never happened and needed the parents nor the school counselor looked at the issue of a violent paper as indicated of the possibility of some real deterioration in thinking. on the 1999 special columbine high school shooting friday at 8:00 eastern on c-span. the chief washington correspondent for kaiser health news is here to help us continue the conversation about medicare for all and the affordable care act, the status of it. act, the status of it, what may be ahead. we have focused a little bit why do you think it remains the top of the democrats agenda for 2020? >> mainly because it is the top of the public's agenda going in, 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

always, julie >> watch washington journal, live at 7 a.m. eastern this morning. join the discussion. >> here's a look at live coverage wednesday. the priorities for the agency. the bipartisan policy center at

10 a.m. eastern. on c-span2, noon, the effect wildfires have on public health. later the american enterprise institute looks at modernizing the foreign agents registration act, which requires lobbyists working on behalf of another country to disclose relationship and finances to the federal government. morning, they justice department is expected to reach and release a redacted version of the robert mueller report. we will have it available online at www.c-span.org and we will open the phone lines to get your reaction. once, tv was three giant networks and a government supported service called pbs.

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