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Why these House Democrats think Medicare for All is the best path for U.S. health care

In the U.S., health care costs continue to rise, insurance is more difficult to obtain and millions lack access to care entirely. As a result, some House Democrats want to implement a single-payer, universal coverage system in which all costs are paid by the federal government. Rep. Pramila Jayapal, D-Wash., talks to Amna Nawaz about the benefits of expanding Medicare for all Americans.

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  • Judy Woodruff:

    Speaking of the Democratic Party's agenda, health care is a big part of it, and specifically a push to expand health care coverage and to lower costs.

    But there are many different ideas within the party on how to do that and just how far to go. Many have been loosely referred to as Medicare for all.

    Even so, there's a new bill in the House that is considered the most comprehensive version of Medicare for all.

    Amna Nawaz explores what it might do and how it could affect the political conversation.

  • Amna Nawaz:

    Well, Judy, you might remember Medicare for all from the 2016 platform of Senator Bernie Sanders.

    But there's an even more ambitious plan now in the House. It would move the U.S. to a single-payer, government-run health care system. Every American would be able to go to the doctor, or the hospital, or get prescriptions without paying anything out of pocket. Hospitals would be paid lump sums to manage, not paid by patient visits or procedures.

    Even long-term care for people with disabilities or home health services would be covered. And the plan for this total health care overhaul would take effect in just two years.

    There's no price tag yet, but some estimate a cost of trillions or tens of trillions over 10 years.

    Congresswoman Pramila Jayapal of Washington state is the lead co-sponsor of the bill, and she joins me now.

    Congresswoman, welcome back to the "NewsHour."

    Let's start about with what Americans think of your plan. Broadly speaking, there's a lot of support. Over 70 percent say they like the idea. When you drill into details, you ask people about delays in care or higher taxes, that support drops off significantly, down to 25 and 37 percent.

    So what is your message to the people who like the idea, but don't like the details or the impact?

  • Rep. Pramila Jayapal, D-Wash.:

    Well, here's the thing that is so important about this.

    It is not a government-run system, number one, because we use the same existing system of doctors and hospitals that is already there. And I think sometimes people confuse what is in our plan. All we're saying is, you can see the doctor and the hospital of your choice, in fact, more choice than you have right now, with insurance plans that — private insurance plans that continue to limit that.

    The only thing we are changing is who pays for that. So instead of having five insurance plans, instead of having to argue with the insurance company about what's covered or not covered, which facility is in or out of that network, you can go see anyone you want and get comprehensive care.

    Now, the second thing is, Medicare is a very popular system. And it already exists today for our seniors. And what we have done is, we have expanded and improved upon that Medicare system. So, instead of having to buy an additional Medicare Advantage plan for vision, hearing and dental, we cover that for everybody, same thing with mental health and substance abuse.

    And then we say, instead of just applying to seniors, it applies to everyone, so expanded and improved Medicare.

    And then, in terms of the transition, I would remind people two years seems so hard to imagine, but, in fact, Social Security was implemented within one year, and there were no computers, nothing existed there to actually be able to do that.

    So this plan is about making sure that every American gets guaranteed universal health care, and that is something that every major peer country of ours already has, and it is affecting our people. People are dying. They're having to choose…

  • Amna Nawaz:

    Congresswoman, let me ask you about what some of those people are saying, though.

    In their concern about the plan, they do say they don't want to have to pay higher taxes for it. You haven't proposed in your plan how this would be paid for. So how would you pay for it?

  • Rep. Pramila Jayapal, D-Wash.:

    Yes, thanks for the question.

    So, we already cover about two-thirds of people through Medicaid and Medicare. So, two-thirds of the costs are already taken care of. The other third, we have a number of different ways in which you could pay for it, including that employers are already paying enormous premiums to insurance companies. They could pay just a fraction of that into this plan and create some of that money that we need.

    And then we can have a tax on millionaires and billionaires. We can roll back tax loopholes. We have never had really a conversation about why it's so important to keep the costs of our health care system down, right now, 19 percent of GDP, that's double what any other industrialized country in the world pays already.

  • Amna Nawaz:

    One of the criticisms, I should point out, is that your plan doesn't include any efforts to bring down the cost of health care before the government would essentially take over the system.

    So are you worried about that? I mean, there are people who will say, look, it already costs so much, why not work to do that first?

  • Rep. Pramila Jayapal, D-Wash.:

    No, actually, that's the beauty of our plan, is it has cost containment built into it through using something called global budgets, which is a really important tool for building in cost containment.

    And it allows, on pharmaceutical drugs, dramatically brings down the price, probably to 50 percent of what pharmaceutical drugs now cost. And we do that through required negotiation of drug prices, which we already have in the VA, but we don't have in the Medicare system.

  • Amna Nawaz:

    There is the situation of having to transfer — transition, rather, over 150 million Americans who are currently privately insured to this single-payer system.

    I want to run by you something the health and human services secretary, Alex Azar, said today when he was asked about a Medicare for all plan. He first attacked it as a government takeover of health care.

    But then he said this. He said: "The best doctors are going to jump out of the program. They will be paid under market rates. To get quality care, you will end up going outside the system if you have got the money the do so."

    So, my question is, is that a concern, that you end up making a two-tier system, where people who can afford to go out of it do?

  • Rep. Pramila Jayapal, D-Wash.:

    Actually, it's the opposite.

    Because we would be covering everybody and we wouldn't allow duplicative care, which is how we operate with Medicare right now, we believe that the majority of doctors will actually get paid either the same or a little bit more. Some specialty doctors might have to earn a little bit less, but everyone will get the same care.

    You don't have to be rich, you don't have to be poor, but you get quality health care. That's actually one of the huge benefits of the system we have proposed, vs. the system that we have now, 30 million people uninsured, 40 million people underinsured, two-thirds of all bankruptcies in this country because of medical costs.

    That's wrong. And we need to end that.

  • Amna Nawaz:

    Finally, Congresswoman, it's fair to say you have an uphill legislative battle, not just against the Republicans who control the Senate, but some of your own party members don't really love this plan.

    Is the idea here, by pushing to a very, very ambitious — there's nothing incremental about this plan — is the idea that you change the conversation so that more incremental steps are maybe more palatable?

  • Rep. Pramila Jayapal, D-Wash.:


    We really are all about passing this plan. It sounds ambitious, only because health care in this country is so broken. But the reality is, every industrialized country in the world provides this. Why is it that the United States, the richest country in the world, cannot guarantee health care for every single person in this country?

    Right now, we spend double what other countries spend, and we have more mothers dying in childbirth, we have more babies who are dying in terms of our infant mortality rates, and our life expectancy is the lowest of all our peer countries.

    Again, this is not a particularly ambitious plan, in the sense that so many others have done it. The United States should be leading on this issue. And I think this is the plan that gets us there.

  • Amna Nawaz:

    Just a few seconds left here, Congresswoman.

    I want to ask you about the idea of something being medically necessary, right? Those are the things that would be covered as part of this plan. Wouldn't that change based on who's in charge, what people deem necessary and not?

  • Rep. Pramila Jayapal, D-Wash.:


    We actually specify very clearly what is actually in it, what is covered. So, dental vision, comprehensive care, reproductive care, substance abuse, all of those things are detailed in our bill. It's a very comprehensive bill. It's over 150 pages.

    We put a lot of thoughts into it. And it really is a real transformation of our health care system, so that everybody in the United States doesn't have to go to bed worrying about where they get their care.

  • Amna Nawaz:

    Congresswoman Pramila Jayapal, thank you very much for your time.

  • Rep. Pramila Jayapal, D-Wash.:

    Thank you.

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