" "washington journal" continues. host: we will talk about drug costs in the reconciliation bill. before we get to those details, what do democrats want to do with the three point $5 trillion package? guest: they would like to expand medicaid for the dozen or so states that have not yet expanded under the affordable

care act. the supreme court made that optional in most states have gone ahead and joint because the federal government pays 90% of the cost of that. there for about a dozen states including big states like texas and florida and georgia that have not yet expanded. there are several million people worth of not getting the benefits of the affordable care act. they increased some of the subsidies for people who by their coverage through the aca. earlier this year, they would like to extend them or make them permanent. they want to expand benefits for medicare. cover things like dental care or eye care or hearing coverage. they would like to add those things to medicare. finally, they want to expand home and community-based care. this is part of a long-term care issue that congress has been grappling with for decades and every time they tried to do something, the price tag makes them sit back and think we will

do this another day. it's possible that will happen here. the way they will pay for these expanded benefits is with these prescription drug visions which would not only help people with the cost of prescription drugs but it would save the federal government a lot of money it now spends on perception drugs. host: how would that work? guest: the main ideas to let medicare negotiate the price of prescription drugs which it is not allowed to do. congress added prescription drug coverage to medicare back in 2003. it was mostly a republican bill. at the time, congress is run by republicans and there was a republican president and one of the things they did and that bill in order to not cause the drug industry to come after them was saying the federal government. could not negotiate the prices that has caused a lot of price inflation on prescription drugs and everybody complained.

everybody pays for prescription drugs. the federal government complained that it cost too much though there's been a bipartisan effort to do something about drug prices for the last three or four years, with the major goal of former president trump who didn't manage to get it over the finish line. is something both democrats and republicans want to do with the drug industry is quite opposed to the idea of cutting back on the profits. host: how much profit are we talking about? >> the drug companies make billions and billions of dollars. we are talking about a relatively small number of drugs that medicare would be able to negotiate for, drugs that don't have a current genetic version. there would be a limit under most proposals that would be based on what those drugs cost and other developed countries where they have price controls.

just those relatively small things could save hundreds of billions of dollars for the federal government. host: would it also guest: that's a big part of this. the way the medicare prescription drug benefit is created in part d where most of the outpatient drugs are, there is what's called a catastrophic cap. as a patient, you only have to pay a certain amount but once you exceed that cap come you still have to pay 5%. in 2003, there weren't many drugs that were expensive enough that the 5% could be a lot of money but now there are. a lot of medicare patients are paying a lot of money for their prescription drugs. one of the goals of this is to help them save money. host: we have a line for medicare recipients this morning step.

you can also text us with your name, city and state. talk more about expanding medicare benefits. which benefits are we talking about and how much money with that said recipients? guest: that could save recipients a lot of money depending on how they do it. there were two competing desires for expanding medicare this year. one was to lower the eligibility age from its current 65 down to 60 and the other wants to add benefits that medicare doesn't have. medicare hasn't changed that much since it was first created in 1965 when it emulated what was then your average blue cross blue shield policy that people in the private sector had. insurance has changed in the

private sector as it has for medicare. medicare covers many things but it doesn't cover dental care for the most part, it doesn't cover eye care, doesn't cover hearing care. on till recently it didn't cover much preventive care which congress has added and those are benefits that are obviously used a lot by senior citizens. they could end up saving people a lot of money that they now have to pay on their own. host: lowering the age of medicare from 65 to 60 is included in this package? guest: it's not, they decided to go with the benefits instead. host: if they had lowered the eligibility age, what would have been the impact on that on taxpayers? guest: it would have helped a

lot of people who currently are paying a lot for their insurance. the increase in subsidies they gave four people to buy coverage through the affordable care act can help those people between 60-65 whose premiums are higher. that is something i think people who are advocating for medicare for all would like to come back to at some point. it's something president biden and doors to the campaign trail. host: what are progressives saying about this proposal the guest:, the lead proponent is bernie sanders in the senate who is on the budget committee and the main backer in the senate of medicaid for all. this is something he wants to do. host: you mentioned the reaction from industry to what democrats are pushing. i want to show people a reason pharma adam negotiating rises of medicare and have you talk about it. [video clip] >> they say they want to

negotiate medicine prices and met his care but make no mistake in what politicians mean is they will decide which medicines you can and cannot get regardless of what your doctor prescribes, regardless of which medicine has been working, regardless of what new treatments become available. it can even lead to long waits and medicare for new treatments and cures. call congress, tell them not to play doctor with your medicine. k four by pharma. host: is that true? guest: this has been the argument the drug companies have been making since the 1980's. the first big bill i covered in congress was the medicare catastrophic coverage act that passed in 1988 and was repealed in 1989 for reasons that were mostly unrelated to the drug benefit but not completely. it was the first attempt i congress to at a drug benefit to medicare in the drug industry argued at the time that if you don't let us make unlimited

profits, we won't be able to discover the next generation of breakthrough drugs. this has been the argument all along, that if we limit much prescription drug makers can take in, then we limit our ability to have new drugs going forward. it's been a constant tug of war and since then, in 2003, when republicans were trying to add a drug benefit, we are seeing it now and it's basically the exact same argument. host: let's go to oscar in california, welcome to the conversation, go ahead. caller: good morning all step thank you to c-span. what really stuck out in my mind listening to mitch mcconnell, and it relates to the 3.5 trillion dollars and medicare, is this " reckless taxing and spending." i would say it's reckless to not tax and spend and i know think there's a

single american, never mind kentucky but basically the rest of the united states that doesn't think these billionaires, these fortune 500 companies that are getting away with paying no taxes, i don't think there is a single american that doesn't think they need to increase their taxes and they could build in a tax incentive if they lower drug pricing. it's not the money, it's the money. host: what about that? guest: it's always about the money at least on capitol hill step who will pay more and who will pay less? that is what congress is there to decide. host: good this proposal benixed by the senate parliamentarian? guest: that's unlikely. congress has made many of not most of the changes to medicare over the years as part of budget

reconciliation bills. that's what budget reconciliation is for, it's for congress to offer mandatory programs as opposed to the annual spending bills. the reconciliation process was designed to make budget related changes to programs like medicare and medicaid and that's exactly what they are doing here. host: how popular is the prescription drug prices with americans? guest: extremely popular and that's why democrats and republicans say they want to do something. the trick is doing it in a way that will not cause the enormous multimillion dollar negative ad campaigns from the drug industry but doing it in a way that will actually save money and lower prescription drug prices. do u.s. is one of the only developed nations that doesn't somehow limit drug prices. most of the rest of the world does and that's why the prescription drug industry is so agitated about the possibility the u.s. could join the rest of

the world in limiting how much you pay for prescription drugs. host: which democrats are opposing this plan? guest: there are a number of moderate democrats in the house. the drug part of the bill didn't make it through the house energy and commerce committee last week because three democrats voted against it so the amendment failed on the amendment failed on a 29-29 try. they would like to do a much more limited package of prescription drug benefits mostly aimed at part b drugs, drugs that are delivered by doctors in their offices or in hospitals. they can be some of the most expensive drugs like anticancer drugs, but those are not the drugs that most people end up using. there would be a lot of relief for a few people with that sort of thing. it's not to say that it won't happen and it might end up in a house built, but they only have a couple of votes to spare and

none of the republicans will join them. host: mary in nevada, democrats line. caller: good morning, i agree with the prior caller. i saw mitch mcconnell on fox news talking about the democrats wanting to what they call free giveaways. he failed to speak about the free checks giveaways to billionaires, $2 trillion, not paid for on her debt. that's giving money to people who don't need it. as for medicare, are you aware under the trump administration the push to privatize medicare? if you are somebody who has traditional medicare, it puts you into one of the private advantage plans. guest: this has been a push to

the last 20 years or so. republicans would like to see more private plans involved in medicare. there is something called medicare advantage and is currently optional but an increasing number of people who are used to being in managed care plans during their working years are opting for these medicare advantage lands partly because many of them, because they get paid more by the federal government, are able to provide some of these extra benefits, things like dental care, vision care, hearing care. that's in exchange for agreeing to only use certain networks of doctors and hospitals. you can get more benefits in most parts of the country with medicare advantage and that's what a lot of people are opting to do. it's currently optional. you can remain with the traditional medicare package which allows you to see any provider who accepts medicare which is most of them. you can buy a medicare supplement insurance policy that

will help you pay the rather large medicare deductible and copayment or you can opt into one of these medicare advantage plans. republicans would like to see more of that and less of the government side. democrats believe there should be a medicare advantage and don't believe people should be pushed into it. host: jerry in virginia, independent all step turn down your television. caller: hello? good morning. we all know that drug prices are too high in this country. europeans of price controls and even mexico and canada. that's a moot point at this time. what i'm worried about, i was

watching the tom harmon show yesterday and they had the president of the physicians fraud on national health plan on and he was talking about that liz fowler in the current administration who was in the obama administration, they are pushing this new model, this cmmi model called direct contract entities where they are pretty much bribing medical writers. i don't even think they notify the patients. host: do you know anything about that? guest: cmmi is the center for medicare and medicaid innovation and was created under the medic here -- under the aca and they expired with different types of

payment possibilities. liz fowler is the head of that agency and worked in the obama ended his duration and help write the affordable care act, it's basically her job to test out new payment systems. this is something that democrats and republicans are anxious to do, to find more efficient ways to create that balance between what the government pays and what patients get in some of these experiments work pretty well and some of them have not worked well, but that's kind of the idea behind this center is to figure out what works and doesn't. host: talk about how he started out, that americans pay more than others in other countries and we are subsidizing drug prices around the world. guest: that's absolutely true. that's why the prescription drug companies are fighting so hard because the united states is the last -- place they can make unlimited profits. host: this is from the health

and human services department on september 9 -- americans spend more than $1500 per person which are far higher than any comparable nation step brand-name drugs are rising faster than at least -- then inflation. some americans don't take drugs because of the cost. what are they saying here? guest: this is everybody's goal. they want people to be able to pay less at the prescription drug counter and insurance companies to pay less to get the drugs, they want the prescription drug industry to continue to make enough money to research and develop the next generation of drugs and finding that palance is really hard and

that's been the goal. i've been doing this for 35 years. this has been an -- a continuing team. host: rockville, maryland, independent. caller: good morning, it's really mind-boggling how people have to choose between buying food and paying drug prices or their kids will suffer. they keep getting millions and millions in bonuses every year. this is not capitalism, this is theft. thank you. host: we will go to george in ruth or glenn, virginia. caller: how are you this morning?

besides having medicare, i also have a supplemental insurance to help cover the cost of my medications which can be a little high. over the past couple of years, since i've been on medicare and had the supplemental insurance, i have seen my supplemental insurance cost for my premiums go up 50% just over three years. i've also heard the drug companies are saying that if we are going to be limited on what we can charge for medications, we're just going to up your premiums every month and i would like to hear some information on that. guest: there is lively competition among the medicare drug plans. they cannot increase the payments too much because then you can switch plans and people do. when my mom had medicare part d which is prescription drug insurance, i switched her plan almost every year.

medicare has one of the few really good websites that let you compare and put it the doses and you can see pretty clearly which of the various plans are available to you will be the best value. that is the break on increasing amy adams. it's true that if the prices of drugs go up, so will the amount of rhenium's that beneficiaries have to pay for. it's one of the reasons why when you ask voters what their top priorities are, prescription drug rises are very much near the top and they have been for. the last several years host: what about the overall cost of health care for americans? the front page of the new york times has a piece -- painful reminder of baby deaths, 207,000 dollars in bills for a

hospital stay for their baby, for this couple. a daughter born prematurely and loses her life weeks later and their reminder is the small those that start rolling in. guest: the cost of health care is one of the largest problems facing the united states right now. that's where the money is. it's almost 1/5 of the u.s. economy right now and the amount americans had to pay for health care is too much for the vast majority of people. it's something congress has been grappling with. there are a lot of vested interest to give a lot of money to members of congress. they complained that if they are not allowed to earn this money, they will not bellow treatments and cures and drugs. it is a constant push and pull

on what the u.s. will do about health care and it's become a very partisan issue. democrats would like to see more government involvement in health care and republicans would like to see less guest:. guest:host:host: lancaster, california, done caller. caller: my name is wanda and my problem is not just the price of these prescription drugs. i want every last one of you guys to check your prescriptions. they are not even fda approved. check them out, check out the medication you are taking. it is host: have any thoughts on that? guest:guest: prescription drugs have to be fda approved or they cannot be dispensed. there are many over-the-counter medications. the fda does not for instance regulate supplements. that's a whole separate issue we

can spend an hour on about fda oversight of vitamins and drug supplements. there are things that people take they consider to be drugs but the fda does not. if you get it from behind the prescription counter come it has to be approved the fda. host: here is a tweet from georgia. guest: these are medicare advantage programs. if you're willing to abide by the restrictions they have, you can see providers in a certain network, then you can save a fair bit of money. one of the tricky things about medicare advantage is you go into a plan and you want to go back later to traditional medicare, you can do that but you might not be able to buy a medicare supplemental plan to help you with the other out of

pocket costs that come with additional medicare. you can switch to a different medicare advantage plan but it's hard to go back to regular medicare once you want to medicare advantage. host: john in louisiana, republican. caller: good morning, i will take the assumption that neither one of you are on medicare or medicaid or any of the government plans. i spent 28 years in the air force, retired and completed a 16 year stint with delta airlines. i am 78 years old so i have been on the government planned for quite a while. military retirees get our prescriptions and it's called express scripts. i saw that number of $1500 per year. i must be on the low end of that for some reason.

i have not seen a single prescription for myself or my wife who has considerable drug issues. her health is bad for a lot of reasons. i don't see anything over $10 for a prescription. i don't know if somebody has come up with a better plan that we, the military get. host: let's look at that. is the military plan better? guest: tricare is a generous plan and i know many people who are on it all stop express scripts scripts as the pharmacy benefit management that many with public and private insurance use so it's not really the express scripts program, if the underlying insurance which i imagine is tricare that lawyers on top of medicare. it's pretty generous and some people have that her insurance than others. if you do, be thankful.

host: harry from georgia, medicare recipient. caller: good morning to you and thank you c-span. i just wanted to raise this issue. i hadn't heard it mentioned yet. it's already been demonstrated that the pharmaceutical companies spend twice as much on advertising in a year as they do on research and development. their argument that they cannot produce all of these new innovative drugs if we start negotiating with them for prices is really a lie. they are spending probably a whole lot more in advertising to produce these advertisements again to scare us. host: what about the cost of lobbying? guest: the drug industry spends

a lot of money on lobbying and advertising. and in campaign contributions to members of congress which may be one of the reasons why it been so hard for congress to do something about prescription drug rises. there were efforts in the late 1990's to band scription drug companies from being able to deduct the cost of their advertising and promotional activities which didn't go anywhere. this is not the first time this has been pointed out step they spend an enormous amount of money on promotion as they do on research and development for new drugs. and medications host: you can find a julierovne r and follow her on twitter and follow her >> today, the house is

considering short-term government spending legislation that would prevent a government shutdown on september 30. also considering the $768 billion defense programs and policy bill. later this week, a bill prohibiting states from enacting certain restrictions on abortion providers. when the house is back in session, you can find live coverage here on c-span. ♪ "washington journal" continues. host: maria