continues. host: this is chris pope, a senior fellow at the manhattan institute, talking about issues related to health care. guest: thanks for inviting me. host: the manhattan institute, what positioning does it take on issues of health care? with health care, the cost is a big issue and a big

part of my job is to try and figure out new policy solutions to reduce cost to people. host: one of the issues that has come up as of late is this idea of medicare for all. what you think about it. ? assumption ofn buying everything for everybody. ultimately that just fails to engage with the real essence of the issue which is health care is all about trade-off. host: tell us why. guest: the recent piece was about the medicare program traditionally. if you think about existing medicare benefits, there are big gaps in medicare benefits. medicare part b which covers outpatient drugs does not have an out-of-pocket cap. people are potentially exposed to tens of thousands of dollars of out-of-pocket cost which is why seniors by medicare gap plans. cost is quite substantial on

prescription drugs, in many cases more than what some people might be used to playing -- used to paying. medicare is a benefit that falls short in many ways. what is promised under medicare for all is providing everything for everybody at almost no cost out-of-pocket. there is a real big gap between the reality of medicare and the proposal. host: could there be a hybrid? guest: there could but you have to find the money from somewhere. i think the appeal of medicare for all as rhetoric is saying we have a medicare program that exists. leave from there to the proposals, the proposals don't look that much like the medicare program. host: there was a hearing in the

health budget committee and one of the discussions that came up was a single-payer health care. the congressional budget deputy director was asked about a single-payer health system. i will let you hear his comments. [video clip] >> according to the cbo report, how much did we spend on health care in 2017? >> $3.5 trillion. >> how does that, and that is annually correct? that is 2017. over 10 years, it would be $35 trillion. how does that which takes up 18% of our gdp compared to other developed countries? >> significant -- significantly higher. >> higher than what other countries are paying. -- current system costs 3 $3.5 trillion and is projected to cost $6 trillion by 2027, the most in the world by far.

and yet we have 29 million people without insurance, and another 44 million who are uninsured -- underinsured. the richest country in the world is unable to access health care. is a single-payer system capable of providing coverage for everyone and achieving universal health care? >> yes. a single-payer system could achieve universal health care. >> i like your answer. a single-payer system could achieve universal health care. host: those are the questions and responses. what do you think? guest: if you are willing to spend an unlimited amount, you can certainly purchase whatever you want. how much money does that achieve for other public priorities such as health, education, transport, defense. if you look at budget ,redictions -- projections other physical commitments are out there.

we are struggling with the meat that we are already on the hook for. host: our guest is with us until 8:30. if you have questions about medicare for all, (202)-748-8000 for democrats. (202)-748-8001 for republicans. for independents, (202)-748-8002 . what did you think of the representative's comparison of health care in this country to other countries? guest: countries are different in an -- in many ways. the united states has twice the rate of obesity. we have a high risk of diabetes, higher rates of cancer. our health care system has to do more. by nature, more people are coming through the door. more people are going to hospitals. we also have more hospitals. i grew up in england and england has 200 hospitals. the united states has about 5000.

the unit estates is a much bigger country than england but not that big. we have a much higher level of intensity of care, a greater level of access of care. edgeu want cutting treatment and have insurance, you can get it. there are reasons we spend more than other countries and ultimately there are different ways in which we fall short but in terms of filling gaps, it is going to mean spending more money, not saving money. single-payer of will point to the national health service in england and talk about dire consequences. are those assessments fair? guest: like everything, every country is dealing with trade-offs in health care. there is not a free lunch for anybody. in britain what you tend to have

is you have primary care be essentially free for people to go to. the emergency room is essentially free, so a lot of services have no immediate financial burden but then there are some high-end procedures that you are just not going to build have access to. some of the cutting edge treatments are not available and even things like hip or knee replacement, there might be a very substantial wait. you may be waiting for five months if you're able to get it or all -- at all -- waiting four or five months if you are able to get it at all. host: what about pre-existing conditions? guest: it is an relevant distinction in england because they do not purchase insurance, they are automatically enrolled. host: what is the best approach? guest: i think a part of the affordable care act has worked

-- that worked pretty well was the entitlement part of it. subsidies for people who want to go on the exchange, financial assistance, people with pre-existing conditions able to buy from the exchange. that part has worked fairly well and can essentially be allowed to continue. host: is that sustainable? guest: the amount of people on the individual market is relatively small. this gets lost in the discussion of the affordable care act. 90% of people of working age get health through their employers. with the affordable -- what the affordable care act it was it revolutionize the individual market and that is less than 10% of people. the individual market by itself is not the biggest fiscal burden. host: this is chris pope from the manhattan institute here to talk about health care issues. first up is mike from baltimore, democrats line. caller: i would like to ask your

guest, i am for single-payer. insuranceays had through my job. i got laid off and once i got laid off, i did not have therance so i called maryland health connection. the process was very easy. the next thing i know, i am a , i was in between jobs at the time. my $40 medication was free. i got my checkups and i am back to work now. now i pay a certain amount a month. it is a really good thing to know that when i was down, it came through and really helped me. let is all i've got to say. i don't know too much about whether it is a good thing for

all but i know one thing, this health care really works for you when you fall. host: that is mike in baltimore. many ways toare think about the impact that medicare for all would have. for people who already get substantial assistance from government programs, they would see the least change or would have the least benefit or cost one way or the other. the revolution would be for people who are on employer plans and individual plans and are currently in different arrangements. if you are on a state medicaid plan like maryland, little would change with single-payer. john,from michigan, independent line. caller: thank you for c-span. i had a quick question. if it consumer in the health care market gets in the hospital, they are forced to buy

health care. essentially they're going into the shoe store or restaurant or mall and the supplier is basically holding all the leverage. i was wondering how can you possibly bring health care cost down if the consumer is forced to buy the product? guest: that is a great question, especially in given that congress is going to be talking about it today, which is the price about -- out-of-network billing. when you buy a normal product in most markets, you know the price before because you shop around, you know what different options there are. hospital care, even scheduled care, you don't know what the price is. you don't know what services you were going to be billed for. you don't know what the anesthesiologist is going to charge or whether they are going to be in or out of your network. this is a problem. host: the administration made some progress on these issues as

well. guest: that's right. the house energy and commerce committee had a bill on it. there was a bill led by senator cassidy and later today we will see the health, education and labor committee. host: our republican line, florida, irene. caller: good morning. i would like to say this. greatre for all sounds but i wish that you would have a program explaining that once you turn 65, it doesn't matter. you're going to pay a premium from your social security for you as anwhich gives older person no benefits. a lot of people get sick because -- and it have an 8 creates a bigger issue.

i wish someone would explain. i was 16 years old when medicare first came on the market, when it was first put in place. i worked 40 years, so i have been paying into it all this time and i am still paying it and the part of it we still have to pay, our co-pay if i have to go to a primary care doctor, a co-pay of five have to go to a specialist. i wish that someone would fully explain it so people won't inc. -- won't think everything is covered. host: we will let our guest explain it. guest: that caller does a great job. that is exactly how it is. medicaid is more like what the proposals for medicare for all looks like. medicaid, most coverage depends on the state.

there is essentially no cost sharing, no out-of-pocket expenses in the medicaid program. seniors, there are substantial co-pays, deductibles, premiums associated with part b. the thing to bear in mind with medicaid is there is a reason why medicaid can be so generous and it is because that program is targeted to a subset of the population. the neediest subset, the disabled, children, low income, elderly. if we try to do the same thing for everybody, there is no way we can be as generous in terms of coverage and access to care for the neediest sections. host: clear politics today paul about medicare for all and they asked one question, a system in which all americans are on the government's health care system.

67% support it. -- 34% opposing it. guest: americans generally like having choice and being in control and there is an aspect of medicare for all where the government would be in charge of the money. the government would be in charge of choosing which doctors and types of procedures you get covered and paid. if the government decides a procedure or type of care is not going to be covered, then people would just be out of luck. that is the thing that is going to be challenging for selling a medicare for all proposal. i think people do value the access to care that they are currently able to get. host: from massachusetts on our line for democrats, mary you are on the line with chris pope of the manhattan institute. caller: hello.

i am calling from massachusetts. host: you are on. go ahead. caller: ok. medicarent to say, worked out great for me. i don't have to pay anything. i have had all kinds of procedures over the years. cataracts. specialized eye surgery for glaucoma. hip replacement. all things that happen when you get older and with the supplement, it's about $195 a month. for me, it has been perfect. i lived in the same area my whole life. everybody i know seems perfectly satisfied.

i have not heard any complaints as long as i can remember. i think medicare has been fabulous. host: thank you for sharing your experience. guest: that reveal something important about the medicare program which is it is a very generous benefit provided by taxpayers to the elderly. we understand that there were elderly, retirees and the disabled and the medicare program unable to work so taxpayers fund about 60% of the benefit. it is essentially a 60% subsidy of the cost of your health care you get when you become eligible for medicare. -- we wouldnerous not be able to provide as generous as assistance to everybody across the board. host: chris pope, kaiser health news tells us there was a hearing taking a look at

something known as junk insurance plans. what are they and tell us about the nature of these hearings? guest: this relates to the affordable care act. the trump administration made restoring plans, plans that existed prior to the affordable care act. they were essentially about half the cost of the plans that you can get through obamacare. president obama famously said if you like your health care plan, you can keep it. that rule was restoring the choice of plans the people previously had. host: as far as the plans themselves, are you and advocate for them, and opponent? guest: i am very much in advocate of these plans. what the affordable care act did was it said that insurance has to be priced the same for people who sign up before they get sick as people who sign up after they get sick. what we saw happen a couple years after was that people started waiting to get sick

before they purchased insurance. that means that the premium started spiraling upwards because the only people buying insurance had serious medical conditions. what happened is even though the subsidies that were attached to the affordable care act plans protected people who were enrolled from catastrophic expenses and stabilize the guarantees, people who are willing to sign up before they got sick had no access to affordable coverage. the average plan, the benchmark premium was something like $5,000 and then you are facing a deductible on top of that. it was like $9,000 before you get any real services or care under a standard aca plan. what these plans that the trumpet administration made available do is they restore health insurance prices in proportion to what you face. we have premiums that are about half the levels that obamacare

offered that are becoming available. the insurance benefit is essentially the same. host: there is a legislative effort to push back against this plan. one of the signers onto this is richard blumenthal from connecticut. he says junk plans reduces access to quality care. the bill will halt the trump administration's efforts to expand these incomplete plans that don't even cover basic benefits like prescription drugs or mental health services. guest: that's not true. there maybe a couple plans that don't cover prescription drugs but the best majority of them do. when you look at the coverage, people are able to get, it makes it more affordable to get a more comprehensive benefit package. the junk insurance line is a political attack because it has become a partisan thing. these are traditional insurance plans that americans were used to before the acute -- before the affordable care act. host: let's listen to our next

caller from colorado, independent line. caller: i have a couple questions. a lot of the democratic candidates are talking about they talkor all and about putting a plan out there and letting people buy into it as a glide path as opposed to just changing the system. my question is this. if somebody wanted to buy the plan or even a company wanted to buy it. coca-cola, for all 20,000 employees, what would the monthly premium be for medicare? guest: that is a far more complicated question that a lot of the democratic candidates recognize. who arey for seniors entitled to medicare -- you medicare,itled to there is a medicare buy-in option. the premium is about $900 a month which is twice as much as

the average plan you will find through the affordable care act. in --tual body and -- by buy in for medicare -- for all the times that i worked. is the races this tick that says when the average person has exhausted all the money they have contributed, at what age have you exhausted all of your contributions and then after that, you are being picked up by the taxpayer? sense in which a yes, people do quote, contribute but the way they contribute is through paying taxes. it is fair enough to think about the medicare program has funded through taxes. that is especially true for medicare part b and part