The Young Turks - Medicare For All National Town Hall January 23, 2018

Episode Date: January 24, 2018

TYT’s Ana Kasparian hosts Bernie Sanders’ Medicare For All National Town Hall. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

You're listening to The Young Turks, the online news show. Make sure to follow and rate our show with not one, not two, not three, not four, but five stars. You're awesome. Thank you. There was never affordable insurance. No child or adult or human being in the United States should have to worry about dying because they can't afford medical care. People are finding that even with health insurance,

they're having to spend so much money on their own pockets for prescription drugs that many people just simply forego taking the descriptions they need. No parent should have to go through the heartache of losing a child needlessly. In 1935, it was Franklin Roosevelt to first try for a national health care bill, but felt short he could only get social security. Rightful had it with medical care and the opportunity to a chain that is dry for health. Then President Lyndon Johnson in 65 gambled big and lost. He added Medicare, though.

We marveled not simply at the passage of this bill, but what we marveled at is it took so many years to pay. How average how many Canadian patients are waiting lists now each year? Do you honor? I don't, sir, but I know that there are 45,000 in America who die waiting because they don't have insurance. We are serious about adopting a universal, comprehensive, cost-effective health care system that treats all people, rich and more alike, that the single-payer approach is the only way to go. I know how hard it would be.

I love you. All over our country's drug companies, they don't want to get other problems. All over our country, the American people understand that there is something profoundly wrong when we remain the only major country on earth, not to guarantee health care to all people as a right, not a privilege. insurance that families aren't faced with impossible choices like mine. When we talk about morality, what we are talking about is all of God's children, the poor direction, they have a right to go to a doctor when they are sick. Welcome everyone to an incredibly important discussion on Senator Sanders' proposal for Medicare

for all. that you are unlikely to ever see in cable news or in the mainstream media, a discussion on a policy that the majority of Americans care about and want desperate action on. Today we are going to hear not only from Senator Sanders himself, but we will also hear from healthcare professionals, individuals who are in the thick of it,

who have experienced what it's like to provide care in a country that has nearly 30 million Americans who are still uninsured. Now, there will be three segments to today's discussion, to today's town hall. The first portion of tonight will focus on the healthcare crisis in the United States. We will then move on to a discussion

about the economic impact of Medicare for All. And finally, we will do a comparative analysis of other countries that offer universal health care and what the future could look like in the United States if we have a single payer system. It is an honor and a pleasure to be here along with my peers at Now This and also attention. And thank you so much for attending

and being part of this monumental event. I appreciate it. Anna, thank you very much. And let me begin by thanking all of you who are here in this beautiful auditorium at the visitor center of the U.S. Capitol. Let me thank the many hundreds of thousands of people who are watching this event through live stream. And let me thank the panelists who are here tonight who have come from all over our country and, in fact, all over the world, to participate in this extremely important

discussion. I'm excited about this event tonight because this and fact is an historic event. This is the first Medicare for All town meeting ever held in our nation's capital. This is the first nationally televised town meeting on Medicare for all, and very importantly, this is the first nationally televised Senate town meeting that is taking place outside of corporate media. This event is being live streamed tonight by three outstanding digital media outlets, the young Turks, now this and attention. And I thank them very much for helping us put on this event tonight.

And I'll tell you why. Far too often corporate television, because of economic conflicts, limits the nature of what we see and the kinds of discussions that we have. So tonight, let me guarantee you that this event will not be interrupted by commercials from the drug companies or Wall Street or the insurance companies. So thanks again, thanks again to the Young Turks, now this, and attention. Let me begin with our very first panel, and this is a panel designed to discuss the dysfunctionality of what is going on in America today in terms of health care. We've got three great panelists who are with us. us, Stan Brock, Dr. Claudia Fegan, and Deborah Wachtell.

Stan Brock has lived an interesting life. What he does is go around this country, and he's been doing this for a few years, Stan, yeah? A few years. And what he does, and this will shock many Americans, in this country, the wealthiest country in the history of the world, Stan and his organization, remote area medical due, is provide free clinics in remote parts of the United States of America. And over the last many years, you've done some 800 of these free clinics, volunteer doctors, and dentists. Stan, why do you do these events and what are you seeing out there in the world in terms of health care needs?

Well, in the first place, Senator, thank you very much for inviting me here today and this distinguished audience. My feelings about this problem go back to 1953. I grew up in the Depression. I grew up through World War II, and I found myself in the Upper Amazon in the 1950s, and in 1953 I had a very, very serious accident, and when they picked me up off the ground, One of the people said the nearest doctor is 26 days on foot from here through that narrow trail through the rainforest. Well, I wasn't able to make that narrow trail through the rainforest, but what I did say was, we're going to bring these doctors a little bit closer than 26 days on foot.

Then when I came to this country, many years later, I found that there were millions of Americans who, there may not have been 26 days on foot from the nearest doctor, but they were certainly unable to afford access to the care that they need. And so we formed this organization called Remote Area Medical Ram, and we've had over 130,000 volunteers, so this tells you the scope of the volunteer spirit here in America, that people want to help of why the government needs to allow doctors to cross state lines so that these volunteers can provide free care

where the government at the moment is not able to provide affordable care. We have found out that in the last 34 years that the major problem for people in this country is dentistry. They can't afford to go to the dentist. Now, kids, they get some of the dental care that they need, but as soon as they leave school, they're on their own, and by the time they're getting into their 30,

They haven't been able to go to the dentist, and they're coming to one of our events by the thousands. And when there's a thousand people out there who've got numbers, they've been waiting there for maybe two days, and they want to get their health care. I say, how many people are in the audience here, meaning that audience of patients, are here to see the dentist, and all the hands go up. Okay, now we've got a lot of really fine optometrists and ophthalmologists here. How many people are here to see the eye doctor because they need a pair of glasses to function and all the hands go up again.

It's the same people. But when they're pressed, they're going to take the dentist first and then the eye doctor because they are liable to get all kinds of unhappy things happen to them if they don't take care of their teeth. Stan, let me ask you this. When I have seen photographs of the clinics that you run, if I did not know that this was taking place in the United States, I surely would have believed

this is a poor third world country where people spend the night sleeping in their cars in order to get dental care or health care. Is that accurate? Yeah, I mean two weeks from now we're going to hold the 900th expedition in our hometown, actually, in Knoxville,

Tennessee, where we're based. And I can tell you that for two or three days before that event, there are going to be a thousand people, sleeping in their cars, sleeping in makeshift tents, and some of them don't even afford, can't, don't have a car, they're going to walk there. And when we open the door on January the 31st,

and I call out who's got number one, they're going to come in there by the 1,000, and 70% of them are going to be for the dentist and 30% for the eye doctor, but they all need to see the medical doctors as well because they're riddled with heart disease, and diabetes. We diagnose people

with diabetes and heart disease by the thousands, but when they don't feel well, they go to the emergency room at the hospital. But the emergency room doesn't do dentistry, the emergency room doesn't make eyeglasses. Okay, let me jump in here because I want to go to Dr. Claudia Fegan.

Dr. Fegan is the chief medical officer at Cook County Health and Hospital System in Chicago. During the course of a year, I believe you have million visits. I mean, it's a huge enterprise, mostly lower income people, often people of color. What are you seeing in Chicago, Dr. Fegan? Well, I can tell you that 36,000 people died in the United States in 2016 as a result of being uninsured, and that we base access to health

care in this country on your ability to pay for it and not on your need for care. So I work in this large public system, and every day people come to see us. with advanced disease because they don't have insurance and they thought that they could manage their problems until times got better, but they got too sick and they had to come in to be seen. I could tell you about a 56-year-old cook with hypertension who had no medications and had a stroke on his way home from work.

I could talk about the 64-year-old salesman also with hypertension who thought he could wait until he turned 65 and got Medicare to take care of his high blood pressure. But that little bit of nausea he developed with kidney failure, and now he needs dialysis. I could tell you about the 50-year-old with diabetes who had no medication, who came in with his blood sugar so high that he developed such severe nausea and vomiting. He tore his esophagus, so he came in to see us bleeding, dehydrated, and in diabetic ketoacidosis. But I probably will never forget the 54-year-old woman who was a nurse's aide

who came into us after struggling for months with difficulty swallowing and we diagnosed her with advanced esophageal cancer. And I was telling her, I remember telling her that we could put in a feeding tube and talking to her about putting her affairs in order. And she wanted me to arrange for her radiation treatment to be given in the early evening or late afternoon

so that she could continue to work because what she knew was that if she couldn't continue to work, she wouldn't be able to pay her bills, including her rent, and if she couldn't pay her bills, nothing else mattered. So what we see is that we have studies that show that people who do not have insurance delay and seeking care for heart attacks, that people who have co-payments for medication, no matter how low, it decreases the utilization of much-needed medications, decreases the uses of blood pressure medicine decreases the use of diabetic medication and cholesterol lowering statins.

We know that the higher the co-payment, the poorer the outcome for children with asthma. So we need to make health care a right in this country. The reality is that we already spend enough money on health care in this country. We just allow too many people who are not involved in the delivery of health care to take profit from it. Let me ask a question. Tell me if I'm wrong, but I expect some of the people who actually walk in your door do have health insurance, but their deductibles and co-payments are so high they can't

get to the doctor when they need it. Would that be true? That's exactly right. So when you see someone who has health insurance but their deductible is 10 percent of their income, $35,000 a year with a $3,500 deductible. That's not insurance. And so the problem we have is people who don't have access to medications. We provide access to medications for our patients. Now, when we talk about a dysfunctional health care system and a wasteful system, tell me about people who walk in your door much later than they should have and end up a great

expense to the system, not to mention suffering in the hospital. Does that take place as well? So the patients that I gave you examples of were all examples of people who would have been much cheaper to take care of them earlier on. That cook would have been able to continue working if he could afford his blood pressure medication. That gentleman with diabetes got very sick or the salesman who had uncontrolled hypertension and got kidney failure. He could have continued to work and not need dialysis. if he had controlled his blood pressure. So you see people who are walking into your door a lot later than they should?

Every day. Every day. It is what fills our emergency room, it burdens our clinics. We find it's much easier to control the blood pressure than to pay for the rehabilitation after your stroke. And that's one of the crazinesses of the system. We pay after at 10 times more than we spend rather than preventing the crisis. The preventive care is far cheaper.

Okay. Deborah Wachtell is a nurse practitioner outside of in Burlington, Vermont. Deborah, you and I were discussing an issue that is probably the issue of most concern to the American people in terms of health care, and that is the high cost of prescription drugs. When somebody walks into your office and they get a prescription for medicine, how often does it happen that then they're unable to fill, get that prescription filled that the doctor prescribed? Right. Well, in our case, it's the... Hold up, mic, close the amount. In our case, it's the nurse practitioners, because we have a nurse practitioner practice.

And whether you're a nurse practitioner, a physician, a PA, when we prescribe medications for patients, it becomes a circus. So one patient might walk in with insurance, and their co-pay is $4, and they walk out very happy. The next patient who has the identical medical issues and has insurance, their insurance company makes them pay $1,200 for the same medication than another patient would pay $4 for. My day is spent seeing patients, but interjected throughout my day, is phone calls from pharmacists with rejection after denial, after rejection of the prescriptions that we write. And you spent an enormous, waste an enormous amount of time on them? Huge amounts of time when I could actually be seeing patients or talking to patients on the phone. And the other issue is that when I write the prescription, and this is the worst part of it,

that the insurance companies have multiple different rules about what you can prescribe. So one, there's like 50 different insurance companies with 50 different formularies. So I write a prescription for a generic medication, send it in, I get a call two hours later, three hours later, that was denied. But they can't tell me what prescription to write.

I sometimes have to redo that prescription, four or five times before the pharmacist says, oh, okay, they'll prescribe this, they'll pay for this one. Okay. Let me jump in now. I believe we have a video question. Hello, Senator Defendant, Anna, and T.Y. My name is Mrs. Svallon from Washington State. And my question is, with the implementation of Medicare for all the inversions rates, Dr. will be fixed for accepting more wages. There is also the country that patient will not be able to keep their doctors when the Medicare are also in the country to place. A so large concern that the ACA has when it came into place.

As such, there might be significant respect from both doctors and patients on the issues. Are there any specific plans that have been proposed to tackle these two issues? Thank you for making my question. All right, the answer is that I'm going to give it all with the Dr. Fegan, who has spent half a life fighting for a single-payer system, so?

Well, so the reality is that the majority of physicians in this country accept Medicare rates, But the other important point here is that with a single-payer system, physicians may take home a greater percentage of what they make because the billing is so simple. And so they don't have to spend the money on billing staff and trying to figure out the wants or needs of the various insurance company. So actually, and their malpractice is actually decreased as well. So physicians actually may make less gross, but their net is greater so it equals up. Tell me if I'm wrong in this one. And, you know, Debra, you talked about having to argue with insurance companies and all that stuff.

I detect a lot of demoralization among many people in the medical profession who went to medical school because they wanted to practice medicine, not spend their lives arguing with the insurance companies. So you have non-physicians directing your practice, and it's insulting, to spend as much time as we do training as, whether nurse practitioners or physicians' assistants, or physicians, and then to have a bureaucrat tell you you can have this drug and not that drug. And it's not necessarily because one is cheaper over the other, but because they have a contract with one as opposed to the other. And can I add to that the other tragedy is that

we are already struggling with a shortage of primary care providers. I am also at faculty, and I work with medical students and nurse practitioner students. And when they are in the clinical setting and they observe how difficult it is to practice what they're learning in school to practice, they often at that point in time make a decision to not go into primary care because it's impossible you spend your entire day fighting when really what you want to be doing is helping people to heal. Stan, did you have anything to add to this? Well, I get a lot of remarks from doctors and dentists around the country that's easier to volunteer their services in Guatemala than it is in their own country. And so I think that although this is not the panacea,

not the, some people call it a Band-Aid operation, but we've seen close to a million people and doctors need to be allowed across state lines to provide pre-care to people that simply can't afford it. I think what is frustrating about what we're hearing is the enormous waste of time and money. You're arguing with somebody who's well-paid at the other end of that telephone, telling you you can't use this drug, and you add all that stuff up.

You're talking about billions of dollars every single year that is wasted in that kind of effort rather than putting that money into health care. And not just that. We're also arguing every imaging study we order. I had a patient who had a cancer diagnosis, we did not know where the primary tumor was. The only way to start her treatment was to know where the primary tumor was,

and every test I ordered, every imaging study got an immediate denial. It delayed her ultimate treatment by weeks and weeks, and we will never really know if her death was due to the delay in getting these imaging studies done. I don't think anyone argues with evidence, practice guidelines. What we argue with is restrictions just to limit access. We know that co-payments will deter the use of appropriate care. We know that these barriers that are placed in front of patients, the fact that you ask a patient if they have insurance

or how this visit will be paid for, deterred people from seeking necessary care. What we want to do is take care of patients in the most appropriate way and give them the best care available. Because who doesn't deserve the best care available? available. We have the capability, and we're restrained by the lack of access in this country. Okay. I think we have a question now from the audience. Please. Thank you, Senator. Hi, everyone. I'm Versa from Now This. We're excited to be one of the co-hosts of this town hall. We have many thousands of people watching online, but we also

have hundreds of you in the auditorium tonight. One of those people is Amelia McGuire, who is a health care, a public health professional in the D.C. area, and she has the question for your panel. Thank you. So I know the panel touched on prevention a little bit during that discussion, but I am a registered dietitian, and I'm currently serving in a public health role. So I am very frustrated working with my population that I work with, which is all low-income families, and it doesn't only apply to low-income families, but this is just what I see. many people struggling to control chronic diseases that are, that could be 100% preventable

through, you know, different lifestyle interventions. So on top of trying to manage the chronic conditions, then also trying to navigate the health insurance atmosphere. And as you were saying, it does take up a lot of the health providers time, trying to help clients and patients just navigate through the whole mess of what health care is. So I guess my question is, how would single-payer health care address or expand prevention issues? Okay, I'm going to give it up to Dr. Fegan. Yeah, so I think that it's a realization that preventive services are far more cost-effective

than treating patients after the fact. It Cook County, we've actually partnered because we recognize the problems with nutrition, and we've partnered with the great, Greater Chicago Food Depository so that our providers are able to write prescriptions for food. And that actually the Greater Food Depository sends trucks with fresh fruits and vegetables to our clinics on a monthly basis. And we're able to write a prescription and a patient leaves with several pounds of fresh produce. Not only several pounds of fresh produce, but recipes on how to prepare the produce. And when we have produce in, when we do this in different communities, for example, in Mexico community, the recipes are in Spanish and they are more suited to whatever the ethnicity of the community. So I think that this is vital.

I think that the American, the patient-centered medical home or the primary care of medical home recognizes the need for the support services. It will never be just the physician or just a nurse practitioner or PA who will make the different. to a patient, it will be a team, and part of that is helping to educate patients about how to take care of themselves. Single payer gets us to the point where we can begin to talk about preventive services and not just worry about how the bill is paid. And I'd like to reinforce what Claudia was saying, because we are already doing that in Vermont. We have, again, primary care health homes for our patients. with a complete complement of wraparound services.

So when we recognize a patient needs a dietitian or a nutritionist, that's what they get. They need social services, that's what they get. This is a workable solution that already has evidence in practice, and it will not be hard in a single-payer system to be able to adapt that into the bigger picture of this country. I think your question speaks to a huge issue. We're going to get into that more in the next panel. But we spend twice as much per capita on health care as to the people of any other country.

We spend about $10,000 for a man, woman, and child. And I don't think there's much debate that we do not do anywhere near what we should in terms of prevention, in terms of making sure that people are eating. Well, there are parts of the United States of America. There are urban areas where you can't get fresh vegetables. what are they called? Urban deserts? Food deserts. Food deserts.

Food deserts. All right. There are... Pharmacy deserts as well because the pharmacies are exiting these communities that need access to medications. And furthermore, it is clear, and Debra raised this issue,

we have a crisis in primary health care. For a lot of reasons, if you are a young doctor leaving, young graduate of medical school, leaving school a couple hundred thousand dollars in debt, you know what? It's not too likely, going to go into primary health care. And everybody knows that a strong system is a system

in which people can walk in the door when they need to walk in that door. That's the way we save money by people not ending up in the emergency room or the hospital. And everybody knows that looking at families that are in trouble, that when you reach out and you prevent crises, you ease human suffering, and you save substantial sums of money. Right now, we have a health care system that is not designed to provide quality care to all people in a cost-effective way. Let us be frank. We have a health system designed to make enormous profits for insurance companies and drug companies and disease prevention and disease prevention is not very high on their list prevention what should we be doing

that we're not doing well I think first the what I tell my residents is that you will never ever take care of a patient you will teach patients how to take care of themselves. And that prevention is all about teaching patients about themselves, their disease process, and what are the most important things for them to do. What we're asking is to free the hands of the providers so that they don't have to spend so much time worry about how they'll be compensated for that time and allow them to spend the time with patients and educate them about heart disease, educate them about their diet and exercise and lifestyle. I would like to add that we're in an era of climate change and disaster relief. And when you get a big disaster,

like the one we all responded to, Hurricane Harvey, for example, in Houston, and the place is flooded. It's bringing on health care issues, and the people that are suffering more than anybody else are the poor and the underserved. That's right. Okay, we're going to have to wrap up, wrap up this panel. Deborah, any final words that you want? I just want to reiterate that until we fix this description.

graceful situation where we have insurance companies and pharmaceutical companies dictating to us how we practice and how we deliver health care. We're not going to fix this situation. We need to get, in order to get primary care providers back into the system, we have to let people practice and we have to give them an environment that they can actually practice in. And until we do this, until we provide a better system that allows us to take care of our patients, it's not going to work. Okay. And with that, let me thank this panel, guys. Great job. Thank you very much.

Okay. Anna, Anna is now going to introduce the next segment. Anna. Yes, hi, everyone. I'm Anna Kasparian from the Young Turks. of you who are watching online and just tuning in, we are having an incredibly important discussion about Medicare for all in a single-payer system here in the United States. And we just had a conversation about the crisis of health care in the U.S., what it's like to be a doctor dealing with health insurance companies, private insurers, and what it's like to be an American who is uninsured and can't afford the care that he or she needs. Now, in the second segment of this town hall, we will focus on the economic

questions that arise when it comes to health care. There is a lot of fear-mongering out there. You will have individuals who will look at this proposal by Senator Sanders, and they'll say that doctors won't be compensated fairly, or that it's going to cost the United States $1.4 trillion a year in order to have a Medicare for all system. But what is the reality? What will it really cost Americans?

What will it take for doctors to agree to this type of system? These are all the questions that we will dive into in this next segment, so stay tuned. It's a debate over the economics, it's a debate over the insurance companies, certain physicians, the pharmaceutical companies, the medical equipment suppliers who are making billions and billions of dollars off of human misery. It's time for our business community to get involved in this health care. for a board to pay. And nowhere on the face of the earth, is there a free health insurance market that works?

It's just a myth that health insurance companies can, or even want to control health care costs. Health care costs are normally the third highest cost, beyond staff and materials. These costs are astronomical and not allowing businesses to actually invest back to their businesses who invest back in their employees. When we talk about tax rates in a variety of countries,

versus the United States. And do you think it's important to remember that, for example, although it's true that Canadians take slightly higher tax rates depending on the income bracket as compared to the U.S., we don't have to pay the private health insurance. What Republicans sometimes do is confused the issue. They say, well, you're going to pay more in taxes. What they forget to tell you is that if you were a family or four,

now pay $15,000 a year in private health insurance, you're not going to be paying that at all. Our health care system here in the United States is eating the rest of the economy alive. I'm a business guy. I'm a capitalist. If you could show me a system where this actually works, an unadulterated free market system, where the market handles it all, I would embrace it. But this is what we in business call a market failure.

We're providing health care to every citizen of the country without cocaine, without deductible. We're very high quality at two-thirds the cost of the U.S. system. There's no rush for people to come to America where health care. care costs twice as much per person as anywhere else in the developed world. The volatility associated with our current insurance system for small and mid-sized employers is untenable. It cannot continue. Let's control health care costs. Let's do what the rest of the industrialized world does.

Let us pass a single-payer factual health care system. Thank you. Who was that young guy? We've got a panel now to discuss an aspect of our health care system that does not get enough attention. And that is, what does it mean when we spend $10,000 per person on health care? What does that mean to the business community? What does it mean for the overall economy? What does it mean for international competitiveness when we're spending so much more than other countries that guarantee health care to all people?

We've got a great panel to discuss some of these issues. Let's start with Richard Master. Richard is the founder and CEO of MCS Industries in eastern Pennsylvania, and this is a company which does about $200 million a year in business. and for a number of years now, he has been very active in the fight for single-payer. Richard, you're a business guy. Why is single-payer sensible to you and to the business community? Senator, about five years ago, after many, many years,

ten years of volatility in cost and demands from insurance companies annually for increase in premiums, I realized that this was something that I had to get involved in as a patriotic American. Our company employs 180 people in Pennsylvania and throughout the United States. Our health care bill is $2.8 million a year. It cost $27,000,000. to insure an employee with a family. That's $13.50 an hour, which is, if you put this into context, it is about as much as one third of the population can't make in a year. So this is an outrageous cost. We're beyond the tipping point at this point. we have really got to do something to control costs.

Now, we look at the Medicare for All solution. Right now, we are spending about 18% of payroll for health care costs, for health insurance. We look at Medicare, the model for Medicare for All. It's 10%. We could be saving tremendous amounts of money, and we would be relieving our employees of the actual. anxiety of maybe not being able to pay their deductibles and co-pays.

As an employer of a couple of hundred people, how many people do you have? 180. 180 people. What would it mean to you to know that every one of your employees had good quality, health care, and it's not an issue that you have to spend half your life worrying about? It would mean so much to the spirit of our organization. We're a caring company. We provide scholarships for our employees to go to the community college and other colleges, and to their children. And we see day after day employees that are threatened with bankruptcy. Now, what we have done, we've had insurance policies, and then we have

a secondary insurance policy that takes care of the deductible so that our employees don't have that anxiety, but that's the reason for the massive expense. The $27,000 a year, that's approximately the cost for average cost across the country for a family of four in this country. Are you finding more and more people in the business community going beyond ideology and understanding that Medicare for all would be a good policy for them from a business perspective? Yes, we're seeing that. We started an organization called the Business Initiative for Health Policy, and we're getting substantial support for that. We started another organization called Business Leaders Transforming Healthcare.

In California, we have 300 members, business members, for the Business Alliance for Healthy California. We have other members, 200, 300 members across the United States. New York is starting an organization. Ohio is starting an organization. Yes, there is momentum. Okay, let me jump to Jen Kimick. Jen, you and your husband co-founded a brewery, Alchemist Brewery.

You have about 50-some-odd employee ease. What does this current health care system mean to you as a small, medium-sized business person? Hold on my closely mouth. We provide health insurance to all 50 of our employees, full health insurance for employees, their children. We cover half for spouses. My husband and I do this for three reasons. The main reason is because we believe everyone should have access to quality health care.

Simple. The second reason is it's just a plain good business decision when our employees are healthy and when our employees' families are healthy, our business does better. Moral is up and productivity goes up. And the third reason, and this is really important, is we can afford it. And I say that because it took us eight years of business

before we were able to afford it. We spend $300,000 a year now on health insurance. And our employees don't have the best health insurance. We have what is considered a great plan. It's a silver plan, but the deductibles are high, the co-pays are high, and the out-of-pocket expenses are high. So we spend all of this money

and our employees still don't have the stability they need and they still don't visit the doctor when they need to. We need to talk about a relatively new show called Un-F-The Republic or UNFTR. As a Young Turks fan, you already know that the government, the media, and corporations are constantly peddling lies that serve the interests of the rich and powerful.

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Jen, what would it mean to you running a business in a competitive industry if all of your employees had health care as a right and you could worry about making the best beer in the country rather than providing health care. It would be great for our business because, again, our employees would go to the doctor and get the medicine they need and get the treatment they need, but it would also level the playing field for all businesses,

especially small businesses. Vermont, like a lot of states in this country, are really small business states. 90% of the businesses in the state of Vermont have 20 or less employees. And it seems to me you have, you're trying to do the right, right thing from a moral perspective. But if you're competing against somebody who has a different

point of view, am I mistaken that you're in an economic disadvantage? Absolutely. Absolutely. And it's harder to compete with recruitment and retainment. Yeah, it would level the playing field for all businesses. And then I would also add that while there are a lot of employers that can't afford insurance, there are a lot that can and simply don't. And so when we're covering 50% of those spouses, we're covering bigger employers that just are not willing to change. That's an interesting point. Our next guest needs no introduction to some people, at least. Dr. Don Berwick was trained as a pediatrician and served in the Obama administration is the Director for Medicare and Medicaid Services, the head of CMS.

Don, let me ask you, start off with a simple question. You ran Medicare, you ran Medicare, you ran Medicaid for the United States of America. My understanding is that the administrative costs for Medicare are somewhere between 1 and 2%. Administrative costs for private insurance vary 11 to 15, 18%. Why is Medicare so much more cost effective than private insurance? Because the only thing we're trying to do is stand up for the Medicare beneficiary. No billboards, no high salaries, no, the complexity of the system just isn't there. It's simple.

I spent the bulk of my career, I'm a pediatrician, but most of my career has been spent trying to figure out ways to improve quality and lower cost in health care all over the world, not just the U.S. And what we got here is insane. It's not a medical term. You know, we are, like you said, double the next most expensive country. our life expectancies 31st in the world, our infant mortality is 38th in the world.

We have an underperforming system at extremely high cost. And you heard from the business side, what that does to business. What it does on the public side, you know better than me, Senator. But in my state, Massachusetts, every line item in the state budget has gone down steadily in two decades. Parks and Recreations down 50%. Education's down 20%. You name it.

Law enforcement's down 20%. Because we're pumping more and more money to escalating health care costs. 52% increase in health care costs in the same interval from 2000 to 2018. So this is confiscation. This is health care taking money from businesses that need it, labor that needs it, and public services that need it, and it's wrong. Let me ask you this. You ran Medicare for the Obama administration.

Medicare is, in fact, the most popular health insurance program in the country. Is there any reason in your judgment why we should not expand Medicare, which now covers people 65 and older, every man, women, and child in this country? No, there's no reason. It's just will. Running Medicare, I ran Medicare for all, I ran Medicare for Medicare, but it's a privilege. You get to go to work in the morning. There are 50 million Medicare beneficiaries, 60 million or 70 million in Medicaid, and you figure out what they need.

And it just makes sense. Well, we need transparency. We have transparency. We can find out the prices. We need prevention. We shifted money to prevention before and since the Affordable Care Act. You need chronic disease care. You need a nutrition program.

Medicare can do it. When I got a report from the inspector general saying that we're over-sedating people in nursing homes, the next day I was on the phone with the nursing homes and the geriatricians said, you stop it or we'll stop it. You can stand up for people. Why wouldn't we do that for all? Americans, not just people over 65.

Okay. Let's jump to a video question. Hi, Senator Sanders. I'm Andy from Washington State. My question is, if Medicare for all were asked, would the tax increase be more or less than what I'm already paying out for my employer

sponsor plan? Thank you very much, Andy, for that question. as a recipient of 30-second ads that raised that issue. Let me respond. Here's what goes on. When you watch TV, what people will say, and I had this thrown at me all of the time during my presidential campaign,

Sanders is trying to raise taxes. Well, it is true that many people, many people, not all, will pay more in taxes. But if I told you today that instead of paying $10,000 a year or $15,000 a year for private insurance, you would have to pay $5,000 or $7,000 more for comprehensive health care for your whole family, what most Americans would say is, where can I sign up? So my Republican colleagues think it is somehow godly to be paying incredibly large amounts of money to insurance companies.

That's good. That's wonderful. But somehow it is terrible to be paying somewhat more in taxes. Bottom line is that when we spend twice as much, per capita on health care as any other nation, we could substantially lower the cost of health care in America, which drives down the cost per capita, which means that we are spending less. Right now, we have the absurd situation where in the last five years, the largest, I'm sorry, in the last year, the largest five pharmaceutical companies in America,

made $50 billion in profit. $50 billion in profit at a time when millions of Americans cannot afford the health insurance that they desperately need and cannot afford the medicine that they need. So the issue is whether or not we join every other country on earth

and talk about a national health care system or we continue our dysfunctional system. Now, I shouldn't have ranted for that long, but let me throw it back to our distinguished panel. Richard? Senator, this... Hold up, Michael, a little bit closer, please. The United States is the only country in the industrialized world

that relies on private, for-profit insurance companies to finance a substantial part of its health care system. We spend $1.1 trillion a year in this country for private insurance. $200 billion of that goes for administration, sales and marketing expense, and overhead and profit. If that money were devoted to Medicare, it would be in the $20 to $30 million billion, dollars incrementally. It's an absurdity, and the reason we do it is because the insurance companies and the pharmaceutical companies spend enormous amounts of money on lobbying Congress, on public

relations campaigns, on corrupting our media so that we don't get the information that we really need to make an intelligent decision as a population. Don, did you want to add something with Richard said? I just think about the future we could have. If we really could organize care on behalf of people and communities, really move the money around to where it's really needed, really be transparent about prices and about where the money is flowing, and be accountable.

We could have a better system. I think it would cost less. I think it would cost substantially less. But even if it costs the same, which I don't think it would, It would perform better. We'd finally have a system that's responsive. Medicare, you can find out what's going on. You can't find out what's going on in this incredibly complex system

that's built for opacity. This is an accountability issue to me, which is if we have Medicare for all, finally the system would work for the people. And it demands transparency. Would it be simple? No. Lots of problems to solve.

But will you solving them in daylight? And that's what intrigues me about the possibility here. Let me pick up on a point. Let me pick up on a point that Richard just made, because really what we're talking about is not primarily a health care issue, it is a political issue. That's really what it is. Since 1998, in the last 20 years, the pharmaceutical industry alone has spent over $3.6 billion in lobbying, not to mention hundreds of, of millions of dollars in campaign contributions. They have an endless amount of money,

and they use that money to maintain a system which uniquely in the world allows them to raise prices any time they want to any level they want. They have been able to keep Medicare from negotiating, prices with the drug companies. We're the only major country that does not sit down and negotiate prices. Veterans Administration does, but in general, we don't. Medicare does not.

We are not allowed to re-import into this country lower cost priced prescription drugs from Canada or other countries, and we pay by far the highest prices in the world for our medicine. So I think when you look at the crisis that we're saying it is not a debate over health care. It is very difficult to defend a system in which 30 million people have zero health insurance, even more are underinsured. Our health care outcomes are not particularly good, our life expectancy, not particularly high, and for all of that we spent twice as much as any other country. Hard to defend that. But what goes on here, what goes on here is lobbyists all over this place campaign contributions in the hundreds of millions of dollars, which takes us to the issue of campaign finance reform, et cetera, et cetera.

But, okay, I think we've got a question right here from the audience. Yes. Very quickly, I want to give some comments. for the people here in the audience and also the people watching on the live stream. The video questions that you're seeing were sourced from Facebook, Twitter, YouTube comments. We got hundreds of comments of people wanting to ask all of you and the Senator questions, which just shows the level of public interest in this topic. And we also have another great question from our audience here.

Michael Mashat has a question for you all. Thank you, Senator Sanders and the panel. Senator Sanders, I want to say that your advocacy for the middle class is the only reason I find myself in Washington, D.C. today and able to ask you this question. Thank you very much. So I've worked for several corporate employers over the course of my adult life, and I found that they prefer hiring part-time employees rather than taking on full-time workers. There was one full-time position.

They'll staff maybe one part-time, maybe two if you're lucky, and they'll schedule the part-timers, including myself, right up to that full-time threshold, within a half an hour of it, just so that they can avoid providing full medical coverage. Because of this, I went 10 years without access to affordable health care until the Affordable Care Act. That was the first health care I have known as an adult. So my question is, what can be done to address this kind of exploitation of workers by employers who could easily afford extending coverage, especially in states where health care exchanges offer very few choices like my home state of Arizona. Thank you.

Thank you, Michael. Thank you. Great question. Look, thank you for that question, Michael. A simple issue, very simple issue. It's a moral issue, an economic issue, it's a political issue. Do we believe as a people that health care is a right or is it a privilege? I believe that it is a right for every man, woman, and child in this country. And so do most of the American people. But because of the dysfunctional system that we have, we run into absurd situations like you described Michael. Let me give you an example of how crazy, or to quote Don over here, how insane this situation is. You've got a company like Walmart.

Walmart is owned by the Walton family, which is the wealthiest family in our country. They're the wealthiest family in America. But they pay wages that are so low that many of their employees end up on Medicaid, paid, which you pay for. So on behalf of the Walton family, I want to thank the working families of this country for subsidizing them. They're very grateful to you. But the point is, that's one situation. You described another situation, and that is people working part-time so that the employer can avoid providing the benefits that that employee would otherwise be entitled to. How crazy is that? So what we have ultimately got to do, it seems to

me is two very simple things. Number one, as a nation, do we say that we join every other major country on earth in recognizing that whether you work full-time or part-time, whether you're a single mom, whether you're 90 years of age, health care is a right, not a privilege. And once you make that determination, then the next question in which we're discussing now, is what is the most cost-effective way to do it? And I think all of the evidence suggests that a Medicare-for-all single-payer system is that way. Now, what we have going in America today is we have, if you like, an example of what a good system is. We don't have to invent Medicare. We have it.

And as I mentioned earlier, it is a popular, effective program. Unfortunately, it only is applicable to people 65 or older. So the simple answer is, Michael, that whether you work part-time or whatever, Medicare should be available to all of us. And the legislation that I've introduced along with 16 co-sponsors here in the Senate would do just that. All right, let me throw it out to the panel. Michael raises the absurdity of employers intentionally finding ways to avoid providing health care. Who wants to comment on that?

Well, the system is full of incentives that really don't make sense. We have employees at MCS that are 50, 60 years old, and the insurance companies are asking us every year at renewal time, well, you have an aging workforce. What are you doing about it? Well, are they suggesting you should fire your older workers? They're not, but the incentive is for us to move our older workers out through bonuses, through various ways of retirement, which becomes very expensive, and also it is a waste of human capital.

I mean, what a gross injustice. Somebody is working, working well at 60. Why shouldn't the person continue to work? Here's another incentive. The insurance companies make more money as health care costs rise. At the same time, they're supposed to be representing us, Senator, in negotiating reimbursement rates effectively for our benefit. That's a serious conflict of interest. And we know that there are, we call it crony capitalism, we know that there are deals being cut throughout the system between insurance, sures, and hospitals, okay, you raise your price a little bit here, you cover me over there, and the rate payers will pay. That is, that's the way this system is working. Jen, what's your experience? Well, we experience the same thing, as I said before, we have several employees.

whose spouses don't get insurance from their employers. And we need everyone in the pool. We need everyone to pitch in. Everyone needs health care. But I just want to say, we don't just want our employees to have health care. We want, and we need everyone in this country to have health care, if we are going to seriously have economic progress in this country. Without it, it's just not possible.

Don, if you could jump in, and respond, but also we haven't gotten very far into the question of international competitiveness. So if you're an American company competing against the company in Canada, a company of Europe, and their health care costs are all covered by the government, aren't we at a disadvantage? Aren't our companies at a disadvantage? Richard Donne? Jen? Well, certainly Warren Buffett, one of our most profound and successful business leaders, has reflected on this.

And his statement several months ago at a Berkshire Hathaway meeting was very profound. He said that health care is the tapeworm in the belly of American competitiveness. And it's true. It's very true. If we're spending $10,000 a person and another country is spending $5,000 a person, we're at a serious disadvantage.

We're going in the wrong direction. Right. Don? Well, first, the same is true on the public side. It hurts American public integrity, the ability to invest in housing and transport and the things that make us the country we want to be compared to other countries if the money's all going over to health care. I just want to come to Mr. Michaud's story. You know, all I could reflect on when I was the head of Medicare, I went all over the country, visiting centers for the aging and populations of Medicare beneficiaries. The one question that was never in the room, never, was do I have coverage? They do. They know it. We walk in and the platform's completely different. We could do that for everybody. And the behaviors of the insurance companies and the drug companies and all. Look, they're playing the game according to the way the rules are written now. And as we don't change the rules, we're going to get the same game. We have to change the rules. Medicare for All is a fundamental change in the social contract of America. And it would change behaviors because it would be the new rules. Let me toss out a question, and tell me what you think about this. My guess is there are millions of American workers who are currently at jobs that they don't particularly enjoy because they get decent health care. I remember some years ago there was an article in the paper about some guy in his 50s who had been in the military, went back into the

the military and somebody said, why are you going into the military at the age of 55 or whatever it was? They said, well, my wife has breast cancer, and that's the only way that I can get treatment for her. How many people do you think are it jobs they really are not happy with, but have decent insurance? What would it mean for the economy if people could say, you know what, I don't have to stay at this job, I can go someplace else, I could start a small business, and I'm going to have good quality health care. Is that a factor that we should be thinking about? Absolutely. Small business is the economic engine of our communities. We know that. And it's small businesses aren't able to go out and start up because they can't compete with

recruitment and retainment or young entrepreneurs aren't inspired to go out and start their business because of lack of health care. We're really not doing the best we can. We really need health care to move our economy forward. Right. Don? The other thing to remember is the only source of the money is labor. I mean, whether it goes through taxes or the employer's contribution or the out-of-pocket expenditures, it's always coming from the worker. Everything is coming from the worker. So when we say these costs are high, we mean American public, American worker, you deserve to get more money. You deserve to have the money in your pocket or better used. You know, Senator, we haven't discussed the phenomenon of flat wages.

You've just talked about job lock. Flat wages, if you look at $13.50 an hour, and if that's going up 10% a year, for that employee, it's $1.30 next year more than it is this year. If his premium share is 25% or 20% as it is in most cases, his cost of living increase is not going to cover the increase in premium. And that means flat wages or even negative wages,

while the employer is experiencing a 5 to 7% increase in labor costs. This is economically unsustainable. We have got to do something about it. Well, I think what we have got to do about it is to start thinking big, not small. And just ask yourself, this is not a radical idea. The point I want to make over and over and over again, what we are talking about exists in virtually every major country on earth. Think about a nation where you could start a small business and not worry about having to provide health insurance to your workers.

Think about a young person who has a dream of what kind of business you want to start and you don't have to worry about whether or not your family is going to have health insurance. This is not a radical idea. It exists all over the country. And it's time for us to get off the dime here and move forward and join other countries for a Medicare for all single-payer system. So, panel, thank you very much. Great job.

Anna. Thank you, Senator Sanders. Thank you to the panel. For those of you who are just tuning in online, I'm Anna Casparian with the Young Turks, and we are having a town hall discussion on Medicare for All, a proposal that Senator Sanders has championed and is now digging deep into with health care professionals. We've talked about the crisis of health care in America. We've talked about what the economic impact of a Medicare for all system would have.

and now we are going to discuss what it's like in other countries that have a single-payer system. Now, how many of you have heard politicians say things like, oh, health care in Canada is terrible? They all hate it. They all hate it, right? How many of you actually hear Canadians say that? Well, you're very lucky tonight because we are going to have health care professionals who have some insight into what a single-payer system is like in other countries. And we will take questions not only from the audience, but we have questions that the audience members from the Young Turks now this and attention put together for this event.

So without further ado, let's take it away. We have a failing hand out. I shouldn't say this to our great gentleman and my friend from Australia. is one of the greatest privileges I would ever know. In Norway, that is cross-party support for universal health care coverage. People in Canada, people in Norway, people in the United Kingdom, people in Sweden, people in Denmark, in all of those countries that I named in that clip, outcomes are better. Life expectancy is longer. I practice in inner-city practice here in downtown Toronto.

I have folks who have difficulty making ends meet. But when they see me, they don't have to worry about deductibles or co-paid, they don't have to worry about credit card debts or medical bankruptcy. you believe in slavery. We don't see health care as a human right makes slavery. Quite the contrary. We made the step into universal coverage. There is virtually no one in Switzerland who would go out to go back.

I'm going to be the universal head canons. If I'm a physician in your community and you say you have a right to health care, do you have a right to beat down my door with the police, escort me away and force me to take care of the doctors in Canada have complete the freedom to do whatever they think is appropriate to provide the care for the patient that they're sitting in front of it. As a position, universal health care great because it makes my life so much. The division health system ranks relatively high compared to the universe. Countries in Scandinavia, like them are nowhere sweet.

In those countries, health care is a right of all people. As far as a single payer, it works in Canada, it works incredibly well in Scotland. You see, there's not sure, when Canada come here for extensive surgery, Did they come here and get done in the United States? So I broke in Canada, I live in Canada, my entire family can get out, and nobody I know ever came to the United States for us around me. I'm sure you have to have her stories about things like that. It's not actually statistically true.

And I hope everyone in the world would have the healthcare with French people have. We hope the Americans get more life, more liberty. We have more freedom to pursue the things that make them happy. At TYT, we frequently talk about all the ways that big tech companies are taking control of our online lives, constantly monitoring us and storing and selling our data. But that doesn't mean we have to let them. It's possible to stay anonymous online and hide your data from the prying eyes of big tech. And one of the best ways is with ExpressVPN. ExpressVPN hides your IP address, making your active ID more difficult to trace and sell the advertisers. ExpressVPN also

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I know you're all shocked to hear that, but it is true. And one of the uglier aspects of that dishonesty is how health care systems around the world, all of which have problems. No health care system in the world does not have its share. share problems. But the lies that occur here about health care systems around the world are unbelievable. I was in the U.K. during the debate of the Affordable Care Act. And I talked to conservative, conservative members of parliament who are outraged about the lies that they were hearing about the British health care system, and it's similar with regard to Canada.

So we're delighted to have a panel here to give us maybe a little bit of a glimpse. as to what's going on around the rest of the world. And let's begin with Dr. Danielle Raza, who is the assistant professor and physician at the University of Toronto. Doctor, has anyone beaten down your doors in the middle of the night lately and forced you to go to work? I couldn't believe my ears when I heard that clip

from the senator. Senator Paul, yeah. Yeah, you know, I think what the American people need to know about health care in Canada is that access to care, it's not based on your ability to pay, and it's not based on your bank account balance. It's based on your medical need. And the way that we operationalize that principle is through a comprehensive single-payer insurance plan for a physician and hospital services, and it's a plan that has no co-pays and no deductory.

I want to say that again. Somebody walks into your office. how much do they have to pay? So I'm a primary care physician. When a patient comes to see me, they check in at our reception. They show our receptionist their health care card, which is their card for our single-payer plan. I call them in.

I see them for whatever it brings them in, a check-up on their diabetes or prenatal care, and then they go home. There are no co-pays when they check in, and when they go home, they don't have to worry about deductibles or complicated insurance forms. In fact, medical bankruptcies are, unheard of in Canada because we have this comprehensive single-payer plan.

So family has a baby? No cost. No cost. Somebody is diagnosed with cancer. No cost? They might have to pay for parking. Might have to pay for parking. But everybody from Canada is running across the border to get care in the United States. True? There are retired Canadians who will spend, you know, Canadian winters vacationing in Florida, and actually that's most of the time where Canadians are accessing U.S. care. Besides this, it happens so uncommonly and so rarely that it's difficult to measure, and actually the best research paper that's looked into this problem, it's titled Phantoms in the snow. All right. Let's go for a moment to...

Trump to Dr. Mitali Kakad. Is that close to being right? That's completely right. And Dr. Kakad comes from a country which has recently received a lot of attention. She's from Norway. But I don't want to get President Trump excited. She does not plan to move to the United States. I don't think.

Dr. Kakad, tell us about the Norwegian health care system. Sure. President Trump, you should be so lucky, is what I would say. What I should say is that the Norwegian Health Service is based on the fundamental premise that all residents in Norway should have access to affordable, high-quality care. And that's irrespective of who you are, what you are, and where you live in our country. The other thing I should say is that there is cross-party support

for universal health care coverage. No politician worth their salt in Norway would dream of taking that away. So somebody decided to run for parliament and said, we're going to junk our system in Norway or in Canada, and we're going to go to the American health care system. Would that person get many votes?

It would never happen. All right, this is an important point to make, because I think in Canada for a number of years, you had a prime minister that was pretty conservative guy, right? Wasn't, you know, liberal, wasn't progressive, wasn't social democratic, conservative. Does anybody talk about junking the Canadian health care system and moving to an American system? No, it's the same thing in Canada, there's cross-party support. No one, the Canadian health care system is held up to such high esteem that a few years, years ago when one of our national TV networks held a poll on the greatest Canadian, the person

who won was a fellow named Tommy Douglas, who was actually the founder of single-payer healthcare in Canada. And I also just want to add, you know, it's not just out of altruism. Single-payer healthcare is much more cost-effective than the system here in the U.S., and that's true regardless of how you measure it. So for example, in the U.S., America spends 17% of its gross domestic product on health health care. In Canada, it's 10%. If you look at it, you know, per person or per capita spending, in the U.S., it's around $9,800. And in Canada, it's $4,600. And it's much less

bureaucratic than it is here for both patients and providers. Well, that raises an issue. Let me go to Dr. Kakot again. You're a practicing physician. I'm a public health physician, but I have been a practicing physician, yeah. Okay. You heard perhaps earlier some of the concerns that American medical professionals have in spending half their life arguing with the insurance companies. Is that a problem that existed in Norway? In Norway, there are no, I mean, I think predictability for both providers and patients is a great benefit of a single payer system.

Patients know where they have to go to in terms of accessing care. Everyone has a GP that is their first point of contact into the health. Can they choose any doctor they want? They can. So you are often assigned to a GP that's near you, but if you don't like your GP, you're well within your rights to move. And choice is a fundamental tenet of the Norwegian health system. So if you're referred by your GP to a specialist, then you have a right to choose where your referral is sent

and where your treatment should you so need it takes place. So having a single-payer system doesn't mean that you have an inflate, flexible system where the patient's choice or preferences isn't taken into account. Okay. Jill, you are not a physician, right? Absolutely not. You're just a plain old American who spent some years in France. Yes. Talk a little bit about your experience in France and maybe contrasts that with what you're

going through right now in the United States. Yeah, so I moved to France when I was 22 years old. I was working there, and as a legal resident in France, I was automatically covered under their national health care system. The way it was paid for was the same way we pay for Social Security and Medicare here in the U.S. It was deducted from my monthly paycheck. Then I went back to school. The year I was a student in France, I paid a total of a little more than 200 euros for an entire year's worth of coverage.

And then I had a brief period of unemployment, and I remained covered. So no matter what my status was, as a legal citizen, I was guaranteed care in France. I recently moved back to the U.S. two months ago, and I had to go about purchasing insurance through the Obamacare health care exchanges. And I think as a patient, we've talked a lot about the cost, and what I've noticed is that there's, you know, a financial cost, but there's also a high emotional cost in the American system. I spent many frantic hours, consulting, documentation, you know, bombarded by the jargon of co-pays, deductibles, premiums and your health is extremely important. You don't want to do to make any choice that puts your health at risk, but at the same time, it's very difficult to understand this system. So when I came back to the U.S., I eventually made the choice to go with a catastrophic health

care plan because I am young and in pretty good health. So what I pay for that is a little bit more than $100 a month in premiums. However, I have a $7,000 deductible that I have to meet before any of my care would be covered. So it's almost like not really being insured because I would have to front those costs. And I did have a kind of a sad, ironic chuckle to myself when I realized that what I pay for one month in a premium here was equivalent to what I paid

for nearly six months of coverage when I was a student in France. And when I was in France, everything was affordable and most of my costs were reimbursed. Jill, you raised the issue, which we don't talk about enough, about the emotional costs associated with health care, about the millions of people today who are scared to death

if they get ill, what it will mean to their families, the possibility of bankruptcy. Now for our Canadian and Norwegian friends, tell me what it means in your countries that every person in that country, I mean, does not have to worry about, they gotta worry about staying well, but they don't have to worry about the financial costs associated with illness. It's bad enough when you get a diagnosis that's not good.

You've got to focus on that. In this country, you've got to focus on that, and then you've got to focus about how you're going to pay the bill when it meets your family. What does that mean, Dr. Codd? Well, I quite agree. I think in Norway we believe that if you are sick or you think you're being sick, that in of itself is stressful enough. The health system should not be, as you said, contributing to furthering that story.

stress. In Norway, some of the things you don't have to worry about when you're trying to access healthcare, obviously we've talked about catastrophic costs. You don't have to worry about that. We do have co-pays, but there is a ceiling on those co-pays every year. So once you reach that ceiling of about $300, care is free for the rest of the year. You don't have to worry about the quality. Your co-pay is $300. No. Well, the co-pay varies. The co-pay only applies to outpatient services and some investigations and drugs. If you're acutely unwell, admitted to hospital, need inpatient care, that's free.

But if the total of your co-pays in the space of a year reaches $300, after that all care is free for the rest of that year. So people don't have to worry about the cost of care. What I'd like to say is they don't have to worry about the quality of care, because often there's an idea that publicly sponsored health care is somehow second-rate health care. We spend a little more on health care per capita than Canada. We spend about two-thirds of what the U.S. spends per capita, but we have better health outcomes. Well, let me ask us.

There are some people, some critics of single-pay will say, okay, it's true. They spend less in Canada. do they spend less in Norway? It's true that people, all people are covered. Anybody can walk into the doctor's office and not have to worry about money, that's fine. But the quality is not as good as it is in the United States. That's what some would argue.

What's your response? I don't need to offer my opinion on this because the evidence actually bores this out. There's lots of different ingredients that go into living a long and healthy life, but of course access to health care is one of them. In Canada, our life expectancy is about 82 years, which is three years longer than it is in the U.S. We have lower rates of diabetes, lower rates of chronic kidney disease, better maternal care,

and higher cancer survival rates. So it's not true that having a single payer system means you're going to have a low-quality system. In fact, we heard it from Dr. Burwick earlier in his experience with Medicaid. When you have a single-payer system, it's easier to also collect data, to understand where the pain points are in your system and then actually intervene to try and make things better. Dr. Kakata, what's the quality of the Norwegian system? Is it good?

We're up there with the best, and any comparative healthcare survey will show you this. The Commonwealth Fund publishes a report every year where the Norwegian health system performs extremely well and far better than the US system and Canada. As physicians. I just had to get that in there. As physicians, what does it mean that when you consider the therapies that you need for your patients

that you don't have to worry about the financial capability of those patients to pay? Does that make a difference? Of course it does. At the end of the day, the types of therapies that you receive should be based on your medical need and not on your willingness to pay. I want to concur to that. And actually, you know, I'm very proud as a Canadian physician to be working in a single-payer system, but I also don't want to, you know, paint too rosy of a picture.

We're struggling with health care challenges as well. You know, our single-payer plan covers things like hospital and physician care, but one of the things it doesn't cover yet is outpatient prescription drugs. And actually, I'm part of this organization called Canadian Doctors for Medicare in Canada that are campaigning to expand our single-payer plan to include things like prescription drugs. And actually, that's one of the reasons why the Norwegian system performs better than ours,

because outpatient prescription drugs are included in their plan, and they're not yet in the Canadian single-payer plan. Is that a free outpatient prescription drugs? No, that they're part of the co-pay system. Drugs on our national formulary, you'll pay about 40% of the cost as a patient. But as I said, once you reach a threshold, they will be free.

Okay, I think we have a video question. Let's do it. Hey, my name is Amanda, and I come to your state. And my question is, how do other countries hold down the cost of medicine? Okay, great question, Amanda. Short, to the point. Good question. In the United States, we pay the highest prices in the world for prescription drugs a number of years ago when I was in the house. I took people from St. Albans, Vermont, across the Canadian border to buy medicine that was far, far cheaper in Montreal than it was in Vermont. Why is it? Tell me about the cost. Actually, Canada is the second highest prices in the world, I think.

But let's start with Norway. Why is prescription drugs less expensive in Norway than we'll go to Canada? What do you guys do? Well, one of the aspects that's important to raise here is that as a single payer, you represent the entire market. That gives you a lot of purchasing power and ability to negotiate down prices with drunk companies. So the key word there is negotiate, right? Negotiate. All right. So the drug companies in Norway cannot charge any price they want. that's a negative she's taking her head all right um Canada so you know we have this

government agency called the Patent Medicine Review Board and they set the price for new drugs that come on the market and the way they do it is they take the average of seven other industrialized countries that are comparable to Canada and they use that the price of this new drug the average of it in these seven countries to set the maximum that that drug company can charge for the that medication in Canada. So that's how we set the ceiling. But, you know, as I mentioned before, this is actually something that we need to do better in Canada. Prescription drugs are one of the things that aren't covered by our single-payer plan. And actually, we've identified through rigorous

research that the best way to bring down costs are to bring it under single-payer, to do things like Norway and what other countries like New Zealand and the UK do, bulk by, and then make sure that drug manufacturers are bidding against each other to give us the most value for money. And then also pay for medications that work. Use science and evidence-based medicine to decide what medications are worth paying for and which ones are on the market because there's a new marketing gimmick or there's some new trick on an old drug that the drug companies have put on to try and pad their profit margins. Okay, before we get to our audience questionnaire, Let us be honest and acknowledge that every country in the world has its share of problems.

What are the major problems that exist in the Canadian system right now? So I identified one, I think, prescription drugs. You know, the other thing that, you know, we're very good at in Canada is we're very good at triage. So when a patient is sick, they get care immediately. And it's not a matter of waiting, you know, weeks or months. It's a matter of waiting hours or days for the sickest patients. But one thing that is true is we need to get better at our elective weights. So things like hip and knee replacements, things like cataract surgeries.

But because we have a single-payer system, because we're able to collect the data, when we tackle these problems, we're able to use it in a data-driven way. And that's actually the approach that we're taking right now to drive down these weight lists for non-urgent medical issues. Dr. Leklachd, what are the weaknesses in the Norwegian system? Well, I'll start with the weakness that I don't think has anything to do with the fact that we have single-payer system, and that is care coordination. In Norway, we have three levels of government. We have the parliament, the national level. We have the county level, and we have the municipal level.

At each of these, or at least the national level and the county level, both have responsibilities for health care. So this contributes to a fragmented landscape. That doesn't have anything to do with the fact that we're a single-payer system. We, too, have some challenges around elective wait times, but they're not spectacular, and there is a lot of political focus on this in encouraging how do we reduce bottlenecks, how do we use information to improve the quality of our care processes to drive down times. The other thing I'll say is about choice that people are also free to seek care at an institution with lower weight times, which allows patients to take charge of their condition.

Okay, let's go to our question. Hi, Brescia from now this here again. I just wanted to say I appreciate you addressing wait time specifically because I know that that is something that we hear from our audience and people all the time as being a major issue in other countries. And I know Grace will follow up on that. But I also want to reiterate for everybody that this is not the end of the conversation. The conversation will continue.

Please reach out to us after the town hall and on social media. We want to keep hearing your questions and talking to you guys about this issue. but I'll hand it over to Grace. Hi, so countries like England and Canada have already shown successful free health care programs. Why does our government not learn and try to build programs like that? You know, I am, thank you for that question.

Your name is? My name is Grace. Grace, thank you, Grace. I'm a member of the Senate Committee on Health Education, Labor, and Pensions, which has jurisdiction, obviously, over health issues. And I remember that when we got into the debate over the Affordable Care Act,

the issue of looking at the strengths and weaknesses of other countries never arose. No discussion. We try to force it. But can you imagine when you pay twice as much per capita as any other country that the first question you might ask is, okay why do they do what they do in Norway or Canada or the UK what are the advantages the strengths of each one of these systems

what can we learn from them that question never arose and the reason it did not arise the reason there are this is the first town meeting ever held on the capital on single-payer is as I mentioned earlier the power of insurance companies and pharmaceutical industry These guys have unlimited, and I underline it, unlimited sums of money to spend in the political process in order to make sure that they make billions and billions of dollars every single year in profit. That is the answer to your question, pure and simple.

So we are not debating health care. What we are looking at is incredible power from entities, that have unlimited resources who want to continue this dysfunctional system so long as they can make very, very large profits and allow their CEOs to make, in some cases, tens of millions of dollars a year. So thank you very much, Grace, for that question.

What do the people in your countries think about the American system where so many of our people are uninsured or, as Jill indicated a moment ago, under-insured? She has, what is it, $7,000 deductible? Yes. I mean, if you told somebody in Norway that they'd have to spend $7,000 out of their own pocket before they can get health care, what would they think? they think you were joking I think probably I think it is as I said at the start the value the set of values that our health care system is based on is pretty much reflected throughout the whole of Norwegian society the idea of making of being in a situation where people could be subject to cast catastrophic health care bills is just so far out of the reach of most Norwegian's consciousness

So it's something that would be unthinkable in many ways. It's the unthinkable. It's the unthinkable. It is a firmly ingrained part of our society. Canada? We don't have to imagine this. We are just across the border, and we have friends and family who live right here in the U.S. I just got to D.C. yesterday, and I'm actually staying with an aunt who lives just outside of Washington, D.C.,

and she drove me to the auditorium tonight. And on the way, guess what we were talking about? We were talking about the struggles that she's having with choosing a health care provider. You know, she wants to change her doctor, but it's not covered by her insurance plan. She's going to have to find a new plan with new co-pays and deductibles. So as Canadians with friends and family here in the U.S., we hear it all the time, and, you know, it's a shock test. Jill? Yeah, so I actually asked French people this because I was really interested in their perspective.

Last summer, actually, my dad, who kind of has insurance the way it's designed to work in the U.S. His employer helps him pay for it. He works for a pretty good company, a big company, that helps provide insurance for their employees. However, in recent years, even good insurance in America has somehow become worse. So when he had to have emergency surgery last summer, he had to meet a pretty big deductible, which was around $6,000. And I told this to my friends in France, and they were like, doesn't he have? insurance. It was like she was saying it literally does not compute. They kind of become like a broken robot. They don't understand what you're saying to them. And so

the reaction is one of utter disbelief. They can't comprehend a system where most of the costs, whether it's an emotional cost, the financial costs, are born by individuals and not the entire society. In France, when they talk about their system, they always use a French word solider, which means solidarity. Their system is based on principles of solidarity, that the weakest person in France must be guaranteed care because otherwise the country cannot be strong and functioning. Well, maybe on that note, we can wrap it up. And let me just pick up on Jill's point, because that really what it is, that's what

what it's all about. Because the issue that we're discussing tonight is health care. But you know what? Other issues as well. How much does it cost to go to college in no way? It doesn't cause anything actually. Okay. And in Canada it's inexpensive, but it does, I guess what, some provinces is virtually free? Yeah, so for example, I actually studied engineering before medicine and my tuition was about $5,000 a year. Okay. I mean, it really, you know, and by the way, and the reason we're doing this program tonight

is you don't see this stuff. I think Anna made that point before. It ain't could be on CBS. It ain't going to be on NBC. And what astounds me is that we already have a pretty good majority of the American people who believe in universal health care, believe that it is the government's responsibility to make sure that everybody has health care as a right.

And we've reached that stage with media not talking about the issue at all. So my strong belief is that most Americans do not know than in virtually every other country on earth not only is health care considered a right with limited out-of-pocket or no out-of-pocket expenses, But the same thing in many cases applies to higher education or to child care. So I think the issue maybe we can conclude on is what Jill just said. And that is whether we choose to live in a nation which has massive levels of income and wealth inequality, where the very, very wealthy are doing phenomenally well while the middle class is struggling and 40 million people live in poverty.

Or whether or not we try to create a government, in a society which works for all of us, which understands that all of us suffer when one child in this country goes without health care. That is the issue, and that is our struggle, and I absolutely believe that the momentum is with us. Everybody believes that we should be throwing tens of millions of people off of health insurance. What people believe is that all of us should be guaranteed health care. We have the momentum, but we're not going to win this fight unless all of us are actively

involved, unless we stand up, unless we fight back, unless we make sure that every American recognizes that health care is a rights, not a privilege. Thank you all very much. Thanks for listening to the full episode of the Young Turks. Support our work, listen to ad-free, access members-only bonus content, and more by subscribing to Apple Podcasts at apple.com slash t-y-t. I'm your host, Shank Huger, and I'll see you soon.