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Jan. 15, 2021 - Epoch Times
25:17
How Government Run, Single Payer Healthcare Would Change California| California Insider: SALLY PIPES
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I also think a bigger worry is that a lot of young people in this country, traditionally, the best and brightest young people in this country go into medicine.
It's considered a really top position.
I think if docs are going to be paid 40% below, if they're going to be mandated how they can practice medicine, what kind of equipment will be available, because the government will have to cut back on that, a lot of the best and brightest kids traditionally will not then go into medicine.
My guest today is Sally Pipes.
She's the president and CEO of Pacific Research Institute.
She's also a healthcare policy expert.
We're excited to have you, Sally, on the show.
Thank you.
I'm excited to be on it.
You've got a great, growing audience, and it's great to get the message out.
We're here to talk to you about California and healthcare issues in California.
Recently, there's been a commission that Governor Newsom had put together to actually evaluate if healthcare can be done, run by government, and a single-payer model.
Can you tell us more about this?
What's going on?
Yes.
Governor Newsom, when he was elected governor in 2016, he was really...
I think one of the reasons he was elected, the Nurses Union and some of the other union members in particular really supported him on the grounds that he would bring about single-payer health care into California.
That means there would be no private coverage at all.
It would all be government-run information.
We're into 2020, and I think some of the union people are getting upset that he's done nothing about moving closer to single-payer.
He's done some other things we can talk about later, but he set up this commission in December.
It's called Healthy California for All Commission, and it's made up of 13 members, academics, some doctors, some people from various aspects of business, and five non-voting members.
All of the people on the Commission are people who support the idea of single-payer government-run insurance.
The first meeting of the Commission was held on January 27th and they are expected to have an interim report by July 2020 and a final report by February 2021 recommending how does California get to single-payer.
Have they talked about anything out of their first meeting?
Did they come up with any conclusions or any initiatives?
Well, so far I haven't heard other than that they held the first meeting.
Of course, I wasn't invited to join the Commission, even though one of the people on the Commission is a professor from Berkeley, Dr.
Richard Scheffler.
I debated him at UC Berkeley in November on the issue of single-payer He is on the commission, but of course I wasn't invited to be on it, so I have to just watch and see what comes out.
But I know that the people that are on it are going to be people who are really pushing for a Canadian-style single-payer system.
Canada's health care system is one in which all private coverage is outlawed for anything considered medically necessary.
So this is what these people want, i.e.
no private coverage.
There are only three countries in the world that have a true single-payer system, i.e.
outlawing all private coverage.
Canada, Cuba, and North Korea.
So, you know, it's not really...
None of these countries is one that supports allowing the private sector to compete.
Can you tell us more about what does it mean single-payer coverage, healthcare coverage?
Does it mean that the government will cover the insurance or does it mean the government will take over all the hospitals, the doctors, pays the doctors?
How does it work?
So all of the health care in America, if Bernie Sanders were to be elected president, would be, he said, within one week of his election, the government would fully take over the health care system.
There would only be two other groups that are allowed to run.
One would be the Indian Health Services.
The other would be the Veterans Administration.
All Medicare, Medicaid for low-income people, the CHIP program, and everyone would be covered under this government program, banning any private coverage.
Estimated that his plan would cost between 30 to 40 trillion dollars over 10 years, the increase in federal spending.
He's backed away from that now.
He told Norah O'Donnell on CBS Evening News, I don't know how much my plans are going to cost, but we do know from a number of economists and the Congressional Budget Office that have costed it out, the total cost of complete government takeover would be about 60 trillion dollars over 10 years.
All the people that work in insurance would be out of work.
And Sanders has said, well, the one million people who work in health insurance, I would set up some federal funding so they could train to move into a different career, on a different career path.
But anyway, all private insurance would be banned, and we would all be in a system run by the government.
Doctors, hospitals, everything would be run by the federal government.
And what does it mean for the doctors and patients?
How would they get affected?
So a lot of doctors, only about 20% of doctors in America belong to the American Medical Association.
I think a lot of people think the AMA represents all doctors.
It is a small and declining number, but in their recent annual meeting last June in Chicago, The House of Delegates, for the first time, voted 47% in favor of Medicare for All or single payer, 53% against.
That's the highest percentage that we've seen in these numbers.
But, you know, it'll mean that all doctors would be paid by the government.
And I think, because what the estimates are, that doctors would be paid 40% below what they get paid for treating Private patients today, this is going to have a very negative impact on doctors practicing medicine.
We've already seen a number of doctors retire early under Obamacare.
The paperwork, the electronic health records, the mandates, they've just said, I'm out of the practice of medicine.
I also think a bigger worry is that a lot of young people in this country traditionally The best and brightest young people in this country go into medicine.
It's considered a really top position.
I think if docs are going to be paid 40% below, if they're going to be mandated how they can practice medicine, what kind of equipment will be available, because the government will have to cut back on that, a lot of the best and brightest kids traditionally will not then go into medicine.
So we would have less doctors, and what about the patients?
Yes, we would definitely have fewer doctors, which already there's a shortage of primary care doctors in this country.
A lot of young docs go into specialized care.
They don't want to do primary care, long, long hours, physician burnout, and all of that, so they want to do specialized training.
And the impact on patients would be long waiting lists for care, ration care, and higher taxes, and a doctor shortage.
We have seen That in Canada today, the average wait from seeing a primary care doctor to getting treatment by a specialist is 20.9 weeks.
That's over five months.
And it's more than double the wait time in 1993 when that wait time was only 9.3 weeks.
So the waiting times would be greater.
Care would be rationed.
My own mother died from colon cancer as a senior because when she thought she had colon cancer and went to her doctor, primary care doctor, She had an x-ray taken.
I told her, you don't detect colon cancer from an x-ray.
And he said, well, I'm sorry, but we can't get you a colonoscopy done by a specialist because there are too many younger people who are on the waiting list that would be ahead of you.
Six months later, my mother was hemorrhaging.
She'd lost 30 pounds.
She went to the hospital in an ambulance in Vancouver.
She spent two days in emergency room, two days in the transit lounge, and finally got her colonoscopy.
But she died two weeks later from metastasized colon cancer because that's how government controls costs and controls access.
So the older you are, the less likely you'll have access to care.
The average weight in Canada today for getting an MRI Is 22 weeks, that's over 5 months, for neurosurgery 33 weeks.
So is it any wonder that patients, about 608,000 Canadians, crossed the border last year in 2019 to pay out of pocket in the US for MRI, CT scans, heart valve replacement surgeries, just like Mick Jagger, the Rolling Stones front man, when he had a heart problem.
He didn't go back to the UK and get his heart valve replacement under the National Health Service.
He went to New York Presbyterian and had it done right away.
And as his younger brother said, thank goodness Mick didn't have to go back to the UK and get his care under the National Health Service.
So this is what happens to patients when government is the sole provider.
They determine what's going to be spent, who's going to get care, and when you will get that care.
Sorry to hear about your loss in your mother.
I know.
And do you think people realize this in the U.S. when it comes to the topic of single payer health care?
No, I don't.
And that's why when the new poll that came out from Kaiser Family Foundation in January, it showed that support for single-payer health care was up from 53% in November to 56%.
Support for the public option went up from 65% to 68%.
The public option being a government insurance plan that would compete against private insurers.
It's really a stepping stone approach to single-payer health care.
So when you ask the same people, though, well, what do you think about the fact that if you're going to lose your employer-sponsored coverage, which about 180 million Americans get, then the support went down to 37 percent.
They don't understand single-payer.
71% of people with ESI said they rate their employer-sponsored coverage as good or as excellent.
So if you say we're going to take that away, support goes down.
When asked, well, what do you think if you're going to have to have increased taxes to pay for this kind of a program that costs, you know, $60 trillion over 10 years, then support also goes down to 37%.
So we have a very large educational program A project that has to be done so that people do understand what it means when the government is the only provider of health care.
I see.
And do you think these initiatives in California will get to a place, will get us to a place that it would be a single payer coverage in California?
Well, I certainly hope not.
Back in 2017, the Senate in California, Democratic-controlled, passed Senate Bill No.
562, which would have been a complete takeover of the health care system.
It was costed out by the Senate Appropriations Committee at $400 billion a year, double the entire state budget.
The Assembly Speaker, Mr.
Rendon, who's also a Democrat, he said he just wouldn't bring this to a vote.
Because it was going to be too costly.
There were no principles and it just couldn't be done.
So I'm hoping that it's not going to move forward in California because the people of California would find out that they would have limited access to care, ration care.
And so I'm hoping that this new commission, well they will come out in favor of single payer, but when they look at the tax consequences, the impact on doctors practicing medicine, I'm totally hoping that it doesn't happen.
What if they push it through?
Well, if they push it through, the state would have to get funds from the federal government.
And as long as Donald Trump is the president, and if he is re-elected this fall, there is no way that he would approve all the funds going to California that support Medicare and Medicaid to a single-payer system.
Governor Newsom last year Asked the federal government if they would consider waiving the funds that go for Medicare and Medicaid and send them to the state so they could implement a single-payer system.
And of course there was no response, which is a good thing.
I see.
And what about the UK model?
You have written a book and I read your new book.
What's your book about?
And I want to learn more about the UK model as well.
So my new book is called False Premise, False Promise, The Disastrous Reality of Medicare for All.
It has a lot of vignettes in it, a lot of real information explaining to people what it means when the government would be totally in charge of your health care.
As I said, Canada has a true single-payer system, i.e.
no private coverage for anything considered medically necessary.
LASIK surgery, cosmetic surgery, you can pay for those things, but not for your tonsillectomy or your heart surgery or whatever.
The United Kingdom started their service, the National Health Service, in 1947 and they actually allow, in the UK, private healthcare to run parallel to the National Health Service.
About 20% of Brits now have private coverage.
Because the waiting times under the National Health Service, the lack of access to the latest treatments, the UK, in the latest international survey of five-year cancer survival rates, the United Kingdom was at the bottom of the list of international countries in terms of esophageal cancer, cervical cancer, breast cancer, prostate cancer, and over four million Brits.
We're on a waiting list, waiting for treatment because of the long waits and the fact that care has to be rationed under the National Health Service.
So, you know, they're having to eliminate their four-hour waiting time for an ambulance to get someone into the hospital because they can't meet it.
They had a 62-day Waiting time for getting cancer treatment, they can't meet that.
And so in Britain, there's a lot of trouble with the National Health Service.
They're now talking about having group appointments, 15 people with a similar condition all meeting with one doctor at the same time.
Can you imagine Americans tolerating something like that?
I just don't think so.
So the NHS has got severe funding problems, low cancer survival rates.
There were about 11 million Brits waiting over three weeks just to get an appointment with a primary care doctor.
So this would not be something my mom used to say, I hope you're not becoming one of those impatient Americans.
And unfortunately, I am an impatient American.
Most Americans are impatient.
They want to get their health care.
They want to get their tests when they want it and when they feel they need it.
They wouldn't want government telling them when they have access to health care.
I see.
And now there's other things that are going on in California with the individual mandate.
Do you mind explaining those as well?
Yeah, so Governor Newsom was not able to, you know, implement, figure out how to implement single payer right away, but he has done some things that are sort of stepping stone approaches.
One, federally, in December 2017, the individual mandate under Obamacare was eliminated.
But January 1st of this year in California, the individual mandate is back in effect.
Anyone who doesn't The individual mandate is a terrible idea, but California has it.
Increase the age from 19 up to 26 for young illegal immigrants so that they can then get coverage on Medi-Cal, which is the state's version of Medicaid.
They say 90,000 people are in that category.
They will now be getting Medicaid at a cost of about $98 million.
I think a lot of people who are illegal in other states, this will be an incentive for them if they don't have health coverage to come to California.
To get their coverage.
So those are two big issues.
The other issue is, you know, under Obamacare, the subsidies for people earning below between 138 percent of the federal poverty level and 400 percent, they're eligible for subsidies for getting health insurance on the exchanges.
California, as of January 1st this year, the subsidy has been increased so people earning up to 600 percent of the federal poverty level will be eligible for subsidies, which is adding a tremendous cost to the cost of health care in California under the government.
And do you think the taxes will go up as a result of these additions?
or...
How many more tax increases can we face?
We've got the highest state tax burden in the nation, but government doesn't have money.
Government gets money from us, the people.
We pay taxes, and I think definitely there would have to be increases in Vermont.
Governor Shumlin, with Vermont being Bernie Sanders state, Vermont passed and the governor signed a single-payer bill back in 2011.
By December of 2014, Governor Shumlin, a Democrat, said, we just can't afford this.
Even with a huge increase in the payroll tax, it wouldn't be enough.
The people of Vermont couldn't afford it.
So he took his single-payer bill off the market.
So in Colorado, Amendment 69.
Which was a single-payer initiative back in 2016.
The voters rejected that 79% to 21%.
Even the Democratic Governor Hickenlooper at the time said you don't want to vote for this.
It would double the state budget in Colorado.
So these things are very expensive.
Taxpayers would have to pay for it.
But I think the worst part is that people in whether California or in the country as a whole We'd have long waiting lists for care.
Care would be rationed.
People come here from all over the world for the best in technology, the best in biologics, pharmaceuticals, and the machinery that does all the great tests and the surgeries that we expect in America.
How about politicians?
How much do they know about healthcare and the problems in the healthcare space?
Well, I have found that politicians hate talking about health care.
It is.
It's very complicated.
I say understanding health care is similar to unraveling an onion.
Many layers and many tearful moments.
I meet with people in Sacramento.
I meet with people in Washington, D.C., who are senators and members of the House.
And they really don't like to talk about it because they're afraid that they're going to get beaten up.
And so it's something I'm trying to make health care simple so that people can understand what it would mean if the government took over our health care system and what it would mean for their constituents.
So it is complicated, but we need to make it simple so that we can not make a bad choice about our health.
Now, there was another initiative that they extended Medi-Cal to a lot of other patients, a lot of patients in California, but apparently the service level, the health care service went down as a result of this.
Do you mind explaining this?
Right.
So, under Obamacare, it was not compulsory.
Chief Justice John Roberts of the U.S. Supreme Court said that the federal government couldn't mandate that the states increase their Medicaid or their Medi-Cal programs to all people in the state that are eligible.
But in California, the Medi-Cal program was extended, and the Assembly and Senate voted to expand Medi-Cal.
13 million out of 39 million Californians, a third of our state population is now on Medi-Cal, this program for people earning below 138% of the federal poverty level.
The issue is that these people are now having a hard time finding a doctor.
The whole idea of Obamacare was by expanding Medicaid more people would be able to access doctors and wouldn't have to use the emergency room which is expensive care.
But now these people are finding that they can't find doctors Because doctors who treat Medi-Cal patients are reimbursed at about 38% below what they get paid for treating private patients.
So emergency room use is up by people in the Medi-Cal-eligible age income bracket, and it's not working for the people.
But Governor Newsom is very keen on moving to single-payer, expanding access to health care by using the power of government.
So is that similar?
That's very similar to the single-payer model, right?
Right.
Well, it's a stepping stone approach, just like the public option didn't make it into the final Obamacare legislation.
It was in the House version, Nancy Pelosi's version.
The Senate stripped it out.
But now you're seeing a lot of the candidates on the Democratic side who are competing to become the Democratic candidates.
Presidential candidate, whether it's Mayor Buttigieg, Elizabeth Warren, Amy Klobuchar, Joe Biden, they're all saying instead of single payer right away, let's go first to the public option and have a government insurer compete against private insurers, crowd out private insurers.
And Buttigieg and Elizabeth Warren have all said that they would then, if everyone wasn't covered, they would move that.
To a single payer system, which is undoubtedly what would happen.
Now what do you recommend for us in this space?
So, you know, there's no question there are problems with our health care system.
Some people, you know, are not getting coverage or getting the best coverage.
So my thought, my belief is that we can achieve universal coverage in this country if we offer people universal choice.
Young people don't want a system, a health care plan that covers, you know, 45 different issues, whether it's alcohol rehabilitation, in vitro fertilization.
Let people get the type of plan that suits their needs and those of their families.
One of the big issues in healthcare in this country is during World War II, when wage and price controls were in, the government, the federal government, gave employers the ability to provide health coverage for people, which, as I said, 180 million Americans have, and they can get their healthcare tax-free.
If you lose your job or you quit your job and go into the individual market, you have to buy your healthcare with after-tax dollars.
So this really distorts the market.
I'd like to see us get out of the employer-sponsored health insurance market, but in the meantime, I think individuals should have that same opportunity to get their healthcare tax-free.
We need to Expand health savings accounts.
Health savings accounts, you can put your money away in a bank account every month.
You carry it forward year to year.
You can use it if you want for health care conditions.
21 million Americans now have HSAs.
The problem is that right now you can't use your HSA to help pay your premium, which you might have difficulty with.
So I think people should be able to use their HSA to pay their premium.
People over age 65, if they can afford it, they should still be able to use And put money into their HSA. We need to do medical malpractice reform.
The cost of defensive medicine in this country is $210 billion a year, according to PricewaterhouseCoopers.
Docs do a lot of testing because they are afraid of being sued.
We need to cap non-economic damages.
We need to cap punitive damages.
We need to, you know, means test the Medicare program.
When it came into being in 1965, the average American lived to 65.
Today they live to 79.
And so, you know, we need to means test it so that people, wealthy people, you know, don't need to be on Medicare.
It should be there for the people that really need it.
We need to open up Medicaid, a health opportunity account, something that the President has talked about.
We need to get rid of certificate of need laws which limit hospitals from a new hospital opening down the corner until they get all this information through and that really destroys opening up the market to having more hospitals and more competition in healthcare.
We need to expand retail clinics which are terrific for young families.
They're in the Walmart's, the CVS pharmacies.
These are another way to put the nurse and a patient in charge.
It's much cheaper.
And so those are some of the things that I really think would, if we have more competition, we would have more choice and we could get, lead to universal coverage.
In fact, of the 27 million Americans who don't have insurance, there are only about 3 million of them who, you know, are having, would have a hard time purchasing coverage.
Most of the people are people, A, they're illegal immigrants.
They're people who could sign up for employer-sponsored coverage and don't.
They're people who could sign up, um, On the exchanges, but decided against it.
It's too expensive.
So, really, there are very few people that, you know, are uninsured because they can't afford coverage.
Now, what do you recommend our audience do about health care in California?
Well, we really need to, my job is to educate Californians on what single payer would And when the people of the state realize what it means, they need to talk to their own members of the Assembly, members of the House, their senator, and their state senator, and their national senator, to explain, we don't want this, so why are you pushing it?
Because politicians only do what they think their constituents are demanding.
And so we need to open this up and let people...
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