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tv   Washington Journal Maura Calsyn and Benedic Ippolito  CSPAN  August 29, 2019 4:36pm-5:34pm EDT

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quick sorry, we lied about you, would be nice. to all those who spent two years talking about me going to jail or being alive, ask yourself why you still trust people who gave you that info for so long including the president. the white house reacting to the news releasing a statement, james, is a proven flyer. it went on to say he shamefully leaked information to the press and blatant violation of the fbi policies. you can read the full report, all 83 pages at c-span.org. >> healthcare in particular this morning, report by spark whose health policy managing director for the center for american progress in our research fellow with the american enterprise institute. we stood the first hour hearing from viewers on what they thought about improving the u.s. thg healthcare system. so far, we've heard a lot from democrats the biggest item is what's called medicare for all.
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how much traction do you think it has on the campaign trail for bernie sanders and others you support medicare for all? >> i think what do viewers mean onby medicare for all? there's a lot of different visions for that. what's gaining traction is this idea that the affordable care act was the starting point having built on that. there are still people who do not have coverage. people have a lot of concerns about their out-of-pocket costs and what's the best way to build on daca. medicare for all has been by sanders one of thee. different proposals out there. i think it's easy to kind of look at them into three different pieces. bernie sanders, none more incremental plants. o >> where they stood on healthcare.
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at the time, they had 23 candidates. all of them are for the expansion of daca expanding affordable care act coverage. what do you see in terms of care for all and traction for that among the democrats? where do you see potential stumbling blocks? the first is exactly the right point, one of the talking about? difference inig what might the stumbling blocks might be. at least a high level, they poke quite well on thebo democratic electorate. however, one of the things that becomes clear is once you start talking about the trade-offs or task, it really dwindles. what you see is that the majority of democrats certainly
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support medicare for all at a high level but that lipsf wanto talk about what if you have to lose an insurance plan? it's a long way of saying that plans that do less of those things, less tax increases and less destruction to your health insurance, to have more traction. >> the potential for what the cap administration does, they spent a lot off time preventing further expansions of obamacare, affordable care act. president promised a potential healthcare plan before the election m year. what might be in those plans? >> your guess is as good as mine. >> i don't think the president has a plan. i think thehe plan is that there is one that comes up beforehand. well, i should take the president has a plan and that is to repeal the affordable care
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act in the texas versus u.s. case. there's something he thinks will replace it for other experts think will replace it. i would imagine it will look like daca. i think it's -- maybe some tweaks around the edges that i think that, i don't know how they welcome up with anything else at this time. >> one thing that's clear since the election of donald trump, they haven't really had a unified one but i do think the experience ofth what we've seenn the last two or three years has been important. if we think about a world in which bernie sanders filed medicare for all, there's one insurer and it is the federal
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government. let's think about what the administration has done. the elimination of individual mandate is a lawsuit trying to undermine the entire aca. we've seen title x and all of a sudden, i would say people thinking about this system is, what if somebody you don't like is in charge of that system? that speaks to one of these stumbling blocks. choice is good in some cases. >> joe biden said he supports expanding the affordable care act in adding public option. how would that work? >> it would allow everybody who's in one of daca marketplaces the option to purchase a plant that is designed by and has payment rates set by the federal government. the idea is that the affordable carere act has competition in certain areas but there are a lot of people in places where
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people do not qualify for help under daca are increasingly finding it unaffordable because of the trump administration. he would have a public option which would be more affordable for people, and to help people get under the affordable care act. >> we welcome your calls and comments on healthcare. what would you do to improve it? they continue this week on "washington journal". during the conversation. reluctance to a 27,488,001 democrats 2078000. -- a plan that would allow private insurers to continue under medicare advantage.
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they got some pushback about the role of private insurers in a potential medicare for all system. how would senator harris' planned work? >> center harasses stumbling around on this. there are some challenges that come with these. medicare advantagelk style, i think it represents a much more plausible version of medicare for all world. medicare for all, what we have seen is a large gravitation toward the public private partnership as opposed to a purely public system. we've seen this happen in medicaid as well. what she seems to have stumbled on a bit is actually i think a more plausible version of the world where basically, the sick private insurers, here's money, you figure out how to provide these benefits. then we'll go from there.
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the details of course are important for that but i would say that is much closer to a more plausible support. >> i think that is correct. one of the pieces that is interesting about that, it goes back to your first question about what medicare for all means. it's a current medicare system that is both public and private. what's important about her plan is that she would impose stricter rules on private plans and to make sure they would get the benefit of a lot of the influx of people they would have to place by the terms of who will be covered and things like that.
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the devil is in the details as always. it's a good thing to have though in healthcare is such a huge part of our economy that having variations of people thinking about these issues more and more is really important. >> we had a caller talking about pharmacy benefit managers as a real issue. political size 15 of the candidates declared a position on drug costs. this is also an issue for president trump making some initiatives in the first three years of his presidency or to tackle drug costs. where are we on any of that? >> we've seen a few things. we've also seen them making headway on this, they voted out a bill that is a bipartisan bill that included a number of overhaul to put back programs like medicare restriction drug benefit aimed atti trying to impose some market discipline on the drug crisis. it's quite clear this one of the
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most bipartisan issues for the voters that they are simply too high. the president has quoted some unusual plans at least for a republican in the sense that he is on boarder with importing frm out of the country and using international leverage, will pay for other countries pay plus extra. neither of those is a traditional plan and both are with challenges. it is certainly unexpected. >> i think what we will see, we will hopefully see something come out from the head of representatives and head of leadership. will be interesting is the comparison between that proposal what we have seen from us and administration. one of the things that is really challenging is the prices are really high for all americans, not just people with medicare.
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how can policy makers and law makers start to tackle the overall list price of these productsts and bring some relief to all people regardless of whether or not they are enrolled in medicare? >> we welcome your calls and comments on camping 2020, the focus is on healthcare.. let's go to tennessee on the republican line. >> good morning, thank you forer taking my call. i'm an insurance agent. ten years ago, the health insurance in the program was $1000. once the bill got up to $5000, the insurance company paid one
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100%.ha because they screwed up, the cost is $10000 deductible. 15000 or 20000 and two, three, $4000 a month. if it's not broke, don't fix it. insurance agency brought in business and the national average. but the stakes handle it. >> the insurance agent there. >> the affordable care act from one of thego big problems is tht they continued what is tradition at this time, which is week subsidized healthcare very
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explicitly and with a lot of money. however, we'd be much less to control the cost of healthcare. i don't think it is a surprise that will we have seen as long as prices keep going up, once you hit your maximum, that's not a great system.nt we are trying to actually control the cost of healthcare.o so it's not surprising we've seen best. >> one of the states that has had this expansion of medicare. >> i would take the collar is glossing over a lot of problems of the individual insurance market has for daca. it worked perfectly well for people who are healthy, younger, who were not women and aca did provide critical protection for people. iis think i agree that the
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underlying insurance is going up because the prices we are paying for these services are going up. we talked about drug prices but they are only a part of the cost of hospital care going up and we are seeing that this is one of the challenges with any sort of medicare for all. their vested interest is in keeping them high. >> good morning. thank you for taking my call. i hate to be too simplistic but it's my understanding that congressman and senators get healthcare for life. until, if that's correct, retirement, if you ever want to have any changes from take that from senators and within a a we,
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i promise you that c there wille changes. insurance money pays for these congressmen to get elected. there's a big lobbyist in the government. so take the money away, take the healthcare away from the clowns that are up there making excuses of this and that, the democrats destroying healthcare. the republicans don't want to pay for nothing. i don't want to hear that crab. take their healthcare away and you will see a difference tomorrow. >> will go to morgan joining us from nashville. good morning. >> i was curious about this. we pay for government and workers paychecks, militaries paychecks. and we pay for their free healthcare. basically, we pay for everybodyc
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else's healthcare and we don't get any. we are like the shoe banker that has no shoes. our taxes go to pay their paychecks. our taxes go to pay their healthcare. they get free healthcare.. it's like the working poor formerly known as the middle class are supporting all of these other people's healthcare pand we don't get it. i don't understand why people aren't listening to bernie sanders. this is like a no-brainer. we pay for everybody else's but we don't get it. why is that? >> we've heard from bernie sanders on his plan. about how much would that be? >> independent experts on both the right and left estimated that by taking all of the healthcare costs and putting them on the federal government,
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it would cost somewhere around $30 trillion over ten years. >> which is not pocket change. >> no. >> so what's the argument bernie t: make?will if you institute hisan plan, thy would pop the money to pay the premium and we would collect it as taxes. you still have to collect the money. that is a massive stumbling block for any plan like us. part of the reason why some people like joe biden, even bernie sanders last campaign for example included a wish list of taxes to finance his plan. that was sort of about $17 trillion short over a ten year window. bernie sanders campaign can't come up with a list of ways to pay this, we are talking about something else. >> bernie sanders completely did
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away with the role of health insurance? >> yes and no. he basically says, you cannotll compete with a single payer plan. however, we seen some recent changes to his rhetoric where he said well, yes but unions for example, if they negotiate for benefits as part of their contract, they can still do that as long as there wraparound plans which speaks to this idea of we are really one 100% comfortable with the idea of health insurance banishing so it's a kind idea where americans maybe aren't fully on board with medicare for all. >> i think there's something in between, for example the biden plan and senatorwe sanders singe payer, everybody just under one plan. those are plans like anderson have a plan called medicare for
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america which has some of the same attributes of kamala harris isf more recent plan. i would seek in place a private market for employers who want to offer insurance. ise idea is to keep choice, keeping employers in the market and allowing the federal cost to go down. it's possible to get everybody automatically enrolled in a medicare for all plan and keep other in the system and dramatically reduce the costs. it's really about the levers. >> 162 americans get their healthcare through their employer and they pulled the acceptability of single-payer, they say in favor about 51% of those, 40% on the party side, democrats 72% favoring single-payer health care plan according to the family poll in
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july and independent 55% republicans, 15%. next up on the democrat line. >> i think it is misleading, the cost ofs healthcare in the u.s. would be 50 trillion in the next ten years.. he said the cost of the plan would be 30 -- 40 trillion. a lot of the money is already paid by the government. you have medicare, medicaid, you have the money for healthcare in this country. second, american progress is really a place for future
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appointees. they're talking about the public option. that takes one real example in the u.s., washington state. it's not working too well. medicare fors all in canada, canada is a very effective system. it's very popular, 90% approval, its capital cost. they do have higher insurance. it's very limited, very inexpensive. in legislation medicare for all, i think there would be a very limited role for private insurance. sanders offers a menu of options of how to pay for it. the next person who talked about
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bill clinton, it's a range. it's a lot more than the average income. the average worker earned $60000. >> thanks for that. you served in the department of health of human services. >> yes. i was a lawyer during the obama administration but also previously, i was a career lawyer. i worked with both the bush appointees and obama appointees. i would sayut i think the colors correct and that we've been talking a lot about the biden public option and i think that a detriment of a lot of the other proposals in the second bucket n talked about, there is, there are ways to get universal coverage that are not a single payer option. the public option doesn't get you there. if you have automatic enrollment
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in the plan is to default medicare think the default andit people opt out of it from an organization i worked for the caller mentioned, we have our own plan that again keeps our role for privater insurance but we have a default automatic enrollment so it is far more expensive than that plan. >> he said upland wasn't working, i'm not sure how expensive the public option plan is. is there an example in the plan like that were similar to the works that iss working. >> the washington plan is really just up and coming now. we haven't really seen that yet. there are ways to really design it and there's a myriad of different options. i think what the public option does is it addresses a specific set of people were unable to get coverage through their employers and having a hard time getting coverage in the marketplaces. it speaks to the patrick we have here.e
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the desire a lot of progressiv progressives. centralized system whether or not it includes public or private insurance. >> lower prices and in canada, other lessons to be learned from the canadian system? ... n about drug importation -- it has this feature that frankly i think a pewter care -- a pure medicare for all plan has -- it is simple. we can finally find this whole thing down. however, the however there are realities that this could be problematic. for example the idea of importing drugs from canada. canada has 35 million people. pfizer is a practice sin drugs
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for another 330 million drugs to canada and have them ship them across the border. i don't know why that would be a priority of any federal or state legislator in the united states but that strikes me is the more realistic plan. doesn't mean there aren't lessons from canada which has a system that in some ways has a type of federalist arrangements that he hath but i think it would be the over -- overly simplified version. >> host: next up in westchester, ohio. good morning, republican line. >> caller: our focus is insurance during all of these debates at in the focus really should the health. we spend approximately $500 billion a year in smoking-related disease, trauma associated with driving under the influence and shooting one
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another etc.. those costs won't go with regardless of the insurance choice that we make. the only way tof really solve this is a radical change, when the changes are behavior. all public policy should focus on health. for example we should take, and they realize -- i've studied this for so many years now but we should take those particular costs associated with their choices, take it out of insurance, put it into a state system that is like a payroll production tax for high-cost, high-risk choice. as a result it's 100 100 to $15a month to pay for those choices. if we were to educate the american public to realize this is why your insurance premiums are part of why your insurance premiums are so high then what we would do is we take that out
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of insurance and insurance costs would go down together thing it would do is give the medical community the correct incentives which is wellness and general health. right now we develop drugs like for instance for itce idiopathic pulmonary fibrosis. that costs $100,000 year. keeps an individual living may be an additional six months to one year and the key was to prevent the individual were to give people incentives to be healthier not to smoke in the firstot place. but as long as you know right now health care costs are $9000 a year per person in the united states and its almost 18% of our gdp. no insurance regardless of the plan will ever solve the issue. the only thing that will solve the issue is changing our system toward health. >> host: thanks for that deborah and the issue is smoking and vaping very much in the news the front page story about the
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baby related illnesses being linked to thcer use. ben ippolito your thoughts on in terms of these high-risk -- >> guest: one of the things i heard in the comments that is 100% right is that we do really a really good job of paying for things regardless of frankly how good they are so what you have are these perverse incentives were sometimes when people would be able to use drugs for example the way medicare pays for drugs in the hospital and actually encourage his a focus on very expensive and not very high-value drugs. i would actually point to something that is going on on the hille right now in congress where there are real bipartisan efforts to reform the way that we pay for drugs in for example the medicare program to try and give insurers the incentive to not have patients on these extremely highie cost to a
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relatively low value drugs and instead tilt the scale toward some of these higher value your lower-cost drugs. those are the changes if they want to get back to reality from a true overhaul the system those are the kinds of instrumental changes that she points to that are absolutely worth taking wplace in do we should have a t of focus on right now. >> host: maura calsyn. >> guest: there's an increasing focus on t a lot of issues and i would go broader than smoking. there is ad real process of trying to think through what health wonksl and medical professionals called the social determinants of health so thels fact of where you live, your housing, your access to healthy foods and how that impacts your health. there is just a lot of interesting pieces of policy debate and academic research going on about that. i think that we are starting to see for example medicare including some of those social
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returns and health. >> host: next up david is an florida on our republican line. go ahead, david. >> caller: thank you. i am a retired registered nurse. obamacare was never voted on by any republican to the first thing the house of representatives did was to exempt themselves, their staff, their families from obamacare. ms. maura calsyn is totally clueless, utterly clueless. the amount of premium has skyrocketed. the amount of coverage for the average family has diminished and it's infuriating because
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obamacare has ruined the emergency rooms. they have earned the hospitals. get the government out of health care. they know nothing. they have ruined basically everything that they have touched when it comes to health care. those who you're shaking your head. maura calsyn goo ahead. >> guest: i don't even know where to start. florida has not expanded medicaid and there are a lot of resources by emergency rooms especially in rural areas that are struggling but the decision to not expandd medicaid is one f the key reasons. i will just leave it at that. >> guest: when the plan was voted on and implemented by the obama administration was the expansion of medicaid to key an integral part of that? was anticipated to be as big a
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deal as it has become? >> guest: when it was implemented it was part of the law. it wasn't intended to be optional. it was a supreme court decision that gave us the option to opt out and not expand. the result that states haves and have-nots with this day. >> guest: . >> host: we have seen that in the data mainly southern in some western states. guess who you're seeing it in correlation with a lot of her hospital cultures and where also seeing it with the uninsured. >> host: ben ippolito. >> guest: i don't think you are clueless. i would say the affordable care act or obamacare may crystallize a few issues that were percolating under the surface
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and on the forefront of a lot of americans understanding health care. health care costs have been going up for a long timet . insurance is extremely expensive. now it's up to an average family plan is something like $25,000 a year. that's like buying a new toyota camry every year for your health care. that's a lot of money. in the obamacare market nothing is more salient and to some extent i think that's good. we need to grapple with the fact that again i'm not the biggest obamacare supporter. that's where i would hate obamacare is that it going the strategy of subsidizing but osn't put any sort of restraints on the cost side. what we see in obama obamacare is a very explicit version of that. i don't think it prevented that problem. health care costs have have been going up for a long time and have profound influences on anything to the obamacare exchanges to the amount of take home pay the people have at the end of the day. >> host: the annual premium is
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$6,019,616 for family coverage. antioch tennessee on the independent line. >> caller: yes, hello. can you hear me? >> host: yes, we can. go ahead. >> caller: the affordable care act was everybody had to anticipate -- participate. all the sick people were the ones that got enrolled. i have medicare and i was recently in the hospital. medicare was billed 10,700 odd dollars bertie -- ct scan that takes threeat minutes. i've had several mris that took 45 minutes and they were nearly $4000. and they billed for two oxygen
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canisters that i never received and 20 and $40 per pill and i was never given, there is no way was given that because i didn't have anything to drink not even nice chip. government is good about appropriations for programs with little oversight. they review 1% of medicare claims. there so much fraud that goes on , it's sickening. i have had a question on my itemized bill and i called medicare. they didn't seem too interested. they said to call the hospital and tell them and then get back with them. i guess that's all i wanted. part b coverage of medicare when they added that medicare cannot even negotiate. that's unreal. there are millions of people on
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medicare. they have negotiation power to make prices much lower than what they are paying. >> host: thank you. maura calsyn. >> guest: a lot of what the caller was talking about our a lot of issues we are talking about today and the prices and the hospitals and the other providers the prices keep going up and that's where the cost of insurance goes up. most people with medicare unlike the caller dolsey that necessarily. i think that also goes to a lot of political pressure that a lot of congress is seeing already. it's the exact same issue where there are a lot of excess profits in theof system that hospitals and doctors are charging. as soon as those are at risk the lobby kicks into high gear with
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a lotat of dark money. that's one of the big challenges we are talking about with any reform. it's a large part of why it includes some of those pieces. >> host: there've been several hearings on surprise medicalar bills seemingly a bipartisan issue with modern health care reporting legislation is that now by provider lobbying. you said the money. as i was we are referring to the lobbying against some of that legislation? >> guest: yes, large amount of that money has very friendly names like patient provider partnership. i probably just named a group that's perfectly fine i don't know but you see a lot of ads that have a lot of scare tactics about how any increase in payment and any decrease to the system is going to suddenly have a terrible effect. those scare tactics have always been very effective. those who we have been playing some of the comments on some of
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the candidates. i want to share a common type keep buttigieg in his proposal on mental health care issues. >> today we have been traveling the state talking about the problems, the crisis really an mental health and addiction. it deserves to be named and it deserves action. olivia can this be treated as a marginal issue or specialty issue because it is x. all of us , all of us. postel what does that look likes it means enforcing parity so health insurance companies actually have to treat mental health conditions and provide from and to help visits as much as we do for physical health. [applause] it means training our police officers and their teachers on how to recognize signs of mental health issues but also equipping them with the place to send people when they do identify those issues by making sure we have the providers that we need when it comes to mental health.
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[applause] it means building up our defense as the country air defenses to the risk posed by mental health addiction and suicide risks. you got to be a three digit number linking to the suicide or mention hotline so it's that easy to tell somebody where to go. [applause] and it is time to break the silence that has people struggling with mental health issues or addiction thinking that they are long because one in five americans will experience a mental health challenge. people who are experiencing that need to know and their loved ones too that there is nothing to be ashamed of. would need to talk about these issues as openly as we would talk about cancer or a twisted ankle or diabetes because lives on the line. if we get this right, if you just do the math on deaths from despair from alcohol drugs and suicide and lookhs at what will happen next in years if we don't do something different, it means if we act, if we can cut in half
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the deaths from despair in this country willof save 1 million lives. how can we not? how can we not do that? [applause] >> host: ben ippolito of the american enterprise institute he talked about a lot of things but why are mental health issue seemingly treated differently on different health care plans than regular health concerns? >> guest: it's a good question and i don't think they should be. think it's the probably the fact that we treat things that we can observe and we can observe things better mental health issues. i have to say it was at the national institute of health training an issue near and dear to my heart if you think about it one easy way to think about it isab a simple question how do you feel today and whether it was a physical problem or a mental problem it doesn't natter. if you wake up in the morning and he feel that, that's a
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problem in nasa we are trying to get out. with health insurance and health care and so on. this idea that mental health up it be treated in some sort of similar fashion as physical health seems like it might be a good moment to hammer that home. >> guest: i agree completely. two things that need to increase the number of mental health providers especially in rural areas. and explore ways to do that perhaps by loan forgiveness and things like that. also we need to make sure that insurance companies and all insurance systems including medicare and medicaid are really paying appropriate amounts and something we keep talking about in places where there's there is too much money in the system. this is an area where there are more incentives for people to accept medicare and medicaid and private paid patients. >> host: the medical health care field professionals, not
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health care professionals -- professionals as an attorney and a research fellow and now the american enterprise institute what first interested you about health care? guess who in some sense it's everything. as a normal citizen is hard to about policy issues that are more relevant. it is 20% of our gdp. weth have some of the biggest programs like medicare and medicaid and so on. it's all centered around health but as an american what is more fundamental to your ability to do everything we study in economics, workom and all of th. it's health so the end of the day it set the root of just about everything i care about. >> guest: i think for me well before i got to high school or college i was seeing my grandparents in the hospital and
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one of my grandfathers was a doctor who i've never met but i had always heard about the work he had done and again we all have interactions with the health care system and we all know people who have had health care interactions every single day. i also started in college it health debates i found that really interesting. it's the experience that is so fundamental to every other policy issue and everything else about her country. >> host: we will go to david in michigan next onn our democrt line. >> caller: hi, good morning. a couple of comments. i would just like to give a warning to the country in general of the looming health care crisis coming. one, we have an increasingly aging population and two, a number of physicians are getting out of medicine be because i am
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a position myself to the public health care, it is not health care anymore. it's the business of health. there are lots of t people whetr it be insurance companies pharmaceutical companies. a lot of people are taking money out of the system and a few callers mention we are looking at health care representing 18 to 20% of gdp. that's a lot of money. my proposal is the whole system io scrapped. a condition of health care such that we are putting a band-aid on a leaky roof. imagine if you would abuse a model that was similar to the military where we pay her taxes and we contribute to the military and the military takes care of common well-being, that's not the correct word. safety and our defense. imagine if we used a system like that in health care where we all paid inton it and we are notnt worried about what they mainly
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we paid etc.. health care is very simple. simple to take care of patients with there are too many people who are incentivized to make the system difficult. it's very to take care of patients. it's very easy to take care of the physical and mental health of our population. it is not difficult but we have too many people who are incentivized to make it difficult and as i sit and listen to your panelists i hear a lot of words but i don't hear a lot of solutions. i am arguing for a very simple and simplified health care system and maybe a model like that is something for the future. it's a big ask. >> guest: it sounds a lot like the bernie sanders medicare for all single-payer option. >> guest: which sounds simple and i agree end of honestly if i were writing a cam pain message for democrats and i'm not but if i was i would really emphasize
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thatha point. that doesn't mean it's easy to do and that doesn't mean it's the best plan. i don't think it is personally but it's simple but it still has to overcome all of the challenges that come with that plan. you still have to raise all of that on the to pay for it. you still have to design the plan.d you still have towh be responsie to what people want so ordered so forth and i totally am sympathetic to the idea that there are places in our health care system where we are not even remotely as efficient as wish could be. that does not mean private plans or drugmakers add little value to the system. i think if we think about realistic policies that don't involve blowing everything up and replacing it with the va then we havepl to start thinking about how this public policy, are those private actors the right incentive to actually move toward a more efficient system? that's the thing we need to
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think about. plus who we are taking about health care and on twitter one for you mr. ben ippolito. ben ippolito wrote a piece on biologicals and bio similars. can you give us a primer brief on what each drug is and how these drugs could save money and why they are different from generic? >> guest: this is one of the biggest issues in pharmaceuticals right now. a smallll molecule drug is easyo make so that means when a drug loses its exclusivity it's easy to copy them when we get cheap generic drugs. there are new drugs that are very exciting that treat all sorts of various issues but they are much more complex, literally cost hundreds of millions of dollars just to manufacture. it's very very expensive and the question is is our current regulatory setup appropriate for
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these new expensive drugs and i think the question is ultimately going to come down to a simple one but a very challenging one which is how much innovation do we really want to encourage here versus how much do we want to just hammer down these prices when exclusivity runs out pics of the hard question and i think the current regulatory environment shouldn't be giving up on it quite yet but we are very much in the early years of this and it's going to be something that's going to be incredibly important to watch. >> host: maura calsyn? >> guest: is important to point out that anyway of getting a bio similar and a new approach put in place by the affordable care so it's one of the many pieces of the affordable care act, it's a lawsuit to completely put it away and, i'm sorry not put it away, to repeal it. in them t ability to have it st speaks to the fact that there
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are a lot of pieces of the affordable care act that are now a central part of the infrastructure of how we have health care inf this country. >> host: we will go to bryson in chestertown maryland on the republican line. call for goodd morning. i have a couple of comments. first of all back to the physician that talked about blowing up the system. i don't think we necessarily need to blow up the system but has anyone in government thought of combining medicare and medicaid, the va, the perceived golden health care plan that the congress and senatorsat have ino one system and then you save money by not having three different administrators and secondly, several callers go the lady that talked about the middle class that was covering all these programs and yet she
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said why don't we get our health care? i am befuddled by all these people that think when they get medicare like me or medicaid or or whatever for free it doesn't cost comment it cost me about $4500 a year for medicare with my supplemental and my drug program. nothing is free. anyway. let's appreciate that bryson. is there an efficiency to be gained by combining health care plans? is anybody looking to back? >> guest: there has been a lot of research and there are a lot of plans out there again like the medicare for america plan that does actually combine all those pieces into them medicare type plan and keep some part of the employer market on its own. there are lots of ways. for example if you have the same
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rules about how much they pay and how they paid you can save a lot of money. for japan. for example those tht prevent thousands of individual plans. >> guest: it's interesting whoever did this conversation with health care we hear about lots of folks to get their insurance from the va. >> guest: the va you love it or you hate it. some concept a lot of people really love it. the closest a true vertically integrated plan and provider that we have inn this country. that said it does has its issues related to wait time and quality are major issues. the one thing is not a crazy idea at all.
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the idea that we could streamline the fragmented system where we have medicaid and medicare and so on. if we were going to do that with probably want to implement what exactly medicare and medicaid are doing rightle now which is giving insurance companies a pot of money and saying look here's what you get you figure it out. we have seen some success. >> host: let's hear from david in los angeles california. go ahead. >> caller: good morning. this is a very telling conversation between the two of these guests you have here today. each one presents as though they don't have a particular dog in this fight. for example they keep undermining solutions brought forth by bernie sanders. it would be wise if we would have someone from bernie sanders medicare for all arguing his point as opposed to these people
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doing it. they both have an agenda and they both maintain the status quo. the money is in the problem and they hire people like your two guests here tole perpetuate ando maintain no solution to keep the same madness in place. i would suggest to you, are you still with me? >> host: we are. >> caller: i would suggest any time you're dealing with two variant different -- differences, let's say points of view talked to bernie sanders on this to discuss this because these two people are being paid by their areas whoever they are owners are. >> host: we have had bernie sanders and all of the candidates on our coverage most recently for example the iowa state fair.
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but maura calsyn if you want to win. >> host: guess i worked for the center for american progress and all of our donors are on line if the caller wants to take a look. i think that it is inaccurate to say that i had my colleague at the center for american progress have not put forward transformational universal coverageon proposals. we just happen to keep some pieces -- if we had a great medicare program people vote with their feet and we'll see what happens over time. >> host: and to be fair we have our guests on, many of our guests are policy experts in the area of health care. ben ippolito. guess why don't begrudge anybody for liking bernie sanders. it's another option but i think it's wrong to say we are misrepresenting some of the challenges. there are practical issues that
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those kind of plans have. if bernie sanders in his campaign want to propose for example way a way to raise the money that they would need to do that plan i would loveld to see that generally but they can't do that so it's hard for me to sit here and say i support a plan that costs $17 trillion over 10 years. >> host: one more call evelyn, good morning. >> caller: good morning. thanks for taking my call. i just wanted to say that i have great insurance. i have medicare and i have tried care for life. i had a heart attack in december and i have had two heart attacks actually. i got my same cardiologist that i had 10 years ago. i had excellent care. i didn't haveha to pay anything. everything was paid for me by medicare and tri-care for life.
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a month later i had a g.i. bleed. i'm almost 93. i will be 93 next month but i had a g.i. bleed and i had to go back in there and stay six more days. i had excellent care all the time. i had all my nurses and the doctors were just wonderful. as far as my prescriptions go i get thoset from express script. i have to pay $7 even if i have to take three pills a day. i can get that medicine for $7. >> host: atlanta we are glad you are with us this one from tennessee. the just ben ippolito with american enterprise institute and maura calsyn with the center for american progress talking about health care. as we wrap up as you look ahead to the 2020 campaign, if you have to project what you think
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the republican plan will be in terms of health care what might be the final democratic platform and i will start with you maura calsyn. >> guest: i think that we will see i think it very much depends on who the nominee is. there's a start difference between republicans and democrats. it comes down to democrats, whoever the nominee is is going to have a plan to lower costs for people who are struggling right now and expand coverage and i think president trump's going to have a hard time coming up with a plan that doesn't raise costs for people and increase the number of uninsured there is still that texas there. hanging out >> host: we think the health care plan would look like if we see a likely nominee? >> guest: i suspect there will probably in be more focus on prescription drugs in less on the portable care act because it's kind of a minefield with
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the lawsuit to overturn the ace a hanging out there. it's unusual to say but i think he's going to be talking a lot about doing things like importing drugs for the country. going to talk a lot about it and putting the pricing systems of our country and slurs are proposed for medicare part b i wouldn't be the least bit surprised if he proposes that for the rest of a prescription drug benefit. i tend to think there will be more visits on those types of things and a little bit less emphasis on to. ca issues. >> host: ben ippolito and maura calsyn thanks for being with us.

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