>> UNIVERSAL HEALTHCARE IS A CENTRAL TALKING POINT FOR MANY
DEMOCRATS IN THE RACE FOR THE WHITE HOUSE.
BUT WHAT WOULD IT LOOK LIKE AND WHAT WOULD IT
COST?
OPPONENTS OF SUCH A HEALTHCARE OVERHAUL SAY IT WOULD
BREAK THE BANK AND COULD LEAD TO A LOWER QUALITY OF HEALTHCARE
FOR ALL.
PROPONENTS, LIKE ECONOMICS PROFESSOR ROBERT POLLIN,
CO-DIRECTOR OF THE UNIVERSITY OF MASSACHUSETTS POLITICAL ECONOMY
RESEARCH INSTITUTE, SAY UNIVERSAL HEALTHCARE IS
ECONOMICALLY VIABLE.
HE SAT DOWN RECENTLY WITH CAROLEE MCGRATH TO SHARE HIS
PERSPECTIVE.
>> BASIC FEATURES OF MEDICARE FOR ALL ARE NUMBER 1, THAT EVERY
RESIDENT OF THE COUNTRY IS COVERED WITH GOOD QUALITY HEALTH
INSURANCE.
THEY ALL HAVE ACCESS TO GOOD QUALITY CARE WHICH IS NOT THE
CASE NOW. AND THEN THE SECOND FEATURE OF
IT IS BECAUSE THE WAY IT'S DESIGNED, YOU ALSO SAVE MONEY.
RIGHT NOW THE U.S. SPENDS ROUGHLY TWICE AS MUCH AS OTHER
ADVANCED ECONOMIES PER PERSON ON HEALTHCARE AND MEDICARE FOR ALL
WOULD LOWER COSTS AND EXTEND COVERAGE FOR EVERYBODY.
>> SO ALL PRIVATE INSURANCE GOES AWAY?
>> YES.
>> SO ANY PLAN THAT A PERSON CURRENTLY HAS THROUGH THEIR
EMPLOYER THAT THEY LIKE, THEY DON'T HAVE ANYMORE, THEY'RE PUT
INTO A GOVERNMENT SYSTEM.
THAT MAKES SOME PEOPLE WORRIED.
>> RIGHT.
IT DEPENDS HOW YOU ASK THE QUESTION.
IF YOU SAY -- LET'S TAKE A MIDDLE CLASS PERSON.
IF YOU SAY RIGHT NOW YOU'RE SPENDING $8,000 ON HEALTHCARE,
NOW, UNDER MEDICARE FOR ALL YOU'RE GOING TO SPEND $800 A
YEAR FOR HEALTHCARE AND YOU'RE GOING TO GET TO CHOOSE ALL YOUR
DOCTORS, ALL YOUR PROVIDERS, WHICH ONE WOULD YOU RATHER HAVE?
>> AND THEN THEY MIGHT SAY TO YOU HOW MUCH ARE MY TAXES GOING
TO GO UP BECAUSE A FEW DIFFERENT STUDIES HAVE TALKED ABOUT $32.6
TRILLION OVER THE FIRST 10 YEARS AND THAT'S FROM CONSERVATIVE
GROUPS AND FROM SORT OF THE CENTER GROUPS AS WELL OR THAT'S
FROM YOU?
>> NO, NO.
SO, YEAH, BUT WHAT YOU FORGET IS UNDER THE SYSTEM WE HAVE NOW FOR
THE 10-YEAR PROJECTION WE'RE LOOKING AT $55 TRILLION SO THIS
IS ACTUALLY A BIG SAVINGS.
THAT'S THE THING THAT PEOPLE FORGET.
WHEN THEY MAKE THESE COMPARISONS LIKE SOME OF THE POLITICIANS I
WON'T MENTION NAMES, MAKE COMPARISONS THEY SAY WELL, THIS
IS GOING TO COST 35 TRILLION.
THIS IS GOING TO COST 50 TRILLION OVER 10 YEARS, AND
THEY'RE NOT OFF IN TERMS OF THE BROAD RANGE BUT THE PRIVATE
HEALTH INSURANCE SYSTEM, DOMINATED SYSTEM THAT WE HAVE
RIGHT NOW IS MORE EXPENSIVE.
>> SO YOU'RE SAYING OVER THE NEXT 10 YEARS THE SYSTEM THAT WE
CURRENTLY HAVE IF WE DID NOTHING ELSE WILL INCREASE TO 55
MILLION, THAT WHAT YOU JUST SAID?
>> NOT MILLION, TRILLION.
>> OKAY.
SO IF NOTHING IS DONE?
>> WELL, THIS IS THE ESTIMATE OF THE U.S. GOVERNMENT, YOU KNOW,
THE CENTER FOR MEDICARE AND MEDICAID.
THEIR ESTIMATE IS IF WE MAINTAIN THE SAME SYSTEM WE HAVE NOW OVER
THE NEXT DECADE IT WILL COST US FOR 10 YEARS ROUGHLY $55
TRILLION.
>> SO THE 32.6 TRILLION THAT YOU'RE TALKING ABOUT -- SO NOW
THIS ALL GETS DOLLED OUT, YOU KNOW, INTO TAXES, HOW IS THIS
PAID FOR VERSUS HOW IS THE SYSTEM THAT WE WOULD CURRENTLY
HAVE CONTINUE TO BE PAID FOR BECAUSE PART OF THAT IS PRIVATE
INSURANCE SO THAT WOULD BE PAID FOR BY PEOPLE WHO HAVE THEIR OWN
INSURANCE BUT YOUR PLAN OR THE PLAN MEDICARE FOR ALL WOULD THEN
BE DIVIDED BY EVERYBODY?
HOW WOULD THAT WORK?
>> WELL, YOU KNOW, THERE'S VARIOUS WAYS.
BASICALLY WE'RE SAYING WE HAVE A SYSTEM WHERE EVERYBODY GETS
COVERED AND YOU HAVE TO PAY FOR IT.
NOW, IN THE CURRENT SYSTEM JUST TO BREAK IT DOWN -- 'CAUSE WHEN
YOU GET THESE AGGREGATE NUMBERS THEY'RE SO GIGANTIC, YOU KNOW,
MILLION, TRILLION -- SO LET'S BREAK IT DOWN AGAIN TO AN
AVERAGE MIDDLE CLASS HOUSEHOLD.
THE AVERAGE MIDDLE CLASS HOUSEHOLD NOW IS GOING TO PAY ON
AVERAGE ABOUT $8,000 A YEAR THROUGH PREMIUMS, THROUGH OUT OF
POCKET, THROUGH DEDUCTIBLES, THROUGH CO-PAYS AND, YEAH,
THAT'S WHAT THEY PAY.
THAT'S MONEY THAT THEY PAY.
NOW, UNDER THE WAY THAT I DESIGNED MEDICARE FOR ALL, THEY
WOULD PAY ABOUT $800.
>> OKAY.
SO WHAT IS THEIR TAX DIFFERENTIAL THERE?
THEIR TAX DIFFERENTIAL THEY WOULD PAY $800.
UNDER MY THING -- I WAS BASICALLY ASKED TO WRITE A
PROPOSAL BY SIXTEENTER SANDERS SO THE DETAILS WILL CHANGE BUT
ROUGHLY SPELL WHAT WE'RE TALKING ABOUT, IS YES, YOU WILL PAY
TAXES BUT THE TAXES YOU PAY -- LET'S SAY THE $800 IN TAXES ARE
GOING TO BE A WHOLE LOT LESS THAN WHAT YOU'RE NOW PAYING FOR
HEALTH INSURANCE PREMIUMS, DEDUCTIBLES, COPAYS OUT OF
POCKETS.
>> SO OTHER STUDIES HAVE SAID THAT IS NOT THE CASE.
THAT PEOPLE WILL PAY -- A LOT OF PEOPLE WILL PAY MORE IN TAXES --
>> THAT'S NOT TRUE.
>> THE HERITAGE FOUNDATION IS ONE OF THE STUDIES.
>> IF WE WANT TO LOOK AT A VERY CONSERVATIVE THINK TAKE THAT,
THE MUR CADES INSTITUTE FOUND BY THE KOCH BROTHERS AT GEORGE
MASON UNIVERSITY.
THEY COME TO A RESULT THAT'S ROUGHLY SIMILAR TO MINE.
IN TERMS OF THE NET COSTS THAT THE COSTS WILL GO DOWN.
>> ACTUALLY, THEY ALSO SAID THAT THE REIMBURSEMENTS FOR MEDICAL
PROVIDERS WOULD ALSO GO DOWN WHICH WOULD BE A BIG CHALLENGE
SO THEY DIDN'T EXACTLY COMPLETELY AGREE WITH YOUR
REPORT.
THERE WERE SOME DEFINITE DESCRIPT SIS.
>> THERE'S -- DISCREPANCIES.
>> THERE'S DIFFERENCES BUT THEY'RE NOT AS LOW AS MINE BUT
THERE ACTUALLY WAS A NEWS STUDY THAT WAS JUST PUBLISHED 2 DAYS
AGO THAT LOOKED AT ABOUT 12 DIFFERENT STUDIES INCLUDING
MINE, INCLUDING THE MER CADES INSTITUTE, INCLUDING THE YOU
SHALL INSTITUTE AND I THINK -- I MIGHT NOT GET IT ACTUALLY RIGHT
11 OUT OF 12 SAY THE COSTS GO DOWN AND THIS IS ACROSS THE
POLITICAL SPECTRUM.
THE COSTS DO GO DOWN BASICALLY FOR 2 HUGE REASONS AND SOME
SMALLER ONES.
THE TWO HUGE REASONS ARE YOU GET RID OF ALL THE ADMINISTRATIVE
WASTE, EXCESSIVE ADMINISTRATIVE ACTIVITY THAT ARE BUILT INTO OUR
EXISTING SYSTEM.
>> WITH THE GOVERNMENT 'CAUSE A LOT OF PEOPLE WOULD SAY THAT'S
IMPOSSIBLE.
THERE WOULD BE SO MUCH ADMINISTRATION WITH A
GOVERNMENT-RUN PROGRAM.
>> ACTUALLY WE HAVE A VERY EASY WAY TO COMPARE.
MEDICARE, EXISTING MEDICARE, AND THE ADMINISTRATIVE COSTS ARE 2%
OF ADMINISTRATIVE COST WITH EXISTING HEALTH INSURANCE
ADMINISTRATIVE COSTS ARE ABOUT 12% SO THAT'S A FAIR COMPARISON.
2% VERSUS 12%.
AND A BIG SOURCE OF SAVINGS ARE PHARMACEUTICAL PRICES.
RIGHT NOW ON AVERAGE IN THE U.S., WE PAY ROUGHLY TWICE AS
MUCH AS PEOPLE PAY IN BRITAIN, GERMANY, JAPAN, FRANCE FOR THE
SAME DRUGS BECAUSE WE DON'T INTERVENE IN THE MARKET IN THE
WAY THEY DO AND SO THE DRUG COMPANIES BASICALLY EXERCISE
THIS MARKET POWER AND PEOPLE PAY TWICE AS MUCH.
>> HOW WOULD HOSPITALS BE ABLE TO PROVIDE THE CARE THAT YOU'RE
SAYING THAT THEY CAN PROVIDE IF THEY'RE REIMBURSED AT A LOWER
RATE?
HOW WOULD THEY REMAIN PROFITABLE AND BE ABLE TO CARE FOR PEOPLE
IN A WAY THAT, YOU KNOW, PEOPLE WOULD NEED TO BE CARED FOR?
>> THE HOSPITALS ARE REALLY NOT GOING TO BE AFFECTED, PER SE.
WHAT GETS AFFECTED IS THE INSURANCE PROVISION, SO THE
HOSPITALS ACTUALLY ARE GOING TO SAVE MONEY BECAUSE THEY
THEMSELVES ALSO WILL HAVE LOWER ADMINISTRATIVE COSTS BECAUSE
RIGHT NOW, YEAH, HOSPITALS, PROVIDERS, DOCTORS' OFFICES,
THEY HAVE TO DEAL WITH THIS LAB RINTH INSURANCE INSURANCE SYSTEM
THERE'S ALL DIFFERENT KIND OF PAIRS AND RULES AND THERE'S WAYS
TO GET APPROVALS THAT ARE DIFFERENT.
THERE'S DOCTORS THAT ARE WITHIN THE PLAN, DOCTORS THAT ARE NOT
WITHIN THE PLAN AND THAT TAKES A LOT OF ADMINISTRATIVE TIME AND
THE HOSPITALS ARE GOING TO END UP SAVING MONEY ON
ADMINISTRATION AS WELL.
>> OKAY.
THE CATO INSTITUTE SAID THERE WOULD BE A 40% LOWER
REIMBURSEMENT RATE -- >> I DON'T KNOW -- THAT NUMBER
IS NOT CORRECT.
I ACTUALLY WAS IN TOUCH WITH THE AUTHOR ABOUT THAT.
I MEAN, HERE'S -- IF WE ASSUME THAT ALL DOCTORS ARE PAID AT
EXISTING MEDICARE RATES, OKAY, MY ESTIMATE IS THAT PER PATIENT
EVERY DOCTOR GETS ON AVERAGE A 7% LOWER REIMBURSEMENT RATE.
NOT -- I DON'T KNOW WHERE HE GOT 44%.
>> OBVIOUSLY, HE DISAGREES 'CAUSE HE HAD PUBLISHED THAT IN
THE REPORT.
>> YES, HE DID.
SO BUT I CAN TELL YOU HOW I GOT MY NUMBER AND THEN ON TOP OF
THAT, WHICH HE DID NOT FACTOR IN -- UNDER MEDICARE FOR ALL,
THERE WILL BE MORE COVERAGE.
PEOPLE WILL GO AND USE THE SYSTEM, WHICH MEANS THERE WILL
BE MORE DEMAND FOR PHYSICIAN SERVICES.
IN ADDITION THE DOCTORS WILL BE RELEASED FOR A LOT OF THE TIME
THAT THEY NOW SPEND FILLING OUT FORMS SO THAT WILL GIVE THEM
MORE TIME FOR TREATING PATIENTS, BILLABLE HOURS.
I MYSELF TALKED TO MY OWN PRIMARY CARE PHYSICIAN AND I
ASKED HER AND SHE SAYS SHE SPENDS 20% OF HER WEEK FILLING
OUT FORMS.
>> I THINK ONE OF THE BIG CONCERNS FOR PEOPLE WHO DISAGREE
WITH YOU WILL SAY THAT, YOU KNOW, A GOVERNMENT-RUN
HEALTHCARE SYSTEM WOULD LEAD TO RATIONING OF CARE, RIGHT OFF THE
BAT WHEN WE STARTED THE CONVERSATION YOU SAID PEOPLE
WILL HAVE BETTER HEALTHCARE AND A LOT OF PEOPLE DOUBT YOU AND
THEY SAY LOOK, IF WE'RE PUT IN ONE SYSTEM IT'S VERY POSSIBLE
SOMEBODY WHO MAY BE AN ELDERLY PATIENT MIGHT BE KIND OF PUSHED
TO THE SIDE.
HOW DO YOU RESPOND TO PEOPLE WHO HAVE THOSE CONCERNS?
>> WELL, LOOK, WE ALREADY HAVE MEDICARE.
IT'S BEEN OPERATING SINCE 1965.
PEOPLE LIKE IT.
YOU MENTIONED ELDERLY PEOPLE, ELDERLY PEOPLE ARE ALL IN
MEDICARE NOW AND, YOU KNOW, OF COURSE, THERE'S PROBLEMS BUT
GENERALLY SPEAKING, IT WORKS PRETTY WELL SO WE COULD EXTEND
THAT MODEL AND SAY, WELL, THAT'S GOING TO BE AVAILABLE TO
EVERYBODY.
>> COULD THERE BE RATIONING OF CARE.
>> OF COURSE THERE'S RATIONING OF CARE -- HERE'S HOW WE RATION
CARE NOW, IF YOU DON'T HAVE ENOUGH MONEY YOU DON'T GET THE
CARE AND THAT'S WHY, YOU KNOW, 20% OF THE -- 27% OF THE
POPULATION THAT HAS INSURANCE, THAT HAS INSURANCE DOESN'T GET
THE CARE THEY NEED BECAUSE EVEN WITH INSURANCE THEY CAN'T AFFORD
TO PAY FOR A DOCTOR'S VISIT OR TO GET THE DRUGS THAT THEY NEED.
THAT THEY'RE ASKED TO GET SO THAT'S THE WAY THAT WE RATION
NOW.
THE WAY THAT WE WOULD RATION UNDER MEDICARE FOR ALL WOULD BE
MORE EGALITARIAN.
EVERYBODY WOULD BE COVERED AND WE WOULD SAVE MONEY.
WE WOULD -- WE WOULD NOT HAVE THIS MASSIVE ADMINISTRATIVE
BURDEN OVERHANGING US.