lives of the 44 american presidents through stories gathered by interviews with noted presidential historians. explore the life events that shaped our leaders, challenges they faced, and the legacies they have left behind. shelves april 23, but you can preorder your copy today at c-span.org/thepresid ents or wherever books are sold. >> live today on c-span, "washington journal" is next. at 10:00, look at u.s. maritime security. at three: 30 p.m., discussion on investment opportunities in low-income neighborhoods. coming up incoming up in an hour health news julie rovner on how

the issue of health care is playing out in congress and campaign 2020. at 9:00 a.m., christel marchand aprigliano talks about the rising cost of insulin. [captions copyright national cable satellite corp. 2019] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] ♪ host: as more democrats join the 2020 demo -- presidential race, health care including substantially larger government programs like that to care for all are becoming key parts of their platforms. good morning and welcome to "washington journal" for tuesday, april 16. we begin the program taking a look at some of those plans and asking you if you would support or oppose a medicare for all type plan. here is how to be part of the conversation. if you would support that, call 202-748-8000. if you would oppose a medicare

for all type program, that line is 202-748-8001. postsl also look for your on our facebook page, facebook.com/cspan. and send us a tweet @cspanwj. the issue came up last night during a town hall with bernie sanders on fox. we will show you some of his comments announcing the plan over the weekend and more about that. at first, the fire that capture the world attention is on the front pages. the wall street journal, blaze ravages notre dame, the structure of the 850-year-old cathedral at the center of paris was saved, officials say. beloved notreis' dame. you are seeing the spire collapsing in the late afternoon. front page of the washington post, and their headline is vowsn vowz to rebuild --

to rebuild the landmark. a catastrophic fire spread through a building that has embodied the heart of paris for more than 800 years. the fire, which came during christianity's holiest week left a shell where there had once been a peerless work of architecture, engineering, and craftsmanship. an update on that story from the associated press and this tweet by bloomberg, they say there is no evidence of arson in the fire and police are working on the assumption the blaze was an accident, citing the paris parisutor and from the bureau chief of the economist, tweeting this remark, "notre dame this morning damaged, but defiant. huge relief to see it. funny how even to the secular i, the word that keeps coming to

mind is a miracle." our topic for the first hour on medicare for all came up last night in a town hall with bernie sanders on fox with bret baier. the headline from the hill, sanders town hall audience cheers after fox news host asks if they would support medicare for all. how many are willing to transition to what the senator says is a government run system? bernie sanders was, over the the cbs program sunday morning asked about his plan, which was introduced last week. here is what senator sanders had to say about his plan. [video clip] >> it sounds expensive, so how would you pay for it? >> it is less expensive. what is expensive and unsustainable is the current health care system. if we are spending twice as much per capita on health care than

any other nation, that is expensive. what our system does is get rid of insurance companies and drug companies making billions of dollars in profit every single year, outrageous compensation packages for the ceos of drug companies and the insurance companies, doing away with the administrative nightmare that exists when hospitals and doctors have to deal with hundreds of separate health insurance programs. our program is far more cost-effective. we will save the average american substantial sums of money. >> how much? >> i am not going to sit here and tell you i know exactly to the cent. what cms estimates, over the next 10 years, we will spend $50 trillion. every single study that has been done, even by conservative entities tell us that medicare for all a's far more cost-effective than the current

system. just some quick details on his plan from cnbc. they write senator sanders' bill would cover primary and preventive care, prescription drugs, vision and dental care, mental health, substance abuse treatment as well as maternity, newborn, and long-term care. his plan would let americans see whatever doctor they want to with no deductibles and co-pays. what theoader look at program would look like from the washington post in terms of other plans, senator sanders included, a medicare for all type program. it would move the u.s. in the direction of a single-payer system where the government steps in rather than insurance companies as the intermediary between patients and providers and health care transactions. let's hear your thoughts. if you support that type of program, 202-748-8000.

if you would oppose it, 202-748-8001. let's hear from willis in thomasville, north carolina. first up this morning. welcome. caller: good morning. thank you for taking my call. i would support medicare for all, but we cannot even cut the .ost of prescription drugs thank you for taking my call. that is all i have got. phoenix,istian in arizona, also would oppose that plan. good morning, christian. caller: good morning. thank you so much for taking my call. it is a total abomination the democrats continue on with this nonsensical government takeover of everything. we just watched an attempt by obamacare, which was ruled unconstitutional by the supreme supreme courtsib

case. , we have the democrat presidential candidates making note promises as if we did just watch obamacare fall flat and now all of a sudden we are supposed to believe that they are going to take care of the entire country. it is just like the promises they make about reparations, when almost every single that ku in 1871, for klux klan act, the third enforcement act known as 42 u.s. 3, almost every democrat voted against reparations. it is a total abomination they continue with these lies over and over and over again and yet

they are calling trump the liar after he has been in office for almost 2.5 years that they have been in power for decades? host: that is christian in arizona. this is pat in mountain home, arkansas, who supports a medicare for all type program. caller: good morning, thank you for taking my call. i support wholeheartedly because i pay for it now. i have disability because i have a broken back and parkinson's. i would not be able to pay for my expenses. i think bernie sanders is the best candidate. thank you. host: do you know people who are not eligible for medicare who would benefit at a younger age from having that type of program? backr: my son has troubles, too, and he is 46. his insurance at work is out rages he has to pay $68 --

60 --eous, he has to bay he has to pay $68. medicare, it pays for everything. my surgeries i have had, everything. host: thank you for calling in. we started the program talking about bernie sanders, his medicare for all program and there are a number of presidential candidates who support that kind of program, the washington post on where the 2020 democrats stand on medicare for all. it is supporting some version, not all have been specific about how far they are willing to go to support single-payer health care. ,enators booker, pete buttigieg kiersten gillibrand, senator harris, and also bernie sanders, elizabeth warren, andrew yang who we had on before the program, one of his events from

yesterday. also, preferring something else, some of the democratic candidate , former governor hickenlooper, governor inslee, john delaney, amy klobuchar, and beto o'rourke, you will find that at washingtonpost.com. in general, support for some type of program for the democratic side opposing a medicare-type plan is barbara in north bergen, new jersey. tell us why. caller: i disagree on having it approved for the part that i was a democrat at one time and now i am republican. i just think having medicare for everybody is going to bankrupt our system. it is just not right. far left,ders is so it is unbelievable, and i disagree on approving it. it is sad. host: north bend, oregon, david

is on the line supporting a plan . tell us why, david. caller: hello? host: david, are you on a speakerphone? can you pick up your handset and talk to us? you sound a little far away. caller: can you hear me now? host: we sure can. that is better. caller: what i am about to say, i don't know if they have the patience because it may take two minutes. i am a veteran with a v.a. pension and i was dealing with the general hospitals they have .round i was also on v.a. choice, that is what i am back on now, which, essentially, that program is like medicare, it is paid for through the general funds, probably, because the v.a. is supported by the general funds and there is really no

comparison. my situation with the hospital, .ith the v.a. was disastrous i have been on a very long morphine and what happened is they were mailing my morphine and because the v.a. is so understaffed, this is not the v.a. choice system, this is the one i was on, what happened was it was delayed in the mail 9 days. i called the hospital, i left messages for my doctors, i was told they would follow up, they would follow up. i eventually collapsed, could not put my head -- could not risk my head after laying on the floor, i could not crawl to the door, there was someone knocking at the door. host: you are on the v.a. choice

program, correct? caller: that is correct and i would like to see an identical program nationally because i get medicare also, but the v.a. choice pays for everything, it all depends on your income. host: how much of a choice do you have under that program? any surgeon,octor, any specialist, you have to first get a primary care doctor in their program and after that, it is a piece of cake. if there is a doctor that will take it, and i don't know what they pay as compared to medicare because i know medicare is rather frugal in what they will pay the doctors, but you can get much better care, much better k because i have been through the middle of it. i know it is anecdotal propaganda. host: thanks for sharing your experience with us.

asking your thoughts whether you support or oppose a edda care for all type plan. bernie sanders talking about it last night on his box town hall and the plan in general, here is in brief,ders' plan it would establish a national single-payer medicare system with vastly expanded benefits, prohibit private plans from competing with medicare, eliminate cost-sharing. it would include universal provision for long-term care in the home and community settings, part of the plan. the cost of the plan, this is a look at the new york times and their question was would medicare for all save millions -- billions or cost billions? this basic chart shows under the current plan, this is current spending for medicare, just medicare, $800 billion. medicaid, $623 billion.

and other areas of spending, other health spending, private health insurance. one of the men who is advising bernie sanders, gerald freedman, economist at the university of massachusetts in amherst. if we push this under his cost, here is what the projected cost for medicare for all and you can see a lot of those other expenses go away, but their projected cost for medicare for almost $2.8 trillion. you can find other manifestations about this. it is in one of the upshot pieces they did. let's hear from tom in fort lauderdale, florida. hello there. caller: good morning. the democrats are up to the usual thing, and that is they are playing on the emotions of the american people to sell a fantasy backed by a high school valedictorian speech.

let's go through some fantasy versus reality with the democrat arguments for just about everything. number one, this medicare for all would be something new and it would work. the reality is we have had a medicare for all, it is called the v.a. the v.a. was a catastrophe or people who needed its services. you say, they fixed that by letting them go to doctors. really what happened was the free market capital system, which is the doctors, have been saving the v.a. and that is what people find out, the only way you can save a socialist system is to enact free-market capitalist methods of doing things. let's do a couple of other ones, the medicare and social security are successful programs.

actually, if you put the numbers up, you would find out of they are both disasters financially. we need transparency on the cost of these programs and we need to stop letting democrats run around saying they are successful when they are really so far in debt, we will be lucky if we froze it today, that we could ever pay for it. democrats wanted transparency with trump, where is the transparency on their argument that these programs are successful when they are really complete financial disasters? host: let's hear from land o lakes, florida, dorothy supports a medicare for all type plan. caller: thank you for taking my call and it is a beautiful day today in florida. i have been on medicare for 10 years and i have a supplement. i pay for the supplement and it

kind of hurts a little bit because i am on a fixed income, but i have not seen a bill from a doctor, a hospital in 10 years . you either pay upfront or you pay after. i used to get bills three years after i had a procedure and i would say, what is this for? i don't even remember. it took them that long to push it through your insurance company. host: do you have any concerns at all if you expand this program to cover pretty much everybody that people like you who are currently pleased with your medicare, happy with your health care, that somehow the care and the choices will be watered down? caller: i am not selfish. i think everyone should have the same privileges i have. in addition to that, i think -- ahave a friend that is on

medicare advantage program and she needs a surgery badly and her advantage program, her doctor, because you have to go to doctors with that, will not let her have that procedure, they want her to have a partial procedure and she is just a few years younger than me and she really needs this procedure. host: how long has she been waiting for it to be done? caller: about five years. she keeps saying i need this done and they say, you don't really need that, you only need it partially done. i don't want to get into the particulars. host: thanks for that. appreciate you calling in. your thoughts on whether you support or oppose a medicare for all program. 202-748-8000 if you would support that type of program. 202-748-8001 if you oppose it. keeping an eye on the mueller

report release coming up thursday, the headline in the new york times tells us the attorney general will release the highly anticipated special counsel's report to congress and the public on thursday. a justice department spokeswoman said yesterday, mr. barr will release the report after department lawyers blackout secret grand jury testimony including classified information, material related to continuing investigations, and other delicate information. while the special counsel rules allow the attorney general to decide what -- whether to share the report with the public and how much of it to release, democrats have shown an unwillingness to rely on mr. barr's judgments. the house judiciary committee voted to authorize its chairman, jared nadler, to subpoena mr. barr to compel him to turn over an unredacted copy of the special counsel's report as well as the underlying investigative files. mr. barr told senators releasing

the redacted report would be the first step in what promises to be a protracted back-and-forth with democratic lawmakers over how much of the document they are allowed to see. at nytre about that imes.com. in the washington post, one opinion on the lead up to the release of the mueller report. a columnist writing with the headline admit it, fox news has been right all along. throughout most of southern ohio, residents who watch cable news are predominantly glued to fox news. people do not watch fox news news to know what they think, they already know what to think and they avoid news channels intelligence.eir to be fair, when a democrat is in the white house, the networks switch places with fox news criticizing every move and msnbc

and cnn defending the oval office fortress. for now, while partisans on the left may quibble, on the subject of collusion with russia by president trump or his campaign, fox news was right and the others were wrong. upon and cnn devoted hour hour day after day to promoting the narrative that trump colluded with russians and the special counsel robert mueller was going to prove it. that turned out to be wrong. you can read that at washingtonposted.com. support or propose -- oppose a medicare for all type plan? in florida, good morning. caller: let me give you an example so you understand why medicare for all and single-payer is wrong. remember the government is offering free education, especially college. now we are to trillion dollars in debt in student loans that

nobody is paying back. they even took away the contracts from the collection agency is collecting millions from default student loan people and now we are not collecting at all. that added $2 trillion onto our debt. what do you think medicare for all where the government is not only going to be setting the salaries for every doctor, every health care worker in america, but you will not be able to get services. i have been in florida for four years and i have medicare and medicaid because i am on this ability after getting run over by a drunk driver at 55 miles per hour. i was working two part-time jobs paying my way through college when this happened and i have been in limbo in florida for four years because everything i need to help me, medicare does not cover. i am stuck, literally stuck. host: here is randy in michigan, he would support a medicare for

all program. caller: good morning, bill. i would like to start by thanking you and all the men and women that bring us this program . i would support medicare for all, but you are going to have to set up a support system for that medicare for all and what i mean is you hear people say the government is going to set the doctor possible wages and health care worker's wages. of thesea, most doctors, i don't have private doctors, i have doctors that are contracted by one of the hospitals in the big cities, it is not a private practice, so they are already moving toward that where they are comfortable with getting a salary of whatever it is a year and benefits and whatever. i would also set it up where he would have a program where we pay for x amount, whatever that

is, of your general practitioners and of all your different fields you would need. we would keep a supply of doctors, nurses throwing -- flowing into it. you are also going to have to figure that raises, you cannot just set it at that. it is an investment in us. i really don't care if i have a $2 trillion debt, i have more than that, we spent money on the last four months and i guess i am one of those, 20 years, because i am 62 and i only have about 20 some years left on this earth. millenials should get out and vote. i am making decisions and i ain't got long to live. host: thanks for calling in. you can also weigh in out our facebook and twitter. delays rights -- liz writes difficult to see why anyone would be listening to bernie sanders.

to ask him out right how he got so much money to buy a million-dollar dollar home right after losing to hillary. veterans can attest socialized medicine does not work well and michelle on our facebook page says the government cannot govern their own house, i surely do not want them governing my health care. on the issue of medicare for all, alec cesar last month on capitol hill was asked about what kind of affect that system would have on doctors and health care professional salaries. [video clip] >> i think there is a real risk that it becomes a single-payer and eventually the move may be to own the providers under that as we see with other country's socialist systems. that would end up with a system where congress or hhs would set salaries for providers.

i think that is a risk with single-payer systems, we have seen it in other countries. host: medicare for all, do you support or oppose it? opposing it is lauren. you are on the air. caller: i had the opportunity to experience the military health care while i was in the military and i also had the opportunity to observe the canadian health .are system both, because they are free, because one, you take away the set of good doctors and 2, the system is unable to work because you get too many people coming. in the military, health care was free and the pendants were all firstng their children in things that were abusing the system, so even on the military base, the system was overwhelmed

. then in canada, my wife was up there, she was canadian. i am a united states citizen. i had to wait in line for a year to get a medical procedure that she needed. ishink free enterprise that itated in the past also gives us quality of health care. if you remove that system, i think we are all going to suffer. bobby, whoar from would support medicare for all. hello. yes, i support a for all and i support joe biden or bernie sanders, either one, would not make any difference to me. i know people from oklahoma that

cannot even afford any kind of health care. it is bad. it's really bad. host: how about yourself? can you afford it? caller: yeah, i can afford medicare. i have a plan right now which is pretty good for me, but medicare for all, i am not a selfish person, so medicare for all would really help a lot of people here in oklahoma and throughout the united states. host: asking the question this morning brought up last night at presidential candidate and senator bernie sanders on his box town hall was asked about it, a number of the presidential candidates supporting that type of program. there is a new candidate in the republican race, politico headline, william weld announces challenges to trump and gop challenges, he most recently ran as the running mate of gary johnson. let's take a look at his online

announcement which came out yesterday. [video clip] moreday we need bill weld than ever because america deserves better. don't know what i said, i don't remember. and mexico will pay for the wall. >> shameful, dangerous, and weak, some of the words both parties are describing president remarks to russian president today. >> you can do anything, grab them by the -- of him,e crap out would you? you can see there was blood coming out of her eyes, blood coming out of her forever. you had people that were very fine people on both sides. i know nothing about wikileaks.

, newerica has a choice hampshire, 2019. a better america starts here, bill weld for president, join us. >> i am bill weld and i support this message. host: former massachusetts senator william weld now in the gop race for president in 2020. one reaction, donna tweeting this william weld is way to normal for the right to take seriously. back to our calls and comments, bruce in chestertown, maryland, opposing that kind of plan. caller: hello? host: you are on the air. caller: hi. i don't know whether anyone has brought this up before, but since the right is against it and the left is for medicare for all, why not do a simple thing? 30 not cover the current

million people, 40 million people in this country that have no insurance and start the plan with that and see how costly it is as you work it through and let the other people who have private insurance, medicare, veterans insurance continue with policies, that certainly is not going to cost $32 trillion and it might work. also, they need to fix part d or prescription drug costs. why not just insure those that do not have it and work up from there? host: do you think people would buy that? in terms of that that as an alternative? again, you talk to the would i like medicare for all? i am on medicare and i think medicare is wonderful. again, if you give everybody everything, we will go broke

doing it no matter what it is, that's why we have issues with social security and medicare, medicaid. you have to take this in incremental steps because you are going to have to pay for it. host: how long have you been on medicare, bruce? caller: four years and i was on obamacare before that. host: appreciate you telling your story. i am sorry, go ahead. caller: and i still have your -- my doctors. host: thanks for sharing your story. let's go to charles in cincinnati who supports medicare for all. cincinnati, charles, you are on the air. all right, we will hear from bill -- charles, one more time, cincinnati? we will go to bill, canton, ohio. charles, are you on the air? caller: yeah. host: go ahead with your comment.

i think medicare would .ll -- for all would be great take a look at bernie sanders, he is a good man. host: let's hear next from bill in canton, ohio. caller: good morning, c-span. it is canton, illinois. host: canton, illinois. my apologies. caller: no problem. at the thing is, you are going to have to lay off hundreds of thousands, if not millions of insurance workers. bernie sanders in the town hall speech that he gave yesterday, he said if a millennial is making over $50,000 and pays $28,000 a year for private insurance, that is what he will .ave to pay on medicare for all

a lot of millennials do not want insurance because they are healthy. it was estimated before when this came up, when democrats were pushing this before a couple years ago that, according to the cpl, it would cost $29 trillion in 10 years. there is no way to pay for this unless you take it out of the pockets of the future middle-class, which is the millenials and that will wipe out the middle class in the united states. how many young people who are healthy want to pay $28,000 a year for medicare for all? that is who is going to pay for this program for the people that do not work, do not have insurance. it is ridiculous. it is totally ridiculous and it will never work and it will bankrupt america. host: bill in ohio talked about

the loss of insurance workers. howard schultz is the starbucks founder and potential presidential candidate saying the medicare for all proposal would cause 180 million people to lose current health care coverage. all that sanders and the far left care about is furthering their agenda. this is unrealistic and shows a total disregard of our country's overwhelming debt. this is donald in conway, new hampshire. caller: good morning. about currently spending $1100 a year per person in america, which means we currently spend about three point $3 trillion for health care it is right now and there is 30 million people who are not on any kind of health care. i have been on medicare and i also have a medigap insurance policy which i pay for and i have been on for 20 years. medicare is a wonderful system.

the people who say it is going to cost us $30 trillion in 10 years are not rational. $3.3e currently spending trillion a year. talk about waiting in line, when you have things that you need to have done, a lot of us have waited in line in the united states. that is part of the system. it is a wonderful system and my suggestion is that we need to have a yard stick. if private insurance companies want to compete with a government program, they would be allowed to compete, like i said, i already have a private insurance company providing for my medigap insurance policy, so, therefore, the people who are talking about it is never going to work and so forth.

the last comment, social nowrity is totally funded by the money that is paid in taxes. my suggestion to pay for everything would be to make it the republicans are always talking about we need a flat tax, let's make the social security tax, payroll tax a flat tax instead of stopping at 125 or $130,000 and letting the people who make $100 billion a year stop paying, let's tax every dollar that people make with the payroll tax. that will raise in excess of $3 trillion right there. anyway, have a great day. it's a great problem --program. host: their headline from the national review and their take , "bernie'ssanders bad plan."

hardlyclass taxation is the only objection. scores of millions of people with private health insurance plans, the vast majority of whom are satisfied with them would be forced to purchase paid in a government plan, roughly another 20 million on medicare advantage would find their plans terminated. you can read more at national review -- nationalreview.com. we had a guest last month, dr. adam gaffney, president of the physicians for a national health program and he talked about his support for medicare for all type program and here is what he said. [video clip] >> the concept for medicare for all is not an especially complicated one. in the name itself, it is medicare, universal program that is currently for seniors that we would apply for all, meaning everyone in the nation, but a key additional point i would make is we think of this as

improved medicare for all, this is a program that would expand medicare to everyone in the country and make it a much , making benefits comprehensive including things like dental care that medicare does not currently cover as well as improving medicare by eliminating cost barriers to care, things like co-pays and deductibles. there is now, as you mentioned, a bill in both the house and the senate that are medicare for all bills that would create a system for the united states. this is referred to as single-payer and it is essentially a universal health care system that would provide a comprehensive benefits without barriers of care to the american public. host: our topic this first hour is medicare for all or medicare for all type programs. would you support or oppose that kind of plan? 202-748-8000 the number to call if you would support that kind of plan. 202-748-8001 if you oppose.

opposing in raleigh, north carolina, is denise. go ahead. caller: good morning, c-span. i have been listening quite saidly to what is being and i do know one thing, having so many family members in the health care system working in the health care system at this time, the cut off right now for wages is $135,000. i have been on medicare for 6 years. there are certain things medicare does not cover. one of them being a female -- let's use a for instance, the 3-d mammogram, that was not paid until last year.

i ended up with breast cancer because i could not get the 3-d mammogram. this is what is going on in the system. plus, medicare only pays 80%, you still have to pay out-of-pocket for your supplement, so there are a lot of drawbacks to medicare for all that i haveors discussed this with, many of .hem are retiring also, if we do medicare for all, they would have to set parameters on how much money a doctor can make. i am going to give you a for instance. it now, when i go to my primary portion,or, i pay a

still, with medicare. medicare is only giving them $45. if i am really, really sick, my doctor does not have time to find out really what is wrong with me and let me make you aware of this, medicare does not want to pay for all of your laboratory work, you have to pay for some of your laboratory work. now i want to say this, if we go medicare for all, we are going to probably have to pay even more out-of-pocket because medicare, the government is going to say we are going to pay less. please think carefully about what happened to veterans and my father was a veteran. what happened to the veterans that had cancer and that were in line for a year to get treatment

. this is what will happen to our medicare program and thank you very much. host: let's hear from a supporter for medicare for all, dale in new jersey. caller: hi. i am sort of in a unique position because i was recently laid off. my previous company had good insurance and i went to another company which has a very high deductible plan. i also lived in a country which they call -- having social medicine, which was france. i lived there for three years on the dock -- my wife had to deal with the doctors. i had -- new engineers whose wives were physicians and spoke perfect, fluent english and wanted to come to the u.s., but when my wife told them, as a doctor, you can come to the u.s. and be rich, she said i don't think that would make me happy because if doctors are so rich, that means people who need my

services might not come. i think that is a key distinction. france has more doctors per capita than the united states and so there are some myths t here. i have private insurance coming -- i think my wife and i pay 600 or- i want to say $700 a month, but we have deductibles that are roughly about $6,500 a year. the then, i have a 10% -- 20% you have to pay out-of-pocket even if you have catastrophic care. if you end up with something serious like cancer, the woman earlier talked about having breast cancer, if you have that, you are looking at roughly $60,000 every two weeks for chemo treatments because they give you the three different medicines. you are talking roughly a half

million dollars, $2 million. if america goes medicare for all, i would hope that people being able to see doctors earlier will enable their diseases to be treated when they are still in early stage and can be treated at a lower cost because i think it is very important and also, to point out the foods causing a lot of our problems. america has health problems that other countries don't and i think a lot of that is diet driven. host: let's take a look at what people are saying on facebook and twitter. william says for those who believe you will get the same quality care you are receiving now for free, that is impossible. i also wish there was free, quality care, but something will have to give. it will be our money and we will see subpar health care. sweden and denmark provide health care for all with just 3%

more taxes. middleton tweeting some insurance company is the best, but there are a lot of company insurance plans that are not worth the paper they are written on. look at the company -- the money the companies would save and the people who have private insurance would not have a huge policy payment every month. in terms of insurance company from the washington post weekend business section, and industry push against medicare for all. at a company town hall meeting in february, united health care executives ensured -- assured employees they were working to undercut support for medicare for all, but the company is trying to tread lightly. "one of the things you said were really quiet or seems like we are quiet on, we have done a lot more than you might think." said the chief executive in response to the company -- a question about the company possible role. according to video of his marx,

"you wanted to be kind of thoughtful about how you show up and have these kind of conversations because the last thing you want to do is become the poster child during the presidential campaign." you can read more of that at washingtonpost.com. to me read more about what they are reporting on some in the insurance industry, how they are reacting to news of medicare for all or the push of medicare for all. the remarks, made a broader push from the health insurance industry to prevent legislation to enact medicare for all getting off the ground including by trying to direct democrats toward more centrist efforts and reject plans that would legislate many of the companies out of existence. wary of bringing unwanted political controversy to their companies, some private health care firms have in part relied on advocacy groups and lobbyists in their fight. joining the push without leaving too many company specific fingerprints.

here is buffy in new york, supports a medicare for all type program. go ahead, buffy, in new york. caller: yes, i support the medicare for all program. if you take a look at finland, they are very happy with their also, care system and they pay for college, too. they don't have to have -- worry about college at all. they seem very happy with it. thate heard on twitter only to improve their health care system, because everybody had to have the same machine, so they had to have the same updated machine because otherwise some doctors would not be seen. everybody had to have the same equipment. they are very happy with it. if they can do it, i don't see why we can't do it.

host: do you have concerns at all in terms of paying for it? the current medicare system, down the road, is it affordable? caller: i think they found a way i think they pay a small tax -- sweden, i think it was like 3% i heard somebody say, something like that, increase in tax, and everybody is very happy with it. host: thanks for that. henry is in the bronx, opposing medicare for all. good morning. caller: good morning. what i would like to know is who is going to reimburse senior citizens that paid into medicare for this insurance policy for all of our lives, 40 years i paid into it and now they are going to give these other people free and come into our insurance policy we paid for? nobody answers that question. i would please like to know who

could answer that question about senior citizens, about getting ripped off. host: lost you there, we started the program talking about bernie sanders and other presidential candidates supporting a medicare for all type plan. senator elizabeth warren in a recent campaign stomp in plymouth, new hampshire, talked about how she could envision the u.s. transitioning to a medicare for all type plan. [video clip] >> i believe in medicare for all. i think that is how we are going to build a health system that works. right now, there are a lot of different paths, a lot of different bills people have signed onto. i have cosponsored with bernie, there are other ways. some people are saying bring the age down, bring this in gradually. we will start 65 and then 60 and

bring it down to 40. people are saying start at the other end. what,eople say, tell you let's start by letting companies by in. if they are doing private insurance and would like to switch to medicare, let them buy into the system. some people are saying that individuals buy in. it is going to take time, it is a big part of our economy. i go back to where we started this. the principal goal has to be 100% coverage at the lowest possible price. the good news is we are moving. the bad news is we are not moving fast enough. i am in this fight all the way. presidentialour campaign coverage, you will find that online at c-span.org. in that case, search elizabeth warren.

it back to the new york times and the projected cost for a medicare for all type plan, this is a look at the upshot and their color-coded chart on the current spending. under current law, the government estimates the u.s. will spend about 1/6 of gdp on health care with costs provided by the federal government, individuals, insurance, and state governments. plan, bernie sanders' estimates the largest savings converting to medicare for all, his cost, $2.8 trillion over one year. there are a number of other estimates as well, that one from the rand corporation's which includes other health spending and you can find that at nyt imes.com. they break it into areas of scription drugs and doctor reimbursement. let's hear from stuart in

madison, indiana supporting medicare for all. good morning. c-span.thank you, i am all for medicare for all. nothing in this world is perfect. absolutely nothing. especially with health care. formport getting some health care for all americans. medicare is not perfect. i am 74, been on health care since i was 69. it was great to be able to go see a doctor, which i cannot really afford to do. i ended up being diagnosed with hepatitis c. i don't care what kind of supplemental plan you have, it is not going to pay $85,000 for

the treatment for three months for hepatitis c. fortunately, i am also a military veteran. notnt to v.a., it is perfect. in three months, i was cured of hepatitis c. talking 30 million people that don't have any health care coverage. if i did not have the v.a., i would be dead by now, you know? that is extreme, but let's get folks on medicare. one of the biggest problems of is there is- wait not enough doctors in the united states. my daughter was qualified to go to medical school, there is no way we could help her out. host: how do you think a

medicare for all type plan would incentivize more people to join -- to become a doctor -- enter the medical profession? caller: that is where our government ought to step in. host: how? caller: we need more doctors, period. the government needs to help out getting people who are well qualified to go through medical school. got to be some payback, maybe salary foror a lower four years or whatever to help pay that back, but we need more doctors. my daughter did go through and become an athletic trainer. she knows every bone and joint and ligament in the entire human body. host: thanks for that story, we

want to get a couple more calls on the topic. let's hear from bill in norfolk, connecticut, opposing medicare for all. caller: no matter what we do, medicare and a lot of other things, we have got a lot of .erious choices to make like, no matter which one you have, if somebody gets shot in the street where they keep going back and forth, he is not going to have insurance or a lot of people don't have insurance, they are not going to leave them in the street, no matter what you do, one way or another, the taxpayers are going to pick up the tab or the hospitals will close down. the serious choices that have to be made, at what point do we have to let people go? last days ofon's his life, of his total medicare

-- his total hospital expenses -- the last month of their lives . also, we are taking all these people into this country that don't have insurance. this is all going to add up with other things, it is all going to add to the deficit and eventually, we will have to pay 20% interest rates for the government and we will turn into a third world country. host: on the front page of the washington times, they are leading with the fire story, notre dame and this one, the day after tax day, americans save money, time on tax filing. david writing filling out taxes this year was not as simple as filling out a postcard, undercutting one republican promise, but the typical taxpayer did have an easier time, saving hours of time thanks to the 2017 overhaul according to a study released monday.

somebody had asked about this and back to senator sanders on another issue on his tax returns, senator from vermont and his wife earning 1.7 million over the past two years, the senator earning most of his income, 500 66,000 last year and $1.5 million in 2017, putting them in the nation's highest income brackets. annual salaryrs' is $174,000. most of his income came from his book. carolinaext in north supporting medicare for all. caller: good morning. host: good morning, bill. caller: the parts that -- the part that gets me is everybody is going to getthe thing that gs everyone is going to get sick. there is no way around it. i don't understand how we are paying for insurance for something that is inevitable.

here we are buying insurance for something that is going to happen. it just makes no sense to me. we are paying a middle person, the insurance companies. they are not needed. as sure as you live, you are going to get sick, and you are going to die. it seems like it is a money scheme. of course, i cannot see why anybody would be against medicare or free health care. it just does not make sense to like they it seems are playing a money game, shell game. host: appreciate that. we are going to continue with the conversation on medicare for all, the affordable care act and health care in general in 2019. we will continue the conversation. our guest is kaiser health new'' julie rovner. and up next is christel marchand

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public's agenda going into 2020, we saw in 2018 health care was a big issue for voters. even with all the changes made by the affordable care act, health care is still too expensive for many people, including people who have insurance. they are worrying about what will happen if they get sick. our health care system is bipartisanly considered dysfunctional. i have been covering health care in washington since the 1980's. it has retained its status as an issue that the voting public .ares a lot about i host: what is the status of their formal care act on capitol hill? we have heard the democratic leadership wants to take steps to bolster it. this is part of a struggle within the democratic party in the house. do they want to spend their time

and effort fixing the problems with the afford a book care act? there are problems. it turns out it is not generous enough for a lot of people who cannot buy insurance or can buy insurance but cannot afford the parts they are expected to pay themselves, deductibles and copayments. do they want to spend their time talking about medicare for all? whe house democrats kno whatever they pass is unlikely to get through the republican senate and unlikely to be signed by a republican president. they are messaging for the next time they are fully in power. there are a number of democrats who say do both. let's fix the affordable care act now and get on a glide path to more changes. the overall fate of the law itself is in the balance with this court case in texas. guest: the overall fate of the

law is still in question. in 2018, a number of republican state attorneys general and governor's filed suit, saying when republicans passed the tax bill in 2017 that got rid of the tax penalty for not having insurance, that rendered the entire talaw unconstitutional. in 2012, when the supreme court upheld the aca, chief justice on the tax part of the individual mandate. thatfound a judge in texas agreed with them. view that no matter what happens it will go to the supreme court. there is this doubt in the air about the legal future of the affordable care act. host: for the moment it appears the president has set aside his ideas mentioned several weeks ago about being beaten party of

health care and coming up with ofold -- being the party health care and coming up with an alternative plan. what would be the put essential republican plan -- buq uintessential republican plan on health care? guest: republicans, like democrats, are not united on health care. is returningee on a lot of the money government spends on health care to the states and let the states decide. that was the last bill that was not able to pass the republican senate in 2017. a version of that is in the presidents budget. there is some work in the white house to put some flesh on those bones and come up with something more robust. senate republicans can who did not fare well trying to repeal

and replace the affordable care no uncertainin terms they do not want to address this this year. they have found no success. they don't think things have changed. senate republicans are working on pieces of the health system, high drug prices, surprise bills, things they think they might find bipartisan agreement with democrats. democrats are working on these things. host: president trump is the likely nominee in 2020. to,t the campaign be forced no matter who is nominated by the democrats, there will be some medicare for all or health care plan proposed by the democrats. guest: the republicans have one place where they all agreed, which they thought they agreed on the affordable care act, which is saying no. they have not been able to reach

agreement on what they would like instead. they all say they don't like medicare for all. that is the republican party line is that medicare for all is socialism, and that is not anything they have intention of ever supporting. i think that will be the strategy going into 2020. rather than have their own proposal, just be sure they are able to pin with the democrats are proposing is something they don't like i. host: julie rovner is our guest. if you are getting employer insurance, that line is (202) 748-8001. uninsured (202) 748-8002. for all others (202) 748-8003. we will get to your calls momentarily. we started looking at bernie sanders' medicare for all

program. looking at the kaiser health chart, you need a landscape to look at because there are many proposals out there. does it surprise you the broad range of plans out there on the democratic side? guest: no. i think it is a healthy debate. there is general agreement, much as there is consensus among republicans that medicare for all is back, there is agreement among democrats that expanding the affordable care act would be a good thing. how to do that is confiscated. the health care system is sprawling and touches different people in different ways. at some point you have to figure out how to get from here to there. what we are seeing among democrats are various plans are doing that. democratshe house medicare for all plan is the most dramatic. it would shift everybody into a new program for two years.

-- in two years. bernie sanders has a four-year transition. option forpublic people that buy their own insurance. people forbuy-in for whom insurance is very expensive starting at 55 or 60. some proposals start for children when they are born and gradually moves the age of. host: we had a caller on the west coast was happy with his veteran's choice plan. that is relatively new. is there anything similar in a medicare for all program? is that program working? guest: most programs would exempt the v.a. the v.a. health system is really the third rail of politics. there are a lot of problems as we have seen, but generally

.eterans are pretty happy there is some question whether that would retain its standalone status. it might. that is one of the things that needs to be discussed. i think it is important to remember that the v.a. is very different from medicare. thev.a. is more like british health system where the facilities are owned by the government and health officials are paid a salary by the government. that is not the case in medicare for all or even our medicare system. the government sets the prices, but the service is private. host: in the new york times on terms of funding for this, bernie sanders estimates over the course of a year $2.8 trillion, and a number of other economists looking at it. how would it be paid for? what is the accepted way of how

this new plan would be paid for? guest: the general accepted way is that federal taxes would be raised. who would pay and how much is up for debate. no one who produces these medicare for all plans has produced their own financing system. that is what took the longest when congress was doing if audible care act. as complicated as it was, republicans sat on the sidelines. democrats agreed it needed to be paid for. there was a lot of work about figuring out the sources of revenue. i think the same will be true with any kind of expansion and any further expansion of the health care system. there is all this talk about how much it would cost. the real question is cost to whom? will be all federal taxpayers, just the wealthy, will people be expected to kick in some money? a lot of these proposals will

say we give you all the health care you need, and you will not pay for it at the time of service. it does need to be paid for. it is as complicated on that side. we have julie rovner, our guest discussing health care in general, medicare for all proposals. let's go to maria in virginia. caller: good morning. i have health insurance through the affordable care act in 2014. i had great experience. before that, i was giving my job because of insurance. it is amazing. it went up this year, but it is better to have insurance than not to have it at all. worked threerce, i jobs, and i did not have insurance. suddenly i had surgery. i believe in the affordable care act.

experienced never to be without medical insurance or never read a page of the affordable care act. i am a cancer survivor. that is why my premiums were high when i was an employee of the state of virginia. now i work privately. they don't cover insurance, but i do have from the affordable care act. i believe everybody should have insurance. host: thank you. guest: thank you for the call. this is an example of one of the things the affordable care act did that everybody agrees should stay. that is to enable people with pre-existing health conditions to get coverage. prior to the affordable care act, people with pre-existing conditions could not afford coverage at any cost. if they did find coverage, it would be dramatically more expensive. that is one of the things therefore the care act changed.

republicans said they would like to keep that. it is hard to keep that without many of the other changes in the affordable care act, particularly subsidies to help people by insurance. you need some help people to buy insurance. host: we are eight or nine years into the affordable care act. caller: -- guest: the main part started in 2014. we are really five years into it. how are the numbers for those under the affordable care act? guest: it is hard to tell exactly how many people gained insurance under the aca because at some point the health system he the entire health system. there are about 11 million people on the exchanges. that is less than many experts predicted. one of the reasons i think it is less is they anticipated small businesses who offered insurance would stop offering it and send

people to the exchanges. the exchanges have not been very secure. there were a number of supreme court challenges. there were all kinds of changes. the system to sign up did not work when it launched in 2013. this seems a lot of people who were expected to end up on the exchange have not. we also know some large number of people ended up on medicaid. probably about 14 million. it is hard to tell. a number of states have not expanded medicaid. some are looking at it now. a large number of people got insurance through the expansion of medicaid. host: let's go to ohio, deborah who gets employer insurance. good morning. caller: good morning. have employernd insurance. regardless of the type of weurance we all have, unless

address high risk costs associated with high risk choices, none of us will have reasonable health care costs. example, treating trauma associated with driving under the influence is $35 billion a year. children who are born to a mother who is addicted to drugs, the cost of that child, our newest citizen coming to the u.s., is $400,000 per child. totaling the costs associated with these high-risk behaviors is approximately $500 billion a hurdle inh is $1500 the u.s. -- per adult in u.s. per year. we have to start talking about our personal choice and personal behavior. there needs to be compassion, but a monetary consequence.

if we were to take those behaviors and set them aside and allow them to be considered a tax, which they are, put that in a separate account within each state and let the people in each state pay a tax towards the personal behavior of that state. no doctor or politician could ever get their hand on that money. the doctors would apply for reimbursement for services within that state. if the state of colorado, which is extremely healthy, then the people within colorado would split that cost, and it is a lower cost. if the people in kentucky, heavy smokers, their costs are higher, the people within kentucky would pay that cost. changeto be a radical because our medical costs now are $9,000 per person in the u.s. host: thank you. guest: the main reason the u.s.

pays more in health care than other industrialized countries are not high risk behaviors but the prices charged by the health care system, what hospitals and doctors in nursing homes and physical therapists charge. we don't use that much health the othersociety as industrialized nations we compare with. there has been a fairly robust extent to which people should be responsible for their own health care woes, particularly things like high-risk behavior. that is why there are laws dictating the use of bicycle helmets and seatbelts. the health care did a lot of variance for smokers and non-smokers. this is something that has been addressed over the years. it is hard to know exactly where it will land.

it is a fraught debate. host: in some ways, is smoking a pre-existing condition? guest: you can be charged more in some states, not every state. yes, it is a pre-existing condition, a personal choice, but it is also addictive. it can be hard to quit. costs,n the issue of prescription drugs came up before a house hearing last week or so. post writingn about it, house leaders are eyei ng a vote to lower the high cost of prescription drugs as republicans and democrats try to prove they are serious about taking on the troubling issues this year. it would draw from a slate of bills passed by the ways and means committee and energy and commerce committee. how could congress legislate prescription drug prices?

guest: there are a number of things they are looking at. one of them is transparency. getting inside that black box to see how much various players within the health care system are paying for these drugs and what is left for the patient. we don't know. there is a list price. it goes through the middlemen and distributors and comes out at the pharmacy, you have no idea what anyone has paid for that except for you. proposalsa number of to help generic copies get to market. there are ways that brand-name manufacturers managed to block those. there are efforts to get rid of some of those roadblocks. there is a push among democrats for medicare to negotiate drug prices. when medicare added its drug benefit in 2003, they were explicitly not allowed to negotiate drug prices. that is controversial. medicare is going to negotiate

prices, they will have to say no to some drugs. getle will not be in the to some of the drugs they want. that will be an issue how that happens. nothing in health care is easy. the prices are particularly complicated. it is an issue that republicans and democrats and the president say they want to work on. host: let's hear from all over in connecticut on our all others line. go ahead. caller: good morning. listening to the conversation, i wonder when we are going to get away from debate and start talking about compromise. wantnow, the democrats affordable health care for all. i see that as being a noble thing. the republicans want borders that are secure from the other side of the aisle.

if you look get most countries people are talking about when they call in, denmark and places like that. i lived in australia for three years. while in australia, they have a health care system that works very well. medicale low costs for care and drugs and prescriptions. the reason why these countries are able to do this is simple. it is money in verses money out. the money that comes in from taxpayers is used. there is a small amount of folks in that country that is not paying taxes. compared to the u.s. where we have a number of people in our country that are not paying taxes, that are not paying into the system, that will be sucking off that system. the compromise in my estimation when you look at it is what we do is say democrats want the health care. i got that.

republicans say we are willing to compromise on that come but we need to close the borders. that is my opinion. host: thank you for that. compromise on health care. guest: compromise is increasingly short supply. i covered health care before it was a big electoral issue. there was a lot of compromise because people did not run on it. there was an enormous amount that could be done, particularly on medicare and medicaid because that was the main thing congress oversaw. after president bill clinton, who made a huge push to change the nation's health care system, ultimately unsuccessful, it got a little bit more politicized. it has been politicized as the years have gone by. when democrats did the affordable care act in 2009, republicans decided they just were not going to participate because they wanted to keep it as an electoral issue.

the more you want to run on it, the harder it is to get people to sit down and say maybe we should give a little and take a little. there is also the primary the coming a verb. democrats are afraid if they moved to the center, they will be challenged from the left. republicans are afraid they will be challenged from the right. they are correct. host: we have talked about attorneys general opposing the aca, the california attorney general was asked by democrats why the justice department was making these efforts to strike down the aca. [video clip] >> have you conducted a review to evaluate the effects of doj's litigation position to overturn the aca, the effects on consumer costs and coverage? have you done that analysis or reviewed one? >> when we are faced with a legal question, we try to base

our answer on the law. >> so the answer is no. i cannot imagine that he would take that kind of a dramatic, drastic action without even trying to evaluate the consequences for the american consumers, the people using the health care, the people for whom these premiums are paid. if you are successful in this lawsuit that you are supporting, and the entire patient protection and affordable care act is struck down, millions of americans who currently receive health care coverage under the law are at risk of losing that coverage. in my correct? >> i think the president has made clear he supports pre-existing conditions and wants action on a broad health plan. he is proposing a substitute for obamacare. >> the one that is coming after the next election?

>> the one that will come down if and when -- >> let me be the one to inform you that if the law is struck down, millions of people would lose coverage and tens of millions more would see their premiums skyrocket. in addition, if you are successful, 12 million people nationally and 750,000 people in my home state of pennsylvania, who have coverage under the medicaid expansion, would also likely lose that coverage. mi correct? >> do you think it is likely we are going to prevail? >> you are devoting scarce resources of your department to that effort, are you not? >> we are in litigation. we have to take a position. >> the answer is yes. succeed, people will lose

coverage nationally from medicaid and 750,000 from pennsylvania alone. >> guest: we do agree that maybe some of the provisions that are most closely tied to this tax penalty, which is the issue, should come down. provisions tied to the tax penalty are pre-existing conditions. when the tax penalty was put into law, it was so healthy people would sign up so insurers could afford to cover the people who are sick or.

-- sicker. now that the tax penalty has gone away, it is mostly the subsidies, the ability for people to afford that coverage that is helping the healthy people sign up. the tax penalty turned out to not make that much difference. what the justice department did, the case was decided in december, and it is now at the appeals level. the justice department had to take a position on the appeal. they said since the district court found that this was the case, we are going to side with them. they are not only now siding against the law, which is unusual for the justice department. their job is to defend federal laws in court. they changed their position. there is reporting from a number of outlets that both the attorney general and the secretary of health and human services did not wish for the justice department to come out

with this position and were apparentlyn what was a fairly tense white house meeting. the attorney general in this exchange, in subsequent exchanges was pretty clear that this was not his idea to take this position, but as far as he was concerned it was legally defensible. host: if the appeals court finds in their favor, that would end conditions barring a supreme court appeal. guest: it would end the entire law barring appeal. host: this is the first year that the tax penalty is gone, not on the tax return for 2018. guest: it is on the tax return for 2018. 2019 is the first year it is gone. host: is there an expectation that there will be a significant loss of revenue? you said it was not a significant incentive.

guest: it was not revenue, it was whether it was encouraging people to sign up for coverage. what we are discovering is that almost as many people signed up for 2019 as signed up for 2018. we cannot demonstrate that it did not have a very large effect. there is not this huge drop-off of there is no penalty. host: the administration reduced that window for sign up at the end of the year, the length they sure did. had cut that the year before. they cut outreach money for people to sign up. in the wake of all those things that would tend to depress sign up, sign ups were pretty robust. host: let's go to larry. go ahead. caller: good morning. this reminds me of the dog chasing his tail. i don't think the dog wants to

catch his tail. i have insurance. i have blue cross blue shield. i have the v.a., tri-care, medicare. pay, blueoes not cross blue shield will cover. i go to the v.a. to get my pills. i also have tri-care. my son is a primary care doctor. he says that medicine is a privilege, not a right. if you have medicare for all, it will become a right. it will not become a privilege. you do not want your doctors all being paid the same. a primary care doctor, all primary care doctors would be paid the same wage. an anesthesiologist, they would all be paid the same. federal inmates in rochester,

minnesota. you learn at the mayo clinic. on look at all the planes the tarmac, they are from foreign countries that fly into minnesota. tost: it is important remember that most of what is being proposed is not what they have in england. in england it is a truly socialized system. there is a role for private insurance in england, not much. there is one. what is being proposed is more like canada and the current medicare program where the government negotiates prices, employy do not own and people to work in the health care system. host: what is the future of americans being able to get there prescriptions from places like canada and england?

it seems like a number, certainly the resources and canada are not there like they used to be. choiceot get as much from canada. guest: if everybody were to get their drugs from canada, canada would run out of drugs. canada does not exist to supply a lower-cost medications to the united states. and flowed over the last 20 years. when medicare additives drug pressure for u.s. citizens to buy drugs in other countries went down. now that we are seeing this fight and prescription drug spending, we are seeing the desire. every country except for the u.s. has some sort of price control on their drugs. that is why they are cheaper in other countries. manufacturers don't like it, but they sell there.

what drug companies say is the u.s. is their biggest market, and if they were forced to pay these prices, they would go broke. this is the back-and-forth tension about the ability of u.s. citizens to buy their drugs elsewhere. most peopletension agree the bet solution to this would be to do something about drug prices here. host: the net effect is essentially buying from a country that supports the reduction of price in that country, england or canada or elsewhere, from that of american-made prescription. guest: that is right. host: julie rovner discussing the affordable care act, medicare for all. if you are748-8000 on the affordable care act. if you get your health care through your employer, (202) 748-8001. for those of you that are

uninsured (202) 748-8002. all,ng about medicare for just a broad look at it from the washington post, they say it would move the u.s. in the direction of a single-payer system where the government steps in rather than insurance companies as the intermediary between patients and providers in health care transactions. bernie sanders plan, a single system wouldcare vastly expand benefits, would prohibit private plans from woulding with medicare, limit cost-sharing. what is cost-sharing? guest: cost-sharing is when you pay at the point of service. host: co-pay. guest: four coinsurance. increasingly people have coinsurance where they have to pay a percentage of the bill.

for some of these expensive drugs, it can be in the thousands of dollars. a 10% co-pay can be in the hundreds of dollars. host: let's hear from clarksburg, west virginia. frank on our others line. caller: how are you doing? host: fine, thank you. caller: julie, how are you doing? guest: fine. caller: other countries have care for their people. our lobbyists could not put so much money in the politicians' pockets that this issue is literally bought and paid for. to the point that people literally have to file bankruptcy because of medical costs. everythingms like relies on politics. he never thought it would be

anything like this. other countries tend to be able to do it. are we so backwards that we cannot? is it all about money in politicians' pockets? guest: there is a lot of lobbying on capitol hill. you have an article about how the industry is already mobilizing to fight medicare for all. it is particularly the hospital industry. almost every hospital takes medicare, but it pays less than most commercial insurance. they are afraid if congress were to set prices, it would be lower or only slightly higher. they would not be able to afford to keep their doors open. the insurance industry would be depending on the proposal, either put out of business or shrunk considerably. they are concerned. everybody makes money in health care now wants to keep that money. obviously, we pay trillions of

dollars as adollars as a societh care costs, and people are trying to protect that. host: what are we hearing from candidates like bernie sanders or just members who have introduced plans that would affect those workers, those companies, insurance companies, potentially putting them out of business or reducing their business? guest: it is a big concern. i think there are half a million people who work in the private insurance company. other peoplefed by are making lots of money in the current system and creating the tension that is producing the debate. the more money they make, the more money we as a society have to pay. there is going to have to be some rebalancing of that. it is a concern. would there be some sort of retraining, transition? that is not an insignificant piece of this debate. what happened so the private insurance industry? -- happens to the private insurance industry? host:

is bill. caller: good morning. after listening through the lost trackrt of of what i want to say. my insurance is pretty good. i worked in the steel industry for 30 years, northwest indiana. i saw a lot of my friends come and neighbors, and -- friends, neighbors, and we worked in a filthy neighborhood. into coke,oal cancers with children and adults. i saw so many of my friends kicked off of insurance because of cancer, pre-existing conditions. i got sick in 2009, was in the hospital for seven weeks, close to death. feet,00 later, i am on my but i am disabled.

at the hospital, there was one gentleman who stuck his head in and every morning he said, mr. miller, how are you feeling? i wonder how much he charged to stick his nose in the door and say how are you feeling? there is a pink elephant called the military. they cannot even audit what they do. when you fly over parts of arizona, new mexico, california, there are thousands of airplanes just sitting there. they have not been off the ground ever. we have congressman who insist on building army tanks that no one wants. that has to stop. en are mostly wealthy. flying away every weekend, $20,000 an hour to fly air force one. we can create money to give

medicare for all. or to work your insurance companies to save money. when i was in the hospital, take this. don't worry. you are not paying for it. somebody is. people need to be aware. cepping back three allers, as to the gentleman that was concerned about closing our borders. i am from pennsylvania, mushroom capital of the world. mushroom factories are closing workers,here are no mostly mexicans. workers, mostly mexicans. host: thank you for that. bringing up the issue partly of transparency in hospital costs. guest: that is a big issue. all of this is walking around the edges of why are we spending so much? what are we getting for how much we are spending? tell, extent that we can

we are spending more and getting less than many of our international competitors. something needs to be done. host: let me bring a chart from the kaiser family foundation on single-payer, medicare for all. timechart support over the , modest increase in support over time. getting near the passage of the affordable care act, 46% in favor. where we are now in march of 2019, 56% in favor. what do you think is driving that modest increase, driving that increasing support for medicare for all? guest: i think frustration with the system as it is. as we have been talking for the last two hours, people feel they are paying more and getting less. what is interesting about the medicare for all debate, as a concept it has been around since the 1980's, probably before

that. in its current form since the 1980's. people like medicare. should we give medicare for everyone? the medicare for all we're talking about is not necessarily the current medicare program. it would not be the current medicare program. people generally like that concept because they know their parents and grandparents like medicare. when you start adding things like would you still want it if you have to pay more, if you have to give up employer-provided insurance, support drops. we are at that formative stage where people like the slogan, but they don't know what would go into achieving that. host: where are we with the states expanding medicaid coverage? states, theluer democratic states were quick to expand medicaid. therefore the care act required states, but that was struck down by the supreme court and made

voluntary. it allowed states to expand medicaid. to get the aca, you had to be low income, and you had to be a child, senior, someone with a disability you had to meet silo requirements. foraca set a national floor medicaid qualification at 133% of poverty. that is higher than it was for some populations. it just said you had to have a low income. you do not need to meet these other requirements. that is where we have gotten into the debate about able-bodied people on medicaid. in most states, able-bodied people were not eligible for medicaid. most states have expended. we are seeing more republican states expand. we are seeing they are expanding, but they want to make these able-bodied people do something to get medicaid

coverage, some kind of work requirement, which has been struck down by a district court in washington. host: federal district court. kentucky'snsas and proposals have been stopped. the administration is continuing to look at and in some cases approve these proposals. there is a lot of litigation going on about whether this is ok. what we saw last november is several republican states, notably utah and idaho, past ballot measures to expand medicaid. public and legislatures in the states have scaled it back. in montana, where they had done temporary expansion, they say we should continue it, we are going to add a work requirement. there is a lot of debate going on. host: the allowance for a work requirement was under the trump administration.

they said you can add this as a requirement for your expansion to medicaid. guest: so far the district court for two states have said you cannot. host: jim from texas. go ahead. are you there? yes, i am. host: you're on the air. caller: the question is, buy-in, thean -- merits of it. based on a percentage of your income. i think in colorado the issue is that, which i believe colorado once youaid buy-in, stop working, you would lose it. is there some way that medicaid buy-in has a solution to these problems? i will hang up and listen.

guest: there are a lot of states that are looking at medicaid buy-in. medicaid is financed jointly by the states and federal government. some of the states cannot attach to medicare because it is a federal program. new mexico and nevada are both looking at the possibility of letting people by medicaid coverage rather than medicare coverage. that is a separate proposal. a lot of people looking at buying into medicare early, which is the proposal of 55 or 60. host: does that become like a high deductible program? guest: it is exactly the opposite. medicaid is more generous than medicare. it covers many more things. sometimes it covers transportation to the hospital. it covers more types of home care. medicaid is a more

robust benefits package. the problem is providers tend to be paid even less than medicare. sometimes dramatically less. it can often be hard to find someone who will provide you care. there are these trade-offs. there are medicaid buy-in proposals out there. senator schatz of hawaii has made a proposal host:. host:what first got you interested in health care? guest: i was first assigned to it. i have always been interested in it. i was looking through some of my old college clips, and i realize i had written an editorial about health care. i have been writing about health care for a long time. things things about a

change, so what you are debating changes, so there is always something new. i never imagined when i started doing this, i will be covering stem cell research and cloning. host: have you ever been tempted to go on staff on the hill or a medical organization? guest: no. i have been asked. i like being a reporter. i like being able to interpret it for the general public. host: we go to nashville and hear from troy, who gets his insurance through his employer. caller: thank you for your time. i just wanted to say that doctors no longer get paid enough to keep the doors open. that is the biggest problem in medicine and health care today. the insurance companies are crushing everyone. they are dictating the debate entirely, to the point where even president trump is supporting medicare for all by

proxy. that is the so-called fix to so-called surprise billing. it is basically the insurance companies don't pay doctors enough anymore. not everyone can be in contract with the insurance companies. if you go to a hospital or doctor, you cannot depend on your insurance paying that bill because the insurance companies control the system. we have total regulatory capture by the insurance companies. they are driving the debate. they are the ones behind medicare for all. not bernie sanders loving the middle class. chance companies would love nothing more than to force mergers and acquisitions. wall street would love it. all the people at the top would make so much money from medicare for all. they want to dictate doctors being paid nothing. do you think doctors are going to work if they are not being paid, if they are going bankrupt?

if the system is not sustainable not, medicare for all is not sustainable. any so-called fix to surprise bills is going to crash the system completely. host: what does that pipeline of people getting educations and becoming doctors look like? he is talking about the potential of what it might look like under a medicare for all program. guest: i am seeing more support from doctors than from any other part of the health care industry. doctors get paid different amounts depending on what kind of doctor they are and where they practice. what business relationship they are in. lots of doctors are making lots of money. lots of primary care doctors are not making lots of money, and they are frustrated having to deal with multiple insurance companies. a lot of them would like to just sue for peace and deal with just the government. host: is there a support for medicare for all? guest: it is not universal support.

if you look at the pieces of the health care industry who are in the least bit sympathetic to it, doctors tend to fall into that group. there are some doctor groups that are maybe grudgingly supportive of medicare for all. one of the big issues in medical education is student debt among medical students. we see an increasing number of medical schools going either tuition free or tuition free for their least wealthy students. one of the issues there is that if they go completely to wish and pray, they are basically subsidizing the students who are to to -- tuition free, they are basically subsidizing the students were going to go on to make an enormous amount of money. there are a number of programs that pay off student loans for medical students who agree to serve as primary care physicians. it is this grappling with like

everything else in health care medical school has become increasingly expensive. you can graduate with hundreds of thousands of dollars in student debt. the argument is that forces the students to become specialists so they can pay off their debt. this is kathleen, we go to texas. kathleen is on the affordable care act in texas. caller: yes, i have been on medicare for 11 years because of my back injury. i barely make $600 a month. i can't hardly go get groceries. i tried to get food stamps. they said the only thing i would to help mea month eat almost. -- all month. medicare has been good to me. these you what, all

hospitals are ripping people off. how much does it cost to push a button? they get millions. people are going bankrupt. they are losing everything. companies arence screwing us over big time. my daughter is pregnant. she can barely make it. her husband makes good money. nobody takes insurance that they provide. host: next is bill from maryland on her others line. caller: thank you julie, and thank you c-span. i think the problem with medicare for all is it could lead to rationing. i wonder if the better approach could be a public option they optiond once taxable -- pot basd on one's taxable income,

late 1% of your taxable income. people could shop around, which might help to keep costs in check. these are all things that have been discussed. i think the previous caller is a good example of why health care continues to be a top of mind political issue. real people, no matter how rich you are, almost nobody can afford their own medical care these days. elected officials are not sure exactly what to do about that, but there is increasing demand from the public to do something. it is interesting the caller the maryland mentioned public option, which is hardly mentioned. it was a big part of the affordable care act. guest: there are still people pushing the public option. there are people who are pushing a public option as a way to get to medicare for all. you can do it in a number of

ways. most people are still talking about offering a government-sponsored health plan on the exchanges. there are only 11 million people who buy coverage on the exchanges. that would be a small place to start. to new yorknext to new york city and hear from ron. good morning. caller: thank you. good morning to c-span. when you put in a this whole business, when you put in a claim for an employer based health insurance, which is what i have come there was a third-party administrator that is often conflicting with what the doctor is ordering. and you have nonmedical people who are making -- whoopi goldberg was just talking about that "the view" yesterday, she had issues where they didn't want to pay for her machine. in 2020, the first wave for

democrats to shoot themselves in the foot is to talk about free this and free that come and free medicare. it has to be a buy-in, if anything. ittalk about free medical, will cost umpteen trillions of dollars. democrats have to be smart and have to talk about it as something that is going to cost you out of your pocket if you are going to go into the medicare system. thank you to c-span. care do you think health will continue to be the top issue going into the 2020 election? guest: i think it will continue to be a top issue. i think what the caller was talking about is what is going to happen with private insurance. hate their private insurance because there gets between what their doctor orders and what they think they deserve, or do people want to keep it because in general they are happy with that?

in this last hour, we have heard people on both sides of that argument. host: great to have you as health julie rovner correspondent for kaiser health news. host: next up, we will speak with christel marchand aprigliano, talking about the rising cost of insulin, as washington journal continues. ♪ >> i think it is important on this day that we continue to offer the people of colorado, the people of littleton, the families involved, the knowledge that all america cares for them and is playing for them -- them.g for >> the columbine high school shooting was one of the deadliest in american history. on friday at 8:00 p.m. eastern, we look back on the shooting and provide some reflection on the

shooting. >> at that time, columbine had never happened and neither the parents or the school counselor looked at the issue of a violent wasr as something that indicative of the possibility of some real deterioration in thinking. announcer: watch our special on the 1989 columbine high school shooting friday at 9:00 a.m. eastern on c-span. jetnce, tv was simply three giant networks and a government supported service called pbs. then, a small network with an unusual name rolled on a big idea, let viewers decide on their own well is important to them. c-span opened the doors to washington policymaking for all to see, bringing you unfiltered content from congress and beyond. in the age of power to let people, this was true people power. in the 40 years since, the landscape has changed. there is no monolithic media,

broadcasting has given way to narrowcasting, youtube stars are a thing. but c-span's big idea is more relevant today than ever. no government money supports c-span. its coverage of washington is funded as a public service by your cable or satellite provider. on washington. c-span is your view of government so you can make up your own mind. announcer: washington journal continues. host: the rising cost of insulin across the country is getting the attention of congress and others. we are joined this morning from tampa by christel marchand aprigliano, ceo of the diabetes patient advocacy coalition. tell us your story, how you were .ounded and why guest: we were founded for an half years ago because we found there was a gap in the policy area of diabetes.

many other organizations, the american diabetes association, juvenile diabetes research association, they do wonderful things, but nobody speaks for the patient when it comes to policy. safety, quality, and most importantly especially these days, access. withent time talking federal and state policymakers to ensure people with diabetes stay safe and get access to the quality medications and services that we need. i myself have diabetes. i have had type one diabetes since 1983 as well as this being something that i do everyday for living, this is something that i am personally impacted by. tell us your story in terms of what it costs you per month to stay healthy, your insulin cost per month. guest: i am fortunate. my husband has insurance under his employer and so right now,

currently, i pay $40 a month for my prescription. however, it is not always that way. for many people with diabetes, it is not the case at all. with i was diagnosed, the very first time and insulin analog came onto the market, a single vial of insulin cost $21. it is now over $250 for the same particular vial. there has been no changes to the formula is else. it is off patent. for individuals who are uninsured or underinsured, these individuals are paying full list price at the pharmacy counter, which is unacceptable. nobody should ever be paying list price. host: what do the cost is going up so dramatically? guest: there is a number of factors. i think what is important to understand is that it is not based off of, we decided this is what the price is going to be.

we have a problem with the current system in which our insurance programs have gone , whereaditional plans you walk into a pharmacy, you pay $20 or $30 for your co-pay card any walkout. we now have high deductible health insurance plans where supposedly, the cost sharing is supposed to be through the patient, and those of us who have chronic illnesses and up paying the most of the from is the counter until we meet our deductible. the deductible is done in order for the entire system to be able to have lower premiums. the other half of the story is that we have a middleman. hour,cussed in the last these are pharmacy benefit managers or third-party administrators. their goal when they started was to provide the best price for patients.on drugs for

unfortunately, that is not currently what is happening right now. what we are finding is that these companies are negotiating with manufacturers. and manufacturers set the list price. but it is predicated upon a rebating system. the pharmacy benefit manager negotiates a large rebate that is supposed to be passed on to the patient, hopefully at the pharmacy counter, but often times it is actually used to lower the cost premiums for everybody in that plan. so instead of it actually helping patients, which was initially what was supposed to happen, we are ending up paying for making sure that everybody else in the system has lower premiums. host: we will hear momentarily testimony from pharmaceutical executives and insurance executives are as well. our guest is. christel marchand aprigliano, she is the ceo of the diabetes

patient advocacy coalition. our topic is the rising cost of insulin. we welcome your phone calls. if you are a diabetic or parent of a diabetic, the line is 202-748-8000, for those of you who aren't, 202-748-8002. some baseline figures on diabetes in the u.s. from the center of disease control, about 5% of people have diabetes. the pancreas doesn't make insulin or very little, so insulin is needed to be taken every day by many diabetics to survive. anrently, prevention is curable -- it is currently on an curable or unpreventable disease. 90% of theabetes, people with diabetes have this type of diabetes. the body doesn't use insulin well, it develops over many years and it can be delayed or prevented with a change in

lifestyle. the average medical expenditure or people with diabetes about $13,700 last year, about 7900 of this amount was attributed to diabetes. more than 30 million americans have the disease. we welcome your phone calls and comments. we go first to albert in augusta, georgia. good morning. caller: good morning. i am calling in. i am a diabetic myself, type ii. i was diagnosed about 15 years military.retired i was getting my insulin through the military program but recently, i was in texas visiting my daughter, i am a new company, a, and a large drug company, i don't know if i can call the name, they

tried to hijack me. the pharmacy couldn't fill my prescription because they would it.them sell it -- fill when i call the company, they said, if you don't get it with us, you will have to pay the full price, which i know is not true. but they tried to hijack me, and i told them, no, i am not going to get it. it was just a pharmacy company trying to make money just like everybody else. it was a very large company. they said, we will mail your prescription to you, but you must get it through us and you can't get it through anyone else. but that is not true. so, i just wanted to make a comment on that. and i get my insulin from the military. i live about five minutes away from --, and it is entirely paid for. host: albert, thanks for your call.

guest: albert, in the current situation, that is sort of where we are stuck, in a system that does not allow individuals like willeople with diabetes need insulin, to get access from wherever we are at. price is what happens when individuals are underinsured or uninsured or are not using the right pharmacy, or not using the right pharmacy benefit managers. in some cases with individuals, we are being forced to switch from one type of insulin to another type of insulin, which can be called nonmedical switching, which is simply because the pharmacy benefit managers have chosen another type of insulin solely for financial purposes. because it can cost less for pharmacy benefit manager has nothing to do with what the patient really needs and what the doctor has prescribed. host: have frequent or how common is rationing insulin, and

is it largely done because the cost is prohibitive? guest: it is widespread. a doctor from yell actually produced a study that shows one in four of us russian insulin. insulin because it is not affordable for everybody, which is anathema. so what we have to deal with right now is making sure that not a single person in the united states rations their insulin or chooses to go without , which in the case of a person with type i diabetes, is definitely death. us.e is no other option for we don't make this in our body and we have to use it and infuse it or injected, otherwise, we die. it is pretty blunt, that is the way of it is. host: from richmond virginia on our others line. caller: are you doing this

morning? most of fine, thank you. caller: my mother and my father diabetes.from sugar i am an avid reader of labels. at it like the sugar and the insulin together, they make 's sugar to people rise the way it does. i read on the front of the label, no sugar added. on the back of the label, there is 20 grams of sugar, natural sugar. but they are deceiving people, especially the elderly who don't have an understanding of the relationship between the hidden sugar and what makes their sugar rise, whether that sugar is absorbed in the system or it is gone. so all of a sudden their sugar is up and they are going into, as, falling out, i have seen it myself -- they are going into a comas, or falling out.

i have seen it myself. why don't they do something about these advertisers who put sugar in this stuff? it is in vegetable juices, but on the front, there is no sugar added. even their baby food labels i was reading, there is sugar in baby food. why isn't anyone standing up to get the sugar out of these products, so that these people can live? host: thanks for the call. guest: surely, first of all, i want to say i am so sorry about both your parents. you have touched him him something that is incredibly important in today's society -- and that is education. you yourself try to educate about what is going on and how sugar impacts the body, and you know exactly what happens. but for many people with diabetes, especially those who are diagnosed, we need training.

one of the things that diabetes patient advocacy coalition is trying to do right now in congress is work with the congressional diabetes caucus on this particular issue of education. . making sure that people understand that no added sugar on the front of a label doesn't mean there isn't sugar in the product. if an apple has sugar in it, we know that if we get that apple it is natural sugars. most cases what we need to do is an education process for individuals who are diagnosed, is to teach them the difference between no added sugar and what is natural sugar, and how to deal with that appropriately. whether that is insulin, or getting some exercise to help bring our blood sugars down. it is a systemic issue an education is an of the ways we can make sure this doesn't happen in the future. thank you so much for your question. host: the cost of insulin got the attention of several congressional committees, and the house energy and commerce subcommittee held a hearing last

month, on why the cost of insulin has risen so dramatically. let's take a listen. >> this is not an issue of negotiation, pbms are very effective negotiators, is what happens after the negotiation. the rebates are not going to patients, they are being used in other parts of the system, and we do not have his ability on how they are used. those rebates are how we secure from larry placement and -- formulary placement and cost-sharing for patients. >> i know i will have to raise my list price, because they want more rebates? is that what you are arguing. >> the rebates are part of the negotiation. i have not giving you -- another question i would rather hear your responses to. myas mentioned previously by colleagues to my left, of course we are looking at the clinical outreach of the product.

i know that you want to get to the economics. the way we make formulary price.ns is based on net everyone all the manufacturers to my right wanted to reduce their list price, there would me be no implication to the list price status as long as the list price remained the same. >> tell me why rebates are so important in the negotiation of the press of a drug, in this case, insulin. >> truthfully, pharmacy benefit managers play a role. administrative. that is really important to understand. as the drug pricing system has role, the rebates play a simply to ensure that they are placed in a particular formulary. so the pharmacy benefit managers and manufacturers have secret negotiations. we have no idea what those rebates actually are. we don't know how much is taken by the pharmacy benefit

managers. we don't know how much is received back to the manufacturer. all we know is that the patient very rarely sees that at the pharmacy counter especially for those of us who are underinsured or uninsured. --we are looking at a time an opportunity. right now in congress, they are examining the proposal that was set up by h.h.s. called rebate reform. it would eliminate essentially the remaining system that currently is happening on medicare part d. for the individuals who are on medicare part d who have diabetes, who use insulin on a daily basis, we are actually paying the brunt of the amount of rebating that is being spread across the system. by removing the rebate on the entire system, the individuals with diabetes would actually save, according to some of the calculations done, almost $1000

per year at the pharmacy counter. as we see what happens of medicare, it usually switches to our commercial health care systems, i removing that rebate and by forcing the manufacturers and the pbm's to focus on the patient, you will see discounts at the point-of-sale, which is the pharmacy counter. we are it would go ahead and actually look at what the true cost of insulin is, not a list price or a net price, but what we as patients will pay to stay alive. executiveas with the who testified before congress last week, they announced the insulin costs, saying last week that the company would cut the cost of its insulin products to $99 a month for uninsured patients and others will pay for it in cash, as the drug made

-- drugmaker contends with criticism about drug pricing. we have a call from keys who is a diabetic from oregon. ask for waiting, keith, go ahead. for advocatingou for us diabetics. 1985e been diabetic since and i am just lucky that my insurance picks up most of the cost. i can't believe the increase in insulin. i had a cat that was diabetic two years ago, and i had to buy insulin for it and it was a most $200 -- it was almost $200. i can't believe how the rebates -- it is obscene. it is just obscene. , ii didn't have insurance don't know how i could afford it. i really don't.

guest: and you are not alone. the majority of individuals who have diabetes who are not like you and i have commercial insurance lands or some way to pay committees individuals who are part of our community, they help becausemuch they cannot be without insulin. we have to focus on the individuals who are paying list price. some people are paying up to $1200 a month. the coping cards and the patient assistance programs are not the optimum way to do this, this is not a long-term solution. host: let us hear from christie in reisterstown maryland, good morning. hi.er: i am a physician assistants, i work in the emergency medicine. i wanted to say that as a physician assistant, this issue is not only causing problems for these patients, what is

happening is these patients are coming to the hospitals in diabetic emergencies and ultimately wind up costing a lot more money when they are in this actual crisis state, billing at the highest level of care in the emergency department, than if they had been able to just deal home.heir blood sugar at i am finding a lot of people coming in and telling me that they are rationing their supply or they stopped even doing finger sticks because "they just didn't want to know." they are starting to avoid dealing with the issue because they don't want to have to deal with a consequence of the cost? guest: and we're looking at long-term issues as well. we have individual issues for individuals who use insulin on a basis. those are the short-term issues, showing up at the emergency room being in crisis and in some cases being in diabetic ketoacidosis, which is a dangerous scenario. individuals end up being. hospitalized. but we are also looking at the long-term implications.

individuals will ration for years or even for our year, we end up with complications of our eyes, our kidneys, pretty much our entire body is dependent on that very gentle negotiation between how much insulin to take versus how much sugar is in your body. so this becomes a take of the can down the road. if we don't address -- it k the can down the road. if we don't address this issue, he will have individuals dying from not being able to afford that they need, and also the government will end up paying for the long-term complications of diabetes. this needs to be addressed now and it is time to do that. thank you so much for sharing from a p.a. perspective. it is important that our medical professionals stand alongside nation's year, so thank you for everything you do.

strugglingine here, to stay alive, rising insulin prices cause diabetics to go to extremes. we will hear from a diabetic from sioux falls, south dakota. thank you. caller: my dad was a type one diabetic, he was a diabetic most of his life, back in the days when you boiled your syringes and use is to learn -- used insulin. in the later years they call humulin and the price went way up. the used it for a few years, then he went back to insulin, and it went down in price. i was a diabetic for 35 years and i had my vision of affected -- my vision affected. six years ago yesterday, i ended up on a dialysis. three years ago yesterday, i got a kidney and a pancreas transplant. i guess there is some good news in that i haven't taken insulin

now for three years, and i am feeling way better than i ever have. so i just thought i would let you know that. thank you. guest: congratulations on the transplant. i apologize on behalf of the community for having to endure all of that in order to get the transplant. while many organizations are seriously and frantically doing research and looking for a cure, in the meantime, we need to focus to make sure that all those of us have access to the insulin we need to survive. host: sera from michigan, also a diabetic. good morning. caller: good morning. 1960, been diabetic since and i have been lucky enough to handle it pretty well. but i have always had to look for an employer that would cover my insulin because this is a very big thing. i could say, no, i can't take

this job because your health enough.e is in good i also have experienced the loss of two siblings due to i.abetes, type i had one brother die of hypoglycemia, his airway was cut off and he ended up with brain damage. notd one brother diet, only was he blind and had been given and you kidney -- i had was blindr die, he and had been given a new kidney, and he also died. this is an issue that scares me. i remember when mom used to buy it for $.99 a bottle, granted, mulin,as not hu -- host: c for them get a risk

wants, what might insulin cost on medicare. guest: if you are using medicare today, if you are using insulin, you would reach the catastrophic coverage level and you would expect to pay almost $7,000 per year. on a fixed income, that is just unmanageable. many individuals are finding that in the current system, they 5, 6, $700 a pay month for insulin. it is happening all over the united states. what we are hoping is that as i mentioned earlier with the rebate reform proposal, is that is set of paying the initial $405, or for hundred $50 each year, each year the price the deductible goes up, what you will find is that instead of playing for the huge list price, you would be paying that discounted list price of the counter. so you actually amanda paying,

but it will be manageable over the course of the year -- you actually may end up paying, that it will be manageable over the course of a year. we are looking at about 60 days before we hear, but as representative potter from georgia explained last week during the testimony, this is pretty much a done deal. so hopefully we'll have some for our population on medicare and take insulin on a daily basis. then, as i have mentioned earlier, what happens on medicare, i would say probably within the next two years, we will see a major shift for our commercial plans, where the rebates don't exist anymore and instead, discounts are passed directly to the patient's. host: we have a few more calls, we go first to gary from west virginia. tell us your situation, gary. caller: i am a retired federal

employee, so my insulin went down this year. i was paying $100 a month, now i am down to $70 a month, and i am hoping it keeps following in a trend like that. but listening to some of the other people calling in, i will all of the things that congress does do for themselves, it does affect some of us retired employees. we have been fighting for everything for years and years, so hopefully it will all keep up. thank you for your work, you and waiting period that definitely helps us out, thank you very much. host: thank you, gary. guest: thank you. i think it is important to understand that for all with diabetes and other family members, we have

been fighting for years to make sure we stay healthy, and we can't do this alone, it is exhausting. the amount of effort we take, whether it is dealing with insurance companies or with the federal government, what is important right now is that we are focused on finding answers and long-term solutions. stories,e hearing the i love hearing the people are so passionate about this. i am very heartened by the fact that we have so many members of congress who now recognize that this is an unsustainable issue that needs to be fixed, and it can't be fixed next congress or the congress after that, it needs to be fixed now. host: we will do about five more minutes with my guest, christel marchand aprigliano, she is the ceo of the diabetes patient advocacy coalition. we welcome your calls if you are a diabetic or parent of a diabetic at 202-748-8000, and for all others, 202-748-8001.

ristel, tell us about the affordable insulin project. of as it came out everything else we are seeing, individuals who are employed and like the individual who talked about having to go to an employer and turned on a job because of the insurance didn't actually work for an individual who uses insulin, what we focus on is giving tools and guides so that individuals like myself could go to an employer and say, as a person with diabetes, this is how much money i spend total over the course of the year. and here's the data that shows that for individuals spend more than x amount of dollars per month on insulin, the insurance will actually go down if it is above a certain level. by exempting insulin from any deductible that is currently provided to help with cost

sharing or making good choices, it is not like a choice we have to take insulin, by exempting insulin from the deductible, you are actually save money as an run.yer in the long this is in conjunction with an organization called the national diabetes volunteer leadership council. they work at a high level with andemployers to look at benefit consultants, to a at ways we can also exempt insulin from the deductibles. so we as a patients are going from the bottom up to the employer, and the national diabetes volunteer counsel are going talk down to the employer. so we are educating the employer on how much insulin is important in our annual costs, and what they can do to help and ensure that we have healthy employees that can go ahead and make sure that we stay in remain healthy employees. most of them let us go to a shallot, michigan and hear from charlene on our line for diabetics.

charlene, go ahead with your comment, make sure your miniature television and then go ahead with your question. cpn, i have ien diabetic since 2007 and am taking four types of -- diabetes. rmin, i am medfo glyohoside and a medication for the pain that i get in my feet and hands. host: charlene, we're going to we haven't really talked much about type two

diabetes. she mentioned some of the medications she is on. are there some arises in prices for those other medications related to the disease? guest: there are rises in prices all across the pharmaceutical and prescription drug system. --are not the only drug insulin is not the on the drug that we are seeing an increased price, however, this is the one drug that for over 8 million of us, we have to take on a daily basis otherwise we are not going to lead. so we are sort of the litmus test on what happens when a drug becomes unaffordable. it is an essential -- in life essential drug, so it is important that we recognize that as the price of insulin rises for individuals at the pharmacy counter, we are also seeing an increase in prices all across for some of these he were drugs or her name drugs -- brand-name

drugs that are essential to health individuals with diabetes glucose with high levels but also with cardiovascular benefits as well. those increases in prices are all due to their rebidding system -- rebidding system. host: from oregon, good morning. caller: good morning. is it crystal? guest: christel. caller: i have been diabetic since 2011. i have been able to get insulin, which is good, that my concern is -- you mentioned pbm's, what actual role do they play other than administrative? i was a little concerned when you were talking about these rebates which never reach a patient. seems like they are nonessential to health care. guest: so i will push back just

a bit. pharmacy benefit managers currently play a role in the united states. no pharmacy benefit managers in any other country except the united states. their job is an administrator role. one of the proposals for the rebate reform that has been thrust forward is that currently, the rebates are paid based off a percentage price of the list price of the drug. so the higher the list price, the higher the rebates and the higher the amount of money that can go back to that pharmacy benefit manager. if the rebate proposal goes --ough, it will no longer the fee will no longer be based off the price of a drug, the list price. they are proposing a fixed fee. this seems to be very logical, so they will still be paid, and they will still be a way to perform the mistreated functions

and ensure that formularies are properly set. but at the same time they will be would have the massive profits that they have been having over the last several years. host: christel marchand aprigliano joining us this the ceo of the diabetes patient advocacy coalition, youp can find them online at diabetespac.org. thank you for being here. guest: thank you. host: we continue our conversation. host: particularly asking those of you who are on the affordable care act. obama care recipients, the line is 202-748-8000 for eastern and central. mounted and pacific time zones, the number is 202-748-8001. what you have experienced with the program, what changes you would like to see and more. washington journal continues . >> i think it is important on

this day that we continue to offer the people of colorado, the people of littleton, the families , the sheer knowledge tl of america cares for them and is praying for them. announcer: 20 years ago, the columbine high school shooting was one of the deadliest in american history. p.m. eastern,:00 we look back on the shooting and provide some reflection on the tragedy. >> at that time columbine had never happened and neither the parents nor the school counselor looked at the issue of a violent paper as something that was indicative of the possibility of some real deterioration in thinking. announcer: watch our special of the 19 and in nine columbine high school shooting friday at --0 p.m. eastern on c-span 1999 columbine high school shooting. tv waser: once,

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health care. we ask of those of you who are affordable care act participants only to call in for the next 20 minutes or so. 2027 for eight 8000 for those of you on the eastern -- 202-748-8000 on the eastern and central time zones, and 202-748-8001 for the mountain and pacific time zones. a look at the headlines, a horrific fire yesterday in paris. their update at the new york times -- to them structure is sound. the structure is sound after the fires that won't through monday though the wood roof also left three holes in the sweeping vaulted ceilings. official said after an inspection earlier today;, with the fire extinguished, officials quote "long and complex

investigation." though for now, they are considering the disaster an accident. or the next 20 minutes or so, the affordable care act. what has been your experience. aca recipients only. we hear from walled in pennsylvania -- walt in pennsylvania. caller: good morning. i have been a recipient of the of for the book air act since 2014 and, great access to quality health care. i didn't have to change any of doctors, none of my hospitals, so all of that gobbledy gook about the --ordable care act not being host: and it is affordable for you. caller: yes. let me give you an example. in 2014, it was $415 a month. the next year, $500 a month.

when the republicans took over, my premiums are now $1100. so if there is a downside, it is the fact that the republicans undermining the program and forcing the cost upward for me. so that is the only downside. a significant downside. but again, if they were to engage the system and try to make it better -- but they just wanted to destroy it, and my premiums have risen. but the quality of care has stayed consistent, and i am happy for that. host: ok. pristina, from montauk pennsylvania. good morning. caller: good morning. be it obamacare or trumpcare or any other care, it will not be sustainable. i think people have to realize their houses there was --

their health is their responsibility. they have to. do something for themselves. they have to understand that they can do for their health what doctors can't, because doctors are only doing damage control. the previous caller said, were the price has gone up but he is still satisfied. have you seen the price of your health insurance go up? caller: no, i hardly go to the i am on a good diet and it is not an issue for me. .ost: linda in arkansas affordable care act recipients only. linda, what is your impression of the aca? caller: the aca is actually wonderful. they would not allow me to get , but theaid

republicans got in there and they are messing with it. it don't cover my payment, i get denied for certain services, but overall, it is really good. host: so you trace that particular -- the lack of coverage to the republicans, to president trump coming into office? caller: it happened after that. was still on i workers comp, and i was denied for pretty much everything. but then, the aca kicked in for me as well as for my other medical and it would cover what they didn't. they startedr going into the overdoses and stuff, they stopped paying for the meds. host: ok. let us hear from mesquite, nevada, this is bobby. go ahead. caller: good morning. host: good morning. caller: i just wanted to say

that both my husband and i were on the aca and to us, it was awful. we never even got to use it. because it was over $1400 a month and we both moved on to medicare, but the deductible was like $8,000, we never used it. we just paid $1400 a month, we didn't get any deductions. so in my opinion, the only way the aca works is if a person makes a low income and gets subsidized by the government. those people are happy. i think that first color you had on their best the first caller -- i think the first caller that you had on their the has been on it since turned 14, i think that is what they on. host: so what are you on now? caller: on medicare.

we pay a basic fee. you still pay when you are on medicare. we are getting sold a bill of goods if you think it will be free, it is not, you are still paying for medicare. host: ok, bobbie in nevada, that. for 202-748-8000 is a number to call if you are in the eastern and central time zones, 202-748-8001 if you are in the mountain and pacific time zones. your experience on the affordable care act, what you would like to see changed or stay the same. we welcome your comments, facebook posts and if you would is@ to send us a treat, it c-spanwj. the president spoke to tiger woods to congratulate him on the victory he had in yesterday's masters, and to inform him that

because of his incredible ,uccess and come back in sports golf, and more importantly, life, i will be presented him with the presidential medal of freedom -- that is from the sports line in "usa today." making the front page this morning is the news of the hefty mother -- hefty meal a report. the headline -- attorney general barr plans to release the full report into the special counsel's investigation into russia's efforts to sway the 2016 election. your reaction late thursday here on c-span, c-span radio, and certainly friday morning's program, we will focus on the mueller report as well. part of the fallout from the report includes this story -- previews moved to dismiss charges. a judge aims for an august trial

in the case on off from the mueller probe. they write that a federal judge named for a august trial of washington attorney gregory craig, on charges of lying in connection with robert mueller's russia probe. he was president obama's first white house counsel and special counsel to clinton and was indicted last week on judges he made false statements to justice department officials examining whether he needed to register as a foreign lobbyist to work for -- for work he and his law firm did on behalf of the ukrainian government. the work was done at the request of paul manafort, according to court filings. you can read more about that at washington post.com. in the post this morning also they are looking at the 2018 returns. program the looking at that yesterday and how it was for our viewers and

listeners. after-tax day, a look at how the g.o.p. tax plan measured up to code. they have a number of different things promised -- your taxes will fit on a postcard -- this didn't happen. . almost all tax filers who filled out the 1040 say it did shrink, but much of the information that used to appear on the 1040 now appears on schedules, meaning most taxpayers simply ended up pages. out more back to our topic, we want to hear from you, aca recipients, on how the affordable care act is working out for you. from shawnee, oklahoma, this is pam. good morning. caller: i applied for this about three years ago and i had retired and i work part-time. will do it,t, ok, i because it didn't have any insurance. i had three months and then i started getting a bill every meth for $450, and they told

it was $1200. . tried to call the insurance they were telling me i had to pay it. the insurance was saying i had to pay it. then they had me on a three party line and they were trying to figure it out because nothing had changed from the beginning. , they quit bailing me and told me they canceled me. so i didn't even want it after that, so i don't have any insurance now. and i am on social security and i were part-time, and i am paying -- i just learned that i have to pay income -- i never had to pay income tax in my life, i had to pay $607 in my income tax. host: so you can't find a health

plan that is affordable for you? guest: right. so i just totally hated everything about it. from shawnee, oklahoma. thank you for that. diane, next. tell us about your experience with the if a look at. caller: it was, of course, thrust upon us, we had to have it or else, but before that our company had gone to our local clinic/hospital in new hampshire, nearby, and negotiated with -- they had health access program based on how much you make, and your family size. we were already doing that and we were forced to do something else because it wasn't what the man said we should have. so in order for the health access to take place, those people, the situation was also

us to go had forced and get the aca, which in vermont, if you are making too much money, they will take it from you. so we live rather frugally on what we make and choose not to make more than what we do. so we are in the situation where we have to get something -- and we can't afford it, it is $800 a month deductible, more than our rent. it is ridiculous. we are healthy and we don't need that much. it forced us to add another level of bureaucracy. now somebody is paying it hundred dollars a month for us, the rest of the country, because , and in this big pool our access to the doctor is still the same. it didn't help one bit, it just made everything more complicated. host: we are going back to the topic we started with, diane, medicare for all, would you a single-payer medicare

for all type of program as opposed to the limited options is a you have under the affordable care act? caller: i am an air force brat, i know the extent of the v.a. and what happens when government runs too much, doesn't do anything well, and i have no reason to believe it could run a health care system for 360 million people. host: appreciate you calling in this morning. 202-748-8000 for those of you in the eastern and central time zones, 202-748-8001 for mounting pacific. reaction on twitter, bobby tweets this -- the aca is a law that affects all of it insurance provision, it is not an insurance provider. we are all recipients of the aca. it benefits insurance providers accessednce providers by aca exchanges are private insurance companies. her view is that it is trash

policy. in other news this morning in the "financial times," nader wraps up boeing campaign. ralph nader, the consumer advocate whose grandniece was killed in the crash of the 737 max in is he of the last legislatorsling on ofreturn campaign credit nations from boeing. the 85-year-old activist and former u.s. presidential candidate promised to expand his campaign to prevent the grounded fleet from ever getting back into the skies. withg's close relationship its regulator, the federal aviation administration, has become a focus point of the investigations into the approval process of the 737 max. that is in the "financial times." we go back to your calls on the aca. jordan in maryland, go ahead. caller: yes.

so, this whole obamacare has been a problem for me. i used to be able to afford my health insurance. i would pay about $200 a month, and it had decent coverage. i had to go through the subsidies, i'm am paying about the same amount of money right now with less coverage and get someg forced to type of government assistance, which i didn't need before. all obamacare did was raise premiums and force me to use government aid, something i have never wanted. i am being put in a situation where i need financial aid to get health care for less coverage than i was able to pay for out-of-pocket before. without any travel assistance.

host: what is your deductible there, jordan? $1500 for any emergency needs. my message inductive well, myay about $200 a month -- monthly deductible, i pay about $200 a month. it doesn't save me anything. host: next up, from north carolina, welcome. caller: yes. the effort will care act has been great for the people that i know that have been on it there. -- iter the government put them in financial ruling and put them in bankruptcy. the affordable care act has been really great for them. but unfortunately myself, i had to get on social security

disability by being hurt and everything, so -- host: bill, how old were you when you got on ssdi? caller: 62. host: go ahead with your comment. caller: the affordable care act has been great for personal withse that have had people that i know personally and everything, in the family and everything, it has been great for them and has really helped them on their medical bills. they have gotten their medical bills paid. they are getting their medical bills paid just as good with the book air act, and in most cases, where they have lost much money, the insurance is basically free .o them

but it has been a lifesaver for them because they have had some help. i have talked to people at the hospitals, doctors offices, and they all say that it is a lot better than anything that has ever been before. host: let's hear from karen in warren, michigan. caller: hello. host: hi, go ahead. caller: i am just concerned with all this negative talk. we need to think about the positive. people could be helped and have been helped. can you hear me? host: yes, we can. caller: i am just really concerned. i have had wonderful experiences with it. if it wasn't for that, i would not be alive today, and many people around me. uplifting. we have to have something, not nothing.

i believe there are ways of fixing the things that we need to fix. you keep the things that do work. and for the millions of people out there who need this desperately come for me, you take it away, i lose it, i die. host: karen, thanks for that. karen in warren, michigan. we hear next from gary in tempe, arizona. caller: yes, good morning. i just wanted to say that the .ca saved my wife's life we didn't have insurance at the she contracted -- and she had the aca, and it paid for everything. also, i would love to mention don't know what people are expecting to pay for insurance, but in 1982, i was single then, and i ordered insurance just for myself, iran

a business, and -- i run a business, and it was $550 a month just for me. so when you add family members and so forth, you get into the thousand dollar range or so. people have to remember, the website, the aca is nothing more .han a website it is not an insurance company and it is not government run insurance, it is insurance -- it is a website that allows you to purchase from private insurance companies. so the private insurance companies are the ones charging whatever they can get. aca is just a group of regulations the matures -- that makes sure they insurance companies work properly. back in the 80's i was also

offered a job to sell those junk insurance things that trump has mentioned and they didn't cover anything. they were lies. they were not equipped. there was not a real product. it was something that claimed to cover things and covered nothing. prejudiced toward the aca because it was saved my wife's life, that is what i wanted to say. host: we appreciate you calling in and thanks for all the calls this morning. "washington journal" back every morning at 7:00 a.m. eastern radio. c-span and c-span next up, we take you over to the center for strategic and international studies. he will hear from the vice chief of naval operations, admiral william moran, as they talk about maritime security. getting underway momentarily here on c-span. underway momentarily here on c-span.

[chatter in the background] announcer: when i live here at the center of strategic and international studies, also being hosted by the u.s. naval institute, a discussion about security with a vice chief of naval operations. we will hear about navy readiness, how it has improved, as well as the importance of competition with other world powers.

today we will take a look at relations between the european union, china and the united states, hosted by the hudson institute my live at noon eastern. we will have that here on c-span as well. we are expecting this discussion to begin shortly.

announcer: again, we are at the center for center for strategic and international studies, waiting for the discussion with a vice chief of naval operations to begin, we will be hearing about navy readiness and how it has improved. also today, we will take a look at relations between the european union, china and the united states at noon eastern. this afternoon, a look at the federal opportunities zone program aimed to invest in a low income communities, that will be hosted by the aspen institute at 3:30 p.m. here on c-span.