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tv   Washington Journal Maura Calsyn and Benedic Ippolito  CSPAN  August 29, 2019 1:59pm-3:00pm EDT

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a public apology from those who defamed me but a quick message but about a sorry lot about you would be nice. he goes on to say, to all those i talked about me going to jail or being a liar and leaker, ask yourselves why you still trust people who give you bad info for so long, including the president." james comey reacting to the inspector general's report. you can read that report at our website c-span.org. issues,us on 2020 health care, particularly, continues this money. calsyn,oined by maura of the center for american progress, and benedic ippolito, research fellow with the american enterprise institute. we spent the first hour hearing from viewers on what they thought about improving the u.s. health care system. so far we have heard a lot from democrats. the biggest item, the biggest is what is called
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medicare for all. maura calsyn, how much traction does it have for bernie sanders and others who support medicare for all? guest: i think the first question is, what do viewers and people mean by medicare for all? there are a lot of different visions for that. reallyhink that what is gaining traction among the democratic electorate, i think, is this idea that the affordable care act was a good starting point. how do we build on that? there are some people who do not have coverage. people have a lot of concerns about out-of-pocket costs. and the medicare for all as envisioned by senator sanders is one of the different puzzles out there. i think it is -- one of the different proposals out there. is bernie sanders' plan, there are other medical plans. host: politico had a piece on where the candidates stood on health care. at the time they had 23 candidates, but it has been
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winnowed down somewhat. all of them are for the expansion of the aca, expanding the affordable care act coverage. ippolito, -- ben where do you see potential stumbling blocks? is it the cost? guest: their first point that mara brought up is exactly the right point. what might the stumbling blocks be? at least at a high level, it pulls quite well amongst the democratic electorate however, one of the things that becomes quite clear is that once you start talking about -- and there trade-offs, taxes per support really dwindled. what you see is that the majority of democrats certainly support medicare for all at a high level. however, that flips once you start talking about, what if you have to raise taxes?
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that is a long way of saying the plans that do less of those increases, less disruption to your own health insurance, are going to have higher traction, more traction. the first hour we talked about the potential for what the trump administration may do. they spent a lot of time limiting or preventing further expansion of obamacare, the affordable care act. the president promised a potential health care plan before the election year. what might be in that? mean, i don't think the president has a plan. i think that is a plan to the extent that there is one that comes out beforehand, i should say, the president has a plan and the plan is to repeal the affordable care act. in the texas versus the united
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states case. to the extent there is something that he thinks is going to replace it or that other experts think is going to replace it, i would imagine it would look something like the aca repeal bills that failed to get through congress two years ago. some tweaks around the edges, but i think that -- i don't know how they are going to come up with anything else. guest: one of the things that has been clear since the last election, the election of donald trump, republicans have not had a unified vision of health care. over the foreseeable future. but i think this experience is quite important for discussion. if we think about a world in which bernie sanders' health care for all exists, there is one insurer and it is the federal government. let's think about what the administration has done. the elimination of the individual mandate -- there is a
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lawsuit trying to undermine the entire apa we have seen medicaid work crime -- undermine the entire aca. we have seen medicaid work environments. 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. host: if polls are to be says he, joe biden supports expanding the affordable care act and adding a public option. how would that work? guest: essentially it would allow everybody who is in one of the aca's marketplaces, the option to purchase a plan that is designed by and has -- designed by and has payment rates set by the federal government. the idea is that the affordable care act has competition in certain areas, but there are a lot of places where people especially do not qualify for help under the aca are finding
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it increasingly unaffordable to find insurance, in large part because of the actions of the trump administration. he would do two things. he would have that public option, which would be more affordable for people. he would also boost up the help that people get under the affordable care act. ippolito and maura calsyn, we welcome your calls on health care. campaign 2020, focus on issues continues this week on washington journal. here's how to reach us and join the conversation. 748-8001.ns, call 202- 202-748-8000. , 202-748-8002.s kamala harris introduced a plan, and bernie sanders had pushed
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back about the role of private insurers in -- how would senator harris' plan work? harris isator stumbling around on this issue and it speaks to the facts that there are challenges and trade-offs to talk about. planicare advantage style i think represents a much more plausible version of a medicare for all world. mainly because medicare for all, if we look at the medicare program, what we have seen is a large gravitation toward the public-private partnership as opposed to a purely single-payer system. we have seen this happen and medicaid programs as well. what she seems to have stumbled upon a little bit is actually i think a more plausible version of the world where basically the federal government says here, private insurers, here is the money, you figure out how to , youde these benefits figure out what patients actually want, and we will go
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from there. the details are incredibly important for that, conceptually i would say that is much closer to a more plausible solution. host: maura calsyn? guest: it goes back to your first question about what does medicare for all mean. her plan is closer to the current medicare system. that is both public and private. what is important about her plan is that she would impose far stricter rules on private plans and make sure that they would get the benefit of a lot of influx of people but they would have to play by pretty strict rules in terms of who would be like that.ings again, the devil is in the details. i think it is a good debate to have. health care is such a huge part of our economy, that having iterations of people start thinking about these issues more and more is really important. we had a call or talking
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about the benefit pharmacy managers. politico says 15 of the ondidates declared positions drug costs. senator amy klobuchar, among others. it has also been an issue for president trump, with some issues initiated to chacko -- to tackle drug costs. where are we with that in the administration? guest: we have also seen congress make some headway. the finance committee voted out a bill, a bipartisan bill, that included a number of overhauls to programs like medicare, prescription drug benefits, aimed at trying to impose some market discipline on the drug prices. i think when you look at pulling , it is quite -- at polling drug prices are simply too high.
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the president has floated some rather unusual plans, at least for a republican, and the sense that he seems to be on board with importing drugs from other countries and using what is called international reference pricing, saying we will pay what other countries pay, plus a little extra. neither of those is a traditional conservative type plan. they are fought with challenges. an unexpectedaps turn for a republican president. guest: i think we will hopefully see something come out from the house of representatives, democratic leadership. what will be interesting is seeing the comparison between that proposal and what we have seen from the senate and the administration. i think one of the things that is really challenging is drug prices are really high for all americans, not just people with medicare. so how can policymakers, how can lawmakers really start to tackle the overall list price of these
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products and really bring some relief to all people regardless of whether or not they are enrolled in medicare? host: maura calsyn is with the center for american progress. .en ippolito the focus here is on health care. your thoughts. republicans, 202-748-8001. democrats, 202-748-8000. caller: thank you for taking my call. i am celibate in my 40th year as an insurance agent. -- i am celebrating in my 40th year as an insurance agent. once the bill got up to $5,000, the inch candidate -- the insurance company paid 100% of it. the cost for that plan was $400
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a month. today, because of democrats screwing it up with your foot of a character, the cost is $10,000. $15,000, $20,000 for my deductible and pain $2000, $3000, $4000 -- and paying $2000, $3000, $4000 a month. they screwed it up. through --f the math of the national average in cost. they should give it to the states. that's where it should be in the first place. host: thank you for your call. guest: i will go first. the affordable care act of the big things i would levy against the aca is it continued in american tradition, we subsidize health care explicitly and with a lot of money. however, we do much less to
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actually control the costs of health care. so i don't think it is a surprise that what we have seen is plans where the federal government basically says as long as prices keep going up, once you as an individual hit your maximum, the federal government absorbs costs forever. that is not a great system. we are trying to control the costs of health care. it is perhaps not surprising we have seen this. host: the caller from tennessee, one of the states that has not accepted the aca expansion of medicaid. what do you say to that? guest: i would say the caller is glossing over a lot of the problems that the individual insurance market had before the aca. it works perfectly well for people who were healthy, younger, who were not women, and the aca really did provide absolutely critical protection for people with pre-existing conditions. i agree with ben and that the
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prices we are paying for these insurances are going up there and we talked about drug prices, but drug prices are one part of this. the cost of hospital care is going up, and we are seeing that. this is one of the challenges with any sort of -- there are vested interest in keeping prices high. host: let's go to beaufort, maine. independent. go ahead. caller: thanks for taking my call. i hate to be too simplistic, but it is my understanding that congressmen and senators get health care for life. if that is correct, i don't know. ever want to have any changes, take that health care away for life from the senators. within a week, within a week, i promise you that there will be changes. the insurance money pays for these congressmen to get
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elected. they are the biggest lobbyists in the government, right? that is correct. take thehe money away, health care away from these clowns that are up there making theses of this and that, democrats destroyed health care. the republicans do not want to pay for nothing. i don't want to hear that crepe. take their health care away -- i don't want to hear that crap. take their health care away and you will see a difference tomorrow. host: good morning, from nashville. caller: i was curious about this. we pay for government and workers' paychecks third military paychecks. -- workers' paychecks. ella terry paychecks. military paychecks. it is free.
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we are like the shoemaker that has no shoes. our taxes go to pay their paychecks. our taxes go to pay their health care. they get free health care. the working class, the working poor, really, far and away known as the middle class, are supporting all of these other people's health care who would not get it. i don't understand why people are not listening to bernie sanders. this is a no-brainer. we pay for everybody else's, but we don't get it. why is that? host: we have heard from bernie sanders on the cost of his health care plan. how much would that be, do you know? guest: independent experts on the right and left have estimated but that -- estimated that by taking all these health-care costs and putting on the federal government, it would cost the government $30 trillion
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over 10 years. guest: which is not pocket change. what we would basically do is take all that money that people pay for premiums and collected as taxes. you still have to collect the money as taxes, and that is a massive stumbling block for any type of plan like his. that joehe reason biden envision something different is -- bernie sanders' last campaign included a wish list of taxes to finance the medicare for all plan. that was scored as being about $17 trillion short over a 10-year window. that says if bernie sanders' campaign can't come up with a list of ways to pay this, we're talking about something that is awfully hard to -- host: bernie sanders, would he do away with the role of private health insurance?
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guest: yes and no. nominally, yesterday says you cannot compete with the single-payer plan the federal government's plan to however, we have seen some recent changes to his rhetoric where he started saying, yes, but unions, for example, if they negotiate for benefits as part of the contract, they can still do that aslong as they -- as long they wrap around. that speaks to the idea that we are not 100% comfortable with private insurance vanishing. i think his idea is that maybe benefits are not fully on board with medicare for all. guest: i think there is something in between the biden plan and center to sanders' single-payer, meaning everybody is under one plan. those are plans like congressman delauro and congressman should caskey have a medicare plan for
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america. they have some of the same attributes of kamala harris' more recent plan, but it we keep in place a private market for employers who want to offer insurance. choice. is to give them keeping the employers in the market also allows the federal cost to go down. so it is possible to actually get everybody automatically enrolled in a medicare for all plan and keep other actors in the system and dramatically reduce those costs. but it is really about those levers. americans geton health care through their employer they also pulled the -- they pulled -- in favor of the 51% of those who they surveyed, 40 2% opposing it. on the party size, democrats, 72% favoring a single-payer care plan, according to the kaiser family pole in july -- the
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kaiser family poll in july. alexandria, virginia, next up on the democrats line. have two comments. first of all, this 30th trillion dollar figure -- i think it is very misleading. sanders said the cost of health care in the united states would be $50 trillion within the next 10 years. be cost of his plan would from $30 trillion to $40 trillion. but a lot of big money is all ready being paid by the government. you have medicare and medicaid. half the money for health care in this country is paid for i the government. secondly, the center for american progress is really -- it is really a place for future biden appointees.
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she keeps on talking about the public option. is one realption -- in washington state it is not working too well. canada, has all, very effective system. it is very popular, 90% approval rating. half ofta costs are what is in the united states. they do have some private insurance. it is very limited, very expensive. medicare for all, it would be a very lucrative world for private insurance. this thing about a middle-class -- cut, tax hike, it is sanders offers options on how to pay for it. this person who talked about the middle class, the middle class is a broad range. his income is a lot more than
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the average income of a person in the middle class. the average worker earns $60,000. host: thanks for that. i will let you respond. you served at the department of health and human services, correct? guest: yes, i was a lawyer during the obama administration, and previously i was a career lawyer. i worked with both the bush appointees and obama and point tease -- and obama appointees. we have been talking a lot about the biden public option, and i think to the detriment of a lot that seconds in bucket, there are ways to get the universal coverage that are not a single-payer option. that option does not get you there. if you have things like automatic enrollment, the plan is to default, that occur being the default, and then having people able to opt out of it. the organization that i work for
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that the caller mentioned, we have our own plan that again keeps the role for plight -- for private insurance. than far more expensive the biden plan. host: he criticized washington state, saying the plan was not working. i am not sure how expansive their public option plan is. is there an example in the 50 states of a plan like that, similar to that, on a smaller scale that is working? the washington plan is really the up-and-coming now. we have not really seen that yet. there are ways to design it and there is a myriad of different options. i think what the public option does and what the biden plan does is address a different set of people who are unable to get coverage through their employers and are having a hard time getting coverage in the marketplaces. it speaks to the patchwork we have here. of the desire of a lot
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progressives, myself included, to have a far bigger role and a centralized system, whether or not that system includes private or public insurance. the president has talked about lower prices of drugs overseas in canada. are there lessons to be learned from the canadian system, good and bad, for u.s. politicians? guest: on the drug point, i found some of this discussion 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 promise, there are these realities that are problematic. for example, the idea of importing drugs from canada. canada is a country of 35 million people. pfizer is not exactly to send drugs for 330 million americans
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to canada to have them shipped across the border. i don't know why that would be a priority for any federal or state legislator in the united states. morethat strike you as a recent outcome? canada has a system that in some ways has some of these types of federal arrangements that we have. but the over simplified versions host: host:. up, republican line. caller: this is deborah in west chester, ohio. host: go ahead. insurance. focus is our focus really should be health. we spend approximately $500 inlion a year smoking-related disease, trauma associate with driving under the influence, drugs, shooting one another, et cetera
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that cost will not go away regardless of the insurance choice we make. the only way to follow this is to make a change, one that changes our behavior. all public policies should focus on health. we should take -- and i realize this is -- i studied this for several years. those particular costs associated with our choices, take it out of insurance, put it into a safe system that is a payroll deduction task -- tax for high-cost, high risk choice. as a result, they'll cost each and everyone one of us about $100 to $150 a month to pay for those choices. it will educate the american public to realize this is why your insurance premiums, or a part of why your insurance premiums, are so hot. then what we would do, when you take that out of insurance, insurance costs go down. the other thing it would do is
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get the medical community to correct -- the correct incentive, which is wellness and general health. right now we develop drugs for instance, for idiopathic pulmonary fibrosis. that cost $100,000 a year. livingeps an individual an additional six months to a year. the key was to give people incentives to be healthier, not to smoke in the first place. as long as we -- you know, right now, care costs are $9,000 a year per person in the united states, and it is almost 18% of our gdp. no insurance, regardless of the plan, will ever solve the issue. the only thing we have -- the only thing that will solve the issue is changing our system toward health. you, deborah, and the issue of smoking. in this case, vaping, very much cases linkedwith
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to thc use. heard one of the things i in her comments that is 100% right is that we do a good job of paying for things, regardless of, frankly, how good they are. so what you have is these reverse incentives where sometimes, with the apple she used, drugs, with the way medicare pays for drugs in hospital, it encourages drug manufacturers to focus on very expensive and potentially not very high value drugs. i would actually point to something going on on the hill right now in congress, where there are real bipartisan efforts to reform the way we pay for drugs in the medicare program, to try and give insurers the incentive to not have patients on these extremely high cost, relatively low value drugs and instead tilt the scale
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more toward the high value, lower-cost drugs. those of the kinds of change that if we want to get back to reality from a true overhaul in the system, those are the incremental changes that i think you can point to that are absolutely worth making. host: maura calsyn? guest: i think there is increasing focus on all of the issues, and i would go broader than smoking and those behaviors. there is a process of trying to think through what health wonks and medical professionals call social determinants. of your health. your housing, your access to healthy foods, how that impacts your health. there is a lot of interesting andes of policy debate academic research going on about that. we are starting to see a lot of insurers, including medicare, be the social determinants of health. whyte,avid is in fort
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florida, on our republican line. thank you. i am a retired registered nurse. on byare was never voted any republicans. the first thing that the house did was totatives did was to exempt themselves, their staffs, their family from obamacare. totally clueless, utterly clueless. premiums has skyrocketed. the amount of coverage for the average family has diminished, .nd it is infuriating theacare has ruined
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emergency rooms. they have ruined the hospitals. get the government out of health care. they know nothing. they have ruined basically everything that they touched when it comes to health care. head you are shaking your there, maura calsyn. go ahead. guest: i don't even know where to start. the caller is from florida, correct? florida has not expanded medicaid. there are a lot of reasons why emergency rooms, especially in emergency areas, are struggling. the decision to not expand medicaid is one of the key reasons. i will leave it at that. host: you think when the plan was voted on and implemented by the obama administration, was the expansion of medicaid a key and integral part to that? was it anticipated to being as big of a deal as it has become?
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>> when it was implemented, it was part of the law and it was not intended to be optional. it was a supreme court decision, the opt to opt -- the option to opt out and not expand. that had the result that there -- it really is a have and have not with the states. host: we are seeing data now between the states, mainly southern and western states? guest: yes, we are seeing it in correlations with a lot of rural hospital closures and also with the uninsured rates. host: ben ippolito? guest: at the start, i don't think you're clueless. [laughter] i think the affordable care obamacare, may have crystallized a few issues that were percolating under the that health fact
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care costs have been going up for a very long time. the cost of insurance is extremely expensive. now it is up to for an average family plan, something like $25,000 a year. that is like buying a new toyota camry every year for your health care. that is a lot of money. in the obamacare market i think it is more salient, and to some extent that is good. again, i am not the biggest obamacare supporter. where i would hit it is that it kept going with this strategy of subsidizing but don't put any sort of over strains on the cost side. what we see in obamacare is an ex post inversion of that. i don't think it invented that problem, though. onre are profound influences everything from the obamacare exchanges to the amount of take-home pay people have at the end of the day. host: the average annual $6,896 for single
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coverage. $19,616 for family coverage. from tennessee, the republicans line. caller: can you hear me? host: we can. caller: the affordable care act, it was supposed to be where everybody had to participate. that technicality got left off the end result of all the sick people being the ones who got involved and they made the last -- i have medicare and i was recently in the hospital. an itemizeduest bill. medicare was billed $10,000 for a ct scan that takes three minutes. i had a similar mri that takes 45 minutes. they are only $4000. they also billed for two applications for oxygen i never received. they build for $1700 worth of
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oral medications, like $20 and $40 per pill. there was no way i was given that because i could not have anything to drink, not even ice chips. there is no way i could swallow these pills with nothing to drink. so the government is good about doing operations for programs with little oversight. they review less than 1% of medicare claims. there is so much fraud, it is sickening. i had to request the itemized bill, and i called medicare. they did not seem -- they said to call the hospital and tell them, then get back with them. medicare, when they added that, it states that medicare cannot even negotiate with the pharmacies, and that is unreal. none of the people and medicare -- they have the negotiation
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power to keep prices much lower than what they are paying. host: thanks. maura calsyn? iller: i think -- guest: think what the caller is discussing goes to a lot of issues we are talking about today and prices. that hospital, the other providers, the prices keep going up so that it is why the insurance keeps going up. most people with medicare, unlike the caller, do not see that necessarily. i think that it also goes to a lot of political pressure that a lot of congress is seeing already. there is a debate right now about private billing. it is the exact same issue, where there are a lot of profits, there are excess profits in the system that hospitals and doctors are charging. theoon those are at risk, lobby kicks into high gear with a lot of dark money. that is one of the big
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challenges we keep talking about with any reform, and it is a large part of why the aca includes some of those pieces. host: modern health care talked about there are several hearings on medical bills, particularly bipartisan issues. surprise medical billing legislation is threatened now by provider lobbying. you said it is dark money. is that what we are referring to? the lobby lobbying against some of that legislation? guest: yes. you have ads with friendly names like patient provider partnership. i am probably just naming a group that is perfect the fine, i don't know. you see a lot of ads that have a lot of scare tactics about how any decrease in payment, to the system, is going to suddenly have terrible effects. scare tactics have always been very effective. host: we have been playing some of the comments of candidates, including president trump. i want to show the comments of
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judge and his proposal on -- of pete buttigieg and his proposal. >> we have been talking about mental health and addiction. no longer can this be treated as a marginal or specialty issue because it affects all of us. all of us. we have to act. [applause] forcing parity so that health insurance companies actually have to treat mental health conditions and provide mental health visits just as they would the physical health. it means training our police officers and teachers on how to recognize signs of the health issues, but also equipping them with a place to send people when they do identify with those officials by making sure we have the providers we need when it comes to mental health. it means building up our
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defenses as a country, our defenses to the risk posed by mental health and addiction and suicide risk. it is where there ought to be a three digit number linking to the national suicide prevention hotline so it is that easy to tell somebody where to go. and it is time to break the silence that has people struggling with mental health issues for addictions, thinking they are alone. one in five americans will experience a mental health challenge. so people experiencing that need to know and their loved ones, too, that there is nothing to be ashamed of. we need to talk about these issues as openly as we would talk about cancer or a twisted ankle or diabetes because lives are on the line. if we get this right. if you just do the math on deaths through alcohol, drugs, and suicide come and look at what will happen in the next 10 years if we do not do something, if we act, if we cut by have the
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deficit of despair. we will save one million lives in this country. how can we not act and do that? let's make it happen together. host: ben ippolito of the american enterprise institute. he talked about a lot of things, but one was forcing parity. why are mental health issues seemingly treated differently under health care plans than regular health care? >> it is an interesting question. i think it is probably the fact that health care came about and we cannot really observe things that are mental health issues. was ---- i used to say i this is an issue that is near and dear to my heart. if you think about what help means, one easy way to think about it is a simple question -- how did you feel today? whether it was a physical problem or a mental problem, it doesn't matter. if you wake up in the morning and it doesn't feel bad, that is a problem. that is what we are trying to
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get out -- to get at. the idea that mental health ought to be treated with some sort of similar passion, physical health makes a ton of sense. right now might be a good moment to really hammer that home. completely.ee two things we need to increase, 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 medicaid and medicare -- are paying appropriate amounts. in some cases we are talking about overpayments, in places where there is too much money in the system. this is an area where there needs to be more money and more incentive for people to accept medicare and medicaid as private paying patients. host: in your case, as an
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attorney, a research fellow at the american enterprise institute, what first attracted you to health care? guest: in some cases, everything. i am an economist. as a normal citizen, it is hard to think about all the issues that are more relevant. it is 20% of our gdp. if we have some of the biggest programs in the country -- to care come medicaid -- all centered around health, but as a citizen, what is more fundamental to your ability to do everything we study in economics -- work and all that -- it is health. at the end of the day, is at the root of everything i care about. me it started well before i got to high school or college. seeing my grandparents in the of myal, and one
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grandfathers was a doctor who i never met, but i had always heard about the work he had done. again, we all -- we all have interaction with the health care system. we all know people who have had health care interactions every single day. also started in college during the clinton health debates, so i found that interesting. again, it is so fundamental to every other policy issue, and everything about our country. host: let's go to david in michigan, on our democrats 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, you have an increasingly aging population. two, a number of physicians are leaving medicine. i say that because i am a physician myself. the problem with health care, and maybe i need to change that,
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it is not health care anymore. is the business of health. there are lots of people feeding at the trough, whether it is the insurance companies, pharmaceutical companies, et cetera a lot of people are taking money out of the system. as the caller mentioned, we are looking at health care representing 18% to 20% of gdp. my proposal is that the whole system be scrapped. the condition of health care is such that we are putting band-aids on a leaking roof. imagine if you would if we used a model that was similar to the military, where we all pay our taxes, we contribute to the military, the military takes well-beinge common -- that is not the correct word. safety and our defense. imagine if we used a system like that in health care where we all paid into it, we are not worried about what premium we paid.
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health care is very simple. it is simple to take care of patients. there are too many patients incentivized who make the system difficult. it is very easy to take care of patients, 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. as i 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 may be a model like that is something for the future. it is a big ask. host: any response for david? guest: it sounds like the bernie sanders single-payer for all solution. were: honestly, if i writing campaign messages for democrats, which i am not, but if i was, i would emphasize that
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point. the simplicity of a single-payer plan. that does not mean it is easy to do or is the best plan. i don't think it is personally, but we have it simple, but you still have to overcome the challenges that come with that plan. you still have to raise all that money to pay for it. you have to design the plan and be responsive what people want. sympathetically agree with the idea that there are places in our health-care system where we are not even remotely close to as efficient as we could be. that does not mean that private addingr drugmakers are zero value to the system. there is a middle ground, and i think if we think about realistic policies that do not involve blowing everything up and replacing it with the v.a., we have to think about how to does public policy -- how does public policy give those private actors the right incentives to move toward a more efficient model? host: you can send us a tweet
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@cpspanwj. one for you, ben ippolito. guest: this is one of the biggest issues in pharmaceutical policy right now. the traditional drug is a small molecule drug and is easy to make. that means the drug loses its exclusivity the fda gives. we get very cheap generic drugs. there are new drugs that are very exciting that could treat all sorts of various issues. ,ut they are much more complex literally costing hundreds of millions of dollars, so even though you know how to make them, it is expensive. the question is, is our current regulatory set up appropriate for these new expensive drugs.
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the question is ultimately going to come down to a simple one, but a very challenging one, which is how much innovation do we want to encourage here, versus how much do we want to just hammer down these prices via government fiat and exclusivity runs out? i think that is a question the current regulatory environment should not be giving up on yet, but we are very much in the early years of this new world. it will be incredibly important to watch. guest: i think it is important to point out that any way of getting the new approach here being put in place by the affordable care act, it is one of the many pieces of the affordable care act that if a awayit would completely it -- i'm sorry, to not put it away -- but to repeal it. any inability to have these drugs, it speaks to the fact --t the affordable care act
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it is now part of the infrastructure of how we do health care in this country. maryland, ontown, the republican line. caller: good morning. i have a couple of comments. first of all, back to the gentleman, the physician who talked about blowing up the system. i don't think we necessarily need to blow up the system, but anyone in government, has anyone in the government thought of combining medicare, medicaid, the v.a., the received golden health care plan that the congress and senators have? into one system? and then you obviously save money by not having three different administrators. callers ago,eral thelady that talked about little -- the middle class that was covering all of these whyrams, and yet she said
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don't we get our health care? well, i am befuddled by all these people that think when they get medicare like me, or that theyor whatever, are getting it for free. it does not cost -- it costs me about $4500 a year for medicare with my supplemental and drug program. so nothing is free. anyway -- host: appreciate that. is there efficiency to be gained by combining health-care plans? has anybody looked into that? guest: there has been a lot of research. there are a lot of plans out there, like the medicare for america plan, that combines all of the pieces into a new medicare type plan. and keeps some part of the employer market on its own. there are lots of ways to have different efficiencies. for example, if you have the
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same rules about how much everybody pays, you can save a lot of money. japan does that. they have thousands of individual plans, but the administrative costs are superlow. host: it is interesting, when we do these talks about health care, sometimes the discrepancy in the service and where they get that coverage is so great. -- youyeah, the v.a. almost seem to love it or hate it. some people like the system because i think it is fair to say it is the closest to a single-parent plan. has issues related to weight taman quality. those are major issues. crazying, it is not a idea at all. the idea that we might see some people streamline the fragmented system where we have medicare
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and medicaid and so on. if we were going to do that, we would want to implement exactly what medicare and medicaid are doing right now, which is giving insurance a pot of money and saying here is all you get, you figure out how to cut these costs. from david inar los angeles, california. go ahead. caller: good morning. this is a very telling conversation that is going on between the two of you, the two guests you have today. it is one by someone who does not have a particular dog in this hype. for example, undermining solutions that have brought forth the bernie sanders plan. it would seem wise if we were to have someone from bernie sanders ' medicare for all on there arguing his point as opposed to these people doing it because
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they both have an agenda. they both are into maintaining the status quo. quo. the money isn't the problem. you hire people like your guests to perpetuate and maintain no solution to keep the same madison play. -- madness in place. are you with me? host: we are. caller: anytime you're dealing let's say point of view, have bernie sanders on their to discuss this. these two people are being paid by their various -- whoever the donors are. host: we have had bernie sanders iowa statecently the fair. maura calsyn? guest: i work for the center of
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american progress and all of our donors are online if the caller wants to take a look. i think it is-- inaccurate to say i in my colleagues have not put forward transformational universal coverage proposals. we happen to keep certain people in the system. we think we have a great medicare program and people will vote for their feet and we see what happens over time. fair we have our guests on, many of our guests that are policy experts in health care. guest: i don't begrudge anyone for liking bernie sanders. it's another option. i think it is wrong to say we are misrepresenting some of the challenges. that are practical issues
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those kind of plans have. if bernie sanders wants to propose i would actually raise the money they would need to do that plan, i would love to see that genuinely. but they can't do that. it is hard for me to sit here loses $17plan that trillion over 10 years. host: evelyn from tennessee. caller: thank you for taking my call. i wanted to say i have great insurance. i have medicare. i have tricare. inad a heart attack december. i've had two heart attacks. i have my same cardiologist i had 10 years ago. i had excellent care. i did not have to pay anything. everything was paid for me by medicare and tricare for life.
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a month later i had a g.i. bleed. i'm almost 93. i had a g.i. bleed. 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 doctors were just wonderful. go, i as my prescriptions get those from express scripts. dollars even seven if i did take three pills a day, i can get that medicine for seven dollars. host: glad you are with us this morning from tennessee. our guests benedic ippolito and maura calsyn. we are talking about health care. to the 2020ahead campaign, if you had a project, what do you think there were
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public and plane will be in terms of health care? what might be in the final democratic platform? see -- ithink we will depends on who the nominee is. it is going to be a stark difference between the republicans and democrats. it comes down to democrats, whoever the nominee is having a plan to lower the costs for people struggling right now and expand coverage. i think president trump will have a hard time coming up with a plan that doesn't raise cost for people increase the number of uninsured, and there is still the texas lawsuit out there. host: what you think president trump's plan looks like? -- i would bet he is probably the nominee. it will focus on things like prescription drugs and less on the affordable care act. it is a minefield to overturn the aca.
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i thinksual to say but he will be talking a lot about doing things like importing drugs from other countries, importing the pricing systems of other countries. proposed that for medicare part d. there will bek more emphasis on those kind of things and for some of the reasons that maura is alluding to. host: maura calsyn >> president trump will confirm today. after that, a discussing on constitutional issues facing the trump administration. we will join the science association event in progress.
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justice ginsburg will -- talk at the clinton school of public service. a reminder, you can follow all of our coverage online at c-span.org and with the receipts than radio and. the u.s. senate comes back into withon monday, september 9 important agendas on their issue. before senators return to washington, get a behind-the-scenes look at the end with c-span's history program, the senate, conflict and for -- conflict and compromise. >> it was created in the spirit of mutual concession. >> let's follow the
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constitution. >> protect people from their rulers. >> the fate of the country is in the hands of congress and the nice -- u.s. senate. we will look at the history, traditions and roles. >> the house judiciary committee three gun violence prevention bills which includes banning high-capacity magazines, restricting firearms deemed by those

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