domestic violence homicides to mental health issues to issues of addiction. >> senior fellow at the manhattanw institute talking about issues related to healthcare. we are basically a market think tank with the cost of healthcare as a big issue people are concerned about and a big part of my job is to try to figure out new policy solutions to reduce the cost to people. >> one of the issues that has come up as of late not only in the presidential race but other aspects of the medicare for all, what do you think about it at the face? >> i think it is the most assumption i don't we buy everything for everybody, that

is essentially what the claim amounts to. that fails to engage with the essence of the issue. >> under the headline isn't all it's cracked up to be. tell us why. >> in a piece about the medicare program if you think about the real existing care benefits, there are big gaps in the medicare benefit. medicare that covers patient drugs which is why lots of seniors by these plans. it's quite substantial on the prescription drugs in many cases more than what we might be used to paying for employment planst available. >> host: are you saying that it isn't for open systems added on to the role was promised

under the name medicare for all is essentially providing everything for everybody at almost no cost there's a big gap between the two. you have to find the money from something. i think that the appeal of medicare for all the rhetoric. when you lead from that, the proposals don't look that much with the medicare program is constructive. there was a hearing yesterday when of the discussions came up withnd this idea asking the congressional budget deputy director about a single-payer health system. i would like to get your response to the comment. >> according to the report from

how much do wee spend on health care in 2017? >> 3.5 trillion. >> and how does the 3.5 trillion annually, over ten years if we continue to spend three to actually know to be 35 trillion people talk about that in a second which takes up 18% of the gdp compared to other developed countries. >> significantly higher than others are paying for their health systems because of the current system is 3.5 trillion. it's actually projected to cost 6 trillion by 2027 the most in the entire world by far and yet, we have 29 million people without insurance which you pointed out in your reports coming ireport, andanother 44 me underinsured almost one quarter of the country the richest country in the world is unable to access healthcare. it's a single-payer system capable of providing coverage

for everyone and achieving universal healthcare? >> yes. >> i like your answer so much i'm going to repeat it. it can achieve universal health care. >> those are the questionings and responses. what do you think? >> guest: if you are willing to spend an unlimited amount the question is how much money does that achieve self-education transportan defense if you lookt the budget projections of the existing commitments and other fiscal commitments that are out there we are going to struggle but we are already on the hook without extending the program potentially three or four times over. >> the guest with us until a:30 if you want to ask questions of batters for healthcare and others gossip and two --

independent (202)748-8002. what he do you think of the representatives comparisons with this country compared to other countries? >> they differ in so many different ways. they have different diseases. the united states has twice the rate of obesity than many others and we have high grades as a result heart disease and cancer so our health care system has to do more. just by nature more people are coming through the doors going to the hospital. we also have more hospitals. i grew up in england with 200 hospitals. the united states has about 5,000 the united states is a bigger country than england but not that much bigger on a per capita basis the united states is four times as many hospitals as england. we have a higher level of intensity of care and access to care if you want the cutting-edge treatments and have insurance in the united states wyou can get them and no one wl

really putut a barrier in many cases. there are reasons we spen spende than other countries and ultimately ways in which we fall short but in terms of filling in the gaps is going to mean spending more money not saving money by doing more. >> critics of single-payer oftes point to the service in england and to talk about it in diree consequences. would you agree with those assessments are there benefits and liabilities? >> guest: every country is dealing with trade-offs and healthcare. there isn't a free lunch for f anybody. what you tend to have is primary care it is essentially free for people to go to the emergency room so a lot of services have no immediate financial burden but then there are some high-end procedures that he will not have

access to some of the cutting-edge treatments are not going to be available and then even things like hip or knee replacement there might be a substantial weight you might be waiting for mom this, four or five months for a major procedure. the distinction between if you purchase insurance before or after there's no distinction because people don't purchase insurance, they are automatically enrolled. >> host: this is a major issue here for health plans, what is the best approach? >> guest: i think thatnk the part of the affordable care act that has worked well is the entitlement part of the subsidies for people who want to go on the extreme j. and the provisions of the financial assistance people with pre-existing conditions able to write plans i think a part of wothat part ofthe affordable cas worked very well and can essentially be allowed. is that sustainable low?

>> guest: it is relatively small because i think that this gets lost in the discussion of the affordable care act 90% of people of working age get health care through their employers. that's less than 10% of people so the individual market by it self is not the biggest fiscal burden because b most people are not in it one way or another. >> host: here to talk about health care issues the first call comes from mike in baltimore maryland you are on ahead.r guest, go >> caller: i would like to ask your guest, i'm from single-payer and i've always had insurance through the job i had a guy laid off and i called the

health connection and the ryprocess was very easy. next thing i know i'm a diabetic. i go to pick up my medication ended between jobs time it was free and i couldn't believe it. it came through and helped me and that is all that i really have to say. i don't know too much about if it is a good thing but i know one thing that works for you when you fall to think that the impactct it would have for peope

that already get substantial assistance from government programs they probably received the least change or benefit or cost one way or another. the revolution would be for people who are on employment plans and currently in different arrangements so if you are in a state program plan like maryland i think relatively little would probably change. >> i just had a quick question they are going to a shoe store or restaurant or the mall and the supplier holds the leverage and i wonder how can you possibly bring healthcare costs down if the consumer is forced to buy the product, thank you. >> guest: when you buy a

normal product in most markets you know the price before you shop around. you know the different options and what they are. you don't know what the price is, what they are going to be built for and especially you don't even know whether they will be in or out of your network and this is an enormous problem i think we will see legislative action. >> .last week the house energy and commerce committee had a bill on it later on we will see the pension committee having a bill again on the issue. >> host: on the republican

line, irene. >> caller: i wish that you would have a program explaining that once you turn 65, it doesn't matter. you are going to pay a premium from your social security. as an older person a lot of people get sick because they dental healthave and it creates a bigger issue for themm but i wish that somebody would explain. i saw it when i was 16-years-old when medicare first came on the market when it was just put in place i worked for 40 some years, so i had pain in it all the time and i'm still paying

it. the part of that w that we stilo pay a copayment i have to go to a primary care doctor a co-pay. if i have to go to a specialist i just kind of wish that someone would explain it. everything is covered. >> host: we will let our guest explain it. >> guest: i think that they w d a great job explaining it. that is how it is more like the proposal of medicare for all. medicare covers most of it really depends on the state there is essentially no cost sharing or out of pocket. but there are substantial premiums associated with part

b.. there's a reason medicaid can be so generous and program is very much targeted as a subset. this the way we could be as generous in terms of coverage and accessd to care for the section of the population. >> host: they did a poll on politics and asked if they support or oppose medicare for all in which all americans are just older ones 65% of those supporting and 27% opposing it. when they oppose medicare for all the system would eliminate private health insurance companies that dropped for those supporting it with 34% opposing it. what does the number tell you? just be like having a choice in being able to be in control.

and there's still aspects are all where the government would be in charge of all the money. the governmentth would be in charge of choosing which doctors in which types of procedures they pay. and if the government decides to send types of care but are not going to be covered up and people will be out of luck and that is some thing that's going to be challenging for the proposal. people very much do value the access to care that they are currently able to get. >> host: on the line for democrats, you are o were on wir guest at the manhattan institute. >> caller: i'm calling from massachusetts. in my still on -- >> host: you are, go ahead. i just want to say medicare has worked out great for me.

i have had all kinds of procedures over the years had surgery for glaucoma and hip replacement and these things will happen when you get older. it's about $195 a month now for me it has been perfect and i have lived in the same area my whole life and everybody i know seems perfectly satisfied. i hadn't heard any complaints at all that i can remember, so i think that medicare has been fabulous. >> host: thanks for sharing your t experience.

>> guest: it is a very generous benefit provided by the taxpayers. thosede that are in the medicare program are not able to work inn for thitso that taxpayers fund % of the benefit. the cost of the health care that you get when you become eligible for medicare that is obviously a very generous proposition for the subsection of the g population. we wouldn't be able to do as sufficient assistance to everybody across the board. >> host: tell us about the nature of these hearings. >> guest: this is relating to the affordable care act. the trump administration made available plans that were essentially restoring the plans that existed prior to the affordable care act.

essentially there were about half of the cost of the plans that you can get for obamacare. he said if yo you'd like to help her plan you can keep it so that was restoring the choice of the things peoplees previously had. >> host: as far as those are you an advocate or do you oppose? >> guest: id said insurance has to be priced the same for people who sign up before they get sick and people that sign up after. so, what the hell happened in the first couple of years after was people started waiting before they purchased insurance so they started spiraling upwards because the only people buying insurance for people that havwithserious medical conditio. and therefore what happened is even though the subsidies that were attached to the affordable direct plan protected the people

who were enrolled from catastrophic expenses and stabilized the guarantees offered. people who are willing to sign upup before they got sick really had no access to affordable coverage. if you think of the plan, the benchmark premiums has like $5,000 then you are facing another deductible on top of the $4,000, so it's like 9,000 before you get any real services were care. so what these plans of the administration made available is basically restore essentially health-insurance priced if you sign u up before you get sick ad so we have premiums that are about half of the levels of obamacare that are becoming available. the benefit is essentially the same. >> host: the effort to push back its producers access foral millions if those with pre-existing conditions.

there might be a couple of these plans that cover prescription drugs, but the vast majority of the coverage but are able to g get. the insurance line is a political attack because it has become a partisan thing, but these are the traditional insurance plan to. >> host: the tea but here from n colorado independence line. >> caller: a lot of the democratic candidates are talking about medicare for all plan and the idea of putting the plan out there and letting people buy into o it so as a gle path as opposedth to just changg

the system so my question is this. if somebody wantedom to buy a pn or a company wantedr to buy for all 20,000 employees with plan b. for medicare do you have any idea? if they immigrated to the countrcountry where they could contribute enough to social security there is an option at a premium for that is about nine the average plan that h but youl find through theug affordable ce act. it already exists for the people that are not directly eligible for medicare. it's actually not that great of a deal. >> host: the second question.

>> caller: i paid him for all the time that i worked. is there a statistic that is when the average person has exhausted all of the money that they have contributed at what age have you exhausted all of your contributions. >> guest: there is a sense in which yes people do contribute but essentially through paying taxes so it is fair enough to think about the medicare program is essentially funded through taxes. that is especially true for medicare part b. and d. the prescription drug benefit. that is entirely funded out of general revenue and certainly medicare part a. it is fun for the dedicated medicare tax and that is just a payroll tax. >> host: on the republican line. >> caller: thank you,

manhattan institute. here in california they've partnered for its affordable and the service is completely open to you for doctors, pharmaceuticals, they want the highest profits increasing and the drug prices and hospital staysll and doctors visits. and the government offered plan lobbied by the millions if not billions of dollars that they don't want the status quo to change. so, there has to be a middle

ground where you have access to health care and in california if you have a good healthy lifestyle, you definitely have the benefit of access to mental health and yoga and preventive care and prediabetic classes. it's very affordable instead of the thousands of dollars like we used to have with the partnership between the government and private industry.

. >> to make it very hard to negotiate a good deal virgo and those prices have been soaring as a result of that. and the insurers then have to pass on the cost so the fact that those hospitals and then from those costs thatpa essentially pay the price.

>> d. >> it is complicated in the sense that yes prescription drugs are very expensive but the reason is they are valuable. it easily could've saved us money but with the drug marketed is to markets. there is a generic drugs and then those that have just come on the market developed recentl recently. 90 percent of drugs are generic which the price is not a problem. they are essentially lower and the patent has expired and the co-pay is low and stable the price problem is on the branded drugs that cost essentially two or $3 million to develop to bring to the

market to go to the regulatory process. and how do you spread that cost with the price of the drugmakers to make the senior fellow talking about health care issues thank you for your time.

. >> there is enormous account. but what they see a group of northerners and southerners armed this looks north and south and a battle.

and it's not that long before the civil war.

and it's not that long before the civil war. securing the us elections for political discourse i recognize myself in five minutes for an opening statement.