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i'm maddie hassan in washington dc.locked down as a result of the.coronavirus.for this special episode i'll be going.head-to-head with not one but two guests.a republican and a democrat.on opposite sides of one of the most.divisive issues in u.s politics today.how to fix the healthcare system.especially in a time of pandemic.[Music].the richest country in the history of.the world spends more on healthcare than.any other nation.and yet americans have worse health.outcomes than most other industrialized.countries.millions of people remain uninsured and.many others suffer crippling debt.from out-of-control medical bills some.democrats say.it's time for a radical overhaul when 30.000 people.are dying each year because they don't.get to a doctor when they should.and when a half a million people are.going bankrupt because of the.dysfunctional.and cruel system that we currently have.you know what.i think we will pass a medicare for all.single-payer system.but republicans on the right say more.government will only make matters worse.with regard to the idea of whether or.not you have a right to a health care.you have to realize what that implies.it's not an abstraction.i'm a physician that means you have a.right to come to my house and conscript.me.means you believe in slavery my guest in.the second half of this show.is a prominent supporter of senator.bernie sanders who will be making the.case for a single-payer.government-funded health care system.government doesn't have to suck.obamacare repeal but my first guest lan.hee-chen has advised republican.presidential candidates on health policy.and remained staunchly opposed to a.state-run health care system.single-payer free healthcare medicare.for all they might sound great.but like all visions of utopia they.ultimately produce.a lot more harm than good.[Music].but does the coronavirus mean that the.time for single-payer.or medicare for all has finally come are.chen.and his fellow republicans defending a.cruel status quo.whose time is up and how much longer can.the u.s justify a system.that makes some rich while keeping many.others sick.[Music].[Applause].lonnie chen thank you for joining me on.head to head.thank you maddie um you said last year.that the united states health care.system.is the finest in the world do you still.stand by that description.i do many i think the united states.healthcare system is not perfect.but i think it has a number of strengths.that continue to persist.uh innovation quality.ability for consumers to access a choice.of different care.options so yes i do believe the american.healthcare system remains the finest in.the world.but lonnie even now in the age of the.coronavirus with the u.s having the.highest.death toll in the world more americans.dead than in world war one.and with a healthcare system that.doesn't guarantee care to everyone.that's riddled with racial and economic.inequities.and that clearly was not up to the.challenge when the pandemic came.knocking at its door.i think we have to take a step back.maddie the healthcare system itself.has actually handled the situation quite.well.the leadership that we've seen in terms.of some of the political leadership.to animate the response to the.coronavirus that has been faulty.but the health care system itself i.would argue has performed pretty well.hasn't the coronavirus learning exposed.perhaps the greatest floor of all.in the u.s healthcare model that.employer-based coverage getting.healthcare through your job.simply does not work especially given.more than a 40 million people.uh in the us have lost their jobs as a.result of the pandemic around 27 million.of them may have lost their health.insurance too.as a result of losing their jobs that's.a savage indictment of the way you run.healthcare in the u.s.isn't it well i disagree i actually.think in the united states we have a.system that is premised as you noted.on the employer being the primary.provider of health care.health care insurance in the united.states that is supplemented of course by.a robust public system that covers.people who are older.as well as people who are poorer but the.employer-sponsored system actually i'd.argue has been the linchpin.of a quality system of care we have in.the u.s.where people get access to a choice of.different plans.that oftentimes their employers help.them to select you know health care can.be very complicated.and without the assistance of an.employer or another entity that can help.determine for example what some of those.plan choices are.it can be a very difficult field to.navigate so the involvement of employers.in the u.s.i would argue has been a net positive.now are there holes in the system.absolutely i mean right now there are 27.million holes in the system.there are 27 million holes in that's how.many people have lost health care in.recent months.people have lost their jobs in canada in.france in the uk.in spain in italy but none of those.people lost their healthcare when they.lost their job.that only happened in the us well and.certainly it is the case that we need to.have more affordable broader options for.people like that.i don't think anyone doubts many for a.moment that we need a health care system.that covers more people i've certainly.advocated for that as well.but lani i'm not even talking about the.30 million people.who started the crisis without insurance.in the us i'm talking about 27 million.people who had perhaps.great insurance with their jobs but when.they lost their jobs they lost their.health care.that doesn't happen anywhere else in the.world the rest of the world looks at the.us and thinks.that's mad that you do it this way well.a few things first of all the answer is.not to abandon the entire.employer-sponsored system which does.work for a hundred million or more.americans.i think the question becomes when people.lose job-based coverage.what is the best way to fill in those.blanks and you're right i think there.needs to be a way to fill in those.blanks there need to be affordable.choices that people can go to.so that their health care isn't.necessarily tied to their employer but.i'm not.willing nor am i ready to say that we.need to to discard the entire.employer-based system we have in the u.s.that does.work quite well for the vast majority of.americans so here's what it shocks a lot.of people both in the u.s and around the.world.your country spends nearly twice as much.on health care as the typical.industrialized country.americans also spend way more on.prescription drugs than anyone else in.the west.and yet you consistently get worse.results worse health.outcomes than other similar countries.who spend way less than you.uh you compare to other members of the.oecd for example the u.s has.the highest rate of avoidable deaths one.of the highest number of.hospitalizations.from preventable causes one of the.highest mortality rates from heart.disease stroke.alzheimer's dementia obesity diabetes it.has a life expectancy two years lower.than the oecd average and again that's.despite spending twice as much.as everyone else on average well surely.we spend too much there's no question.about that so we've got to figure out a.way to get those costs and that spending.down.but let's talk for a moment about.outcomes because i think this is very.important there is this perception.that somehow the u.s healthcare system.does not perform well on these basic.measures what we do know.is that for things like cancer mortality.for example the united states does.far better for certain kinds of heart.conditions.the united states does far better for.certain kinds of uh.of other conditions involving.neurological issues or orthopedic issues.the us system performs quite well so i i.think it's fair to say.i'm not disputing that you do well on.some measures on all measures.i'm not saying i'm not disputing but on.a lot of measures.uh highest rate of avoidable deaths one.of the highest number of.hospitalizations from preventable causes.and a life expectancy lower than.everyone else and you're spending twice.as much it's not even like you're.spending less.so you're getting less you spend more.and you get less.how is that the finest healthcare system.in the world i just don't get it well.you know here here again i think the.fact that we do spend more.is is a challenge i think we've got to.figure out a way to get spending down.but what i've also said is that if you.look carefully at some of our outcomes.if you look carefully at what we're.doing what we are providing is we are.providing the most innovative healthcare.system in the world.people have access to the most.innovative treatments the most.innovative cures.and that access simply is not available.in other countries it's not available in.other places not available.in the us hold on it's not available in.the us either to 30 million people.it's much more broadly available in the.us.and it is in a place like canada well.but it's much more broadly available.here than anywhere else.even before the coronavirus americans.were pretty unhappy with their.healthcare system.tens of thousands of people die every.year because they don't have insurance.and those who do have insurance have to.deal with medical bills.that are one of the leading causes some.studies suggest the highest the biggest.cause of personal bankruptcy in the us.again something unique to the u.s people.don't go bankrupt because of medical.bills in the uk where i'm from.what do you say to all those americans.in debt about the finest health care.system in the world.well i would say first of all we do need.to do more to fix something called.surprise medical billing which has been.in the news here in the u.s the idea.that someone can show up for a treatment.get treated but because that person that.doctor that facility wasn't part of.their health insurance.they get charged a lot more money we've.got to fix that problem so i agree with.you there we have a problem.that we need to fix is the answer that.you would take the existing system we.have and try and build on it to get more.affordable options to more people or is.it to toss out the system entirely and.go to something different.and and my point again is that the.system is not perfect but it is better.than i would contend than other systems.around i mean you're in a minority of.americans on this and gallup did a poll.just a few months ago.63 of americans believe the health care.system in this country.has major problems or is in a state of.crisis um.we talk about you know numbers and stats.and abstract let's talk about some.individuals.cancer patient susan leclair from.florida late last year was on the verge.of filing for bankruptcy a second time.because of all the debt she got from her.cancer treatments the amazing cancer.treatment that you mentioned a moment.ago.and she had health insurance she was.insured jessica hillman from illinois.had a seizure disorder.she had to file for bankruptcy in 2016.because all the medical debt she got.dealing with that disorder again she had.health insurance.isn't it outrageous what women like.jessica and susan have to endure.in the richest country in the history of.the world it is outrageous there's no.question about it but it's also.outrageous that cancer patients in the.uk have to wait weeks for access.to a specialist and weeks for access to.their first treatment the same thing in.canada.it's unconscionable that people have to.wait that long to get access to basic.treatment not just for cancers many.but for conditions that are chronic.conditions for conditions that are.debilitating.so i can tell you all sorts of stories.from around the world that are.unconscionable.that are just as tragic as the stories.you've told me that doesn't make the.american health care.system worse many it simply means that.in each of these countries we have.problems we need to solve in the us.we've got to solve it in our own way.just as people in the uk and canada have.to solve theirs no one's disputing the.other health cases that don't have.problems as i said i'm from the uk.there's a constant debate about problems.in the nhs the canadians have to.everyone has debates about the health.care system i'm talking about problems.unique to the us.in none of those other rich world.countries do people those problems are.not unique.bankrupt because of their medical bills.let me give another example people.insulin people in canada don't die.because they have to ration.their insulin because of the high cost.of insulin well they die because they.don't get access to coverage.they die because they don't get access.to doctors jeremy crawford 39 from.dallas died.last year because he couldn't afford his.insulin mika fisher 26 from wisconsin.died in 2018.couldn't afford his insulin alex smith.26 from minnesota died in 2017..i could go on and on this doesn't happen.in canada or france.or spain it australia people don't die.because they can't afford insulin.well they die because they can't get.access to to care they can't get access.to treatment they may have health.insurance.you can't get access to care in the uk.and that is.you can't get access to the care you.need necessarily no now you may be able.to see a gp.but good luck seeing an oncologist good.luck seeing an orthopedic.insulin here you're not seeing a cardio.oncologist if you have diabetes.i'm talking specifically about insulin.that's a uniquely american i'm bringing.up problems here because these are you.know you are you are you are right we.have we have a unique problem with.prescription drug affordability in.america we absolutely do and you're.right about that.but the answer again is do you take the.system you have.and do you throw it out and the answer.seems to be you seem to be suggesting.well.the system works better in other.countries because you don't have.bankruptcy because you don't have high.insulin costs my point is simply.in those countries those systems don't.work particularly well.in certain conditions as well so you.just have to you have to compare apples.to apples.do you believe that pharmaceutical.industries have done a good job in this.country given how high drug costs are.how high their profits are people are.dying from lack of insulin.well i think i think you got to ask the.question what do we want the.pharmaceutical industry to do and.fundamentally.my argument is we want them to innovate.we want them to have new cures we want.them to be pushing the cutting edge.on covid19 we want them to develop a.vaccine we want them to help us.understand.what are the frontiers of medicine and.science and we have a health care system.in the u.s that allows these.pharmaceutical companies to do just that.and that is why.again not perfect not everybody is.affording the medicines they should have.access to.but the pharmaceutical companies are.doing what we ask them to do by and.large.which is to innovate and to give us new.cures well they don't innovate on their.own the government innovates with them.as you know the single biggest spender.on innovation in this country.spending is private sector i mean the.national institute of health.i believe spent 32 billion in 2017 which.is half as much as the entire.pharmaceutical industry put together if.you take rem deserve you mentioned the.covid19 situation.one of the only drugs that seems to work.so far rem deserver.gilead science is a drug company behind.it says it's going to charge 500.a dose per patient with insurance even.though they could break even charging.a dollar a dose the us government spent.70 million dollars.helping gilead develop rem deserve they.didn't innovate that drug on their own.and yet everyone else has to pay a.fortune for it now.well a few things first of all the.pharmaceutical companies contribute a.lot more in terms of investing.in drugs that never make it to market.that never make it past clinical trials.but those are still costs.that they have to absorb but beyond that.for a moment i do think it's the case.that when you look at something like rem.deserver the.the jury is still out the jury is still.out on how effective it is.the jury is still out on how much it.will cost and i would predict.guillermo said it will cost 500 a dose.it's not gonna be 500.that's what they've said i'm just.telling you what the company said.again i think they are what they're.going to have to do is make a decision.about where they want to price that drug.given its efficacy because i can tell.you something if it's not effective.they're not going to be charging 500.fair enough that much is for sure.so again we've got to see where that.goes.lana you're a republican you've advised.republican presidential candidates like.mitt romney marco rubio.right now in the midst of a pandemic.your party is at the supreme court.challenging the very existence of.obamacare president obama's.signature policy to expand affordable.health coverage to millions of americans.who didn't have it before and again.in the midst of a pandemic is also.proposing 920 billion dollars of cuts.to medicaid the government-run.healthcare program for low-income.families.is it any wonderlani that people look at.the republican party when it comes to.healthcare and think.you're just cruel you're willing to let.people die without insurance.yeah i i completely understand that.point of view maddie and i and i.there are many things that the.republican party and republican leaders.have done over the years on healthcare.that i don't agree with.i think fundamentally it starts with.needing to understand the value of.universal care.i've talked about this before other.conservative analysts have talked about.this as well.that for a conservative philosophy of.health care to not include.some vision of expanding coverage so.that's more affordable so that everyone.can get access to it i think that's a.problem.now i will say this some of these public.systems like medicaid.do need to be reformed because it is not.the case that you can simply continue.spending as much as you're spending.doing as much as you're doing and expect.those programs to continue to exist the.sustainability of those programs.relies on good reform and that's why.it's important.to try and think about efforts even if i.were to agree with you and there's a big.debate about sustainability and debt and.how much debt trump has added.but the bigger question is in the middle.of a pandemic when as we discussed.earlier in the program 27 million people.may have just lost their health.insurance is now the time to be cutting.medicaid is now the time to be going to.the supreme court and saying.strike down the whole of obamacare.including patients who have pre-existing.conditions.20 million people would lose their.insurance on top of the 27 million who.already lost it if obamacare went.tomorrow.is this the time no wonder people say.this is just heartless.yeah it probably isn't the time okay.just putting coronavirus to one side.just on the bigger issue.why wouldn't a single-payer system what.people like bernie sanders call medicare.for all.which provides all americans with access.to health care paid for by the federal.government out of general taxation why.wouldn't that solve the problems.of access of universal coverage of.bankruptcy of high costs.all the things we've talked about so far.all the problems that plague the u.s.healthcare system that you yourself.admit plague.the u.s healthcare system isn't that why.a majority of americans according to the.polls.now support a single-payer.government-funded medicare-for-all.system because they know the case is.undeniable.well they support it until they find out.more about it and then the opposition.increases look i think there's a few.things first of all.the the idea of a single-payer system.the idea of having the government.control a health care system control the.providers that provide that health care.is fundamentally based on the economic.principle of rationing it's.fundamentally based on the notion of.controlling.the supply of health care and when you.do that.you can say people in the uk and people.in canada and people in other places.have health insurance and that's true.but do they have health care.and that i think is the challenge it.would not be of course they have.access to health care you think people.in germany or france.which are widely considered to be better.systems than the us they cover higher.and most league tables you think people.in france don't have health care.well they have health care they they.have health insurance but they don't.have timely access to the care they.might need i'd go back to the examples.around cancers or heart disease or some.of the other conditions that we treat.better here in the us because.fundamentally.we give people access not just to health.insurance.but the french have better health.outcomes yeah they have a better life.for your system.is the need to rationing let's let's.talk about oecd.life expectancy medi medi life.expectancy.is a function of many things beyond a.healthcare not just like functions.i mentioned hospitalization diseases.we talked about a lot of indicators let.me just pick you up on let me just again.preventable diseases.that's also a measure that's related to.social determinants of health.let me pick up on rationing for a moment.i mentioned earlier let me say it again.this idea that the us doesn't ration and.everyone else does you ration.by excluding 10 of your population from.the health care system 30 million people.just written off that's your way of.rationing we've got to figure out a way.to get access for those people.i know i know you want to go back i'm.not saying but would you would you can.see that that is a form of rationing as.well.you just cut ten ten percent of your.it's not a form of rationality.we don't have waiting lists in the u.s.we don't have weights for access to.specialists we don't have to.have waste for 30 million people who.don't have health insurance.to the 90 of people who have health care.everything you're saying only applies to.the people with health care you're just.airbrushing out.30 million people no i'm not airbrushing.them out at all i'm saying well how long.is the way.to get this how long is the wait for the.answer what are the waiting times.for the 30 million people who don't have.health care i'm guessing pretty long.the 30 million people who don't have.access to health care unfortunately they.are presenting in emergency rooms and.getting care there but that's not cost.efficient nor is it good we don't want.them to be waiting.to get preventive screenings to be.getting the sorts of things they need to.be getting.okay just before we wrap up a lot of.americans are very familiar with some.form of single-payer or universal.healthcare or government-funded.healthcare.you have the veterans administration.which provides basically.government-funded free healthcare to.veterans you have medicare.which provides free health care.essentially to pensioners you have.medicaid which you mentioned earlier.which provides support to low-income.families.all government-funded government-run to.one extent or another.and when you look at the polling gallup.does polling on this polling finds that.people who use the veteran system.medicare and medicaid are all happier.with their care than people who get.health care from their employer or.bought privately that kind of tells you.something doesn't it.yeah well first of all none of those.systems are free.they all have a cost they're all imposed.in the form of taxation or other.costs to individuals they're free to the.user is the point obviously.but they're free you know they're.they're they're they're not necessarily.free to the user either there are still.fees and such that individuals have to.pay the veterans administration's an.interesting example.uh i'm surprised you find polling that.suggests it's popular because it's.actually one of the least popular health.care systems in the u.s in fact veterans.uh by and large many of them are.actually quite displeased with the.system.and what it is the polling says.september 2019..82 percent of veterans reported being.somewhat satisfied with their health.experience only seven percent reported.being dissatisfied somewhere the gallup.poll.somewhere look and the gallup poll shows.that seven to seven percent of people.who use.veterans like it 76 percent of people.who use medicare like it.74 of people who use medicaid like it.but only 68 of people who have employer.plan like it.they're clearly more popular that's what.the polling says well look when you ask.people whether they would want to go to.a single-payer system if it meant for.example losing the plan they have.losing access to the doctor they have or.the hospital they like.single-payer healthcare becomes.dramatically less popular so we have to.be careful in using opinion polling that.can be manipulated certainly.and so i think this kind of an idea that.you could simply take the u.s healthcare.system.and graft on some kind of single-payer.government run system.uh it just doesn't work because it works.in limited settings.doesn't mean it's going to work.everywhere okay you make fair points and.i want to put some of these points.to my democratic guest in part two of.this show just before we.end our discussion one last question to.you lani isn't the problem that.republicans like yourself.simply don't consider healthcare to be a.human right.unlike 130 odd countries around the.world that do recognize a constitutional.right to health care and look i know.it's not in the u.s constitution as a.right.but you can't really have life liberty.the pursuit of happiness without good.health care can you.uh you you can't i believe every.american ought to have access to.affordable health care there's no.question about that but they don't have.a right to help.access to affordable care it's a very.interesting phrase but access to.affordable care is not a right to health.care.the rights the the rights that we have.as americans are very clearly delineated.and so i i i quibble sometimes with the.idea.of trying to make this political point.that because you refuse to say that.health care is a human right that.somehow you're against health care for.every american i couldn't disagree more.i believe every american should have.health care but that doesn't mean.that it is a right in the same way that.we have enshrined in our constitution so.you don't believe health care is.important things.i believe every single american should.have health care i don't believe health.care.is a right as stated in the constitution.i do not no.because it's not lonnie chen we'll have.to leave it there thank you so much for.joining me on head to head.thank you manny that's it for part one.of this special head-to-head up next.part two the other side of the argument.i'll challenge a prominent democrat and.supporter of bernie sanders on why he.backs a government-funded.medicare for all system here in the.united states that's in part two coming.up in a few moments.after the news headlines.[Applause].welcome back to this special edition of.head to head in washington dc.where we're debating the u.s health care.system should it be free for all.and government-funded or does the.private sector do it best.in part one my republican guest lani.chen argued.that more competition and less.government are what's needed to improve.the american health care system.one that he and the u.s conservative.movement believe is already the best in.the world.in this second half of the show i'll.challenge abdul el-sayed a top u.s.democrat who ran for governor of.michigan.a medical doctor and author of the book.healing politics.on why he supports the exact opposite a.nationalized health care system.as a cure to what he in the left argue.is a broken.unjust model we've allowed our.health system to run amok with profit.motives both on the providing side who.gives you care.and also on the paying side who pays for.your care what's the simplest way to.make sure everybody has health care in a.country where nearly 10.of us don't you just make sure that the.government provides it.but does u.s health care really need to.be overhauled in such a radical way.as chen and others are quick to point.out the us is a leader in medical.innovation.he's home to some of the world's top.doctors there are now 29 nobel prize.winners and boasts more nobel prizes in.medicine than any other country there's.also the cost factor.americans are much less keen on changing.the system when they hear.it could cost tens of trillions of.dollars so.is the need for socialized medicine a.healthcare reality.or is it just ideological fantasy and.can medicare for all as it's known.really overcome opposition from the.powerful healthcare industry.as well as resistance from establishment.democrats.and the republican party i'm not a big.fan of medicare for i mean i i.welcome the debate this grand scheme.ought to be called.medicare for none abdul sayed thank you.for joining me on head to head.mandy thank you so much for having me uh.in your book healing politics you lay.out your support for medicare for all.which is.senator bernie sanders signature plan.that calls.for a national government-funded what's.often called.single-payer health care system here in.the u.s.you call that plan a simple elegant.approach to providing everyone.with health insurance how so well.medicare for all is a government health.insurance plan that would cover.every single person from cradle to grave.without having to worry about.co-payments.without having to worry about.deductibles or premiums again words that.nobody understands because their.insurance mumbo jumbo.and instead we would all pay into a tax.system that would cover.all of us so we'll talk about that in.this interview but before we get to that.the calls for medicare for all have.intensified haven't they since the start.of the pandemic since the uh coronavirus.got going.is it your argument that if the united.states had medicare for all a.single-payer system like canada's or.like the uk's.that we would not have seen the same.levels of death and suffering in this.country that we have seen.i think there's no doubt about it let's.just remember that.we've got 40 million americans who are.off the payrolls and.in a system that relies on people being.employed.to get health insurance coverage when.then they become unemployed because of.say.a pandemic they then lose their health.care coverage in the middle of a.pandemic.that's what's happened 27 million new.uninsured people.in this system it makes no sense and had.we had a medicare for all system it.would not.matter what happened to your employment.you would have health care and you.wouldn't have to worry about that but.beyond that.there's also an incentive question when.you have 7 000 health insurers which we.have in the united states.who's left with the responsibility of.preventing disease in the first place.any one of them would say well if we.invested in prevention.it wouldn't really pan out because.people move between insurers so often.and that's why there's really no.incentive to invest in.prevention and public health in our.country and we've seen the consequences.of that with continued cuts to.agencies like the cdc and state liberals.you say there's.no don't say that you say there's no.doubt that the u.s would be better off.if it had a single-payer healthcare.system going into this crisis.how then do you explain italy the uk.which have long-standing single-payer.health care systems.universal health care and yet they have.been hit hardest.among the countries in the west they.have the highest death tolls.from covert 19 in europe britain and.italy even the presidential candidate.who your party has nominated who you.support you sit on his health care.reform committee joe biden.he said and i quote with all due respect.to medicare for all you have a.single-payer system in italy.it doesn't work there it has nothing to.do with medicare for all.that would not solve the problem at all.when you look at italy.he's got a point hasn't he with all due.respect to vice president biden whom i.do support.we are four percent of the world's.population we account for 25.of all deaths to covet 19. it has not.worked here and.if you look at the long term the long.tail right that comment hasn't really.aged.all that well um simply because in italy.they're looking at.being able to send their kids to school.next fall they're not dealing with.uh a second surge in fact they've.flattened the curve and it's staged.you're a democrat you could argue that.has more to do with the fact that donald.trump is not the prime minister of italy.uh when you look at health care systems.though the death tolls.in the uk has a higher per capita death.toll from covert 19.than the us it has the national health.service a single-payer health care.system.it didn't stop britain's from dying in.massive numbers.so i'll say this a big focus obviously.you know joe biden would have handled.this uh situation far better than donald.trump did donald trump.continues to deny basic science.continues to deny that we're dealing.with a crisis in the first place so.uh you know let's let's let's also agree.that this is a far.bigger uh issue than simply what kind of.healthcare system.a country has but let's also be clear.that in.our system hospitals were facing.bankruptcy at the same time that they.were facing covet 19..um and that fact alone is enough to ask.whether or not this health care system.ought to stand.as it as it is because the reason why is.because.all of our hospitals in this country are.run on a profit margin and those profit.margins come from.uh the kinds of cases that had to be.cancelled when hospitals were facing a.potential pandemic and so.they had to shut down their lifeline as.they were getting case upon case.of covid19 now not only fighting a.pandemic but also fighting.okay uh to stay open that is absurd and.that didn't happen in italy it didn't.happen in the uk it wouldn't happen in a.system.where government actually supports.hospitals to stay open to provide the.public good of having health care in the.middle of a pandemic.but lots of death and suffering did.happen in the uk and italy despite their.single-payer systems.and despite all the advantages of.single-payer which you've you've.mentioned a few already.it does come with a trade-off as my.republican guest in part one lani chen.pointed out it's quote based on the.economic principle of rationing.lanny and others argue that if you're.not rationing the number of people.who get care then you're rationing the.care itself.and that's indisputable isn't it i mean.i'm from the uk.the nhs has many advantages over the u.s.but the reality is.that you don't have all the same access.to the same specialty treatments that.you do in the us.certainly not in the same quicker time.frame that you have in the u.s.so think about what what lonnie is.implying here.we just celebrate so in our country.right uh.we believe a certain set of ideals we.hold these truths to be self-evident.that all people.are created equal now the idea of.rationing care.by people is basically saying that some.people can have all the health care they.want need.and some people just have to go without.it i don't know that i am comfortable.living in a society.where we just take that as the operating.framework.i would much rather me and everyone else.have health care if say they have a.heart attack or a cancer.or covet 19 then the situation where.which is a good argument which is a good.argument abdul but it comes with a rider.hold on it comes with a rider.why not own the fact that when you do.that people are going to get.less access to treatments they're going.to have to wait longer and americans.don't want to rightly or wrongly.americans don't want to they don't want.a system like the nhs or the canadian.model.where you have to wait for hip and knee.replacement you have to wait for.cataract surgery you have to wait for.some prescription drugs.why not be honest about the fact that.yes we will give healthcare free to.everyone.but it'll take much longer to get the.treatment you currently get.if we want to be if we want to be honest.about it let's also realize that in our.country.even if you are insured if you're one of.the lucky 90.that gets access to health care you're.still waiting in line for treatments.and not only that you're paying on the.back end of those treatments and so.you may be insured but yes if you need.to see a specialist for your cancer.the high probability is you're going to.be waiting in line too and not only that.you're going to have to pay substantial.amounts of money.just to get the health care you already.paid for on the front.door the numbers don't support you.already.hold on you know this you've worked.you're a doctor you know this the.numbers don't support you.when it comes to specialist treatment.the commonwealth fund which i'm sure.you've heard of health think tank.says canada reported the largest.percentage of patients canada which.bernie sanders.often trumpets as his model canada.reported the largest percentage of.patients waiting more than four weeks.for a specialist appointment and more.than four months.for elective surgery in canada for.example 18.of canadians waited four months or.longer for surgery compared to three.percent of americans why would americans.say yeah let's switch to the canadian.model why would they say that when they.hear those numbers.i'll just i'll just ask you this right.are all are all specialists the same.so matthew if you need a cardiologist.right would you rather be in a system.where you're going to move to the front.of the line because you need a.cardiologist independent of whether or.not you're insured.versus an orthopedic surgeon now don't.get me wrong if you have an orthopedic.problem you want to see your doctor.but in their system they focus on needed.care.more than elective care okay and i would.rather live in a society and i'm.guessing you would too given your.experience in the uk.hold on so let's talk about where if you.have a life threatening if you have a.life-threatening moment.that you're gonna get the care you need.when you need it absolutely save your.life even if it may be important you're.waiting a couple of extra weeks.so would you call cancer a.life-threatening illness.well i'll tell you this the number one.cause.of bankruptcy.would you call cancer a life-threatening.illness abdul it's a very simple.question.absolutely and yet if you're diagnosed.with breast cancer or prostate cancer.you want to be in the u.s don't you.i mean you're much more likely to.survive from such a cancer in the us.than in most european countries that's.what all the stats say.if i have a zero deductible health care.plan.then yes that is true i'd rather be in.the united states the problem though is.that too many people don't have that.because two-thirds of people will get.accounted for disputing that but if.you're gonna go bankrupt.i'm not defending that in fact i raised.these points.in part one i'm asking about.survivability if.it's estimated according to a study in.2015.from 1982 to 2010 it's estimated.that the u.s averted almost 67 000.deaths from breast cancer compared with.western europe 60 000 deaths from.prostate cancer.quarter of a million deaths from.colorectal cancer that's a lot of people.who are alive today thanks to the u.s.healthcare system that you want to get.rid of except for.the numbers on medicare for all suggest.that we'd save about 68.500 lives if we if we were to pass.medicare for all.here and that's the question at hand.here it's not whether or not i'd want to.be in the uk.it's not whether or not i want to be in.canada the question at hand is would i.rather live in the united states under.medicare for all or without it.and sixty eight thousand five hundred.lives a year we would save.under medicaid one study study that's.been disputed by a lot of people.that's one study as you know other.studies.68 000 as i say plenty of studies though.agree that you you're more likely to.live if you get cancer in the us.uh than in europe let's let's broaden.them sorry.any study that showed is there any study.that shows that medicare for all.would cost lives in america anyone well.if you is there any study that shows if.you look at the cancer numbers and you.compare canada and the us.well you're better you're better off in.the u.s why are we cherry-picking.outcomes yeah.i mean life is life you said you said.that you said you.okay let's let's broaden it out no no.i'm saying.sorry i'm saying i'm saying look there.are a lot of people in our country.who die of diseases that are not cancer.cancer is not the leading cause of death.leading cause of death.is cardiovascular disease we have no.incentive to prevent it in this country.there are a lot of people.whom if they get a heart attack they may.get stabilized and then will not have.the care that they need over the long.term.they will die younger because they don't.have that health care i don't want to.live in a society.where any of my neighbors and my friends.and my loved ones have to potentially.go bankrupt because they got sick or not.care at all and that's what we have in.the united states so the question that.we have to ask ourselves is.are we willing to invest as america not.uk.not canada as america in a system that.provides everybody health care that.would save us all money.and i would increase the number of i.take your point.i take your point but i'm not the one.who raised candidates bernie sanders the.candidate you back who constantly.mentions canada.um even with all the legitimate.criticisms of the u.s healthcare system.which you very eloquently raised so far.surely you would agree that the us is.still number one in the world when it.comes to innovation.in health care in terms of developing.new drugs in terms of.new treatments in terms of health care.across the board the us.leads the world and many argue that.medicare for all would.kill that innovation with its obsession.with cost cutting and reducing pay and.reducing spending.it would kill innovation in the us and.the u.s.is still number one in innovation surely.you would concede that.well no um i would say that the reason.the united states is the best.place to innovate when it comes to.health care is because we have.institutions publicly funded like the.national institutes of health.every single new drug that has been.created over the past several years.has had some benefit from money we the.taxpayers invest.into innovation through the nih and so i.would actually argue that that doesn't.go away.simply because you're telling.corporations who by the way buy those.drugs from biomedicals.who started usually as nih-funded labs.that somehow they're not going to be.able to profiteer on the back end.to the tune of billions and billions of.dollars take a drug.all over the u.s right now hold on the.u.s right now spends more than half of.all.uh rnd spending is done in the u.s more.than half.that's with a u.s healthcare model that.you don't like and you want to change.you're saying we can change the model.throw out the entire baby with the bath.water and we'll still lead the world on.innovation we'll still lead the world on.r d.we'll still fund the world's innovation.that seems hard to believe i'm saying we.can throw out the bath water without.throwing out the baby.and the reason is the baby is tax fare. taxpayers come on that's not true.like taxpayer spends a lot but so do.private companies.in fact private companies spend more.than the nih after the nih.has already eaten all the risk yes.you're right.the private sector comes in and it.invests the problem though.is that these corporations are a lot.more interested in how.much money they can make off of it it.sets the price way.too expensive so that people don't.actually get the treatment that they.need let me ask you this uh countries.like france and germany.which have done better than the us on.the coroner virus which whose healthcare.systems are often rated much higher than.the us.they have universal coverage but they.don't have pure single-payer systems.where the government pays for everything.they have.big private elements too why are you and.senator bernie sanders so insistent.on getting rid of all private health.insurance and getting just one.government-funded system in its place.why are you such ideologues on this.issue when other countries around the.world are willing to kind of have a bit.of both.well i'll tell you there are also many.many countries around the world that are.doing it the way.uh that senator sanders and i are.proposing um i have a lot of respect for.the french and the german system and.uh let's be honest right it's critical.for us to move toward.more coverage that's more equitable.right away and i will say that.i i disagree with the way that we ought.to do it but i do believe deeply in.uh in vice president biden's goals in.doing that.that being said if we ask ourselves what.the most efficient way.to tackle the biggest problems in our.health care system are to cover everyone.to reduce the bloated prices in our.system to do so equitably.medicare for all is the most efficient.most affordable.it is the most equitable even if that's.true and so i get rid of all.private health care when the uk hasn't.done that.canada which you often invoke hasn't.done that in canada.i believe they take out uh plans to.cover vision dental prescription drugs.why.why such ideologues on the issue of.private health insurance when even the.uk and canada aren't like that.i'll tell you i talked to my canadian.colleagues i talked to my british.colleagues and.both of them tell me that the biggest.challenges to.the canadian healthcare system or the.nhs are the encroachment of.private corporations trying to privatize.the services that they provide if you.look at.the biggest frustration that canadians.have in their healthcare system is that.they have to rely on these private plans.for things.that ought to be included in the public.plan and my point is that if we're going.to.rethink the american healthcare system.let's do it right let's learn from our.colleagues in those other countries.and let's make sure we're covering the.things that they want cover what about.the political viability of medicare for.all abdul regardless of how good or bad.the policy itself is.bernie sanders when he was running for.the presidential nomination of the.democratic party said.he would publish a medicare for all bill.in his first week of office.and get it passed into law in his first.term but those were kind of ridiculous.claims weren't they at the time they.weren't they were hyperbole.medical cannot get through congress.especially when you have.centrist senate democrats dead against.it as.of course are every single republican in.the house and the senate.it's just a non-starter well i'll tell.you this.joe biden is is the democratic nominee.and we are all going to work.with that administration to cover as.many people as affordably and equitably.as possible.that being said we cannot take our eyes.off uh.the goal and the goal is uh medicare for.all and but it's an unrealistic goal.under the time frame set by bernie.sanders that's why a lot of people say.look.even if i like the idea of medicare for.all in theory abdul's very.convincing he's convinced me it's a.great idea the reality is it's not going.to happen anytime soon and why pretend.it is when you look at congress and you.know.bernie sanders was wrong to say he would.get it done in his first term there's no.way even democrats do you know how many.democratic democrats signed on to bernie.sanders bill 14.a third of them he can't even get a.majority of his own party.i feel like i feel like that this.conversation is sort of past the reality.um again joe biden is the nominee and i.will tell you that the beautiful thing.about democracy.is that you can create massive amounts.of change if the people want it.and what bernie sanders has succeeded in.doing is making medicare for all lingua.franca in.our health care debate and uh you look.at where young people in particular are.going where.they want in their health care system.they want medicare for all and if they.don't like the centrist democrats even.and certainly the republicans who are.representing them then they have the.opportunity to vote them out for.somebody who will support medicare for.all or.force them to change their perspective.on it because that's what they demand.and there is no way forward on medicare.for all unless we are able to build the.kind of movement.that makes it possible abdul one of the.many reasons why so many democrats not.just republicans won't back medicare for.all.is because of what they consider to be.the astronomical price tag associated.with it according to some studies it.would cost more than what the federal.government.spends on social security medicare and.medicaid combined.one study found that medicare would have.cost approximately 33 trillion dollars.during its first 10 years of.implementation how do you get political.support for a plan that could cost.three trillion dollars a year for the.next 10 years.because it would save the average.american family twenty four hundred.dollars a year.the fact is is that people are getting.wise to the.ridiculous amount of money that we're.paying into a bureaucracy that does not.work because it replicates itself.through seven thousand.health insurers and lines the pockets of.ceos to the tunes of 10 to 30.million dollars a year um we could do a.lot better.and medicare for all would do that so.yes it would be expensive as a.government program.but when it comes to real people and.their pockets.and their considerations of where they.could be putting their money i'm pretty.sure.that twenty four hundred dollars could.be put to far better use than some ceo.salary it's interesting you say the.public are wising up to this and you.know they're okay with spending.trillions dollars more because they'll.save money.but the polling doesn't say that at all.in fact a lot of the polls show that.medicare for all has a majority support.in this country until you tell people.that their taxes will have to go up.to pay for this multi-trillion dollar.plan in fact if you tell them there.might be delays.their support drops even more that's the.reality when americans are told.you will have to pay more in taxes they.say no thanks to medicare for all you.you guys just avoid that when you're.making the case.but also when you tell people that.they'll save money overall.and that they'll actually get to see any.doctor that they want.uh their support goes back up i'll be.honest with you look the thing.on the big picture aside from the.doctors just let me just hit you with.the polling numbers.kaiser family foundation found 71.percent of americans.support medicare for in the abstract but.when they're asked are you willing to.pay higher taxes their support drops to.37 percent.that's a big drop abdul it's of course a.big drop but.again then you pull them and you ask.them do you recognize that it would save.you money overall.right all your premiums all your co-pays.all your deductibles go away.and people support rises back up if you.look at what studies have shown.right 22 out of 22 studies surveyed.in a a recent uh review article showed.uh that.the medicare for all would save both our.overall health care system money and it.would save individuals money.um 450 billion dollars a year from that.lancet article 100 billion to businesses.2 400 per family on average that kind of.savings is something as you know abdul.that.article has been criticized for.cherry-picking numbers for.uh you know picking the best-case.scenarios for overestimating how much.money would be saved.you know that plenty of other studies.show let's talk about the mercatus.center.hold on it's not just the conservatives.of mechanisms.let me just jump in here it's also the.urban institute which is a center-left.think tank which also said.more than 30 trillion dollars i think.bernie sanders himself in the past has.conceded 17 16 trillion.you yourself said it will be expensive.let's not beat around the bush before we.finish one last question your party's.presidential candidate joe biden.whose healthcare reform committee you.now sit on and who you're now rooting.for.has taken more money in donations from.health care and pharmaceutical.industries.than any other candidate in the race.he's dead against medicare for all to.the point that he even suggested.if congress were to pass a bill he might.not sign it when it got to his desk.now given medicare for all is such a big.issue for many on the left a deal.breaker for some.how do you plan to get your fellow.progressives and leftists.and bernie supporters to get behind joe.biden in november.when he's so dead against the signature.policy of the left medicare for all.well my message to progressives on this.is pretty simple.we can spend the next four years.fighting.for more health care for americans at a.more affordable rate.or we can spend the next four years.fighting against the repeal of the aca.and i believe that joe biden recognizes.that right now we need leadership to.take on.things as basic as recognizing the.science behind this pandemic.yes i supported bernie sanders in the.primary but for damn sure i'm going to.support joe biden.in the general because i know what.donald trump would mean uh for people.who look like me and millions across.this country.for whom four more years of donald trump.would devastate their lives and.livelihoods.abdullah said we'll have to leave it.there thank you so much for joining me.on head to head.it's always a privilege and uh and thank.you for a vigorous conversation.that's our show head to head we'll be.back next week.you.

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