by Rob Bluey
Few issues have animated conservatives as much as Obamacare. But there’s a new threat on the horizon. It’s called Medicare for All – and it would be a massive government takeover of your health care.
The Daily Signal spoke with three medical doctors who are serving in the U.S. House – Reps. Scott DesJarlais (pictured, center), Paul Gosar (pictured, right), and Andy Harris (pictured, left) – to talk about Medicare for All and their solutions for a patient-centered alternative. Listen to the podcast or read the transcript below.
Rob Bluey: I want to ask about not only some of the problems we find in health care today, but also solutions. Some of your colleagues on the left have put forward quite a radical proposal called Medicare for All. As doctors, I want to ask you to weigh in on what you think about it. Congressman Harris, would you like to begin?
Rep. Andy Harris, R-Md.: The Medicare for All plan that was announced a couple weeks by my Democrat colleagues, over 100 of them, really will result in care for none. That’s the bottom line.
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You can’t offer free care to everyone and expect anything but rationing to be the result. The costs are huge. We already have a trillion-dollar deficit in federal government spending. To add more to it will result in rationing.
When you dissect this plan piece by piece, including the elimination of all private insurance, not even socialized medicine in England has that. We go well beyond the socialized medical schemes of Europe in the Medicare for All plan. It’s just going to be a nonstarter.
Bluey: Congressman DesJarlais, we have a question from Tennessee from Katherine of Murfreesboro, Tenn. “With your experience and your medical practice, can you explain why Medicare for All is a bad idea when it comes to quality of care, provider satisfaction, fiscal impact, and the patient-provider relationship?”
Rep. Scott DesJarlais, R-Tenn.: Thank you, Katherine. It’s always good to hear from Tennessee. When I think of Medicare for All, I think, “What can you compare that to? What would it be like?”
I think right now, a system that everybody knows and is aware of is the VA system. The VA system, in a way, is similar for the veterans. The biggest complaint you hear most times out of the VA system is long wait times or sometimes poor access to specialists. Can you just imagine what it would be like if you turned the whole country into a system right now that we can’t handle on a smaller scale?
I think that the relationship with providers would be diminished because access would be inferior. Right now, if you go to a VA and you can’t be seen within a reasonable amount of time at that VA, you’re farmed out to a specialist in the area. Often times that’s dubious too because specialists sometimes are reluctant to take patients because the payer system is so poor. You find it harder and harder to get access to these specialists.
I think, one, the relationship between the patient would be poor. Your access to medical care would be poor and delayed, and honestly, I think it’s inconceivable that it would even work or get off the ground, be cost prohibitive.
Bluey: Congressman Gosar, your colleagues in the Democrat Party say it’s so popular—and who doesn’t like free things? What are the consequences of a policy like this?
Rep. Paul Gosar, R-Ariz.: The thing about it, when they say it’s free, it’s always popular, but when they actually find out how much their taxes are going to be raised, it drops dramatically, in the 30 percent approval aspect. That’s the key here is that nothing is free.
But, there’s alternatives here. Once again, how about market-driven applications that we haven’t seen since 1964? Making insurance compete for the marketplace. Taking away the Sherman and Clayton Antitrust exemptions so that they compete not only for your business, but for the doctor’s provisions? All these things can be revolutionized and who knows what can actually happen.
Bluey: Let’s talk about some of those solutions. Congressman Gosar, you’re a dentist. In terms of the dental profession, what would Medicare for All mean and what is a market-driven, patient-focused solution?
Gosar: First of all, dentistry never took onto Medicare. It walked away from the Medicare discussions in the 1960s. Therefore, the same dollar you spent in the 1970s, is basically the same dollar you spent today in dentistry with inflationary only.
Medicine’s nowhere close to that because what’s happened is there’s been cost shifting. What the government hasn’t covered, somebody else has had to pick up. That’s why you got problems. It is, in essence, a Ponzi scheme where you’re flushing one group of people paying for the services of somebody else’s.
That’s why I keep coming back to market forces. How about getting everybody broken down so they’re competing for the marketplace so that people are patient-focused, patient-friendly, patient-centered, and have the insurance industry actually compete for that marketplace?
It’s amazing what actually happens. You see lower premiums, lower drug prices, lower doctor and hospital visits. It empowers people to create new ideas. Making a market-driven solution is actually beneficial.
Bluey: Congressman DesJarlais, you had a family practice. What would it mean for those patients you are serving?
DesJarlais: Well, again, I think access is the big thing. There just is not enough to go around. When you consider that Medicare for All would eliminate what over half the country realizes now in an employer-based plan, and most people, despite all the horrors we’ve heard about Obamacare, which is really bad, get their insurance through their employer. It would change that and eliminate private insurance altogether. People would be left with what the government tells them they can have.
That was one of the biggest problems with Obamacare, that it mandated the type of the health care you could have, mandated what you had to pay for. People were paying for things that were more expensive than they needed. That left a lot of people on the sidelines or with policies that they couldn’t afford, or, in the case if they could afford, they couldn’t go to see the doctor because the deductibles and copays.
I think that it really created a struggle among a certain group of people in the country that didn’t have employer-covered health care, weren’t on Medicare, or weren’t on Medicaid. It really picked on a small group who had to disproportionately pay, as Dr. Gosar said.
Bluey: I want to follow up on a couple of those points, but I want to give Congressman Harris an opportunity. As a physician, what would you say from your perspective?
Harris: I was an anesthesiologist. Still am. I work with specialists, mostly specialists. I didn’t work with primary care doctors in the operating room.
I will tell you, under the current Medicare program, you already have problems having access to specialists because the payment rates are low. The fact of the matter is, when the government determines a payment rate, it’s going to determine a low payment rate. You’re not going to have physicians that are going to be willing to deal with it.
My district is over half rural. It’s very hard to find a specialist who will see a Medicare patient without getting in line to see it. That’s not what Americans expect. Medicare for All is not patient-driven, it’s bureaucrat-driven. It’s going to be some bureaucrat deciding what you need and how to deliver care in your community. It doesn’t work.
You’ve got to give the patients choice, give them not a one-size-fits-all insurance policy like ACA did. Let them buy an insurance policy that fits them, fits their families. If you’re young and healthy, you might choose a catastrophic policy with a medical savings account or health savings account. Give people more options and let the marketplace work.
Bluey: On that note, you have a leading senator, a liberal senator, who wants to end private insurance, says that’s the solution that we need to be pursuing. You’re painting quite a different picture. Can you talk to us about what that would mean?
Harris: Sure. Look, if you like the DMV, you’ll like government-driven health care. The bottom line is, when the government controls something to a monopoly, what they’re talking about is a monopoly. No private insurance. The DMV is a monopoly. Do you like it? Because, if you like it, you’ll love Medicare for All.
Bluey: Any other thoughts on that, Congressman DesJarlais?
DesJarlais: I just kept thinking about what Medicare for All would cost. One of the biggest things we’ve looked at since we’ve been in Congress—we all came in together in the same class—was the how are we going to pay for Medicare in the future?
It’s unsustainable in its current form. The costs are projected to go up and up and up. Same thing, Medicaid doesn’t have enough money. The VA doesn’t have enough money. You have three government systems that have been failing us all along and yet they want to pivot, put everybody into a failing system that we can’t afford now and make it even bigger. It just doesn’t make sense.
Gosar: I look at the aspect of what’s on the other side? What Medicare for All is actually is victimizing the patient. That’s the key, that they’re forced to do something. How about empowering them?
The second part that I always talk about is HSA reform where you’re actually empowering people to invest in themselves. Health care’s an individual sport, believe it or not. The doctor-patient relationship is very sacrosanct.
When you empower that, particularly when you start looking at empowering those patients to put money aside, and then also maybe looking at maybe redirecting the CSRs to veterans, to Medicare recipients. Rebuild that marketplace. Amazing what happens when patients are empowered with money to make their own decisions. I think most people like to be empowered versus victimized.
Bluey: Congressman Gosar, I’m going to stay with you because we have a question from Arizona. This comes from Bill Williams in Gold Canyon.
Gosar: He’s in my district.
Bluey: He says, “We face a massive problem with growing entitlements,” as you just mentioned. “Congress is willfully blind. Assuming that most elected officials wish to avoid a future train wreck and that solutions will inevitably be needed in time, what do you think we should start doing to solve this long-term entitlement crisis?”
Gosar: First of all, I always come back to keeping it simple stupid and that is break everybody down to the lowest common denominator. I don’t think we know what the final solution looks like because we haven’t liberated the market.
No. 1 is empowering physicians to create new markets. That means making the insurance industry, which is the primary means of reimbursement, start competing whereas right now, they’re in a collusionary-type action. There’s no necessity for them to branch out to put out new market products.
Make them compete against each other. That way physicians actually make more, they’re empowered to be better entrepreneurs, but also to put new, innovative ideas out there. For example, like starting and using the iPad, iWatches to help monitor patients. There’s a lot of different opportunities here.
Then, I think, the other part to that is is maybe tie in people with high risks to the certification of insurances like a blind high-risk pool. Those shouldn’t be scary applications. Those are actually in situations that actually work for rewarding people for solutions on those high-risk pools instead of pushing them to a side.
Bluey: Thank you for that answer. We’ve been talking a lot of policy ideas here, but that’s only part of the equation. The other part is communicating ideas to the American people.
As we saw in the 2018 election, health care was consistently ranked as one of the top concerns on the minds of many voters. They trusted Democrats more than Republicans on that issue, or liberals over conservatives. What is it that conservatives need to do to get their ideas across and gain the trust of the American people when it comes to health care?
Harris: I’ll tell you, if Medicare for All doesn’t scare the American public, it will. … I tell people, “Look, they want coverage. God forbid you have a pre-existing condition because everybody either has one or is afraid they’re going to have one and knows someone who has one.”
Once we clear that hurdle and we make it clear that our plans always cover someone with that, whether it’s, as Dr. Gosar says, a high-risk pooling mechanism or re-insurance pooling mechanism like we have in Maryland, we just have to make sure that the American people understand. We’ve always talked about that.
Our American Health Care Act had it in it. We made sure that, God forbid, that if you have a pre-existing condition, you’re covered. You have some coverage.
For other people, you’ve got to make it affordable. That’s the most important mechanism. … Make sure that they can get it and make sure that it’s affordable.
I will tell you, if a state wants to make universal health care and wants to pay for it, God bless them. I’m a Federalist. Let them go ahead and do that. Vermont and California thought about it and they both rejected it, both very liberal states rejected it because of the huge costs of a government-run program like this.
Bluey: Congressman DesJarlais, how are you communicating this to your constituents?
DesJarlais: I think we’re at a real messaging disadvantage and we have been certainly since President Trump took office. If you look at the coverage of anything President Trump has done, it’s about 90 percent negative as compared to President Obama who it was maybe 20 percent negative. That’s a hurdle that we face.
I think, like Dr. Harris said, if the people really understood what Medicare for All meant, that it doesn’t just mean free health care, they would be very frightened by it.
Messaging has always been key, but President Trump has taken some great steps already to solve the health care problem. We got rid of the individual mandate when we passed the tax reform bill that people are enjoying now.
He’s also dealt with the pharmaceutical companies to bring more drugs to generic price. It doesn’t make sense that here in America, we pay two or three or four times as much for the same drug you can get in Canada, Mexico, or other places in the world, so he’s taken steps to address that.
Then, the association health care plans where these people don’t have insurance through their employer, they can band together and actually find lower premiums.
I think Dr. Gosar brought up two really good points, the health savings account empowers people and they realize that they have a card that they can swipe when they go to the doctor and they pay for it right then and there and that’s money that they put in an account that’s tax-deferred. We need to expand those and we’ve taken a lot of steps.
He mentioned the high-risk pools. States like Maine have successfully done that and that was center in the debate, but we don’t get a fair and honest debate in the mainstream media.
Bluey: No, you certainly don’t. Congressman Gosar?
Gosar: I think it is that we actually have to bring the debate forward. It’s that instead of playing defense, we have to go on the offense. This group of gentleman right here were very responsible in regards to having those solutions that actually lowered rates, gave patients choice, and took in pre-existing conditions. These three guys were actually responsible for that.
We shouldn’t be afraid of it. We should actually be going toward that. I think anytime you look at the application and say, “Listen, the British system is failing. The Canadian system is failing. Aren’t we better than that?” When we start looking at the market-driven solutions, we haven’t had a market-driven solution since 1964. It’s been artificially based on government reimbursement rates.
Aren’t we better than that? Can’t we do something better that empowers the patient, empowers the doctor, and recreates that system where patients are responsible, doctors are responsible, but there’s an open market out there?
I think when you start to look at that, it’s enticing what can possibly be happening. Get people dreaming again.
Bluey: Last year, a federal district court in Texas ruled that Obamacare was unconstitutional. Can you bring us up to speed on what that means about the future of this debate on health care and where you might expect that case ultimately ends up?
Harris: You know the background is that, of course, the landmark ruling, which Chief Justice Roberts, we think, took the wrong side on, was declaring that since it was a tax, the individual mandate was a tax, therefore the process was legitimate.
Once we removed the tax by removing the individual mandate in our reconciliation bill, the bottom line is that argument was removed. It’s going to be up to federal courts to say, “OK, now that there’s no tax, is this, in fact, a legitimate plan?”
Look, a court could rule now that, in fact, it’s out the window. It gives us a chance to learn the lessons. What did we learn? We learned that the American people really, really want coverage of pre-existing conditions and make it clear to them that that exists. We learned it. We’re going to do it. We also know that that scheme was unaffordable because it didn’t share risk across board categories.
We learned a lot from it so I’m not scared of a federal judge saying that that’s unconstitutional because we have a lot of knowledge. Hopefully, this time, we would have a bipartisan solution because when you enact anything this large in the government, nothing works over time unless it’s a bipartisan plan. The ACA was clearly not a bipartisan plan.
Bluey: Congressman DesJarlais, President Trump just spoke at CPAC and said exactly that message—that he would like to bring together Republicans and Democrats to have a bipartisan solution to health care. Do you think that that’s possible?
DesJarlais: I think it should be because health care should be a nonpartisan thing. When I was in practice, I never treated a Democrat or a Republican, I just treated patients. I think that that’s the way most people look at it and they’re very frustrated with what’s going on in Washington with the bickering.
I would like to think we could come together on this. It’s going to be a difficult road, but certainly, we’re sitting here willing to have those conversations.
Bluey: Congressman Gosar, go ahead.
Gosar: I think it’s how you creatively get this done. One of the first things I brought up is breaking down the anti-trust exclusion for the medical insurance industry. That’s not a Democrat or Republican application.
I think bringing that up in this partisan foil or this atmosphere, no one’s going to vote for their insurance company over their constituents. This is a golden opportunity for that ball to drop.
No. 2 is, why isn’t the Senate having that conversation about HSA reform? The Hoover Institution said it was the next best thing that we could do after the tax reforms that we passed last year or in 2017. Why not have that conversation right now, pre-emptively have that, empowering patients?
Who is actually going to say no to patients controlling their destiny on their health care with their own tax dollars? Interesting. If you’re creatively looking at CSRs, everybody wants to spend the money so it’s spent. Why not creatively build it so that actually people are empowered to be fundamentally part of the system instead of being victimized again?
I think there’s some ways that we can change the ground rules even in this partisan climate, that you actually set up a success instead of looking at being victims again of the system.
Bluey: Congressman Gosar, this comes to you again. It’s from Bill Casale of Prescott, Arizona. He says, “The radical left controls the agenda and they seem only interested in endless witch hunts against the president and pushing socialist programs.” He thanks you for being a stalwart conservative but asks, “What we can do to move beyond some of the headlines and get to these serious issues?”
Gosar: Once again, one of the things that we’ve actually done, and Bill, that was a great question, is, how do we set up the system or how do you work the system for your benefit? Looking at what I just brought forward, now we’re seeing introduction of McCarran-Ferguson, which is that repeal of the Sherman and Clayton Antitrust exemption in the Senate. Amazing, and it’s bipartisan. Who is going to stop that?
Once again, the same thing we’re asking over in the Senate is start the conversation about HSA reform. There’s a way when you have a divided government to steer that conversation so that people are actually having that conversation and having to vote on it.
Bluey: Any other follow-up comments?
Harris: Look, this issue’s not going to go away until, as you suggested, the Supreme Court rules one way or another. In a divided Congress now, the only solutions are bipartisan solutions. We’ll have another election. We’ll discuss it again next year and I’m sure people are going to watch.
Bluey: If we could do a lightning round, I’m getting some questions that are not on the topic on health care but are quite pertinent to debates that we’re having in Congress right now. I’d like to ask you some of those.
The first one is about efforts to protect human life. Of course, the Senate had a vote that failed on the Born-Alive Abortion Survivors Protection Act. I know there’s a move here in the U.S. House in a discharge petition. There are other things that you’re trying to do in terms of asking for unanimous consent on those consistently. What can you update our listeners on in terms of what’s going on with that legislation?
Harris: Well, we’re waiting for the clock to run out on the petitioning, which would be around mid-April. But I think every member of Congress should have a position. Obviously, the Senate, every member of the Senate is now on record. Fortunately, a majority of senators, but not a large enough majority to proceed to debate and final passage, thinks that it is wrong to have a baby born alive and not do everything you can to keep it alive.
Having worked in the delivery room, seen thousands of deliveries, I can’t imagine a baby being born and everybody not rushing to it to see to it that it’s going to be resuscitated and living. I can’t imagine that kind of world, but apparently, a minority in the Senate can imagine that kind of world.
I want to see if it’s a majority, minority in the House. I hope the speaker has the courage to put this up for a vote, let people say yes or no. Do you think that’s appropriate?
Gosar: I would look at it and I would advise and warn the American public that if you can do this to the innocence of a child, they will do it at the other end of the life spectrum.
If you think this is not binding to you as an aged American, it actually implies that you’re another victim of the circumstance. Remember, on Medicare for All, if you’re a burden to this system, in this scenario, you’re easily eliminated.
Bluey: Congressman Gosar, I’ll stay with you for a moment. We have a question from Myrna Lieberman also of Prescott, Arizona. She says, “I believe Dr. Gosar is the lone voice in Arizona for a need to get a border wall in place. Does Dr. Gosar believe that is going to happen?”
Gosar: Remember the president has about $4.5 billion at his disposal, even before the emergency fund. He’s actually going to be building that as he promised. It’s sad, though, that so many people don’t understand the emergency that’s our southern border.
The influenza that you’re seeing, the different diseases coming in, measles, mumps, a bacterial-resistant tuberculosis, typhoid, this is an emergency coming in here. You look at the sheer numbers coming across now that are now being reported. This is an emergency of umpteenth degree.
You either address it as individuals in leadership or you become victims of it. I’m tired of those people from around the country, from New York and other states that don’t believe that an infrastructure project in my backyard, our backyard, is very important. Andy Biggs, by the way, is also a big supporter. I’m not by myself.
Bluey: Thanks for that. Congressman DesJarlais, the House [passed] H.R. 1, the For the People Act. You’ve had some opposition even from the left, the ACLU coming out against it. What can you tell us in terms of what the bill would do and why conservatives need to be concerned?
DesJarlais: Basically, the Democrats have taken all the reasons they weren’t successful in the last election and tried to rig the game in their favor. To me, this is more of a show vote on their part. It’s dead on arrival in the Senate.
It’s just part of a poor loser syndrome and they’re wanting to say that people in this country shouldn’t have to show an ID to vote, which I think is ridiculous. Almost everyone I know has to have an ID to do almost anything and that’s one of the most fundamental, important things we do is vote and have the vote be reliable.
They’re basically trying to loosen the restrictions and let people who are not eligible to vote, vote to try to tilt the advantage to their favor. I think that the bill is a desperate attempt on their part to try to rig the game.
Bluey: Finally, I want to ask each of you from your own experience as a doctor to share with what it was about that experience that motivated you to come to Congress and what message you’d like to leave with them in closing as we think about this issue of health care. Congressman Harris, you begin.
Harris: This is simple, when I was trained almost 40 years ago, the bottom line is the relationship between the patient and her doctor was the most important. That was it.
Fast forward to now. You’ve got an insurance company in the room. You’ve got a government bureaucrat in the room. You have a pharmacy benefits manager in the room. You’ve got all these outside parties that are now involved in that relationship. We have got to come full cycle and restore it to the primacy of a patient and her doctor. That’s it.
Bluey: Thank you. Congressman DesJarlais?
DesJarlais: There are a lot of doctors that came in in our class. I think there was six of us and we probably all pretty much agree. Different specialties, but in my case with primary care, that relationship was paramount.
When somebody came in, they didn’t want to just talk about what was wrong with them. They wanted to talk about football or hunting or their children’s sports. You had time to do that in the good old days. You had time to actually be a doctor, get to know them. In that conversation, you tend to elicit more information, because the history is so important when treating patients.
With the government intervention, that’s getting pushed aside, even with the invent of medical records, which maybe made things more efficient, but it made them more impersonal.
Anybody who had a doctor pre-electronic record knows that the doctor spent time examining you, talking to you, and not just tapping on their keyboard inputting data to satisfy big brother.
I think that when my patients started complaining about the government, about health care, and all the problems instead of the common things they talk about, I knew there was a problem in our government and I felt compelled to try to do something about it.
Bluey: Congressman Gosar?
Gosar: I think the biggest key is that people want an individualized health care that was personalized to their needs. What I may want is different than what Andy may want. The physician always tried to tailor that. When the government got involved, that went away.
What I think is magical about the doctors caucus is that in order to solve a problem, we had to ask the patient what hurts, how can we help you? A lot of suggestions that we’ve brought forward today and continue to bring forward have come from Main Street, from you, the patient.
We’re trying to empower you to get back your health care, making everybody accountable, make you centered and focused. When the market competes on you, making sure you’re satisfied with the decisions you make, we all win.
Bluey: Thank you for the work that you’re doing. Thank you for the unique perspective that you bring to this issue of health care as doctors. I know that I benefited from this conversation.
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Rob Bluey is editor-in-chief of The Daily Signal, the multimedia news organization of The Heritage Foundation.