The House of Representatives held its first public Medicare for All hearing on April 30, 2019. Although the general tone was civil and courteous, healthcare activists were quick to remind lawmakers that lives hang in the balance. Several of the important points discussed in the Medicare for All hearing include cost, feasibility on a national level, and the possibility of reduced payments to healthcare providers.
An activist’s plea
Although she has repeatedly stated that she will not support a Medicare for All bill while Republicans hold control of the White House and Senate, Speaker Nancy Pelosi still made an appearance at the hearing, accompanied by healthcare activist Ady Barkan.
Barkan has amyotrophic lateral sclerosis, or ALS, which has rendered him unable to use his voice. He testified before the committee using a computer-generated voice to make an impassioned plea for single-payer healthcare.
Barkan opened the hearing, saying, “Our time on earth is the most precious resource we have. A Medicare-for-all system will save all of us tremendous time. For doctors and nurses and providers, it will mean more time giving high-quality care. And for patients and our families, it will mean less time dealing with a broken healthcare system and more time doing the things we love, together.”
“Some people argue that although Medicare-for-all is a great idea, we need to move slowly to get there,” he continued. “But I needed Medicare-for-all yesterday. Millions of people need it today. The time to pass this law is now.”
As was illustrated in the hearing, cost is always going to be the most contentious part of the Medicare for All debate. Many people are uneasy with the government taking over all responsibility for healthcare spending, which is currently 18 percent GDP.
Yes, Democrats in the hearing argued, taxes would have to be raised in order to pay it. However, deductibles and copays would be eliminated, and premiums would no longer be deducted from paychecks to support employer-sponsored healthcare plans. In other words, it would simply shift the money Americans are already spending on healthcare, and give them better health outcomes than they’re currently receiving at a lower cost.
Rep. Rob Woodall (R-GA) called it “a tremendous increase in tax burden for the country.”
Barkan responded, “One thing I can’t help but think about today, congressman, is how we always seem to find the money for things like tax cuts for the wealthy and for corporate tax cuts. We never ask where the money will come from when we declare war. We always seem to just find the money. We only ask how we’ll pay for it when it comes to our health.”
A national issue
A surprising moment in the Medicare for All hearing came when Rep. Ed Perlmutter (D-CO) admitted that he voted against a single-payer ballot referendum for Colorado in 2016. “I voted against the legislation because I didn’t think Colorado on its own could undertake a Medicare for All system,” he said, “that it was national in scope.”
Grace-Marie Turner of the Galen Institute was asked about the experiences of Colorado and Vermont attempting to pass state-wide single-payer healthcare reform. “The feedback we continually got was people were so nervous about the taxes needed to support it,” she said. Most people understood that the money would simply be redistributed from private insurance premiums to public taxes, she said, but many people felt like “it just wasn’t enough.”
A cut to provider payments
A related issue to cost is the fear a single-payer system would cut doctor fees too much and discourage people from pursuing medicine as a career. Republicans claimed single-payer healthcare would cut doctor payments up to 40 percent. Rep. Tom Cole (R-OK) warned those in the Medicare for All hearing that the bill could close rural hospitals altogether.
Democrats countered: although doctors may receive less from Medicare, they would still receive more than they would from Medicaid or uninsured patients who are unable to pay their medical bills, ultimately yielding the providers a net positive.
Chairman Jim McGovern (D-MA) called it an “historic moment.” McGovern is a strong supporter and cosponsor of the newest Medicare for All bill. This latest iteration was introduced by Reps. Pramila Jayapal (D-CA) and Debbie Dingell (D-MI) and has garnered over 100 cosponsors. “I know this is a politically hazardous topic to go down the road on,” McGovern said in his closing statements. “But we have to do it.”
The House Budget Committee, which typically does not preside over matters of healthcare, will also hold a Medicare for All hearing in May.