[Democratic infighting over Medicare for All is unnecessary and
dangerous. To criticize a plan that is in-depth and thoughtful, and
addresses the very issues we need to address, and has the support of
enormous numbers of Americans, is a big mistake.]
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PRAMILA JAYAPAL TAKES ON MEDICARE FOR ALL’S CRITICS  
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David Dayen
October 30, 2019
American Prospect
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_ Democratic infighting over Medicare for All is unnecessary and
dangerous. To criticize a plan that is in-depth and thoughtful, and
addresses the very issues we need to address, and has the support of
enormous numbers of Americans, is a big mistake. _

Representative Pramila Jayapal speaks with reporters at the Capitol,
June 4, 2019., Bill Clark/CQ Roll Call via AP Images

 

“I wrote the damn bill,” Bernie Sanders frequently says. But on
Medicare for All, he’s not the only one. Pramila Jayapal, a
second-term Representative from Seattle who has rapidly ascended as a
progressive congressional leader, wrote the House version of
single-payer. The co-chair of the Progressive Caucus has been touring
the country to talk about it. She feels Medicare for All has been
unfairly maligned during the presidential primary cycle.

“It is very frustrating to have your own party making the arguments
of Republicans and insurance companies.” Jayapal told
the _Prospect_ in an interview after a health care town hall in Los
Angeles. “And they’re not accurate in their representations.”

Jayapal’s bill, H.R. 1384, has 119 co-sponsors in the House, and was
the subject of historic hearings in the Budget, Rules, and Ways and
Means Committees, the first time Medicare for All has been formally
debated in Congress. Jayapal said that Energy and Commerce, another
committee with jurisdiction over health care, would hold hearings
soon. But as Elizabeth Warren hunkers down to determine the financing
for a national health care program, and as Joe Biden and Pete
Buttigieg attack the concept
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the benefits of getting everyone in the nation covered have been
pushed to the side.

For Jayapal, the debate comes down to two things: coverage and
cost—but not government costs. “It is absolutely absurd to subject
Medicare for All to a different standard of scrutiny,” she says.
“Instead of saying, ‘Wow, Medicare for All costs too much, how are
you going to pay for it,’ the question to every candidate should be,
‘What is your plan to bring down health care costs over the next ten
years? And what is your plan to universally cover everybody, because
none of the other plans do that.’”

H.R. 1384 takes direct aim at lowering health care costs, more than
the Affordable Care Act or even Bernie Sanders’s companion bill in
the Senate, by setting a global budget
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care providers. Instead of Medicare paying individually for each
service, providers would get a set budget for the year to work within.
Bonuses for employees, marketing expenses, and political donations
would be strictly disallowed, and special funds for new equipment or
managing an epidemic would be segregated. Hospitals would have to
manage costs better, perhaps by reducing re-admissions, eliminating
unnecessary treatments, purchasing supplies more cheaply, or maybe
even cutting salaries for administrators.

Rare among politicians
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Jayapal has been willing to cite the hospital industry’s role in
unsustainable price increases. But she has also attempted to drive a
wedge within the wall of opposition to health care reform among
hospital industry leaders. “I’ve been meeting with a number of
major hospital CEOs, in community-based care [and] state hospital
systems,” Jayapal says. “They are getting upset with the American
Hospital Association’s opposition and the money they are putting in.
So I’m working to try to build a little coalition that will feel
brave enough to come out.” Some hospital CEOs have cited the high
cost of securing care for their own employees as a reason to transform
the system.

The U.S. pays more for health care than any other industrialized
nation, which is why a mechanism like global budgeting is so critical.
Yet the only costs being discussed in the national debate involve the
taxes to pay for the government’s assumption of insurance.
Overlooked in that discussion is the fact that the federal and state
governments already pay for two-thirds of the system through Medicare,
Medicaid, and private-insurance subsidies.

Jayapal argues that reducing costs to international norms
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one way for Medicare for All to pay for itself. “You can’t
legitimately say that you’re going to fix the health care crisis we
have if you don’t bring down the costs,” she says.

By driving down costs through global budgeting, negotiating
prescription drug prices, busting up health care monopolies, and other
measures, you end up with significantly lower financing needs. Cutting
out such middlemen as for-profit insurers gets you part of the way
there, but only part. “You do have to have a mechanism to directly
address that for the future,” Jayapal says.

Jayapal’s ideas for reducing costs were borne out recently by an
analysis of the effects of H.R. 3, a modest bill that allows the
government to negotiate prices on 25 high-cost drugs per year. Despite
that small number, the Congressional Budget Office estimated
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negotiations would save the government $345 billion over a ten-year
period. “Imagine if it was 250 drugs,” Jayapal says. “Some
members feel strongly about lifting the entire ban on negotiations.”

Moreover, it’s hard to know if these kinds of savings will be fully
accounted for in the budgeting process. Moving from curative to
preventive care, for instance, could save trillions, and while the
Affordable Care Act went part of the way on that, Jayapal’s bill
would go a lot further, particularly as those currently uninsured get
regular treatments and thereby avoid more costly procedures. Medicare
for All also eliminates the passed-on costs of uncompensated care.

Currently, Warren is working with outside experts
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craft funding for her own Medicare for All plan. Jayapal’s and
Warren’s teams have discussed the funding issue with each other. I
asked Jayapal if she thought it was worth it for Warren to counter
the somewhat disingenuous debate
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costs, where it’s only the supporters of Medicare for All who have
to justify them.

“The way [Warren] talks about it in terms of overall costs instead
of taxes is actually the right way to talk about it,” Jayapal
answers. “I think some of this is also for her to be comfortable
with how to respond on this. Because this was Bernie’s original bill
that she sort of signed onto, I think she has been less engaged on
some of the details. If she wants to come up with two or three things,
that will give her that muscle to say, ‘I’ve looked at this, and
this is how I’m proposing to pay for it.’ What I hope is that it
gets that question off the table, because I think it’s a red
herring.”

The constant talk about financing crowds out the benefits of Medicare
for All. Jayapal highlights the angle of personal freedom. “I have
so many people who write to me with these unbelievable stories about
how they have these dreams and they were lost, because they have to
work for a company that they totally don’t believe in because they
need the health care,” she explains. “People who have gotten
divorced because that’s the only way to get care. I do think a part
of this health care debate is about the freedom to dream and be. And
we don’t talk about that nearly enough.”

Ultimately, Jayapal finds the Democratic infighting over Medicare for
All to be unnecessary and dangerous. “We have to be united in the
end of whatever comes out of this presidential debate,” she says.
“I have not said anything bad about the Affordable Care Act: We
can’t wait for the perfect system, we’ve got to do what we can to
shore it up. However, to criticize a plan that is in-depth and
thoughtful, and actually addresses the very issues we need to address,
and has the support of enormous numbers of Americans, is a big
mistake.”

Jayapal says that one of her biggest fears is that a Democratic
president wins in 2020 and doesn’t follow through on alleviating the
health care crisis. “For 2024, if we don’t have this addressed,
and Americans don’t see substantial improvements in these broad
structural issues, we’re not going to win,” she says. “That is
what gave rise to Trump. I have said that Trump is both a symptom and
a cause. Those entrenched interests that have stopped us from making
these structural changes, like with the Affordable Care Act, have to
be taken on.”

_David Dayen is the executive editor of The American Prospect. His
work has appeared in The Intercept, The New Republic, HuffPost, The
Washington Post, the Los Angeles Times, and more._

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