Medicare, Dan Diamond, Kokomo discussed on 1A

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Off of suffering every year don't want a better system for folks they're taking money from what a shocker that suse and could come Kokomo kid tweets this doesn't Medicare have much lower administrative costs than private insurance if so it would seem that money now paid by employers and individuals for private insurance could be better spent on Medicare for all Dan diamond Kokomo kid gets to a point that you made briefly earlier which is administrative costs and where the money goes whether it's to taxes order premiums in ministry of cost or actual care when you go to the doctor or nurse Kokomo kid is making a point that the famous economist Robert Reinhart would often make which is a dollar in wasted spending to one person is a dollar in income to someone else there are sixteen million people who work in health care many in these administrative bureaucratic jobs those added costs but they also provide income to a lot of people and there is massive resistance from the industry to the listener point that if Medicare for all arrives and those jobs go away what happens then is there a transition plan Bernie Sanders has said there will be some support to help these people find new jobs but it's not clear how that would work or really how much money they might lose Rajin is in great reporting on this good that's so kind of you stay I just want to make one point about administrative costs in our healthcare system it is true that there is a lot of bloated expenditures that are a result a very complicated in ministry of work that currently exists in our healthcare system that being said the way that Medicare for all would be paid for there is I want to say it's pretty widespread agreement that there is not enough fat to cut from the administrative expenses currently to pay for this massive coverage expansion that would take place if Medicare for all were ever to become law so I think one of the biggest uncertainties about Medicare for all is so if you can only squeeze so much out of it ministration where's the rest of the money going to come from if the taxes that you maybe go up aren't enough so what doctors and hospitals be paid less what other parts of the health care industry be paid less and that that could have some very real ramifications for the way that people access medical care in this country and I think that that's important to acknowledge as part of any discussion about you know such a radical change to what our current system is and the way we pay for medical services and what we pay for is a whole separate our that we could do maybe we should do on one a how much we spend on top tier services fancy equipment big dollar M. our eyes the fanciest most expensive drugs when cheaper ones might be available there's money all over the system that appears to be going to a place other than what the data would recommend and that's an extremely important complicated issue that policy makers really have not wrestled with in any significant way and a lot of areas I want to get to the bottom line no I'm of the problem in America we used to talk all the time about how many Americans don't have health insurance what's the number now I think it's down to what about twenty twenty five no it's a twenty seven America twenty seven less than ten percent now and the ACA has driven that number down it used to manage fifty million people Medicaid expansion is driven that number down right that's right what does it mean to live without health insurance in this country well you know when you talk to patients who don't have health coverage in this country they are rationing care they're making decisions to go without medical care to not get prescription drugs that they need if they are unfortunate enough to end up in the emergency room or hospital they're usually hit with thousands sometimes tens of thousands of dollars in medical bills it's it's not good and who is most likely to be on insured now because we had the individual had the individual mandate were people who were student get their insurance elsewhere got coverage through the exchanges we remember this old story but also in many states Medicaid expanded which meant a lot of people who are low income or in poverty or near poverty also got coverage that you have before so who's most likely to be without coverage now so I mean the affordable Care Act which is about to celebrate its tenth anniversary drove this enormous decline in the number of Americans without health insurance lark but it is been on even as you noted some states have not expanded Medicaid through the affordable Care Act the states are largely red states they're concentrated increasingly in the south and there are a lot of the low income Americans who live in the states remain without health insurance if you look at what's happened in states that have fully embraced the affordable Care Act California is one of them which used to have among the highest uninsured rates in the country the rate has dropped by more than half in California so you know they were close to twenty percent unemployment uninsured and in California before the affordable Care Act it's now below ten percent so you have a subsection of Americans many of whom are working but many of whom are low income who don't who don't have access to a health plan through their jobs but similarly cannot get Medicaid because the state in which they live has not expanded eligibility Dan where does the drive for Medicare for all come from another words people who support Bernie Sanders and there's a lot of them because he's the front runner so far support Lizabeth Warren is the drive coming from their own economic situation premiums are going up their kitchen table issues they can't get ahead or is it a an issue of societal concern Bernie Sanders has health care is a human right we should vote for this because far and outside of what I pay for my healthcare everybody should have it because it's just the right thing to do well I think the voters get a different story but all of us have had bad experiences with the healthcare system at some point weather was waiting to see a doctor a surprise medical bill that came no get a great series on high deductibles that patients who have health insurance theoretically good health insurance but are still ending up with these bills that might have surprised them and I think that is a key issue even beyond the uninsured Americans which have gone down though the uninsured rate has crept back up under the trump administration there are another fifty million Americans who are underinsured and many of those people with their mediocre health plans say we need something better now but somebody mentioned president trump we better mention president trump he's Bernie Sanders or whoever wins the democratic nomination will not be the only candidate on offer in November are rushing to help me understand what president trump has proposed if anything on healthcare so as of late I would say as when we look at the Medicare for all discussion public option discussion you know president trump is really focused on saying we do not want the government to expand its footprint anymore in our health care system he says the democratic pants or socialist he uses at those kinds of terms to describe them and really he's saying that there are ways to bolster the existing system that we have we don't need any more government involvement that we already do one of the biggest things that I think we could get to an end Medicare for all and the public option sort of tangentially gets to this is that the rising costs of prescription drugs so president trump has said it's a top priority for him and his administration has had I think it be generous to say they've had mixed success in trying to contain costs but that is a very large priority for them going into the election and we also do have democratic candidates worst proposing different ideas for how to contain rising drug costs I'm speaking of the issue of socialism or expanding government health care let's listen to president trump in his own words I've also made an iron clad pledge to American families we will always protect patients with pre existing conditions we we will always protect your Medicare and we will always protect your social security there's a lot going on there Dan I want to talk about the first part of that statement we will always protect your pre existing conditions that phrase is extremely popular with Americans and at the same time that president trump makes that statement his administration is in court trying to do the opposite of what he just said can you help us explain exactly what's going on with pre existing conditions I I can try and and to cope with this though what is exactly going on in the president's thinking is is a matter of of history that's okay we can we can stick to the truth god the statement that the president at the trump administration is protecting pre existing conditions does not jibe with the actions of the administration as you pointed out Todd the administration is trying to strike down the affordable Care Act in court that would include its historic protection for patients who already have a chronic condition and are looking to shop for health care that is many Americans arguably most Americans depending on how how they are viewed by health insurer the actions by the administration also don't show that they have a plan ready to replace the affordable Care Act I know this because I've done reporting on this at politico with Russian up when she was my colleague we looked at the trump administration asked them again and again where is this plan who is working on it and every attempt that they have made to come up with a patch to replace coverage for pre existing conditions conditions do you don't have that but the trump administration is aware Republicans no this is an Achilles heel and in twenty eighteen Democrats won many seats retook the house in the mid term elections because they campaigned on this message the Donald Trump and Republicans were making it harder for people who had some sickness to get health care indeed Republicans launched a major campaign in the Senate to repeal the affordable Care Act repeal the Medicaid expansion it was a huge story and the fortunes the polling of the affordable Care Act have risen and they have fallen but one thing that's always been wild a popular is protecting pre existing conditions people love it you're listening to one I I'm tots will ask Russia go ahead pre existing conditions and whether they are being defended or not right was it just one thing I want to add really quickly on that it's it's important to remember when we say Irving current protections for pre existing conditions that the affordable Care Act made possible it's not just having insurance protections for a chronic condition that you might have the ACA also includes protections on pricing so that coverage cannot be wildly unaffordable to you because it covers pre existing conditions so I think regardless of which side of the aisle I can't it's on whether it's the twenty twenty Democrats or whether it's the president if you say that you are going to protect pre existing conditions the ACA includes those two categories so it's important for people to understand that the pricing part I think gets forgotten somewhat but it's also it's just as important if not more and now on on prescription drug costs which is where you started president trump has said many times he wants to lower those prescription drug costs people love to hear that of those costs have gone up and up and up and up how how exactly has the trump administration either proposed he said they have a mixed record of success do they have any success there have been proposals in the past to give Medicare the ability to negotiate directly with drug companies so that they use that massive market clout to drive prices down I don't know if president trump is in favor of that or if he's tried to be in favor of it only to run into into lobbyists so the president in the past did say that he favored letting Medicare have the ability to negotiate the price of prescription drugs he has since said he opposes that that policy is arguably the the hallmark of a build that house Democrats spearheaded to lower the cost of prescription drugs it is also very crucial policy in basically every twenty twenty Democrats drug pricing plans so he is so the president says he opposes that he is calling on Congress to pass a bipartisan bill send it to him and he'll sign it but.

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