House Democrats Hold First Hearing on Medicare for All

WASHINGTON (CN) - Lining up what is likely to be a fixture of the 2020 presidential election, health care activists on Tuesday told lawmakers a Medicare for All plan is necessary to truly reform the health care system, as right-leaning economists cautioned them on the legislation's price tag and the fundamental changes it would bring to the U.S. insurance industry.

"I am hopeful because right now there is a mass movement of people from all over this country rising up," Ady Barkan, a health care activist who was diagnosed with ALS at 32, told lawmakers. "Nurses, doctors, patients, caregivers, family members, we are all insisting that there is a better way to structure our society, a better way to care for one another, a better way to use our precious time together."

With the disease leaving him unable to speak and confined to a wheelchair, Barkan spoke to the House Rules Committee through a computer program, urging them to treat health care not as a commodity, but as a human right. He said any health care proposal that does not eliminate for-profit insurance will necessarily make it so some people do not get the care they need.

"The ugly truth is this: Health care is not treated as a human right in the United States of America," Barkan said. "This fact is outrageous and it is far past time we change it."

Tuesday's hearing before the House Rules Committee was the first Congress has held on a Medicare for All proposal, putting a spotlight on legislation that has become increasingly popular among Democrats since Senator Bernie Sanders, I-Vt., made it a major part of his platform during the 2016 Democratic primary. 

The current proposal, which boasts 108 sponsors in the House, would essentially do away with the existing private health insurance system and would within two years cover everyone in the United States under a government-run program, with limited exceptions.

Under the plan, people would not pay monthly premiums or co-pays for health insurance, with those costs instead coming in the form of new taxes.

The costs of the plan are hotly debated and sit at the center of the fight over the bill.

Charles Blahous, a senior research strategist at free-market think tank the Mercatus Center, told the committee the current proposal would likely cost even more than a 2017 version of the plan that he found would add at least $32 trillion to federal spending over 10 years. At a cost of about $10,000 per person, he said doubling current federal income taxes would not be enough to cover the new spending. 

He did acknowledge, however, that the total cost of the proposal does not factor in what the United States as a whole currently spends on health care, noting "most" of the new spending would come from the federal government taking on costs now shouldered by individuals and state and local governments.

Other economists said the plan would save money over the current system in other areas, particularly in the cost of drugs and medical equipment. Dean Baker, a senior economist at the liberal Center for Economic and Policy Research, said Medicare for All should particularly lead to lower administrative costs, which are a major reason the United States pays more for health care than other countries.

"If we look through medical equipment, prescription drugs, physician payments, dentists, we pay twice as much as everyone else in the world," Baker said. "Now, will we get down to other levels? That's an open question, but there's no obvious reason we should be paying twice as much for our drugs, for our medical equipment as people in France and Germany."

However, Baker was clear that in order to make the price tags work, providers would likely have to accept lower payment rates and the government would have to raise taxes on people and businesses.

Blahous said it is unclear how health care providers would respond to the lower payments they would receive under the Medicare for All proposal, especially considering people would likely go to the doctor more under the new system. 

"The honest answer is we have no idea how providers would respond to this," Blahous said.

The political arguments between lawmakers at the hearing have become familiar, as Republicans attacked the plan as a massive increase in federal spending that would fundamentally transform the health care industry, doing away with even the plans people like.

Representative Michael Burgess, R-Texas, noted other countries that have shifted to single-payer systems are much smaller than the United States, putting the undertaking in relatively uncharted territory.

Representative Rob Woodall, R-Ga., was skeptical of the wisdom of undoing the current insurance system rather than targeting changes to the people who need more help with their insurance. 

"Why, to achieve the goal of serving the underserved, is the policy solution to take everything away from people who already feel well-served?" Woodall said.

But Democrats noted other countries have moved to single-payer health care plans and spend less than the United States for their health care. 

Representative Jamie Raskin, D-Md., said shifting to a single-payer system would help not just people who have no health insurance, but people who have too little insurance or whose plans are squeezing their budgets.

"Sometimes people think Medicare for All is just for the 30 million people who have no health insurance, and that for me probably would be enough, but it's actually for the 45 or 50 million Americans who have a weak insurance plan where their premiums are always going up, the deductibles are going up, the co-pays are going up and it doesn't work for them," Raskin said.

The current Medicare for All bill will almost certainly not become law given the present makeup of Congress. However, the proposal has been a feature of the nascent 2020 Democratic primary, with most major candidates supporting the plan in some form.

That likely ties the future of Medicare for All to the 2020 elections and all involved in the hearing acknowledged the proposal will take time to work through.

Dr. Farzon Nahvi, an emergency room physician in New York City who testified at the hearing, said Congress should take time to get the bill right, but urged lawmakers to keep pressure behind the legislation.

"We just need, I think, a little bit more of a sense of urgency," Navi said. "We have to go through the right channels, we have to do things right and we have to take our time, but we have to do this with a sense of urgency that people are dying as we're waiting and as we're doing this. And we need to have that fire to keep moving, whatever the solution is." 

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