gilbert, senator elizabeth warren and senator cory booker. watch the 20/20 presidential candidates live at the iowa state fair starting thursday on c-span. watch anytime online at c-span.org or listen live from wherever you are on the go using the free c-span radio app. >> this is julie rovner, chief washington correspondent for kaiser health news to talk about a theme that emerged from the last week medicare for all, good morning. how would you define those two things mark. >> medicare for all which is what democrats have been running for years now was basically in very, you take the medicare program, that about 60 million seniors and people with disabilities and expanded to everyone. in practice that's not what medicare for all would you create a new or generous program that might or may not be called medicare and extended to the entire population. so the idea of medicare for

all the government would pay all the nations bills and everybody would have coverage area and a public option on the other hand would create a government type program like medicare like medicaid and more available. right now you have to meet certain qualifications to into any of the government provided health programs. a public option would makeit much easier for people to get into government , government page. >> for the democrats debating on these issues, why are they so firmly advocating for these two positions. i guess what i'm asking, what's wrong with the current system ? >> everybody agrees the current system is not working well. people are paying too much, most people have insurance but substantial number of people still do not. a lot of people who do have insurance literally can't afford to use their insurance because they have multi-thousand dollar deductibles so everybody agrees that we need to fix what's broken. how you do that, democrats

generally agree that everybody should have healthcare, that healthcare should be a basic right . there is what the debate is and whether you do it all in one felt like medicare for all, single-payer or whether you do it more gradually with the public option or whether you give people the choice of keeping their private insurance if they like were going on a government plan. that's whatthe democrats are debating. >> if i were a private insurance provider , how am i looking at the various proposals one of my concerns mark. >> your concerns are with medicare for all you can be put out of business although it's hard to know. it's hard to imagine that there will besome rule for private insurance even as just the administrator , a lot of large companies now, they self-insure a higher insurance companies to administer the benefits. private companies administer ge medicaid for the most part and i'm not talking about medicare advantage . the fee for service medicare, most of those are managed by

private insurance companies so private insurance companies are watching this with some greatwariness . i think the providers of healthcare, particularly hospitals are watching it with more panic and the insurance companies, providers say that they can afford to take medicare now because private insurance really pays more. private insurance could go away and some large part or completely. in theory would be paid less and they're worried about that. >>. >> if you want to ask questions, what the democrat candidates are saying, we can by the lines differently you can see insurance for the ada . 70,000 is the number to call, for those in their insurance through employers, thousand yeone. if you're on insurance, 8000 you and all others 202748,000 . it the current medicare system as it stands, doesn't have the ability to flex so far to admit only a few potential people into it?>>

the current medicare program is in some financialdistress . because we got 10,000 baby boomers a day qualifying for medicare. so far the baby boomers are still young and their in low spending days as far as medicare goes but something's going to have tobe done to share up medicare financing going forward . it's not a matter of they couldn't accept more people and of course it could but there would have to be some kind of new financing and as i mentioned at the top, what many of his supporters are calling medicare for all really medicare area isn't necessarily the same medicare program exists now. it might be a brand-new program for people who are currently on medicare go into or that the people on medicare get extra benefits. there's a lot of things not yet completely ironed out. >> he talked earlier about some of the new proposals being more generous. how generous and who's making these proposals? >> according to bernie sanders and then pushing

medicare for all in 1993, probably before that but the first press conference i went to when he was a sort of lower-level coke sponsor was 1993. under his proposal, people wouldn't have to pay anything out of pocket. nopremiums, no deductibles, no copayments, things that most people in private insurance and everybody on medicare now have today . exchange , you would finance the bill through 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 healthcare would save a lot of money . people who don't consume, people who consume little or no healthcare and in any given year there's a lot of those n, most of the population might end up paying more but they would have insurance so when their time came to have health insurance, they would be covered. it's hard to know and really you decide what to be covered and what's going to be paid. you have no ideahow much it's going to cost and therefore

>> how do the candidates deal with things like dental and eye glasses and those other type of health services . >> and mark. >> under medicare those covered and those are things that are very missing largely from the basic medicare package now. things that fwe do need a lot of, things like dental and eye coverage and footcare, things that are medical and are not part of the medicare package until 2000 the prescription drugs were part of the basic medicare package so under the proposals for medicare for all, pretty much everything would be paid. you have now still in senate bill and long-term care would also be paid which could walk everything else and the other one would. that's a huge threshold decision that would have to be made if and when congress gets around to trying to write a health bill. >> we saw kamala harris introducer version of this what are the main features and how is different from the others ?

>> it's an interesting hybrid of what everybody else is talking about. you would have medicare for all and it would presumably be a lot like the current medicare program and that you can choose to go into the g4 service plan. your new choice of doctor, hospital providers. and it would be a generous land so there you would need coverage for you go into what's currently called medicare advantage which is managed-care and generally offers more benefits in exchange, you get a free choice of doctors and hospitals, you have to choose from a network and is popular because of those extra benefits and because it covers a lot of the out-of-pocket costs that medicare doesn't read about a third of medicare beneficiaries are in medicare advantage and so her argument is you choose the public plan or the private version of the public plan. it's not entirely clear but it looks like provider insurance, employer insurance would go away under, harris's

plan. there would be a role for private insurance but not the private insurance people on the job half. >> you talk about these proposals in 1993, let's say a democrat does win in the next election, what's the potential as far as making the actual plans reality ? >> anybody who covered the affordable care act knows it was not easy. the democrats got 60 votes in 2009. and it was still hanging by a thread. almost last any number of times. so if something like this were much more dramatic were to happen , you would need either to get rid of the filibuster from the senate or have 60 votes. you need to get through the house, balance the needs of the people on the more conservative swing district with the more liberal, all the things we're seeing right now going on on capitolhill . it would not be easy. for those who think that okay, we elected democratic president and the democratic candidate, this is going to happen. we elected democratic candidate, you're going to

get a debate. was going happen from the debate? >> is our first color, jim in missouri. you receive insurance from the aca, your own with julie. >> . >> like most people, i got my health insurance through my employer. until i was fired at the age of 58 to be replaced by a younger keeper person. anyway, i am a savor of medicare for all and the way i would take that thousand dollar a month premium that my employer puts towards my insurance and to save 500 in a new finance medicare. the other 500 goes in my pocket. and 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.

funded for me by the government, no out-of-pocket cost for me . i have not been to a doctor in three years. i have no plans on goingto a doctor . if you want to keep your healthcare costs down, avoid doctors. >> yes, and there is the argument that if the government were to start paying for healthcare rather than private insurance, many of them take a profit, many insurance monies are nonprofit, by the way but there's profit in the insurance industry for sure and the idea that his employers didn't have to be providing insurance anymore, some of that money could go back to the workers in higher wages and it could , whether it will or whether they'll irequire it. most people, hundred 80 million people have employer-provided insurance but employers are different and how much of that they pay for so most of them take for a substantial part of it but some employers don't paper

very much at all.those people will probably save money with this tax, people whose employers are paying a lot of that portion and they're making a good salary might end up paying more in taxes and if they don't use the healthcare system very much they come out behind. it's a trade-off, it's always about trade-offs and people aregoing to have to describe individually and everybody's going to be affected differently by this . >> what the potential of the new taxing system to finance this that the middle class will be with that tax? >> 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 costs, it's impossible to finance it without having tax go down. the middle-class argument is that everybody would be better off. many people with some people wouldn't. we learned this with the ll affordable care act where the vast majority of people were

better off the minority they that works, screamed really loud and you would expect the same under medicare for all. a lot of candidates are hedging their bets. they don't want to disrupt too many people's coverage if they like it. nobody loves their insurance company but people are afraid of change and sometimes their promised change will be better and sometimes it is and sometimesit isn't in there where he . >> a person who gets their insurance from their employer, you're on with our r guest . >> caller: thanks for discussing this serious issue. one of the ways to keep it low is hsa, i'm going through a medical situation now where i'm paying my local hospital cash and getting a serious discount so it also gives us more control. but i want to mention that medicare for all is not about health insurance, it's about control. once the government has control, complete control over your healthcare, you're no longer a democracy, where a communist country and what bernie wants to do is eliminate all options and

choices and throw everything we have to do in our life and no one in their right mind would handover the health of their family to the government it would be insane. thank you and i'll hang up for your comments . >> hsa's are something the republicans have pushedpretty hard in health savings accounts . it's a triple threat, it's a savings vehicle and you don't pay taxes going in, you don't pay taxes coming out on what it earns. but you spend it on healthcare and if you have enough money to fund your hsa and you have few enough medical bills that your hsa will cover it, it's a great thing and a lot of people eo have them and a lot of people like them. there's some difficulties with them, one of the things is if you have an issue you can negotiate and usually get a discount. if you're willing to pay cash and they don't have to go to an insurance company, it's

hard to know how much things cost and that's one of the things the trump administration is working on at pretty bipartisan is more transparency in prices in healthcare because even if you're spending your own money , sometimes you call and ask for something low-cost and the provider will be able to tell you. they literally don't know until the bills get processed so there are still issues with hsa's family foundation did a poll in july about single-payer healthcare. it said for supported , favoring it, 51 percent opposing it and that also in july favoring a single-payer health care plan among democrats, 32 percent of support, independence 55 percent, first of all, what is meant by single-payer and secondlywhat do these numbers suggest ? >> one of the things the family foundation has found his support for medicare for all is, it sounds great. everybody likes medicare. it's already socialist as the calling caller says. and it is very popular so

when you tell the general public you can have medicare and you don't have to wait till you're 65 basic great but it means your taxes might go up and then support starts to drop and it means that the government is goingto decide what benefits you get and support starts to drop so i think we're at the stage of this debate where the terms are still being defined . what's interesting is if you read into some of these loads is what the top line says about support and what if xy and z and you see where the real supporters. alwe see this partisan split, democrats are much more in favor of more government run, government paid health care, republicans are in favor of more private , more the private market and that's been the fight as long as i've been covering healthcare which is not a long time. >> in these discussions a lot of people point to the veterans administration and the health care they provide. what are the cautions from that type of service -mark . >> medicare is a single-payer

but it's not a really government run system in that the providers are all private, tjust the government pay their bills. the va is more like the british national health system where the health care professionals are employed by the government. so it's a sort of fully nationalized system although i will put out there's private insurance in england, there's a fair bit of private insurance in england all this that we're going to get rid of it private urinsurance, i don't think there's a single country that has national health insurance that has no role for private insurance but the va is much more like the national health service. our medicare system is more like canada's medicare system in that the government pays the bills but the actual healthcare providers are not government. >> are there cautionary tales and canada's experience mark. >> there are cautionary tales. if you go to canada most canadians like their healthcare but there are sometimes waiting lines for

things and there's people who come to the united states to get care if they don't want to wait, particularly for elective care. on the other handpeople from the united states are going to canada to buy drugs because they're cheaper there . again, a trade-off. >> this is from new hampshire, ron, your next up. >> thank you very much for taking my call. i love this show. you guysare great . i should go ahead and mention i did call on the wrong line. i do not have insurance . i did have aca but i no longer do. i do have a couple questions though . and comment, as far as taxes, the middleclass is shrinking . and e ssthe people that are in the middle class are not very happy . the rich pay very little or no taxes, the result of which they pay general income taxes, the poor don't pay much income taxes so that leaves the onus on the middle

class which is making things very difficult on the middle class. it's squeezing them very hard l . i would like to know where in this next election cycle if we're going to be seeing the republicans for the last 12, 13 years or whatever, 10 years trying to get rid of 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 kind of looking for and i've got to also say that i really don't believe that medicare for all and medical help is going to destroy our democracy. i don't see it as dualism, i see it as a socialist program . but we need some of those two tempered down all of the, some of the wealth that the upper exelon is amassing.

>> color, sorry to cut you there. >> first of all, medicare is what's known by economists as social insurance as is social inch insurance, there popular.is they were called socialist at the time were created. fdr wanted to do healthcare and didn't think he could get through congress so none of these things are new. and i think the caller is right about the middle class being unhappy and both parties always say they want to help the middle class. as what the republicans will do, what's interesting is there's a court case going on right now that was argued at the federal appeals court in new orleans. we are waiting for a decision on that. it could eliminate the aca entirely in the republicans are rambling tocome up with a plan b, what happens if that actually goes away -mark been talking about getting rid of it . the white house is trying to put together a health plan even as we speak although

it's not clear exactly what would be in it. it would not be in the affordable care care act but they would continue to protect people with pre-existing conditions, that's the most popular piece of the affordable care actand that would go away if this lawsuit prevails . it basically says that congress limited the tax for people who don't have health insurance, it's part of the tax bill, that renders the entire law unconstitutional and lawyers on both sides of the issue say that a dubious claim but it was that lower court judge found that to be the case during the oral arguments, the court of appeals, two of the three judges seemed sympathetic to that so it may well be back before the supreme court possibly as early as next year. >> for all the talk of expansion among the democratic candidate, how do pre-existing conditions into those plans to mark. >> the affordable care act at the moment is still the law of the land. one of the big questions among presidential candidates is you build on the affordable care act as joe

biden clearly wants to do. his plan would take the affordable care act and expanded and solve some of the middle-class problems where people can't get out of paying for their care because they're a little bit over that threshold. he would take away the threshold, everybody would be able to get help or do you t basically toss it and start over with a medicare for all type single-payer system? that's the crux of the democratic presidential candidate debate and the crux of thedemocratic debate on health care anyway . >> fromá,áis in maryland. go ahead, you're on. >> i'm a 41-year-old african-american single woman with three children and we've been on medicaid for about 15 a years now area the way i see it, medicare sucks. i understand why peoplelike trump talk about stuff like that and people don't understand , their customer service sucks.if you want to get treatment, you have to be careful how you go into that and dealing with them i don't know what the big

argument is about because the service sucks anyway. nobody shouldtrust that service . as a single mother who has been depending on this, i've had a hard time. i made myself sick trying to find out how i can get an appointment. they all don't take appointments inthe first place, they don't treat for dental care . they don't do anything besides treat people like guinea pigs, especially black women so who cares about medicaid for all? it comes to a time where okay, you have to say there's a major emergency, you got in a car accident or whatever the situation but on a regular just trying to get treatment on a regular basis, they suck . they don't careabout nobody . >> you madeyour point, thanks . >> i think she was talking about medicaid, not medicare.

the health system is bureaucratic and difficult to navigate and it can be difficult to navigate if you have medicaid or medicare or private insurance. a lot of people with private insurance have the same feeling about the health care o system but it is a fair point. medicaid is supposed to cover all the things the caller is talking about and in fact medicare does cover all those thingsthat can be difficult to get . and this is a much more fundamental problem is our, part of it is because we have such a multi-payer healthcare system, there's so many layers of bureaucracy. there are people worried that the public sector takes over the entire thing it will get worse . there are people who think if we get a private insurance on it, there are people on both sides andwe're having a debate . >> on the private insurance side, audit 52 million americans in their healthcare through their jobs, average annual premiums exceed $96 for single coverage, 19,000 $60 for family coverage. on average workers contributing 18 percent of the premium, 29 percent for

family and 85 percent of workers having an annual deductible for single coverage average deductible and for single coverage is $1573.that's the family foundation. and how do those calls change under these other proposals? ultimately it's significantly reduced,nobody paid out any cash to get services. i guess that's the ideal . >> those big numbers, that's not how much individuals pay, that's how much insurance cost, how much the average private insurance cost. then the workers pay a percentage of that, usually a fairly small percentage but as i mentioned if an average. on some employers a pay very little of the premium or they may pay some of the premium but leave large deductibles and coinsurance for people to pay when they use the system . again, it'snot how the system is hostructured . italics providers get paid. in the united states, we don't actually use that much more healthcare than our

competitors and other industrialized nations but we pay more for the care and use our prices are much higher than most other countries and as i mentioned at the top, providers are concerned about having their pay cut, how much of that is a really would close their doors and how much of that isthey are just getting paid a e lot ? that's where things are going to have to be kind of straightened out. >> mayor pete buttiegieg endorses medicare for all who wanted, what does that mean customer. >> medicare for 50, there are all variations on extending a medicare -like program. we're talking about medicaid for all, there are different ways to do this but it's ki basically saying we don't want to take anybody's insurance away. i think what they discovered though is you remember back to the clinton health plan in

1993 and 94, we famously had harry and louise commercials on the insurance industry sitting around their kitchen table worrying about losing their employer-provided insurance and this is the irony. people don't love the insurance industry but they don't want to have their insurance taken away so a lot of these sort of more gradual programs would give people a choice and if they can see that a public plan really is better, maybe we should move to that, it would happen more. it's an evolution, not a revolution is where the debate is sorting itself out among presidential candidates . >> let's show you that between john delaney and bernie sanders talking about how their ideals and how it deals with private health insurance. >> we can create a universal healthcare system to get everyone basic healthcare for free and i have a proposal to do it but we don't have to go around and be the party of subtraction and telling half the country that they are health insurance is illegal.

my dad was a union electrician who love the healthcare he got from the idw, he would never want someone to take that away . half of medicare beneficiaries have medicare advantage is private insurance or supplemental plans. it's also bad policy, it will underfund the industry. >> senator sanders. >> were going to come to you inone second but let go to senator sanders . >> the fact of the matter is tens of millions of people lose their health insurance every single year when they change jobs or their employer changes insurance. if you want stability in the healthcare system, if you want a system which gives you freedom of choice with regard to hospitals , the system will which will not bankrupt you, the answer is to get rid of the profiteering of the drug companies and the insurance companies. >> julie, when bernie sanders

uses that word if you want stability, you make that into this discussion where having their both right and they're both wrong, they're both over talking a little bit which is what candidates do . john delaney has backed off his earlier claim that every hospital would close under medicare for all. now he's saying many hospitals would close and hospitals are closing out and senator sanders is also correct what he says people lose their insurance and their employers change insurance or when they change jobs that's also true e that it's a matter of which you prefer and what are you more worried about? are you worried about profiteering in the healthcare industry? are you worried about the government determining what benefits you get? who do you distrust least is where most people are on this. >> charlotte in texas, i. >> i'd like to know why they need it medicare forall . on medicare, people pay into it. medicaid isfreebies .

the other thing is if you really went with medicare, you'd have to pay the premium that you have to pay every month in medicare. a premium that you have to pay every month for supplemental insurance and a premium for drugs. he sees about this advantage, most doctors don't want to take it . so i don't see for this medicare which is really medicaid that we're talking about for all is, it's a great deal. first of all, it's not medicare. it's medicaid thatwe really talking about . >> guest: they call it medicare for all because medicare is popular, people know what it is and their parents and grandparents had and they like it. the color is correct, medicare has a lot of cost-sharing for its patients and people do pay that, you pay that medicare tax as part of what's held from your spaycheck when you send it

directly to the government so there is a tax or part a of medicare so you get when you retire, when you become eligible you get that forfree but you do have to pay . there's a premium for part b and the premium if you have a standalone prescription drug plan. there's a premium if you decide to go into medicare advantage and as i mentioned, the medicare advantage trade-off is you probably get more benefits and fewer out-of-pocket costs but you don't get to go to every doctor or hospital. that'sthe way medicare is set up, but not necessarily the way medicare for all would be set up . it's not medicaid because medicaid is sharedwith the state. medicaid is a different kind of program .you could do a medicaid for all and there is talk of that because the medicaid benefit package is much wider and there's less cost-sharing because it's for people who don't have a lot of money so they can't afford healthcare costs so there are variations on how to do this but i agree, it's confusing to call it medicare for all

because they start stumbling over themselves because it's not going to be medicare. >> host: how did the proposal to prescription drugs then? >> guest: they would be covered. medicare, the idea of freestanding medicare prescription implants because it was the republican congress, that put the drug plans together and they wanted a role for private insurance created these private prescription only drug plans. >> on the sidebar note, the president, the administration announcing efforts to import drugs from canada. any sketch out what that proposal is and how do the canadian government do that ? >> canadian government is not grim. there are 37 million people in canada which is smaller than california. are not enough drugs in canada to provide all the drums for the united states and what it's doing is not so much importing canadian drugs as importing canadian drug price control so canadians, that's why drugs are cheaper in canada and other places

because the government says were not going to let you make that profit, the united states is practically the only country where drug cacompanies can charge whatever they want so you have people traveling to canada to get over the border and that works. if you can go to canada and save a lot of money on drugs and have a prescription and bring them back and the border patrol will let you bring back drugs for brpersonal use, obviously you can't bring in large amounts to presell and what the trumpet ministration is looking at his letting him states and perhaps pharmacies and drug manufacturers themselves bring back drugs at their lower prices and tell them it's not entirely clear how it would work. you probably wouldn't cover, at least the way of being described now it wouldn't cover some of the most expensive drugs and it would only work if it stayed very small. it's not a long-term solution for drug prices and is not a solution for nieverybody but it

does allow the trumpet ministration to say or going to let you buy cheaper drugs from canada even if maybe on a very smallscale . >> santos in gainesville virginia. >> good morning. i appreciate the conversation. i can talk an hour on this stuff. a couple of things, one was people call in and say going to universal healthcare system or medicaid for all, whatever you want to call it, you say that the move to communism or whatever it is. if that's the case, we have to declare israel and japan or berlin and canada and germany and all those countries communist countries . they all have a universal healthcare, we're the oddball in this equation. it seems when we're talking about the cost, i look at my cost individually so if the highest estimated 10 percent taxes, if i look line 12 on my w-2 form it says how much my employer pays as a benefit

that i never received. i never get this money. it simply is paid towards my medical insurance which you know, in person can be quite high or whatever the lawyers pain and that's money that basically is paid to the insurance company on my behalf at my employer's expense but that money was then moved over to me as a salary and i had my payment that i also paid towards my health insurance for my employer. when you combine that amount, from me personally about, i pay, i missed out on about $17,000 per year and i think about 5000, i looked at 10 percent of my income equaling $23,000 a year, that would imply that i'm making about $230,000 which is well above my employment so when we look at the amount of money that

i'd actually be paying that they write the bill in such a way that that money would be going the insurance company comes to me as income, most people, not making over 150, $200,000 would probably benefit greatly and those people want to buy life insurance, go ahead because they're going to start seeing their fellow employee making 10,$15,000 more a year . >> thank you very much. >> that's a big which is that if employers start providing insurance that money into wages instead, i'm not aware, i don't know that congress can guarantee that and of course, health spending , the amount employers pay towards health insurance changes every year so there would be winners. there would be a lot of people who would pay a lot less . there would be some people know who would pay ulmore rent i think that's also the part that kind of gets brushed aside sometimes. and also it's going to be

individual, everybody's going to have to look at their own situationand figure out what's good for them . congress and the president's job is to figure out the solution that helps the most people but i think it's unrealistic to say that everybody would be helped by anybody's plan be one from tennessee, this is richard. >> caller: good morning, thank you for the conversation. it's very informative for me for the simple reason that my daughter just enrolled in medical school and she is looking at in the neighborhood of $250-$300,000 0 in school costs. so i look at this as medicare for all and everything is free, you're going to have a lot of consumers of medical care. are there going to be enough providers to provide medical care after mark. >>. >> guest: that is a good and

the big question. they were concerned when the affordable care act passed that there would be a shortage of healthcare professionals . one title of the affordable care act that almost nobody talks about went towards helping more health professionals not, not just doctors but practitioners and assistance and other type of health professionals who can provideprimary care to try and ensure there would not be a shortage and to pretty much , 20 million people got insurance as a result of the affordable care act and there are issues with shortages in general but the affordable care act citself did not create a shortage of medical professionals but that's an issue, the gap that medical professionals, not just doctors but nurses, other types of healthcare professionals incur when they become health professional . at one of the reasons theyprsay they charge such high prices is they have enormous loans to pay off . there's a move towards trying to make health professional tool less expensive or tuition free or help with loan repayments which you can .

already do if you have large schooling debt. you can go to provide care in an underserved area and the government will help you pay off your loans . but those types of things can be expanded but yes, it's an issue if you're going to get everybody else health insurance coverage and as the caller pointed out, it makes things free so people will use more healthcare. you're going to get people awho need care who couldn't get it before but you all may also get unnecessary care and thatgoing to be an issue . >> host: have you heard any formal responses from the medical community, doctors or nurses to these public option proposals? >> guest: the healthcare t industry in general is not a fan of medicare for all. the ana basically fought tooth and nail and killed every proposal to expand health insurance . until medicare, they fought against it and they didn't win and the affordable care

act, that was negotiated with the healthcare industry because the decision was made that you can't fight the healthcare industry or you'll lose so you better get them on board. >> host: julie, she's their chief washington correspondent talking about medicare for all and the public option proposals darrell from new brunswick, hello . >> caller: hello. i have a question about the public option. i wanted to find out if i had private insurance and i get sick and can't work and therefore can't pay my premiums, what kind of health insurance what i have? >> guest: that was the idea of the affordable healthcare act, if you had lawyer provided insurance you would be able to buy insurance through the government, through the affordable care act exchanges. right now you geta government subsidy those icare all private plans , under most of the public options that are being proposed you would be able to

go out and as soon as you lose your other insurance you could buy new insurance, a public option plan or a private plan. whatever was best for you. >> host: from newark new jersey, someone who gets aca insurance. >> caller: by don. bernie sanders is proposing, i'm not going to take it because i'm in a health, i love it i do nothing and i go to doctors . my medical doctor, that is. praise god i go to other doctors because united healthcare takes care of me physically and my vitamins. so debate but at the sametime , the working poor pay nothing at all, please do

that. they're in the 70s, the number in this country thank you . >> guest: it's not so much de the type, the company that provides the insurance, it's the type of insurance you have and do some people are happy with their private insurance. at one of the reasons we're debating medicare for all versus a public option, do you want to disrupt the people who are happy with the insurance they have? >> host: the largest hurdle they may have are winning over the .public on this or at least what they want to change. >> guest: it's important to have the debate because i think everybody universally is frustrated with the healthcare system. maybe not this color but most people are frustrated with the healthcare system. we're spending an increasing amount of gdp on it as a society and not necessarily getting the returns that we would, that the us is not better in most of the measures of having good

healthcare. we're way down the list and we're spending a lot of money and not getting a lot of value and everybody agrees we need to do something about it and the debate is what is it we as a society want to do? an>> for our system, how does it compare to other systems and what are they doing better than we are? >> old everything. a lot of our trade competitors do, they have universal health insurance and it's mostly run by the government so employers in some countries they are attacks but at least it doesn't fluctuate so there's more state ability in those other countries. they control the prices of healthcare, of hospitals, of doctors, of drugs. we don't really do that, the insurance companies triedto negotiate . some do a better job than others. it depends where you live, if there's a single hospital system and the insurers basically have to take it or if there's a single insurer, the hospitals have to take so there's difficulty in

different parts of the country. do we want to, if we rationalize it people are going to be dislocated and they're going to complain so. >> is there a system that relates well to the united states as far as the number of people we have in the united states, is there a system has a similar number is healthcare well and why they do it well after mark. >> are bigger than other countries, there are a lot of systems in europe doing well. as the caller pointed out, you can think of them as if it's not communist, socialist. a lot of people look at the scandinavian countries. i spent time in switzerland which has a system that similar r to what i was before the attacks away which is it as an individual mandate, people have to buy private insurance and private insurance is pretty expensive and took me a while to figure out why do people like it so much and then i suddenly realized they can't get high taxes in switzerland and it covers everything elseso they don't have to hundred me thousand dollars of medical school that . i have paid leave, they have

to pay for college. there are always things, they don'thave to pay for retirement . so all these other expenses are things that the middle-class have to worry about, basically they only have to pay for their health insurance. >> from scott, stopped in georgia, hello. >> i just want to make a comment. i am by the way an insurance ogre. and have been in the business probably 20 years and i can remember when in south georgia we have about three or four or five insurance companies to pickfrom from health insurance . most aca, service to individuals you have one. and as a result, you don't have competition and when you don't have competition, it doesn't giveyou a lot of choices . and another thing to comment on, i've noticed how politicians, we always see that the insurance company and it's always the insurance company saw but ultimately,

the providers were the ones making the money. you never hear politicians question the providers themselves. i'm working out with a reference base practicing system direct with the providers. and they in trying to pay two times medicare to get contracts it's a very tough road. the insurance companies are all bad. if anybody complains aboutcar insurance or life insurance, there's only health insurance. i wonder why that's the case . >> thanks caller. >> somehow in the state back to the clinton health plan. it was the insurance companies and drug companies who were the big enemies and everybody else was getting off and the color is correct that the money is ultimately being made by the providers. >> ..

they have a lot of clout in hospital so important. you need hospitals so this is kind of the issue here, if you really want to get to the issue you have to get at prices. that's what the hospitals in the congressional districts will that affectnd how congress overl will take care of her consider this issue? >> guest: that's right. postal is go to south carolina, david is next up. good morning. >> caller: good morning pedro angelie. i'm 65.i it was kaiser permanente and richard nixon then enable the operation and to health care that we have in this country now. i know she's going to say they are not connected by the kaiser family was connected with it some way. the republicans in my life type

have always been for the few, not the many. they were always the bosses and not the workers. they like insurance companies is as big pharma as much as the left-wing democrats are. they are bought and sold. the profits for insurance companies and big pharma are nothing but blatant usury and as far as the middleman i don't want the government between me and my doctor i'd rather have a government between me and my doctor that i can bode out that the ceo of the corporation that can get me for so much as he can get. a good day. >> guest: as i said which one do you distrust the least the government or the private sector when it comes to something as important as health care complex >> host: from livingston, massachusetts, hi. >> caller: good morning. my question is what percentage of the population is for private

insurance and white appropriation is covered by insurance companies? and generally insurance companies will our -- for the service. and the insurance company only covers mostly upper rations with a lot of employees. most people as an individual cannot afford the insurance company. they don't cover individuals because individuals can affordls it. >> guest: actually the insurance companies taken to task. they the percentage of profit so

obviously a cost go up that percentage could be a larger or smaller number but that was a big concern and at least partly addressed in the affordable care act. it's hard to say how many people exactly are in the private insurance because there are so manyny hybrids of medicare medicare which is government insurers who have a private plan. there a lot of people on medicaid tour on private insurance that his contract with the government to provide that care and then there's the 150 to 180 billion people who have an employer-provided insurance. the gentleman at the insurance company loves his insurance and that insurance company provides all kinds of different insurance at different rates in different employers in different segments of the market. we definitely have a hybrid system right now government and private and which one would you like to weed out in which one would you like more of? let's go last week a lot of questions about these health care programs.

what should have beensh asked ad what wasn't as though you think it's an important question to ?sk for these candidates >> guest: i feel like there were a lot of issues that went untouched. they didn't talk much about drug prices which is a huge issue right now. they didn't talk much about the opioid epidemic also a huge issue. there was one brief issue of mental health which is an issue this week so there were a lot of things that did not happen. i really wish somebody would ask more about the public versus private and the caller said would you rather votee out your congressman do not have any control over the ceo that you can't reach, your stakeholder board so those bigger issues a lot of the candidates got through the weeds of their own plan rather than looking at the bigger picture of how do we want to provide health care and spread the cost more fairly?

let's go from north carolina, good morning. you are on with our guests. >> caller: hi. my situation is sort of complicated but i'm retired on disability several years ago and i have medicare and i have private insurance from my employer. medicare sets the rates at what the doctors are paid and since i have gotten on medicare that doctors get a lot less than what they did when i just had to private insurance will put my costs per month for medicaid is -- medicare is just a little over $100 in my private insurance ismy about $250 a mon. the only thing i have to pay for when ith go to the hospital, i'm lucky i live in durham north carolina and i go to duke hospital. i don't pay anything when i go to the hospital. the only thing i pay out-of-pocket or my premiums in the co-payment for my medication. most of those are 10 or $20

except for the specialty drugs i i take what you're like $90 but that's for a 90-day supply. that system works perfectly for me and i don't know why a system like that can be implemented for everybody. it just seems like it's a win-win situation. everybody gets medicare once they retire and medicare sets the rates now. usually as lot less than privae insurance up until you get the medicare. ii have a asleep don't know how the hospital stay in business. i was recently in the hospital for two months and had major surgery and it was hundreds of thousands of dollars. i didn't have to pay anything. >> guest: somebody had to pay something and that's the argument. tends to go towards private insurance to pay more or fewer uninsured were even if you are insured you aren't seeing some of theseve pills.

the costs are turned around but they are invisible in the argument that would be great to me so should be great for everybody providers will say we can't afford to do that for everybody. we can do it for ayb subset of people but the subset of people doesn't payyt anything and some people have to pay what that person didn't. i went point is a sustainable for the health care system that balance they have to find? westco jaleesa appointed 20 years in the trump administration allowed the skinny health care plan. what are they and what has been the result of that? gascon it's a short-term plan. this is a pic fight within the obama administration. the idea of short-term plans with the jobs or college students graduating before they get a job it would tide them over for couple of months and they don't cover a lot of things. they are the only plans i think they can still not sell you

based on. existing conditions or cannot cover pre-existing conditions. they are not compliant with the affordable care act requirement. the obama administration left a dead no more than three months was they were concerned people were buying them instead of the other plan because they were cheaper to the trump administration riverside and said no you can go ahead and buy these plants and they can last as long as 364 days per there was a concern that people are going to be rushing to buy these plants. it's happened in some places and it hasn't happened a lot that we are starting to see stories of people who bought the insurance they get it was real insurance and then they got sick and discover nothing was covered. so there is that part of it. it's not has been as disruptive but there are a lot of things going on in the individual insurance market. it's proven more stable than anybody expected.

almost as many people signed up last year and the year before. the short-term plans werere allowed a little bit of impact but apparently not a lot. >> host: for massachusetts cameron, hi. >> caller: hello. i'm going to try to make this brief. so s complicated. in may i fell and hurt my right arm, wrist and elbow. since then now it's august and i still haven't been able to get my wrist x-rayed. i have blue cross. i pay single-payer, $796 a month at no co-payment. so at least $2700 before they will allowed me to pay only $50 for a visit. since then i've had two primary care office visits, one orthopedic visit in july.

time i couldfirst be seeing. the orthopedics didn't want to deal with my wrist. now i'm told i have to go back to the orthopedic to have another x-ray on my wrist and when i questioned that i was told because of the insurance required that i be seen for one body part at a time. now i'm paying for the full visit and i'm up to five office visits andvi x-rays for one fal. if i went to the emergency room when i fell it would have cost me $1000 that would not be applied to my deductible. i feel like the doctors are making me go back. why do i have to go back for one body part at a time? why couldn't i have been seen by the ortho in orthopedics for my wrist and died -- your response off-line? thank you.

>> guest: i hear these stories every day and to hear them from people with private insurance in people with public insurance. we heard earlier from a caller with publicra insurance. there are very few people who think the system is functioning well for them and that's why we are debating it. posted the public option proposal as we go forward what should people pay attention to particularly on the presidential front? >> guest: what they think a system would look like that would be fair and would work for them and this question of how realistic is it? as a society do we want to throw everything up in the air and start over again? maybe we doan or maybe you wanto do something more gradual. i think that's the thing that people should be thinking about but just remember every system will have it. straight off since some things are going to be better in some things are going to be more difficult. you have to decide if the voter

was best for you. >> host: julie rovner helping us understand these things the washington correspondent. thanks as always. president trump spoke to reporters today as he departed the white