[Congressional Record Volume 164, Number 68 (Thursday, April 26, 2018)]
[House]
[Pages H3692-H3695]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICARE FOR ALL
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 3, 2017, the gentleman from Minnesota (Mr. Ellison) is
recognized for 60 minutes as the designee of the minority leader.
Mr. ELLISON. Mr. Speaker, today we are going to talk about Medicare
for All, the importance of making sure that every American, regardless
of income, can get the healthcare that they need. That will be our
topic over the course of the next hour.
So I would like to invite to the podium to kick off our discussion
the gentleman from California, Mr. Ro Khanna, a distinguished gentleman
from the great State of California who has been a leader on economic
justice, and justice in general.
Mr. Speaker, I yield to the gentleman from California (Mr. Khanna).
Mr. KHANNA. Mr. Speaker, I thank the distinguished gentleman from
Minnesota for his leadership on so many issues, particularly on
healthcare and the fight for Medicare for all.
I rise today to share a heartbreaking story so we understand what is
at stake in this fight.
Sarah Fay Broughton was a young woman in San Jose, California. Sarah
was going to work with special needs kids. At the age of 20, she came
down with a simple sinus infection. Such a condition is usually managed
by a primary care physician and an ordinary specialist. However, Sarah
did not receive treatment because she could not afford health
insurance.
Six months before she fell ill, Sarah applied for Medi-Cal,
California's Medicaid system, but her paperwork kept getting lost. The
county was so overwhelmed that her family went through three different
caseworkers trying to get medical coverage, but each time they were
told to start over. Like more than 28 million Americans without any
healthcare, for Sarah, getting sick meant facing crippling medical
bills and harassment by debt collectors.
So she ignored the pain, only going to the emergency room when it
became too much to bear. By that point, the simple sinus infection had
grown powerful, spreading to her brain, swelling it, and causing
irreversible damage. It was simply too late. On the day Sarah passed
away, her family received a letter saying that her Medi-Cal coverage
had been approved. She was doing everything right, but the system
failed her. Her life was cut short because the wealthiest country in
the world has not yet prioritized healthcare.
The question is: Should a young woman who is 20 years old die of a
simple sinus infection in the United States of America? If we care
about the lives of people like Sarah, if we believe that healthcare is
a basic right, then it is long past time to have Medicare for All.
Every American should be guaranteed decent, basic healthcare from the
day they are born.
This is not a political issue. This is a moral issue. It is an issue
of human decency. It is an issue to make sure we don't have people who
have simple conditions like Sarah be denied the care they deserve.
That is why I am so proud of my colleague Keith Ellison for leading
the call for Medicare for All. I am proud to serve on the task force
and encourage my colleagues to join him, Peter Welch, and other voices
in bringing to this country Medicare for All.
Mr. ELLISON. Mr. Speaker, I want to thank the gentleman again for his
comments. We can talk about statistics. We can talk about the way the
program is going to work. We can talk about all these things. But there
is nothing that can replace the precious life of the young woman whom
you talked about. She had people who loved her. She had people who knew
her. She had everything to look forward to.
She just needed her society, her community, to step forward for her
and to help her. And because we don't have the kind of healthcare
system we could have, we weren't there for her. But in her memory, we
have to be able to make it right for the young people and the people
who are still with us. In her memory, we will fight for Medicare for
All.
I thank the gentleman. Would the gentleman like to make any final
comments?
Mr. KHANNA. Mr. Speaker, I appreciate the gentleman saying that. I
had a conversation with her mother and with the community, and people
just feel: what a tragic loss. So, if there are things we can do here
under your leadership and as elected Representatives, I hope we will--
and we will--take seriously the consequence of the failure in our
healthcare policy.
Mr. ELLISON. Mr. Speaker, I would like to invite to share a few
remarks the gentleman from the great State of Vermont. As you can see
from the course of this debate, Mr. Speaker, we have tremendous
geographic diversity: California, Vermont. But we have one thing in
common: we need a healthcare system that works for everybody.
Mr. Speaker, I yield to the gentleman from Vermont (Mr. Welch), my
good friend.
Mr. WELCH. Mr. Speaker, I thank the gentleman very much for yielding.
We have the wealthiest country in the world, we have the healthcare
system that is the most expensive in the world, and we have more costs
and more people not covered than is at all necessary. The fact is, we
have had as a goal in this country, since the Presidency of Harry
Truman, a goal that all our citizens be covered and have access to
healthcare.
And that dream made a solid step forward when Lyndon Baines Johnson
was the President and Congress, on a bipartisan basis, passed Medicare,
which provided healthcare protection for all Americans 65 and older and
provided Medicaid for low-income children and families. We made a
second step forward, unfortunately not on a bipartisan basis, with the
passage during the Obama administration of the Affordable Care Act.
That extended coverage to millions of Americans who otherwise never
would have had access to care. It also made some significant
improvements in how we deliver care.
We are continuing with that battle. Those are two solid steps
forward. Medicare and Medicaid passed in the Johnson administration and
the Affordable Care Act during the Obama administration. Yet we are
still spending the most on healthcare with outcomes that are not the
best and, in fact, in many cases, are not even in the top ten. So we
are spending the most and getting the least.
The program for healthcare that has the most popularity in this
country among Republicans, among Democrats, and among Independents is
Medicare. The reason: all of us pay into the Medicare fund, and then
when we are eligible at 65, we are all covered. It is simple. It is not
a government-run program. It is financed by taxpayers, and taxpayers
are the beneficiaries of that program itself. It makes sense. It has
the confidence of the American people.
It also puts us in a position to try to control costs, not at the
expense of throwing 24 million people off of the healthcare rolls,
which is what would have happened had the repeal of the Affordable Care
Act been passed; but by bringing down, for instance, the cost of
prescription drugs, where something that was costing $7.50 suddenly
cost $1,500 per pill because the owner bought up a company and then had
a monopoly power and stuck it to the consumers.
I believe we should strive to get Medicare for every single citizen
in this country. Would there be hard questions that we have to address?
Sure. There are. But what we have now with this fractured system is
young girls who, because they don't have access to healthcare, because
the bureaucracy takes so much time to see if she is eligible for
Medicaid, or Medi-Cal in the case of this young girl, they don't get
access to care, and the tragedy of that situation is that this young
woman lost her life.
Had there been healthcare where the parents weren't terrified about
what that bill would be, about how they might have to take out a second
mortgage, about how they would be bearing the burden of escaping the
clutches of bill collectors, that person would have been able to get to
a doctor in time to get limited care that would have taken care of
what, at that point, was a very limited challenge.
So I thank my colleague (Mr. Ellison) for convening this here
tonight. And the goal that I believe we should have in this country is
to have a healthcare system where everybody is covered and everybody
helps pay for that system and is about affordable, quality care where
the emphasis is on the patient and on the taxpayer.
By the way, this is not about making government run the healthcare.
That is
[[Page H3693]]
the important thing to remember. If you are on Medicare or Medicaid or
ObamaCare, you get to pick your doctor, you get to pick your hospital.
This is about having the security of a system that works for you
regardless of your income, regardless of your job status, regardless of
your medical situation. It works in all the other industrialized
countries of the world; it can work here.
By the way, the cost is starting to kill us. If we don't start
dealing with the cost of healthcare, it doesn't matter whether it is
the taxpayer who is footing the bill, the employer who is footing the
bill on behalf of his or her employees, or the individual trying to
reach into his or her pocket to pay. We have got to bring these costs
down, and an organized system without a broken market, I think, is the
way to go.
Mr. Speaker, I thank Mr. Ellison very much, and I applaud him for his
work.
Mr. ELLISON. Mr. Speaker, let me thank my colleague from Vermont for
his comments. And if I can ask him a quick question.
If we are already paying the most in the world per capita, why aren't
we getting the best healthcare outcomes?
Mr. WELCH. That is really a good question. But that example about
that pill going from costing $7.50 to $1,500 means that the owner of
that pill--and Martin Shkreli is the guy who did it; he is now in
jail--was able to corner the market and then just make people who
absolutely have to have that medication pay through the nose, and more
than they can afford. That is an example.
We have all of these stops along the way where private profit is the
motive. The market is about profit; it is not about having a system
that is going to work and be affordable. I think that is a big reason.
Mr. ELLISON. That is a big reason. I want to thank the gentleman for
his work. Let's keep working on this.
Mr. Speaker, we are talking about Medicare for All tonight, H.R. 676.
Mr. John Conyers carried the bill all these years, and I'd like to
thank him.
But we are carrying the fight forward. It is important to note from
the onset that I recognize, the Progressive Caucus recognizes, the
Affordable Care Act made important steps, critical steps, for getting
more people covered, and we must continue to fight for it.
We have to protect the Affordable Care Act. We have to do what we can
to defend it. There are people in our Congress who want to just get rid
of it. But the truth is, it actually helped many people. It helped
bring coverage to people who hadn't had it. It helped bring real
answers for families that needed it.
But we can look further down the line. We can think about a system in
which everybody pays and everybody benefits. We could look forward to a
system like that. We can look to a Medicare for All-styled system where
we can say healthcare is a right for everybody.
This is not something that should surprise anyone. Education is
guaranteed for everyone. Every schoolkid in America can go to a public
school in the United States.
{time} 1830
Fire services--you don't have to pay a separate contract to get the
fire department to put out your fire. If you live in the city and there
is a fire, you can call them, and they will help you. They are paid out
of the taxes that we all pay. The police department, public works--we
have systems in our society now that we pay for through our taxes and
other sorts of things that we do to afford these services. Healthcare,
I believe, is a service that we should look at in a similar light.
A Medicare for All system would decrease overall cost of healthcare
for a multitude of reasons, but most importantly, because it would
allow the government to negotiate decreases in the cost of care with
service providers.
I think that my good friend, Peter Welch, had an excellent example
when it came to prescription drugs. There is a company called
CorePharma that hiked the price of a DARAPRIM pill from $1 to $13.50
and watched revenues climb.
In 2015, CorePharma sold the rights to DARAPRIM to Turing, which
raised the price to $750. So in a system like that, of course, whatever
somebody can make more money doing, they are going to do. And yet, we
don't have any real controls to make sure that they don't do it. It is
the kind of thing that we have to step forward and address.
In 2012, for example, the average cost of coronary bypass surgery was
more that $73,000 in the United States, but it was less than $23,000 in
France. France has good healthcare. The world doesn't deny that--
$73,000 for a coronary bypass surgery in the United States; $23,000 in
France.
A Medicare for All single-payer system would lower administrative
costs and nearly eliminate spending for competitive advertising, which
doesn't really bring health to anyone. The U.S. spends about 18 percent
of its GDP on healthcare, while Canada spends about 11\1/2\ percent on
healthcare.
The United Kingdom, Britain, England, Scotland, Ireland, Wales, the
U.K. spends about 9 percent of its GDP on healthcare. Germany and
France spend about 11 percent. We spend substantially more, and yet, we
do not have the best outcomes in the world. We have to look at this
system and whether it is working for the American people.
I just make this point because we really could join the rest of the
world and have more affordable, more effective healthcare. It is not
only countries like Germany, France, and Canada that spend less and get
better outcomes than the United States. It is also New Zealand, Norway,
Denmark, Sweden, all have systems that are similar in style, and they
cover more people and the people benefit from that.
Our systems like Medicaid and Medicare are some of the most popular
systems out there. People tend to like it. Now, I am not saying they
are trouble-free, but anybody who thinks there is some program made by
human beings that is going to be absolutely perfect all the time, of
course, they are going to be wrong.
But I guarantee you, I spent plenty of time in Montreal, Canada,
Calgary, and I tell you, for all the Americans down south of the border
who complain about Canadian healthcare, Canadians kind of like their
healthcare. They don't want to switch with us; neither do the people in
England. We need A Better Deal, and we can have one if we were to move
forward.
Taiwan has a healthcare system that also is similar to Canada, New
Zealand, Norway, and Denmark. We can do better than we are doing right
now, and we should.
As I mentioned before, Medicaid and Medicare are popular. These are
programs where people get the benefit of a healthcare system that is a
system that we benefit from as a government of, by, and for the people,
and millions of our constituents, from birth until death, benefit, and
they support people with disabilities, having children, pregnant women,
and seniors. They are wildly popular, and they actually have pretty low
administrative costs and essential to the stability of our country.
It also makes sense that Americans must also support Medicare for All
single-payer. Both a Harvard-Harris poll from 2007 and a 2018 Kaiser
Family Foundation poll found that the majority of Americans support a
single-payer healthcare system funded by the government. Yet some folks
in this body want to actually cut Medicaid. They want to cut--they want
to drain funds from the Medicare trust fund.
The fact is Americans all over this country, they think that many of
our programs, whether it be the VA or Medicare or Medicaid, actually
help a lot of people. These programs are popular, and yet, we continue
to have to fight to protect them every day.
What if we just move forward instead so that more people can benefit
from a program like a Medicare-style program? An expanded Medicare for
All will create millions of good jobs. It is a program that would bring
more people in; therefore, we need more healthcare professionals to
cover folks, more nurses, more doctors, more nurse anesthetists, more
folks to keep folks healthy, even more exercise professionals, because
we know that in a good, solid, single-payer system, we would put an
emphasis on preventative care and try to make sure people stay well,
stay healthy.
Let me just say that cost savings for individuals is an important
factor here. Medicare fraud isn't just a fringe idea that will help
very few people. Medicare for All is good for business and
[[Page H3694]]
good for people. A single-payer system would lift the significant
financial burden from businesses that currently fund the healthcare
insurance for their employees and would largely eliminate the financial
burden of illness, a leading cause of bankruptcy, and debt sent into
collection.
Even with the Affordable Care Act, which substantially helped 28
million people, or about 9 percent of the Nation, still remain
uninsured. I am grateful for the Affordable Care Act. It made
substantial advances, but we still can do better.
A single-payer system is not just about ensuring that no person is
uninsured. It is also about making sure that nobody is underinsured.
Many people are underinsured. They face costs associated with their
insurance that they just can't afford to handle, and that is also a
substantial problem.
Underinsured individuals are less likely to obtain healthcare when
they need it. They skip doctor visits, they avoid filling
prescriptions, and they are more likely to end up in medical debt. We
can have a system that can help us avoid these problems. Medical debt
is one of the leading causes of personal bankruptcy in the United
States.
If we were to set up a system that was focused more on health and
wellness where we all could pay and then we can all benefit, it would
make our society stronger, better financially and physically.
Now, Medicare for All would actually help reduce income inequality.
One of the problems of the society we live in now is that we have
really historic record inequality. The rich and the top 1 percent are
far more wealthy relative to the rest of their countrymen and women
than has been the case since the Great Depression, since the Guilded
Age. You probably have to go back to the time when the Great Gatsby was
written to actually see the level of inequality that we see today and
marks the society that we live in.
In a time when we are facing these record levels of inequality, a
single-payer system can also help level the playing field and help
working people make a better go at this economy. Medicare for All would
make sure that everyone would have the same access and level of care,
regardless of their income, their job, or the community that they live
in. A Medicare for All system would mean that people would be able to
cover their medications, cover their bills. It would mean that they
would be able to get what they need.
And if you compare this, what if we had a system--what if we did
healthcare the way we do education, that you have to have a private--it
is a private system and you couldn't go unless you could pay? The
bottom line is that what we would end up with is a system that would be
very unequal, educationally speaking. It would undermine our
productivity. It would weaken our society.
If we were to have a Medicare for All system that would help make
sure that everybody had a basic health benefit, and it didn't matter
whether you had a job at the moment or not, didn't matter whether you--
where you lived, then it would provide a platform for economic
prosperity in the marketplace where people would work.
This would also make our society more equal when it comes to
opportunity for people of color and racial minorities. Black and
Hispanic Americans are more likely to be uninsured than others. The
studies show a direct link between being uninsured and a higher
mortality rate.
By the way, when people have died with a higher mortality rate, they
don't just die. Often, they end up in the ER, which is one of the most
expensive places to treat somebody. But what if they actually had the
treatment that they needed, they had a regular doctor, they had the
treatments they needed, they had ways to keep themselves healthy?
African Americans and indigenous people tend to have lower life
expectancies than White Americans, experiencing higher rates in most
major causes of death: infant mortality, trauma, heart disease, and
diabetes. Much of this is just related to the fact that healthcare
access is not evenly distributed, and, therefore, the disproportionate
impact is on people with the lower income.
Rates of unemployment are higher among African-American men and women
than their non-Hispanic White counterparts, and job loss is more
prevalent among minority groups. Getting employer-based coverage is not
easy if you work a few part-time jobs you have to piece together rather
than a solid full-time job.
So what do people do when that happens? You go without healthcare or
you have gaps in your healthcare coverage, especially if you live in a
State where things like expanding Medicaid are not preferred. If you
are a Governor and your State legislature doesn't want to expand
Medicaid, then the chances that you are going to experience these gaps
in coverage and be uninsured are higher, and consequently, people's
health outcomes are worse.
The U.S. healthcare system is ranked, when we look at it, among the
worst among countries with advanced economies, despite the fact that we
are among the ones that spend the most on healthcare. If we want to
have more equality based on people's different racial backgrounds, if
we want more opportunity for all, regardless of their race but based on
income, and we want to make sure that this is a country where a middle
class person, a working class person can do better, then the fact
stands true that we have got to move to a Medicare for All style
system.
Now, Medicare for All style system and drug pricing--very important
topic to take up. We are one of the only countries in the world that
doesn't in some way regulate the cost of prescription drugs. We talked
a little bit about this before, using the examples of DARAPRIM, but it
just seems to me that if we were to move to a system, a Medicare for
All style system, an expanded better system, we could find ourselves in
a situation where Americans could actually start affording their drugs.
While prescription drugs are not covered by Canada's system, there are
price controls for medications, so prescription drugs are often cheaper
than they are in the U.S.
We have a drug pricing crisis in this country. American people know
it. They live it every day. The worried parent struggling to pay their
kid's insulin, a senior living on a fixed income who takes arthritis
medication, and millions of working people who have to take medication
at some point or another in their life, they know that we have a system
that is uncontrolled and out of control.
In a recent Kaiser Family Foundation poll, over 50 percent of the
people said that addressing this medication crisis would be one--should
be one of the President's and Congress' top priorities. This should
come as no surprise to us.
A majority of Americans are using prescription medication. For too
many folks, people have to choose between paying their bills and
getting the medicine that their family needs.
In fact, 92 percent of Americans support the Federal Government
negotiating lower drug prices for folks on Medicare part D. Medicare
part D is a very unfortunate program where it is written into the law
that we cannot negotiate drug prices. This is an outrageous thing, and
for people dedicated to free-market principles, the fact that you
couldn't negotiate a price seems extremely ironic to me. It seems more
like crony capitalism than free market.
Eighty-six percent of Americans support requiring drug companies to
release information on how they make their drug prices. I think, while
that is certainly something that we should know, it is not particularly
difficult to figure out. They price based on as much as they can get.
And 78 percent of surveyed Americans support lifting what drug
corporations can charge for drugs for illnesses like cancer.
{time} 1845
We must continue to fight to protect the ACA and fight for Medicare
for All as a solution. We should, and we could, begin to tackle so many
of our Nation's problems if we had a shot at good health and stable
healthcare.
There is proof from our fellow wealthy nations that you can have a
free market economy and you can have a national health insurance
program that works. They are doing it in Canada; they are doing it in
the UK; they are doing it in New Zealand; they are doing it in Taiwan;
they are doing it in Norway, Denmark, and Sweden; and they are doing it
all over the world. There is no reason why we can't do it
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here, other than some people want to benefit while other people
actually suffer.
There is an important debate going on in our country. There is an
important conversation that we are having in communities all over. I
hope that all across the United States, in church basements, synagogue
basements, mosques, Quaker meeting rooms, VFW halls and union halls, in
lodges and coffee shops all across America, wherever people gather,
folks will get together and discuss our healthcare future as Americans.
There is a better way, and I think that it is right in front of us.
I was speaking about this issue with somebody who told me: Well,
Keith, I mean, look, how are we going to pay for this?
I thought that was an interesting question, given that we just passed
a Republican tax bill that carved about $1.5 trillion out of Federal
revenue over the next 10 years. Some people have estimated it is even
higher than that. Nobody was particularly worried about how we are
going to pay for that. But the question is still a legitimate question.
We do have to pay for things.
I think that, if we look at the fact that about two-thirds of all the
healthcare spending now is public spending, we are two-thirds of the
way there now. We need to figure out how we are going to come up with
the rest. People will see the healthcare expenditures that they are
already making be able to be part of how we will pay this. But the
other part is a legitimate question.
I think that we can set out a system of a payroll tax or, perhaps, a
tax on Wall Street trades. There are a number of things that we can do.
And we also can squeeze costs out of the system.
We know that simply because you have got multiple insurance
companies, multiple payers, that there is rampant waste in the system;
and if we were to squeeze it out and we get efficiencies, we would be
able to lower costs in the system. If we could control costs better, we
would be able to have a world-class system, as other countries have,
with excellent health outcomes and be able to still pay for it. It is
not beyond our reach.
I can tell you that it has often been said that single-payer systems
have long waiting lines. Well, not according to the data. One grant
from the Commonwealth Fund looks at what percent of adults can get a
same-day doctor's appointment when they are sick, counting systems like
Canada, the United Kingdom, and the rest. And the fact is that in New
Zealand, Germany, Australia, and the United Kingdom, people can get
same-day doctor visits at a higher rate than in the United States. It
is not the case that you have to have these long lines and you have to
wait so long in every system.
Of course, the U.S. system will be an American system. We will design
it for our own purposes. But it simply is not true that a single-payer
system will have longer waiting lines. It is just not the case. People
will say this, but it is not true.
The fact is that we need to have the debate. We need to have the
discussion. We need businesses to say: Well, what would it mean to me
if I didn't have to pay health insurance out of my business expenses?
Individuals have to ask: What would it mean if they never had to pay
for copays, deductibles, things like that, if they could get eyes,
ears, other types of coverages that they need, what would it mean if
these things were possible? How would it impact our economy? Would it
free people and allow them to be more creative and more innovative?
We have seen our country see a decline in small business development
first in startups. Is this in part because people are locked into debt
in jobs just so they can have insurance? I think there is certainly a
possibility there.
At the end of the day, we have got to have a dialogue about how we
can better serve the American people. Other countries around the world
are doing it, and it is time for us to move forward in that direction,
too.
Mr. Speaker, I yield back the balance of my time.
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