washington journal continues. host: this is the chief >> this is julie rovner, chief washington correspondent for kaiser health news here to talk about at theme that emerged from the debate last week, medicare for all versus the public option. how would you define those things? >> guest: medicare for all which is what some democrat seven running on for years now with basically in three take the medicare program that's very popular that serves about 60 million seniors and people with disabilities and expanded are doing. in practice that's not what medicare for all would do. it would createha a new more generous program that might or might not be called medicare and

extend it to the entire population. the idea of medicare for all is the government would pay all the nation's health bills and everybody would have coverage. a public option would create a government type program like medicare, like medicaid and make it more available. now you have to meet certain qualifications to get into any of the government provided health programs. the public option would make it easy for people to get into paid health care. >> host: for the democrats were debate on these issues why are they so fervently advocating? what's wrong with the current system to them? >> guest: everybody agrees, republicans do, the current system is not working. people are paying too much. most people have insurance but a substantial number of people still do not. a lot of people who do have insurance literally can't afford to use their interest because they have multi-thousand dollars deductibles. everybody agrees we need to fix

what's broken at how you do that. democrats generally agree that everybody should have healthh care, health care should be a basic right. how you get there is what the debate is and whether you do it all in one fell swoop i can medicare for all, single-payer or more gradually with a public option or whether you give people the choice of keeping the private insurance if you like it or going on a government plan, that's what the democrats are debating. >> host: if i'm a private entrance provider how a look at these various proposals and what am are my concerns now? >> guest: your concerns with medicare for all, you can be put out of c business although hardo know come hard to imagine there will not be some role for private insurance, evenor as jut the administrator, a lot of large companies now self-insure but they highergh insurance companies to administer the benefits. private companies administer medicare for the most part andnd then talk about medicare advantage. talk about fee-for-service

medicare. most of those bills are managed by private insurance companies. private insurance companies are watching this with some great wariness. the providers of health care particularly hospitals are watching it with sort of more panic in the insurance companies. providers say they can afford to take medicare now because private insurance pays the moret private insurance were to go away in some large part or completely, they in three would be paid less and they are very worried. >> host: we will: talk and other themes on this topic of medicare for all versus the public option. if you want ask questions about to go with the democrat canids are saying we have divided the lines differently. employers, () 748-8001. if your uninsured, (202) 748-8002. is the current medicare system as it stands, does it have the

ability to flex so far to bet all these new potential people and it? >> guest: the current medicare program is in some financial distress because we've got 10,000 baby boomers the day who are qualifying for medicare. so far the baby boomers are still pretty young and in the low spending days at lisa's first medicare goes. something has to be done to show up medicare financing going forward. it couldn't accept more people, of course good but there would have to be some kind of new financing. as i mentioned at the top, what many of its supporters are calling medicare for all is a really medicare. it isn't necessarily the same medicare program that exist now. it might be a a brenda program that people are currently on medicare would go into or the people who run medicare would get extra benefits. there's a lot of things not yet completely i doubt. >> host: you talked about some of these new proposals being much more generous. how generous and was making

these proposals? >> guest: according to bernie sanders who's been pushing medicare for all since 1993, probably before that but the first press conference i went to where he was sort of a lower-level cosponsor, was 1993. under his proposal people wouldn't have to do anything out of pocket, no premiums, no deductibles, no copayments, things most people have private entrance and nobody on medicare now has to pay. in exchange he would finance the filter increased taxes. his argument is that everybody would save money. that's probably not the case. a lot of people would save money. people who consume a lot of healthho care with fake money. people who consume low or no health care in any given year there's a lot of those people. most of the population might end up paying more that they would wohave insurance. it's when the time came to have r health expenditures they would be covered. it's hard to know, until you decide what's going to be covered, what's going to be paid

you have no idea how much it'sto going to cost and, therefore, how high the taxesid will be. >> host: how did the candidates deal with things like dental andth eye classes and the of the type of health services? >> guest: under medicare for all those would all be covered and those are things that are missing largely from the basic medicare package and now, things that seniors to use lot of like dental and eye coverage and footgear, things that a medical but are not part of the medicare package. until 2003 prescription drugs were not part of the basic medicare package. under the proposal for medicare for all pretty much anything would be paid. there's a house built and the senate bill and one in long term care which would be paid which would swap everything else and the other with. that's a huge threshold did she think that would made if and when congress gets around to trying to write help the. >> host: we saw, and here's introduce -- come all the hairs introducer version.

how is it different? >> guest: it's an interesting hybrid. she would have medicare for all and presumably be ad lot like e in thatmedicare program you can choose to go into the fee-for-service plan. free choice of doctor or hospital providers, and it would be generous plan. in theory you would need supplemental coverage or you could go into what's called medicare advantage, which is managed care and it generally offers more benefits in exchange you give up free choice of doctors and hospitals. you have to choose from a network. it's awkward because of the extra benefits and because it covers out-of-pocket cost the medicare doesn't. about a third of medicare beneficiaries are now in medicare advantage. her argument is you could choose the public plan or the private version of the p public plan. it's not entirely clear but it looks like provide insurance, excuse me, employer insurance would go away under her plan.

there would be a role for private insurance but not the private insurance people on the job currently have. >> host: you talk about these proposal since 1993. let's say a a democrat does win the next election. what's the potential s was making these actual plant really? >> guest: anyone who covered the affordable care act knows it was not easy. democrats at 60 votes in the senate in 2009 and it was still hanging by a thread. it almost collapsed any number of times. if something like this were much moreor dramatic would happen you would need to get rid of the filibuster or have 60 votes. you would need to get it to the house. you would need to balance the needs of the people from the more conservative swing districts with the more liberal -- all the things we're seeing now going on in capitol hill, it would not be easy. for those who think it's okay if we elect a democratic president and senate, as is going to

happen, if you like the democratic senate and democratic senate you get a debate. what's going toom happen from te debate? who knows. >> host: this is our first caller, jim in missouri. receiver of insurance from the aca. go ahead. >> caller: good morning. let's see, like most people i get got my health insurance to myce employer until i was fired at the age of 58 2(b) replaced by a younger, cheaper person. anyway, i am in favor of medicare forir all. and the way i i would finance t would be to take that thousand dollars a month premium that my employer put towards my insurance, pay 500 in a new tax to finance the medicare. the other 500 goes in my pocket. to me that's a win-win. a new tax that would be painless. private insurance right now

through the aca, about $16,000 a year provided for me by the government. no out-of-pocket costs to me. i have not been to a doctor in three years. i have no plans on going to a doctor. if you want to keep your health care costs down, avoid doctors. >> host: thanks, caller. >> guest: there is the argument that if the government werear to start paying for healh care rather than private insurance, many insurance companies are nonprofit by the way, but there is profit in the insurance industry for sure and the idea if employers didn't have to be provide insurance anymore some of the money could go back to the workers in higher wages and it could weather fitness of the willr or whether they will require it, and again even come close people about 18,080,000,000 people have employer-provided insurance but employers are very different in how much of that they pay for.

most paper substantial part of it but some employers don't pay for very much at all. dothose people would probably se money with increased taxes. people whose employers are paying a lot of that portion and if there make itng a good salary end up payingpa more in taxes ad if like this, they don't use the health care system much would come out behind. it's a trade-off noia owes much trade-off that people have. to decide individual and everybody will be affected different. >> host: plus the potential ifab a new taxing system to finance this, the middle class will be hit with that tax. >> guest: that's one of the questions. if it's going to be as generous as bernie sanders would like and cover everything with no out-of-pocket cost it's impossible to finance it without having that tax go down to the middle class took his argument is that everybody would be better off. many people would come some people wouldld not. we learned this with the affordable care act with the vast majority would be better off with a few people who were not screen really loud. you would expect exactly the

same under a medicare for all. that's why a lot of the theirates are hedging bets. did want to disrupt people's coverage particularly if they like it or nobody loves her insurance company but if people are afraid of change and sometimes they are promised change will be better and sometimes it is t and sometimest isn't and they are weary. >> host: a person who gets there insurance from the employer is john from texas. >> caller: thanks for discussing this serious, seriouc issue. c one of the voice with a lower cost of insurance is expensive hsa. i'm getting a serious discount. it gives us more control over our spending. i want to mention that the medicare for all is not really about health insurance. it's about control. once they government has control, complete control over your health care, we are no longer a democracy. we are a comments country and what bernie sanders wants to do is eliminate all options and

choices and basically control everything went to do in our life and no in the right mind would hand over the health of the family to the governor. it would simply be insane. thank you and i will hang up and listen to your comments. >> guest: hh a's are something republicans of and pushing pretty hard called health savings account, a tax-deferred, a triple threat tax preferred savings vehicle. you don't pay taxes going in. you don't pay taxes going up if you don't pay taxes on what it hurts. if you spendit on health care. if you have enough money to put in your hsa and you have few enough medical bills that your hsa will cover, it'sca a great thing. a lot ofof people have them and like them. there are some difficulties with them. if you have an issue you can negotiate. you can use get a a discount if you want to pay cash and you don't have to go through an insurance company but it's hard to know how much things cost. that's one of the things the trumpet versace working on debts

by person, or transparency in prices of health care. even if you're if you spend yoy it's come sometimes you call and ask with social cost and a provider not be able to tell you. theyer are not line. they literally don't know until bills get process. there are still issues with hsas. >> host: the kaiser family foundation did a poll how single payer health care. except for of it, save it figure 1%, opposing at 42%. also in july they bring a single health care plan amongst democrats a cut 70% of support independents 55%, republicans 15%. what is meant by single-payer and what do these numbers suggest? >> guest: one of the things that kaiser family foundation found his support for medicare for all is slipping a bit. it sounds great. everybody likes medicare. it's already socialist as the caller said. they government is paying for seniors health care or most of

it. it is very popular. when you tell the general public in a medicare and not wait until you're 65, basic rate rate as a safe but major taxes might go up. support starts tomi u drop. it means the government will decide what benefits you get and support starts to drop and we are at the stage of the debate with the terms are still being defined. what's interesting if you read into some of these goals is not just what the top line says about support but what if x, y and z and then you see what the real support is. we do see this partisan split, democrats are much more in favor of government run, government paid health care. republicans are much more in favor of more private market, and that's been the fight as long as i been coming health care which is not a longtime. >> host: is discussion about expansion, people point to the veterans administration to what are the lessons for the cautions from that type of service?

>> guest: the the v.a. is different. medicare is a single payer but it's not a government run system in that the providers, the doctors and hospitals and nurses are allll private. they government pays their bills. the v.a. is more like the british national health system with health care professionals are employed by the government. it is a fully nationalist system although there's private insurance in england. all this discussion of we're going to get rid of private insurance entirely, i don't think there's aat single country that has national health insurance that has no role for private insurance. the v.a. is much like the national health service. our medicare system is more like canada. the government pays the bills but the actual health care providers are not government run with other cautionary tales from canada? >> guest: there are. if you go to canada most canadians would like the health care system.

but yes, there are sometimes waiting line for things and some people who come to the united states to get care if you don't want to wait, particularly for elective care. people from the united states are going too canada to buy drus because they are cheaper. again,pe trade-offs. >> host: from uninsured like this is ron from new hampshire. you are next up. >> caller: thank you very much for taking my call. i love this show. you guys are great. listen, i should go ahead and mention i did call on the wrong line. i do not haveio insurance. i did have aca that i no longer do. i do have a couple of questions. and a comment. as far as taxes, , the middle class is shrinking and the people that are in the middle class are not very happy. the rich pay for a little or taxes. the ultra rich pay zero in taxes. of course the poor by

definition, they don't pay much in taxes. that leaves the whole owners on the middle class which is making things very difficult on the middle class and squeezing them very hard. i would like to know if we are in this next election cycle if we're going to be seeing the republicans after, for the last 12, 13 years or whatever, ten years trying to get rid of the aca if they're going to be defending it now trying to keep it and defend it against medicare for all, which is what the democrats are looking for. i have also say that i really don't believe that medicare for all and medical help for our general masses in this country destroy our democracy. i don't see it as socialism. i see it as a socialist program, a, you know, but we need some of those two camper down all of them some of the wealth that the

upper echelon is amassing. >> host: sorry to cut you off but there's a lot there. >> guest: medicare is what's known by social insurance. as a source of scooter. they are pretty popular whether their social scope they recalled socials at the time they retreated. fdr wanted to do health care and didn't think it could get to congress amenities things are new. the call that is right about the middle class a being unhappy, ad both parties are saved want to help the middle class. as to what republicans would do, there's a court case going on now it was argued at the federal appeals court in new orleans. we waiting for decision on that they could eliminate the aca entirely and the republicans are scrambling to come up with a plan b, what happens if that goes away next they been talking about -- the president talks in the white house is trying to put

together a health plan even as we speak, although it's not clear exactly what we'd be in it. it would not be the affordable care act what to do say they would continue to protect people existing conditions. that's the most popular piece of the affordable care act and i would go away ifat this lawsuit prevails. it basically says because congress eliminated attacks are people who don't have health c insurance. part of the tax bill in 2017 that renders the entire health law unconstitutional. most lawyers on both sides of the issue say that's a really dubious claim but it was that lower court judge found that to be the case entering the oral arguments of the court of appeals two of the three judges seemed sympathetic to that sort may well be back t before the supreme court possibly as early as nextac year. >> host: for all the talk of expansion programs among the democrat candidates had a a pre-existing conditions fit into thosens plans? >> guest: that affordable care act at the moment is still the law of the land and it is protected. one of the big questions about

president candidate is the bill on the affordable care act? jill biden pledge wants to do that purchase plan would take the affordable care act and expand it and solve some of the middle class problems because there their just a bit over the threshold. he would take away the threshold and that they would be able to get help. or the basically tossed it and start over with a medicare for all type single payer system? that's the crux of the democratic presidential candidate debate. >> host: from star in maryland. maryland. go ahead, you areis on. >> caller: i'm a 41-year-old african-american single woman with three children and we've been on medicaid for about 15 years now. the way i see it, medicare sucks. like i understandar why people like trump talks about things like that people don't understand. their doctors suck. their customer service sucks. like if you want to get treatment, like you have to be

careful how you go into that. i don't know what the big argument is about because the service sucks anyway. nobody seems to trust the service. as a single mother who has been given on thisa i thought hard time. i made myself sick trying tof find out how i can get an appointment. they don't take appointment in the first place. theyth don't treat for dental care.ta they don't really do anything besides treat people right guinea pigs especially black women. so who caresla about medicare fr all? even, if it comes a time were okay yet to say there's a major emergency, you got in a a car accident or whatever the situation, but on a regular just trying to get treatment on a regular basis, they don't -- >> all of this available at c-span.org. we were heading like to capitol hill with a senate cybersecurity caucus is holding a forum on cyber risks and t