[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

[[Page H3695]]

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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