New Medicare for All Bill Will Dramatically Revamp Health Care

JUAN GONZÁLEZ: More than a hundred Democratic lawmakers are co-sponsoring a new House bill to dramatically revamp healthcare in the United States by creating a Medicare-for-all system funded by the federal government. This comes at a time when as many as 30 million Americans have no health insurance and tens of millions more are either underinsured or struggling to pay their health insurance premiums. Democratic Congressmember Pramila Jayapal of Washington announced the bill last week.

REP. PRAMILA JAYAPAL: It is time to ensure that healthcare is a right and not a privilege, guaranteed to every person in our country. It is time for Medicare for all. … Is this a bold and ambitious plan? Damn straight it is, because it has to be. The scale of our healthcare crisis is enormous, and our plan has to tackle the deep sickness within our for-profit system. Here’s the thing: If we can end slavery, if we can give women the right to vote, if we can send a man to the moon, then, God, we can do universal healthcare for every American.

JUAN GONZÁLEZ: Congressmember Jayapal’s bill would expand Medicare to include dental, vision and long-term care, while making the federally run health program available to all Americans. It would eliminate health insurance premiums, copayments and deductibles, while changing how healthcare providers are paid.

AMY GOODMAN: Robert Weissman, president of Public Citizen, says the legislation would eliminate nearly $500 billion in waste spent annually on bureaucracy, inefficiency and excessive corporate profits. Political observers say the bill is largely symbolic, given the Republican-held Senate and White House, but will likely play a major role in the 2020 presidential race.

Well, for more, we’re joined by Congressmember Pramila Jayapal of Washington state.

Welcome back to Democracy Now!, Congressmember Jayapal. So, let me ask you the question. Usually people say, “How much does this plan cost, and who’s going to pay for it?” I’ll turn it around a bit and ask you: How much does the current system cost? Who pays for it? And then how is this system going to be funded?

REP. PRAMILA JAYAPAL: And that’s why I love Democracy Now!, because you are about making sure we get the truth out to people. Thank you, Amy, for the question.

Our healthcare system today costs 18 percent of our GDP. In 10 years, we’re going to be spending $50 trillion on our current healthcare system. And here’s the thing: It’s not like we’re spending all this money and we have better outcomes than the rest of the world. The United States is last among all of our peers in infant mortality rates, in maternity mortality rates. We are last in terms of our life expectancy. We have the lowest life expectancy. And so, here we are, the richest country in the world, and we are unable to provide healthcare for everybody, at — you know, right now we pay double what other industrialized countries pay for their healthcare.

So, my plan says, let’s take the existing, very successful Medicare system that already exists for seniors; let’s expand the kind of coverage that it offers, because that’s the biggest complaint about Medicare, is it doesn’t cover things like dental, vision, mental health, substance abuse, some of those critical pieces; and then let’s extend it to everyone in the country. Same doctors and hospitals, but you would actually be able to choose and not be limited by insurance companies that say this hospital is in network, that hospital is out of network — those kinds of issues. And you won’t have to have five different insurance plans. So, what we do is we say the government is going to pay for all of this.

And in the end, we want to make sure we’re containing the costs. So we change the way that hospitals are paid. We take on pharmaceutical drug pricing, because that is a huge issue. We negotiate now. We allow the Medicare system to negotiate, just as the VA does. And we, for the first time, include long-term services and supports, which is very important for our community that has disabilities and our elders, who simply cannot afford to live with dignity.

JUAN GONZÁLEZ: Well, Congressmember, right now, most of Americans who do have health insurance, their health insurance is paid for either by the premiums they pay out of their paychecks every week or that their employers pay, sometimes a combination of both. How would the funding of the system change under Medicare for all?

REP. PRAMILA JAYAPAL: Right, so, exactly. I mean, right now, the federal government already pays for about two-thirds of the total healthcare costs, because we have Medicaid and Medicare, which are already part of the federal system. The rest of it is either people who have nothing or people who are covered by employer healthcare.

What we are saying is that there’s about half — about $600 billion that employers are paying for their healthcare for their employees. That money, just a portion of that, could come towards the single-payer system, because these for-profit insurance companies are continuing to hike up premiums, not only for families, but also for the employers. So, enormous amounts of waste that are going towards a for-profit insurance system that is more interested in their profit than patients. In addition to that, we’ll need a little bit more money, and we think that’s very doable by, you know, putting a wealth tax on the wealthiest. There are a number of ways to pay that last little bit that would be required.

And in the end, we would have comprehensive care that really would serve every single American, and we would save, with my Medicare-for-all plan, at least $2 trillion over the next 10 years. So, this is a big plan. It’s an important plan. And really it’s about saying healthcare is a human right. It needs to be available to everybody, not just to the wealthiest, because, as you said, 30 million Americans who are uninsured, and then, on top of that, at least 40 million who are underinsured, can’t pay their premiums, don’t get the care they need — one in five Americans that literally does not take their pharmaceutical drugs that they are prescribed, because they can’t afford them.

AMY GOODMAN: Let me go to Alex Azar, the secretary of health and human services, speaking at CPAC, not quite as long as Trump did, for over two hours, but CPAC, the Conservative Political Action Conference. He was asked about Medicare for all.

HHS SECRETARY ALEX AZAR: The threat is an immediate and complete government takeover of healthcare. … They’re at least being transparent this time about what they’re about. You know? Then, also, it’s going to violate the commitment that we have made to our seniors in the Medicare program, because when you put all of these other Americans into the Medicare program, you’re going to have the best doctors and the best hospitals are going to jump out of that program, because they’ll be paid under market rates, and it’ll be just like Europe and other socialist systems, where you’d have to create a two-tier system of healthcare. And to get quality care, you’ll end up going outside the system, if you’ve got the money to do so.

AMY GOODMAN: That’s Health and Human Services Secretary Alex Azar. Congressmember Jayapal, your response to that?

REP. PRAMILA JAYAPAL: Well, Alex Azar and Seema Verma are industry front people. They are interested in preserving the system as it is, so that insurance companies and pharmaceutical drug companies can continue to make profits while people die.

What we know is that the Medicare system can be expanded to everybody, and that, in the end, we can take out the waste, the administrative waste of the insurance companies. I mean, think about this, Amy. You know, the UnitedHealth CEO is making $82 million in take-home salary, profit. All of these CEOs are making enormous amounts of money, and pharmaceutical drugs and simple procedures cost so much more in the United States than anywhere else. And so, they have to try to scare people into thinking that somehow this system is going to hurt the people that are in the existing system, which we really know is not the case. We’re just expanding the existing system to cover everybody.

But most importantly, we’re going to keep costs down. So, this is about coverage, but it’s also about cost. Why is it that the Medicare system pays 80 percent more for prescription drugs than the VA? It’s because the pharmaceutical industry — when this provision was up for Medicare to be able to negotiate for lower drug prices, the pharmaceutical industry put over $100 million into lobbying the federal government to make sure that that could never happen. So, basic things, like negotiating for prescription drug prices, making sure that hospitals are paid — we use what’s called a global budgeting model in this bill — making sure that hospitals are paid — by the way, this is a system that most industrialized countries use, and Maryland has just started to use, with some very effective results. So, cost containment, universal coverage. If you’re sick, go to the doctor. We want you to go when you start to get sick, not when you’re so sick that you have to go to the emergency room and it costs us so much more.

Physicians are with us — largest labor backing that we’ve ever had in the history of this bill. And it is making — I think it’s making a real difference for people to know that we are ready to fight the industry lobby that’s out there, that Alex Azar and others want to, you know, continue to support.

JUAN GONZÁLEZ: Well, Congressmember, you have 107 co-sponsors of the bill, but there’s still opposition even among the Democrats in the House. And then, of course, you have the Democrat Senator Stabenow from Michigan who’s pushing a Medicare at 50, a bill that would just cover Americans 50 and over. What do you say to those critics, especially within the Democratic Party, that say you should take an incremental or partial approach rather than a whole Medicare for all?

REP. PRAMILA JAYAPAL: Well, first I would say that the Democratic Caucus is united around making sure we shore up the Affordable Care Act right now. We do have to fix what Republicans have stripped away even from that accomplishment. However, I do not think that you can really guarantee universal coverage to everybody and contain costs by nibbling around the edges. And with lots of respect to my colleagues, who are, you know, just trying to expand Medicare, buy-in at 50, things like that, that is not going to accomplish the deep sickness of our for-profit healthcare system. We have to take that on, if we are going to provide universal coverage. And Medicare for all is really the only plan that does that.

And, you know, as I said earlier, this is the first time we’re including long-term supports in our Medicare-for-all bill. And that is also very important. If you look at the statistics around this community, that has disabilities, our elders, who literally are not getting the care they need, unless they get so poor that they have to go on Medicaid, and then, in that case, it’s institutionalized care that’s the default — we need to allow our folks with disabilities and our seniors to be able to get good care in their homes and in their communities. So, our bill also switches the focus from institutionalized care as the default to home care, which is significantly cheaper than institutionalized care.

These are — you know, when I think about the United States — and you played that clip about all the things we have been able to achieve in this country — providing universal care, healthcare to everybody, taking it out of the for-profit system, that seems just like something we have to do economically, but really it is the right thing to do. It is a human right that the United States should be leading on.

AMY GOODMAN: You know, people immediately say, “Well, you know, this, whatever you’re proposing, you’ve got the Republican-controlled Senate, etc., and then you have Trump.” But in his 2000 book, called The America We Deserve, Trump wrote, “I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by health care expenses. We must not allow citizens with medical problems to go untreated because of financial problems or red tape. The Canadian plan also helps Canadians live longer and healthier than America. We need, as a nation, to reexamine the single-payer plan, as many individual states are doing,” he said. That’s President Trump. He didn’t say it as president; he said it in 2000. But what about this, Congressmember Jayapal?

REP. PRAMILA JAYAPAL: Well, I think that’s one of the most wonderful things about introducing this plan and working on this plan for the last year, is that there are lots of people who are not liberal Democrats who believe that this is the right thing to do. At our press conference, we also had a series of employers who are part of a business coalition for Medicare for all, who talked about the incredible amount of money that employers are spending, for really good plans, sometimes $35,000 per employee. And so, they did the math and said, “You know what? This is a drain on our competitiveness, our ability to compete in the global economy, when we’re paying this much for healthcare. We would be happy to just pay a portion of that towards the federal government insuring, take the waste out of the insurance company system and bring the cost down and be able to provide comprehensive care.” And so, I think that we’ve seen that from business owners. I have had small business owners, who are Republican, who don’t agree with me on many other things, come up and say to me, “Look, I don’t agree with you on this or that, but, please, get this plan done.” And I’ve even had hospital execs and people who are high up in the hospital industry say, “We know the association may be saying they’re against this, but we know it’s the smart thing to do.”

So, I actually think this is a plan that unites Republicans, Democrats and independents. It’s certainly what the polling shows, that people are with us on this. And I think that Donald Trump is reflecting, in that book, the reality. Now he’s come into the Oval Office, and his Cabinet is designed to protect some of these people who are making profits from the existing system, who are terrified that the goose that laid the golden egg is about to have its neck chopped off, and so they’re trying to protect that system. But the truth is, if we want to provide universal care, this is not a radical idea. Every — almost every industrialized country in the world already does it. They’re paying half the cost of what the United States is paying, and their outcomes are so much better, and they are more competitive, because this system is being provided by the government, as it should be.

JUAN GONZÁLEZ: Congressmember, the issue of the insurance companies, we all — or, many of us remember, during the Clinton administration, the enormous amounts of money that the insurance industry spent to scuttle the Clinton health reform. Then, during the Obama administration, the Obama administration sought to make an alliance with the insurance companies and offer them increased market share for the creation of Obamacare. You’re talking here about putting the insurance — the health insurance industry essentially out of business. What would it take to be able to get this kind of legislation passed, given what is sure to be a life-and-death struggle by the insurance industry to bankroll hundreds of millions of dollars to stop this?

REP. PRAMILA JAYAPAL: Well, we don’t say that insurance companies can’t exist. We just say, same as Medicare, that you can’t provide duplicative coverage. So, an insurance company can’t have a plan that provides the same thing that is in our Medicare plan. Now, if insurance companies want to come up with other plans that are beyond the scope of the services that are provided under Medicare for all, they are free to do that. So they would have to rejigger themselves. And, obviously, we have expanded the range of benefits that are provided. So, we think it’s pretty comprehensive care. They won’t have the space to provide certain things, like vision, dental, through Medicare Advantage, because those will be incorporated. So, yes, they will have to rejigger themselves.

But we know that they are going to pour, I’m sure, hundreds of millions of dollars into trying to defeat this plan, and just the talking points that you’ve already mentioned are out there. But what we have with us is the American people. We have people who have family members who have died because they can’t afford their cancer treatments; people who can’t get insulin treatments, and they have died; people who literally are in the hospitals with bills that are $20,000, $30,000, because they went to an out-of-network provider; people who are trying to decide between paying rent and paying for their medical treatments; people who are foreclosing on their homes; people who are going to GoFundMe campaigns as their primary insurance plan. Americans across this country know that is unsustainable. It is the single biggest issue for Americans — red states, blue states, rural, urban, you name it.

And the letters that I have gotten, Juan, are just stunning, you know, when people write to me. A gentleman with a disability, who’s on employer healthcare, he’s covered, but he’s paying $35,000 in premiums and deductibles, out-of-pocket costs. Another person, who has HIV, and medications cost $5,000 a month, and he is stuck with, you know, trying to get a job that covers that, even if he hates the job. So, the stress on people when they go to bed every night and wake up every morning, I think, is the thing that we have that will counter all the hundreds of millions of dollars that are out there. And then, allowing people to really understand what they’re getting is going to be very important, which is why your coverage and other people’s coverage is essential, because they will try to tell a lot of lies, and we need to get the truth out there about what this plan is.