment. why i said that because ien wod hope we would work on something that is actually going to pass and that is what i would like to do. >> we are the rules committee, oldest committee in congress and the committee to which this bill was referred and all the other committees to hearings, when my colleagues were in charge where there were no hearings on these issues and
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we are doing hearings. in terms of input i don't know what we're doing. everyone offering suggestions and we have witnesses with all kinds of opinions and we are having this discussion, this is what you are supposed to do, this is a deliberative process, this discussion has been good. don't agree with what those colleagues have said. this is a good discussion that needs to continue beyond this committee. having said that i yield to mister morrell. >> thanks for organizing this hearing. we have an extraordinary panel of people testifying, the appropriate place to begin the discussion of healthcare and i would congratulate you for bringing forward a piece of legislation that brings us together. this is an important conversation about a critical issue facing america's patients
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and what we must do to ensure quality affordable healthcare to all our citizens. tomorrow, i will be celebrating my daughter's 33rd birthday but lauren passed away from breast cancer. it is a personal tragedy for my family and myself, we are hardly unique.so i don't think there is a member of this body that hasn't been touched by tragedy as relates to health care and no one who is not hurt by the many ways in which their lives are touched by illness or the difficulties in our healthcare system. after making what i consider significant progress we are backsliding because of purposeful action taken by the white house. at the end of 2018 the percentage of us adults without
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health insurance reached a 4-year high, 1 million people across the nation lost coverage since 2016 and almost 14% ofmo americans are without health insurance, numbers we have not seen since the enactment of the affordable care act and this is in part because of actions of the president. funding for the aca, which americans in short-term health plans which we don't allow the state of new york which i'm privileged to represent essential services, shortened enrollment periods and families that sign up for coverage, burden after burden to seek medicaid coverage and repeated attacks on women's healthcare and essential family-planning services. donald trump does not have a plan to address healthcare and as you consider dismantling the informal care act, stripping protections for people with preexisting conditions, leaving millions of hard-working americans without health coverage, a plan, to say nothing of 70 million uninsured or underinsured people. unlike the president, members of this house believe it is
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cortical we address the healthcare crisis whether it is this plan or others we can take steps toward meaningful healthcare reform that lowers costs, improves and strengthens quality of care, improves patient experience, ensures every person in the nation as coverage they can depend on and the american public has been clear they want essential health benefits, protections for manual and lifetime caps without dissemination based on preexisting conditions and i would say the president and many colleagues on the other side of the aisle including senator mcconnell who indicated the senate despite talk about bipartisanship isn't prepared to even address healthcare until after the 2020 election which i consider reprehensible at the very least. we welcome the opportunity to look to the future to begin the work of making our healthcare system which has serious shortcomings and concerns more
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affordable, more equitable and simpler for people in my community across this country so this hearing is entirely appropriate. there are a number of concerns and questions regarding financing of the system. healthcare costs, trend lines, containment measures that were talked about, providers of reimbursement. i would ask anyone to feel free to respond but i note doctor collins talked about this, doctor baker as well. as i look at it, we spend $3.5 trillion a year in healthcare, all payers, private insurance, public insurers, and my back of the envelope which is not very good but even if you assume 3% increase in the cpi and healthcare which is pretty low but for arguments
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sake we would be at 3 quarters of $1 trillion in 2026, about $41 trillion healthcare spent. most of that goes to healthcare in hospitals and physicians so what i'm struggling to understand is medicare payroll is $289 million out of $3 trillion spent. i was trying to figure out how this works. in the new york times a number of corporations getting is rebates. how we will struggle to make this work unless there is a dramatic increase in payroll tax and i apologize for a long question but i recognize people are paying premiums and those w premiums presumably would pay instead of premiums, pay for the expense so there is clearly a movement of those but there
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are disparities as well, paying for health insurance. others do not. it will not be a smoothsu transition but if you talk about how financing would work in some detail and if you have thoughts about payroll taxes and other forms of taxes or premiums to meet that. >> i will take a stab at that. there are large administrative savings, private health insurance industry spends 20% or 25% of what it pays in benefits in administrative costs whereas medicare system, traditional medicare system isi less than 2% using canada as a reference point of less than 3% allowing for large savings. i apologize but as i look at
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private insurance, guiding your answer, private insurance is a third of medicaid or healthcare so about $1.2 trillion right now and estimate 18% savings which others talked about translates to $214 billion i will give you that but i want to talk about the taxes, take that out of the mix. if you could realize all $200 billion he would be at $3.3 trillion expense so i will give you that. >> there is also administrative costs incurred by hospitals, doctors offices and other providers which don't go to 0 but comparing the us to canada our providers pay more so that
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would be additional savings and i talked about this in my written and oral testimony. we need to reduce payments to providers. we pay twice as much for drugs and medical equipment and doctors, how much do you get those down? we could argue on that but we have to get closer in line with the rest of the world? how to get the rest of the money? to my view a payroll tax has to be a big part of the picture because basically healthcare premiums paid by employers are nkhe and to payroll tax now many employers, and you have to do that with payroll tax to a mandate. that is the biggest chunk and that can be done in 1000 different ways with other forms of progressive taxation where you disproportionately have income tax, senator warner proposing it as well. we can get more taxes from high income people with big winners in the economy in the past four decades.
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>> i appreciate that. anyone have anything they would like to add relative to how we pay for this. >> the point i made earlier about the cost growth from provider prices and private insurance. that is a key growth push. >> to understand what you said. as i think about it, borne by the experience of talking to hospitals and other providers around new york, the public payers medicare, medicaid and other programs, the commercial world and private insurance essentially subsidized payments to allow providers to be
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successful but something at odds with that that i didn't understand. >> the literature on the cost shift which is a cost shift from lower payments and medicare program and medicaid program made up by higher prices, the literature does not show that. a study in colorado on this issue found the higher margins providers are getting, the higher prices providers are getting in colorado were going forward and higher margins, buildings and other things like that.. there wasn't evidence of the cost shift. the prices were not going to fund lower rates on medicare and enormous amount of literature. >> would your argument to be we could pay medicaid or medicare rates and not substantially affect quality of providers or not impact their ability to
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provide service. >> the key thing about the healthcare market that is so different from every other market is prices drive cost in this market, and a fair reflection of the cost of production in healthcare and private insurance and we choose the prices we want to do and we have a huge amount of evidence that major growth in healthcare costs occurring in what we pay providers and private insurance. if we want to get control of healthcare costs we have to start focusing on that issue and what these bills have done is bring this issue up. >> some of you have looked at
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other health systems around the world. in rochester it would not be unusual to pay a neurologist or neurosurgeon 3 quarters of $1 million or more, higher costs compared to metro areas. what would be a comparison to what a surgeon of that kind would get compensated for in other places? canada? great britain? o w anyone know? >> closer to $250,000, compensated considerably lower. we had arguments about compensation because they think they get too little but they don't pay for their healthcare or education for the most part in other countries. that is not offsetting but it is a point to keep in mind. >> may i comment, congressman? >> yes, sir. >> i want to say you are asking good questions. it is important to make sure we have such an ambitious policy
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proposal but we are the richest country in the history of the world, we pay for far more expensive things like wars of choice, we can afford to do this. e we just need to decide to make it happen. it is a political challenge, not an economic one. >> i appreciate that very much and agree with you this is what people are willing to do but there are challenges to doing this. there will be disruptions in the marketplace but if we didn't go into it with a clear headed view of what this will mean, without talking about that. a couple minutes left. as related to cost containment, utilization issues. i was involved in a practice transformation grant from the for the care act, the rochester health innovation collaborative where we embedded case managers, nurse practitioners worked on social determinants
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of care, tried to drive down the cost curve particularly for chronically injured, chronically ill individuals. we had some success, not sure where i see the pressure in this system. this from my mind getting a different view a fee for service, not sure how utilization declined or how you get better coordinated care because i don't see that except in the last moment or so folks could comment to anyone on the panel. >> thank you for the question. if you are looking at the plan and the comprehensiveness of the services you are going to provide it behooves the plan to have those coordinators that are part of it wanting to go out and whether it is
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community, we call them navigators, going to make patients understand how to utilize the system in a more appropriate way, you are talking a patient provider partnership and bring about better care, looking at nutrition or food service, and -- >> the goal was to reduce the healthcare or cost curve down and i am not sure that i see in a fee for service system that this moves where the incentives are to do that, not sure who provides that coordination because i don't see incentives in this, just fee for service, that is the long-term health care trend line in terms of cost. >> in a prepaid way, incentives bills in the program if basinge it on the kinds of system in
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care, are you looking at the integrated healthcare system or the services provided under the va, so focus more on the preventive aspect of it so you want to keep and try care in all services out of the emergency room so you build in emergency care facilities and expand hours and getre those people to practice prevention and not utilize the cost and they can get an incentive for keeping people well and healthy. >> i completely agree, not sure the setup -- >> global billing is exact. global billing is exactly how we bend the curve. no more fee for service. >> i agree, i am not sure this
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proposal contains that in metro -- i apologize i exceeded my time but i appreciate your thoughts. >> do you want to finish? >> medicare has been a leader in innovativehtht payment pracs for providers and care organizations, no reason those innovations could be brought in. >> of those been done by private insurers that create programs around medicare because you use private insurance to do it. >> i yield to mister cole. >> only have a couple minutes here so i will move you along so forgive me for that. primary healthcare jurisdiction, moving legislation that would make fixes to the aca and that legislation can be here in a
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few weeks. if you can't give me yes or no i appreciate it and i will start with you. do you support abandoning these efforts to reform the aca in favor of medicare for all? >> the trump administration is trying to give people more choices, some are things like short-term plans. >> i asked for a yes or no i will not get all the way through this. >> should they abandon his efforts and focus on medicare for all or should we keep moving the efforts to fix the aca?fo >> we should do what we can to fix the aca for administrative and legislative authority. >> i agree. >> that is a false choice. >> it's not a false choice. there's only so much time appear and only so much bandwidth to move something to become law. we debated a lot ofnl legislatn this year that is not going to become law.mo we have a chance to make some e
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fixes we all agree on, to prioritize working on that. >> if there is more bandwidth, a lot of decisions. >> i don't think that is in your power legislatively. >> universal healthcare is one way to fix this. >> there are a lot of good ideas on the table and many bills that would move towards universal coverage and these could help millions of people. >> thanks very much.op >> if you could do fixes, i don't see this coming. >> can i ask one question? is medicare going broke? >> medicare hospital insurance
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trust fund is expected to be insolvent in 2026, half of medicare, the other halfec of medicare by definition insolvent because it is statutory only constructed, given enough money but has financial strains going on. >> let's fix what we have got first before we launch into a new system. a lot of risk involved in this. a system that millions of americans depend on that is going broke under the current financing mechanism. >> before the correct will go broke in 2019, this year. >> seems to me we should be working on that, not medicare for all. >> i accept. if i could ask unanimous consent, i have a letter about coverage i would like to have entered into the record.er
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employer-sponsored coverage, to clarify, in response to a question the chairman asked, your response was it is not true that anyone would lose insurance coverage. we conflate insurance coverage and healthcare access. what is true is everyone would lose insurance coverage because health insurance would no longer exist. healthcare would exist in america. am i misunderstanding the dynamic? >> insurance plan in access to a set of benefits, that would give them access to healthcare. >> the reason the trust fund is insolvent isn't that we stop providing care to people but we have pre-funded it for payroll taxes.it - we have a pot of money to pay
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for every claim that comes through the door. we are no longer insuring against risk but indemnifying first dollar companies. >> under medicare for all, providing first dollar provision of the entirety of people's healthcare and since you're not insuring against the risk of large future health expense, you are providing payment for every service. >> there is a different set of challenges to fix the insurance system, i o can't get access t care system about solving problemset for patients at different challenges. from a financing perspective, so we serve on the budget committee together. we are not paying the promises
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we make today, we are not paying for the wars we are in, we have $3 trillion in revenue, $4 trillion in expenses, happy ot to spend my children's money but it is not enough important to me. it should be important to us, this is an issue that is important to all of us. what is the order of magnitude that you suggest we increase individual citizen contribution? >> this is on the national level, $38 trillion inin additional funds provided to the federal government on a per capita basis. to your other point, we have a substantial financing shortfall in the current medicare system and have not figured out how to finance that. it is a more manageable problem than trying to finance what is called medicare for all, the difference for medicare in many
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ways but that is several orders of magnitude more difficult than current medicare which we have not figured out how to do. >> it is not a republican or democratic shortfall but an american shortfall. talk about your numbers. these aren't republican or oc democratic numbers. certain groups are competing in the same order of magnitude. >> the estimates are consistent regardless who makes them. i provided a table of my that shows ifmony you adjust for the years being estimated and assumptions for administering of costs or drug costs or provider payments you can get a lot of these different things to line up and they are all the same ballpark. >> i'm out of time. i welcome my chairman at indulgence but in answer to that. >> i let you go on for two minutes. uuc >> let me just say one thing, doctor baker has to leave at 3:10 so i don't know ifng anyby has an urgent question for doctor baker.
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he has to leave. thank you. one other thing. the idea can we fix the affordable care act, medicare for all, i believe we can walk and chew gum at the same time.n it will help more people, doesn't mean we can't do this but we can go on both tracks. and incapable of doing great things. if you look at our history, medicare is a great thing, social security is a great thing. we don't have to be picking and choosing. i think he is trying to get a soundbite to say people will
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lose health insurance, to add to -- >> i don't believe you are suggesting my goal is to get a soundbite on an issue as important as this.it >> i hope i am wrong but seems to me the difference between getting provided - i shouldn't go there. this is a mistake. i won't do that. i am simply saying what is motivating us here is the fact the system we have is deeply flawed. we have 29 million americans without insurance, 40 million americans are underinsured, people are afraid to get sick, afraid to take her doctor's advice, there is something terribly wrongng and we need t fix it. i know this is a politically hazardous topic to go down the road on but wehi have to do it
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and this is a political condition we are faced with right now. we could fix this. we have the resources to fix it. we have everything we need to fix it. it is whether we have the political will to fix it. we will see if we do or not. i hope we do and we can do small fixes or we could do a larger piece. letit's . me yield to miss shalala. >> this has been a very smart hearing with very smart people and very good questions. i want to thank all my colleagues. the truth is if any of us had a chance to sit down and establish a health care system from scratch none of us would have designed the system we have. itre s is a system in which wee cobbled together over the last half-century or so a number of programs to fill gaps. some call them incremental but i don't consider medicare anda medicaid or children's health insurance plan or the passage of medicare part d in the mid-2000s let the passage of
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the for the care act small steps. we americans are not afraid of giant steps and certainly congress has demonstrated over and over again that they have c the backbone to take on big problems, but their arms aroud it and try to find a solution. the affordable care act extended the medicare, the hi fund by eight years once we established it because it offset a lot of costs. i want to see more changes in the healthcare system. i want to get to the place that each family does not pay $9000 a month to allow him to live at home with his wife and child and patients are not walking out of doctor's emergency room was treatable conditions. we need that healthcare system. i am for universal care.lt we spent a lifetime filling in the blanks where the private sector couldn't fill in the blanks.
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government stepped up for working folks, the poor, senior citizens, time and time again. and what we have is a system in which we thought the employer-based system was going to be the floor of healthcare for ever in this country. ..of to be the core of health care forever in this country. we adopted it after world war ii. the unions bought into it. but it's deteriorating. and anyone that has talked to employers or has looked at the statistics sees a deterioration of the employer-based system. i know that. i've been an employer. i've sat on corporate boards. ceos are struggling with trying to predict their health care costs for the future. and what have they done? most of us in fact, high deductibles have become the norm here in this country as we try to contain healthcare costs with very crude
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methods. throughout all of that, medicare in many places come in many ways has been a star because it's been better at reforming costs, trying different kinds of reform. but more importantly, from my point of view at containing costs. but i'm perfectly willing to debate the cost issue and how we're going to pay for it, but we are here because the employee system is deteriorating in front of our eyes, as our companies have changed and as we move to a gig economy, as we've gotten smaller and smaller companies, as they've lost their leverage. and because we want better outcomes because we pay twice as much as anyone l else in the wod for our health care. i'm far more interested outcomes and how we get to it integrated system.ou but i'm for universal care. i think medicare for all is one way of getting there, and
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looking at the v.a. and its system, at tricare, we have lots of experience. i'm not afraid of transferring our system that so we decide to do because we've got to plan for good we got lots of experience in taking large-scale problems and integrating them. it. we got lots of platforms. medicare happens to be one of the platforms that we could do it. i could build the system and i'll think i could do in two years but certainly our experience in the public system of taking advantage of platforms and extending it to more and more people is certainly possible. dr. collins, i'd really like to start with you t though. i have some questions. private insurers have been less effective at controlling costs than medicare itself. in fact, private sector costs have gone up faster. you've talked about that a little bit but you have it explained the reasons for it.
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is it because they are smaller part of market the medicare is? could you talk us through the reasons why the private sector? before we laud the private sector let's talk a little about the deterioration as well as the failure of the private sector to be able to control costs themselves. >> great question. one of the main reasons that were seeing the price increases that were seen across the country and private insurance is the fact that prices are set through private negotiations, between providers, hospitals and insurers. and so, providers, particularly and consecrated markets, have a lot of leverage to increase prices. >> this is the complaints that hospitalspaar have with -- they don't have enough doctors to negotiate with, right, or the right option? >> right. so insurers want a hospital in their networks because>> it maks the networks more valuable.
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so then that cost didn't get shifted to the employers. so the employers have a higher premium than they might otherwise have. they share those cost to try to lower those costs, those premium cost by increasing deductibles for employees. employees are already making wage concessions but they're having to have benefits with our deductibles that actually give them less coverage. a simpleally kind of way of looking at how prices are determined and how that kind of filters throughea the system and hurts employees, particularly employs at the midrange of income distribution. >> doctor blahous, give anything to add to that in terms of why the private sector has more trouble negotiating cost-containment? >> i really don't. i'll be brutallyy honest, perhas not that informative, but when i was doing the for my paper i found this area bewildering. i think dr. collins has a clear
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view of literature that i do, but obviously i became an phone in the course of the research of the paper about the discrepancies and payment rates between medicare paysf and what the private sector pays. and i ran into a lot of conflicting explanations as to what was going on, why he was going on and what will be the consequences of making various changes. iin ultimately concluded that it would be a fool's errand on my part to venture too far into there and try to explain what was going on. so instead i simply flag the issue i noted with a payment rates are for private interest relative to hospitaln. cost, or ministers are. i like the issue, identified it and noted some of the conflicting interpretations out there, but i fell well short of being able to explain it. >> any of o you, you know very much about, , i sat on the corporate boards, and one of the things that was about to become particularly on healthcare boards, is they are following
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the medical decisions on payment. that it's not the private sector setting up their own group to decide how much to pay, they're actually watching medicare very carefully. in many ways medicare is a driving that cost. is that your experience as well? >> i'll just sum it up really quickly. i think it goes to congressman morelle question about medicare and how it could lead in innovation and payment, bundled payment, all kinds of different ways of lowering health care i cost pics what has -- medicare program has been a leader in lowering health care cost. what's really driving both those programs is enrollment rather than prices in the private, in the commercial sector. >> denote my way in which, without an integrated system, we
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can get better outcomes? is there any experience in this country getting better outcomes integrated system? v.a. has better outcomes. tricare has struggled with outcomes but have done a pretty good jobme as has the military health care system. >> both of those are sort of integrated systems, so i don't think there's one that is not an integrated system. and if you want to add a a comt comment terms of the medical cost, particularly for mr. cole, when you set, and i'll just use the drive-by mastectomies they had for a while were patients had to stay in hospital for short time, gets his procedure and ghostly could lower the cost for those hospitals. the outcomes have been very different. facing patients home when they have congestive heart failure and some of those issues, and then the plans are penalized because within a certain timeframe that patients are coming back to thehe hospital. it's really not a cost savings
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under the program. you have to, again, practice better health care if you're going to lowerr those costs, and that is an integrated system. >> there's no question that medicare advantage has provided some integration, depending on the plan. and certainly in florida, in my district, over 60% are in medicare advantage plans. they feel like it. but we're paying more for it. we're paying at least 13% more for medicare advantage to get some integration much but it's still pretty fragmented when it comes to referrals for specialists. and that's -- it seems to me, where the system breaks down. because medicare advantage, often the hmos come together. but they're mostly providing primary care. and then they're contracting for the specialty care.
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and contracting with as low costs as they possibly can for the specialty care. but i haven't seen the outcomes research on medicare advantage. have any of you seen that outcomes research on medicare -- as far as i know, the research has not -- even though we're paying more and people may be happier because they're going to one place, i would argue that medicare advantage is as close to medicare for all as we're going to see. medicare for all as we're going to see. but we don't know very much about the outcomes yet. and i assume that that is your experience, as well. and finally, let me give mr. barkann a chance to talk a little about, again, about this fragmented health care system. how many -- how many interactions have you had to have with your private health
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insurance system in a month? can you give us a feel for some of that? >> maybe five or ten. >> you must be the best friend of your insurance company. these are all appeals, i assume, for them to cover more quickly? >> i cost too much. >> mr. barkann, of all the people i've met on this earth, you are the last person i would use that for. thank you. >> congresswoman, i want to say how important your voice is in
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this debate. as chairman mcgovern said, this is a question of political will. many democrats are going to follow your lead on this. so i just want to plead with you to summon all the courage you can and help lead our country to a more rational, just and humane system. >> mr. barkann, i'll try. i'll try. thank you, very much. i yield back my time. >> thank you very much. and yield back to mr. cole. >> thank you, mr. chairman. one second please. as i was -- mr. chairman, as i was thinking about this, i thought of the different, like, fire, police, teacher unions and associations that negotiate
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their health plans. and sometimes it takes them years to get what they want. and they often trade better health plans in lieu of higher wages. or salaries and other things. and so ms. turner, would this bill take away the current health care plans negotiated by, let's say, the teachers' unions? >> yes, it would. and i think one of the issues that would be on the table is, what about the compensation that they have foregone in order to get those benefits? i think that's going to be something that could be very, very disruptive and something that would be of particular concern. because they make considerable sacrifices in their take-home pay in order to get these generous health benefits. >> thank you, ms. turner. and members, i'm just actually a little surprised that some of my
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colleagues would, you know -- understanding these different unions, fire, police, teachers, negotiate a lot. and i know they do, because they came to me when i was in the state legislature. and take away that and replace it with a one-size-fits-all government-run plan. thank you. i yield back. >> and if i could just acknowledge congressman chewy garcia from illinois who is here. and we want to thank him for coming by. >> thank you, mr. chairman. let's talk a little bit about global budgeting and what it means. so if you have a budget and you have more expenditures than your budget, what happens? >> well, then you're going to have to cut something. you're going to have to cut the excess or restrict what you're paying. >> so could you envision a system where that would perhaps result in the rationing of care? >> well, yes. and if i might elaborate a
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little bit. >> please. >> there's been some discussion here about the effects of medicare for all upon the demand for services. the economic literature is actually very, very clear and unanimous on this point. people do use or demand more health services when their insurance covers more. there is a very famous rand insurance study several decades ago that demonstrated that when there's no cost-sharing, people utilize more services. there was a more recent study by coveralls and mahoney about what happens when medicare beneficiaries cover gap insurance that has first-dollar coverage. costs of the benefits they claim goes up by about 22%. so these are very real, very well-documented effects. so we would expect to see a very significant increase above and beyond currently projected health services under medicare for all. so i'm sorry, but just to quickly wrap-up. at the same time we're going to have various constraints upon
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supply because of provider payment productions. the urban institute found some insufficiency of supply to meet demand. clearly, something would have to give. >> something would have to give. i agree. and i'm going to assume that the medicare supplementals have to go away under this bill we're discussing today. they would be duplicative and by law unavailable to people. it's not clear what the punishment would be for violating the law. i get that. so let me just ask you, on the innovation side, new products, new drugs, new treatments, new devices come to market. i've got to tell you, i deal a lot with people who are affected by coverage determinations by cms. so what happens to a patient? do they have to just wait until the next budget cycle if there
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is one of these new therapies or new sickle cell therapy? they just have to wait until the next budget? >> that's what we see in europe. we see that access to the most innovative and oftentimes the most effective medicines are absolutely restricted. as i said earlier, the -- we have access to about 96% of new medicines over the last 11 years in the united states. in france, they only have access to about half. in singapore, only 18%. so they do provide chemotherapy, for example. but it is not likely to be the newest and best chemotherapy drugs. and then the innovation is crippled, because -- and we see in europe it used to have a robust pharmaceutical medical development, medical device industry. has shrunk because of payment
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policies in europe. we are now the medicine chest of the world. most new drugs come from the united states, because we continue to pay for them. we pay for the planet. people object to that. but those new medicines are available, because of thein sin testifi incentives the companies have to continue to produce those new medicines. and without that, i think we would find we have nothing but old drugs and leaky hospitals. >> right. and we're in the 21st century. congress should be proud of their work. ms. turner, our current medicare and hospital provider rates are mandatory rates set for all health services. that's going to have an impact on patient access, correct? >> actually, the cms actuary said it would cause many hospitals to either cut back
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dramatically on services -- hospital operations, services offered. and some would have to close. physicians' offices, many would start operating in the red. so, yes, they would be -- they would have -- this is not us. this is the cms actuary looking at the impact. they simply couldn't keep their doors open. >> true story, personal experience. if you're losing money on every patient, you can't make it up in volume. i learned that in the 1980s. so doctor, you've made some assumptions regarding provider cuts, is that correct? >> yes. i've examined what was in the text of the bill. yes. so just -- someone asked a question about provider rates in other countries. i -- here's an op-ed from a new york post and i'm going to ask to put it in the record. >> without objection. >> in cuba, doctors make the equivalent of 25 cents an hour. teachers, 21 cents an hour and pharmacists, 8 cents an hour,
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for your reading pleasure. so ms. turner, britain's national health service cancelled 25,000 surgeries. is this a problem for a one-size-fits-all system? >> it's a problem when you have a strict global budget, and hospitals make decisions about cancelling or delaying surgeries, and people do have -- are impacted. and once again, they get access to fewer of the new treatments. if you're in the private system, you do have access to more of the new treatments that are surgeons. if you're in the public system, you may not even know it, but you will have fewer options. >> and i do have to bring up the issue of -- we talked about this offline a little bit. patient autonomy. i've got a paper, mr. chairman, i would like to ask noanonymous consent to put in the record. >> without objection. >> the story of charlie gaard, the sad story where the
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determination was made by the hospital not to acquiesce to the parents' request to bring that child to the united states where they thought they had a treatment for his mitochondrial disorder. i would ask that be made part of the record. so the 25,000 surgeries. is that isolated in government-run systems, or does that -- does that seem to be pervasive in government-run systems? >> well, there's no one government-run system, obviously. and some do better than others at being able to -- >> i've got to interrupt you there. >> yeah. >> the director -- no thought for my personal safety. i attended the commonwealth funds health care weekend. thank you, commonwealth fund, for putting that on. i was the only republican there. the director of the national health service was there. and he did point out to me that there is no single european health service. there is england, there is france, there is germany. canada, i believe, is structured provincially the provinces run.
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so this thing that we're building, and with no cost benefit analysis, with no double blind control randomized study, no toxicity study. this thing we're building has never -- no one has ever seen a system that is this big. our medicaid system currently is larger than the national health service, i believe that is correct. but this medicare for all bill that we have under consideration in the speaker's committee, the speaker's desire to have this bill heard today, that is going to be gargantuan. is that a fair statement? >> a fair statement. and you have to worry about access to care. in the u.k., a commission that helps determine benefits available decided that cataract surgery was not a high priority. and so cataract surgery was significantly limited. if you're -- if you have cataracts and you can't see, that should not be an optional visit.
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but when you have centralized government bureaucracies deciding what services are available, i just don't think that's something that americans are going to tolerate. >> so as a practical matter, and i don't understand from my reading of the bill, and i've read through it a couple of times. and it is a frightening bill to read for me. but if you can't get your cataracts surgery, and there's an ophthalmologist down the street saying i'm doing these in my kitchen, what's to prevent that from happening? and what's to prevent a cottage industry of health care that then develops a black market of health care, if you will? >> or offshore. or indian reservations. they have american reservations, enclaves where you could get private care. >> and so the cataracts are an interesting case study, because during the bush administration, the variable lens that could be replaced during cataracts surgery and do away with bifocals, medicare said, hey,
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wait a minute, we don't pay for refractive services. so you only get a one-size lens. so medicare patients were then -- it was a pretty uncomfortable position for the bush administration. we're going to deny the best treatment available to medicare patients. and so they had to actually make a -- i remember when dr. mcclellin did it. and i was jubilant. i thought, oh, man, here's a balanced billing example we can use. patients were allowed to bring their own money to the transaction to get the state of the art lens so they could read their sunday paper without their readers. i mean, it was -- i thought going to herald a new era of insight in the medicare system. but i was wrong. so -- but i did repeal the sgr. thank you very much. thank you, chairman. i yield back. >> okay. but i want to -- some other people want to say -- i'll use remaining time. let me say a couple things
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before i yield to dr. navi and who else -- dr. collins. i know, dr. burgess, you said you read the bill many times and then you referred to the global budget. the bill says in the reading i read, there will be a quarterly review of the global budget so we can choose to make sure there are enough funds if there is any problem. that's actually written into the bill. and i know -- i mean, people like to speak in alarmist terms. we talk about the affordable care act, we talk about -- my friends talking about death panels, but that wasn't true. it wasn't true then, wasn't true now. >> mr. chairman, we don't have a budget for this year, where are we going to get this budget? >> thank you. and then you also raised the issue of u.k. and canada and said they can't get the latest, greatest services. i'm not saying we should be like the u.k. or canada. i would like to think we could do even better. let me ask mr. collins on this point. does that mean that the u.k. and canada have worse outcomes than we do? >> that's a really good point.
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and i was actually going to raise that. why is it -- such a gloomy picture was painted of the u.k. where, in fact, their outcomes and those in other industrialized countries with universal health systems are better than ours with less money spent. i also think, congressman burgess, at the conference, the director of the national health service did say they were covering car t service, because they made a determination that it was highly effective as a curative therapy. and so they made a decision to cover it. so there's a different metric that's applied i think than we often do. >> i did relate to him that at m.d. anderson hospital in houston, they have come up with a therapy that is as effective but less expensive and can be administered as an outpatient. >> thank you. dr. navi. >> dr. burgess, i did just want to respectfully point out that if we're going to be talking about a hypothetical future where there might be rationing,
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we need to make sure we don't forget we have rationing right here today. and it's not for the most expensive and the newest drugs or not only for the most expensive or newest drugs, but patients that can't get antibiotics or anti platelet medications. we have that russiationing here today. and in regards to we would be the first country doing this, that's kind of what america is good at. doing things that no one else has done before. >> dr. brown. >> thank you. and mr. burgess, just wanting to add to the point that we are really not talking about one-size-fits-all. because we are talking about a universal coverage, but we've moved into decision medicine, where we're trying to give the therapy that is specific for those individuals, and when we take in the social determinants that are very important for those individuals, we know the kind of care. and so it's equity that we're talking about. not equality. >> and i know -- i have someone who just showed me a report that
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appeared in "the hill" magazine, because she was curious. i said the ways and means committee will doing a hearing on this very bill. so she doesn't have to worry we'll be the only one. i now yield to mr. de sannier. >> thank you, mr. chairman. you're almost done. if you're on this end of the podium -- the panel, i should say. you're almost done. but i want to thank you all for your patience. your ability to articulate your thoughts and your professional experience. and i obviously want to thank mr. barkann for your tenacity and your being here and your good demeanor, in spite of difficult personal lauds. so thank you all for being here. i am a little bit flummoxed. not unlike the hearing yesterday, with all due respect to my colleagues. the united states is number one in cost as a percentage of gdp.
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and as a cost per capita. almost twice of other developed countries -- per capita for cost of health care. but our outcomes are the opposite of what you would expect. 28th in life and mortality. i think close to 30th in infant mortality. so for me, it just strikes me, not unlike the conversation yesterday, about the energy economy and the environment. we're arguing about status quo versus a world that's already changing and how are we going to adjust to that. i'm a coauthor of the bill. i appreciate the author. and i think this is a discussion we have to have. as a former small business person, i remember owning restaurants and fortunately, where i live in the bay area, kaiser and the east bay is very dominant. it started in the east bay, so the closed system in kaiser is over half the population of the two counties. where i live, 3.5 million people. and they have been able in that closed system to provide a
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pretty good quality of care versus cost. when i started in the restaurant business 30 years ago, i could pay easily for kaiser. and pay a portion and then after someone worked for me for six months in full. but then towards the end, i had employees coming to me in tears, one manager in particular, where she couldn't pay the co-pay. so i came out of pocket as an employer. which goes to the statistics about -- ms. shalala talked about a little bit, the number of employees -- employers, i should say, paying 100 me% or a portion. and i don't know what the numbers are for small businesses but i would imagine it's staggering with small businesses and the cost of staying in business just not being able to pay at all. my memory from reading is in 2000 or 2001, almost 30% of employers paid 100 percent% of their health care costs. so this model to me clearly doesn't work. so it's a question of what we're
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going to do about it. like mr. asken, i'm a survivor of cancer. four years ago, i was diagnosed with stage 4 chronic lympho sattic leukemia. i took a pill that keeps me alive. senator durbin said to me recently because he knows of my health struggles, he said how is your health. and i said fine, dick, i have a pill in my pocket i take every day and it keeps me alive. and he said how much does it cost? and he said $400 and he said that's outrageous and i said not to me, it keeps me alive. my oncologist said 15 years ago somebody who came in with the same diagnosis and we would sprinkle some water on your forehead and say good luck. now the live expectancy is 85 merz if you can get through the first five years and i'm almost there. and a lot of this as i've become familiar with it and gone to nih actually was developed with taxpayer dollars. a doctor who worked for the army for years and is now at ohio
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state, that dr. moynihan, the key person. and most of his research was taxpayer-funded. much of the deployment. i went over to nih and met with these young people making 60, $65,000 a year that went to hopkins and stanford and harvard. and they're working at nih, because that's what they want to do. so one of the things to me is apples and oranges. i'm sorry that one of the panelists had to leave, because this is directed at him. but i want to direct it to dr. navi, because it will lead into this. what are the real costs to the average consumer? so if we know the numbers about individual costs and outcomes and the gdp, it's a huge disadvantage to us, because if we weren't at 18% and if we were like the japanese at 12% with better outcomes, that money could be going to more productive uses. not that health care -- keeping people alive isn't important. but we could be prioritizing.
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so the reason why i've been able to afford this, and there's an interesting story in the "wall street journal" i would ask everyone to read about people who are wealthy with my condition and having a challenge paying through private health insurance. i was lucky enough to get elected to be a county supervisor. i chose to take my health care through what was the first county public option of the united states when the contra costa health plan was approved, the hmo. and they paid. i'm here alive today because of that. if not, i would have stayed -- a restaurant owner, would have made more money. but now when i look back at hindsight, i wouldn't have nearly the service versus what the out-of-pocket costs would be. so doctor, i have an example from my experience as an elected official. in california, we delegate public health and delivery of services to the urban counties. contra costa, where i governed was. our biggest challenge, whether it's los angeles or all urban
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counties, is the cost of the clinics and hospitals who do most of the indigent care. so one of the things we did when we rebuilt our county hospital, i was a swing vote. l.a. at the time, their general fund contributions with five hospitals and with an increasing indigent care population was up to 23, 24%. ours was going in the same direction. so we have tried in california to help the counties and say you've got to cap your cost, be more efficient. my point is, when we get down to 10%, that extra 15% we spend on libraries, sheriff's department, economic development. so that's sort of the color of money. in your experience as a point of sale person, in different emergency rooms, you see people coming in the door, but their costs are all absorbed differently. but the consequences for who pays and subsidizes those costs are also different. could you speak to that on a personal level and then i'd ask ms. collins to also talk to that. >> sure. i think that if you go to
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different hospitals, people will be paying differently. and the interesting thing about new york, we have a lot of hospitals that are right next door to each other that accept different types of insurance and different types of payments. so there's two hospitals that i work at that are right next door to each other. if someone comes in and they have insurance, they'll be taken care of, and if they don't, they often get referred next door to the public hospital where they end up receiving care and the hospital does not get reimbursed for it. and that contributes to the challenges of that hospital not having enough money, and it creates the cycle. i think one of the good things about medicare for all is that in those hospitals that primarily serve the indigent population, they will be able to make more money, because they'll be reimbursed higher than medicaid payments and no one effectively will be uninsured. every patient will be a paying patient. >> before we leave you, this is another -- so the behavioral health costs. in los angeles, we see we're -- they have been pushed out of the
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hospital. i know in my county, i was on joint conference committee. we would look at indigent care in the psych ward. and we were stabilizing them and pushing them out. but they would go into the emergency room first. i think the statistic on people who commit suicide, 60 me% go t see a primary care physician within 60 days. so that's another aspect i don't think we're talking about. we understand the neuro science and the amazing research we're having on helping on behavioral health. but then the acuity of people going through the current system for medical conditions and then accruing greater liabilities, both real and financial on that side -- and you saw that, i assume, in your experience. >> yes, i do. and the people that end up in the e.r. that can't be reimbursed, we end up all paying for that. i'm not sure if that answers your question. >> yeah, it does. ms. collins? >> yes, it is, i think on the
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benefits, the way we're designing benefits and the way employers are being forced to grapple with their higher costs, are giving patients incentives or people incentives that goes goes their own health interests. so people are making decisions based on their deductibles about whether or not to fill a prescription. whether or not to keep their -- to skip doses of the prescriptions because they're afraid of the cost. and it just really does run counter to how we would like people to think about their health care and getting better. >> and i don't know if others have had this experience, but i know the rotary clubs in my area take me out to their clinics where they have pro bono physicians and others who come. and especially in the disadvantaged communities. most of them who come to the rotary clinics once a month won't go to the county hospital. they won't go because they're afraid of the cost. and they're -- and some of it, i'm sure, is part of white smock
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disease -- dr. burgess would remember that. i have that. my blood pressure is usually off -- i don't know why i don't trust doctors, doctor. but i do know, because they have kept me alive. but the rotary care stuff is really fascinating, because people will go to the rotary clinics and it's the same doctor. but the environment is different. i just -- i guess i'm really appreciative. i didn't fully anticipate this hearing. i think it was good and constructive and largely positive. i hope that we go on from here. and i think the genesis of this in the bill -- i remember madison said -- not that this is going to happen. he said, just because a member of congress doesn't think their bill will happen immediately shouldn't inhibit them from introducing it. and i think this is at the very least has restarted an important conversation in this country. so with that, mr. barkann, do you have anything to add to my -- whatever is left of my 15 minutes? or is mr. mcgovern going to take
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it all? >> no, no, no. >> as long as it's not ed. >> thank you so much to members of this committee for having me. this has not been an easy trip to make, and it's a big risk for me. but i came here today because this is one of the most pressing crises facing our society. every day i feel the weight of the moment. every moment feels urgent, and i feel acutely my time running out. i hope that sense of urgency is pressed on everyone here, as we think about how to build a more fair and just society for all. we are at a crossroads as a nation. we can either become a society where care is rationed to those only with immense means to pay the most exorbitant, exploitive health care bills imaginable, or we can transform our society, alleviate families of the enormous financial burdens that come with a for-profit health care system and live with more dignity and joy. i sit before you today hopeful,
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because i believe we will make the right choice. i believe the number of people demanding justice across the country will only grow, and i believe that we will win. thank you again for having me. >> with all our pleasure. thank you for being here. >> so everybody has asked their questions. so at this point, i will yield to mr. cole for his closing remarks and then i'll make closing remarks and we will let you all go home. >> i want to begin, mr. chairman, for thanking you. i want to thank you for the manner in which you have conducted the hearing. you have been exceptionally generous of time and kept us focused skp focus and very civil. you can be very proud of your performance here and we're all very proud of you. and i want to thank all of our witnesses as well. each of you have brought insight, knowledge, professionalism. you have all contributed to
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helping us grapple with what's -- you know, a challenge at the societal level. and obviously we heard a great deal today about the majority's highest priority in congress. in my view, putting everyone in a one-size-fits-all government-run health plan that will double everybody's taxes, eliminate choice and put medicare at risk. it will take plans away from 173 million americans, and give them something they may or may not want and something they may or may not be willing to pay for. as we heard from dr. playhouse, medicare for all would cost a staggering amount, $32 trillion over ten years. worth thinking about that. the current federal budget annually is about $4.5 trillion. this would make it immediately $7.7 trillion. the legislation has not proposed any way to pay for that.
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but dr. blayhouse told us if you doubled the corporate tax rate, it still wouldn't cover these costs. and as my friend, mr. woodall pointed out, we're not paying for all the health care we're getting now. we're putting an awful lot of it on the national credit card. dr. baker offered up several ways to pay for this in his testimony. but many of those involve what euphemistically are called input costs or what everybody in the health care industry would call more than a 40% cut in their compensation. i can't imagine that an entire industry would accept that level of reduction. and i would also note that such cuts would put everybody's health care at risk. indeed, ms. turner testified that many hospitals would simply close if they had to take 40% pay cuts as envisioned in this bill. if such cuts become law, the medicare for all truly would become nothing more than a program that provided minimal care in exchange for astronomically high taxes and much longer wait times.
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most disturbing me to me, i think today's clearing made clear that the medicare for all would put the current medicare system at risk. we force doctors and hospitals to take lower payments. we run the risk of pushing them out of the industry entirely. thus making it impossible for current medicare beneficiaries who have paid into this program for a lifetime to receive health care. in my home district, rural hospitals rely on higher reimbursement rates from private insurance to offset the lower reimbursement rates from medicare patients. if these hospitals were to only be reimbursed at medicare rates, most of them, quite frankly, would close. if nothing else, today's hearing shows jurisdictions need to consider this bill, as well. and i'm proud that you have both called on that, mr. chairman, and announced that at least one of those are going to take it up. you know, i particularly hope my
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friend, mr. burgess, gets another crack at this in the energy and commerce subcommittee and the ways and means committee and the education committee and labor committee, as well. all of them, frankly, have significantly more jurisdiction in this area than we have here, and to be uncharacteristically humble for our committee and ourselves, they probably have more expertise than we have here. because they have both the staff and -- >> i don't know about that. >> well -- i'll let you argue that with mr. neil and his counterpart. so you guys -- and mr. pallone. because, frankly, they do. they just focus on these things. guess what, i probably know more on indian health than some of these things, because i focus on it. we don't have hearings up here, this is an unusual moment for us and a good one. i'm not complaining about that. i'm glad you're going to have the opportunity for these issues to be discussed in front of the committees of jurisdiction. though i think the democratic
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medicare for all proposal is an extreme one, i would remind the majority that republicans are, as ms. lessko said, committed to working together to improve the system we currently have and to build on and improve what works and ensure that every american gets the quality of care that they deserve. and while it's always fashionable to want to do a once and for all total comprehensive bill, we went through that with the aca. and with all due respect to my friends, i heard phrases like, "if you like the doctor you have, you can keep it." "if you like the plan you have, you can keep it." and finally, "your insurance plans are going to decline by $2500." none of those things happened. so count me as skeptical that a new one-size-fits-all system will achieve what advocates have laid out with optimism and such hope, and, you know, again, it's
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worth discussing for sure. i would hope, in the meantime, though, we do what everybody here agreed we ought to do. in addition to looking at this, which i have no objection to, we actually focus on smaller steps that we know can become law. that we know can actually happen. i look forward to working with my good friends on the other side of the aisle. certainly with you, mr. chairman. to make sure we can do something that matters in the weeks and months ahead and make some big difference. so with that, mr. chairman, again, thank you for the hearing. thank you for the manner in which it's been conducted. i yield back my time. >> well, thank you. and let me also thank my ranking member, mr. cole, for his participation in this hearing and for his courtesies and for all -- and for his questions, quite frankly. i want to thank my republican colleagues, as well. i don't agree with you on a lot of what you said. but, you know, i appreciate that this was -- this hearing, which is on a serious topic, was treated in a very serious manner. and i was recounting to some of
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you that some members of the press and some colleagues who have been watching this on c-span are kind of surprised that this has been such a civilized and in-depth hearing. and some of those people are on the committees of jurisdiction. and so i -- so i will tell mr. neil that, you know -- who is chair of the ways and means committee, the second-oldest committee, he should follow our example. and i want to thank the staff on the majority and minority side as well for their -- all their work in this. and i want to thank congresswoman's staff and congresswoman dingell's staff and others who have been very helpful. working with us, with this hearing. i want to thank the panelists. this -- you've been here since 10:00 this morning. and nonstop. with a short break. and i think everybody here was excellent. and we may have some differences
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of opinion, but i think everybody did an excellent job. so i want to thank, again, all of our witnesses for their time today. so as this hearing comes to a close, let's remember why we're all here. we're here because 29 million americans are still without health coverage. 44 million people are underinsured. and many more are paying ridiculous, out-of-pocket costs for health care that just isn't there when they need it the most. you know, there is no -- there's no health care system like what we have in america. and i don't mean that necessarily positively. you know, people are forced to go without care. those with coverage have to wonder whether their insurance provider will play games with their coverage when they need it most. and all of us up here know exactly what i'm talking about, because that's the kind of case work we do each and every day. what we have shown today, i believe, is that medicare for all is possible.
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that we can build on the principles of the affordable care act to make even bolder reforms. reforms that we give doctors like dr. brown and dr. navi the ability to treat patients and give them the best care every time, without letting costs dictate medical decisions. that we can treat patients like addie barkann without forcing them to battle with insurance companies. if you walk away with nothing else today, know that we have the ability to do that. medicare for all is possible. it is reasonable. it can move forward, and i think it should. and i'm proud to support this bill. and to work with congresswoman jai apoll and dingell and many others championing it. and by the way, that includes not just supporters here in congress, but many advocates. the doctors, nurses, patient advocates, skmconsumers and all across the country who have worked tirelessly to make this
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histo historic day a reality. it's been the result of calls and e-mails going on for a long time. i believe in people power. i've got to be honest with you. i don't think we would be talking about any of this if our constituents weren't raising their voices. i'm proud to stand with you and fight alongside you for medicare for all. this is just the first phase of the conversation. and i look forward to continuing this dialogue with all of you. and, again, i just want to say to addie, i love this picture. and i look at your wife, rachel, and your son, and i don't help but believe how proud they are of you. and i've been watching your dad sitting behind you. and i can see how proud he is of your courage and your commitment to being here. this is a big deal. and your presence here is making a huge difference. i just want you to know that. you know, we can do great things. we really can. and, you know -- but it means we have to stand up to the
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naysayers who tell us, no, you've got to think small. we need to think something -- we need to think bigger than tweets, right? we need to think in terms of, you know, how we impact the lives of millions of people in this country who are -- you know, who are struggling every day, wondering whether or not they're going to go bankrupt because their sick or kids are sick. it just shouldn't be. as everybody has said on all sides, we can do better. we have to do better. and so i -- again, want to thank everybody for being here today. this is the first step. it's a big step. but we're on our the rules committee is adjourned. [applause] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations]
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[inaudible conversations] [inaudible conversations] >> on american history tv
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saturday at 2 p.m. eastern on oral histories are interview world war ii navajo code talker samuel. >> big mouse, turkey, space, sheep, sheep i is cured. that's all it said in plain english, but what it really meant is the mount is secure. >> vent on lectures in history, yale university professor julianne suite on the american military during the revolutionary war. >> so this right here is a handcrafted work of art, created by a gunsmith the made lock, stock, and barrel every piece of this by hand, each one is individual different. >> stunned at 30 p.m. eastern astronaut michael cohen on the 50th anniversary of the moon
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landing. >> people want to go to seek him to touch come to snow, to understand whatever that may be on the surface of the planet, a little bit about it, , way above it, to the moon, beyond the moon to mars, whatever. i think it is somehow within us to have this, it's not and need that this will, this desire to explore. >> and that eight on the presidency author on the sense of humor of abraham lincoln. >> writing through the woods he met a lady on horseback. he waited for her to pass but instead she stopped and scrutinized him before saying, wow, the lancet, you are the homeless man i ever saw. yes, madam, but i can't help but come he replied. no, i suppose not, said the lady. but you might stay at home. [laughing] >> this week and on american tv on c-span3.
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>> and now from the national academy of sciences in washington, the start of an all-day symposium on climate change posted by johns hopkins university. some of the issues the conference will look at include energy technology, public policy, and health issues related to climate change. .. [inaudible conversations] .

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