Advocates for Medicare for All Testify in Congress While Others Urge Caution

Speaking through a computerized voice synthesizer because amyotrophic lateral sclerosis (ALS) has deteriorated the movement of his diaphragm and tongue, healthcare activist Ady Barkan appealed to a Congressional committee in support of Medicare for All Tuesday.

“Every family is eventually confronted with serious illness or accidents,” said Barkan, an attorney. Throughout life, he said, “all of us need medical care. And yet in this country, the wealthiest in the history of human civilization, we do not have an effective or fair or rational system for delivering that care.”

Barkan and a New York City emergency department physician, Farzon Nahvi, MD, illustrated for the House Committee on Rules how the current system of employer-based private health insurance had let them, or patients, down with high health costs and denials of care. Some decide not to get treated for preventable illness because of costs, and others, like Barkan, turn to personal fundraising.

Under the Medicare for All bill debated Tuesday, the country would transition to a new system in 2 years. It was introduced in February by Representative Pramila Jayapal, D-Washington, and it closely mirrors the bill championed by Senator Bernie Sanders, I-Vermont.

Most of the nearly 5-hour-long hearing was a polite exchange regarding various aspects of health policy and cost figures, as well as the Affordable Care Act (ACA), the last time major federal health legislation was passed.

Witnesses like Sara R. Collins, PhD, vice president for healthcare coverage and access at The Commonwealth Fund, talked about the reasons why healthcare access and affordability remain a problem 9 years after the ACA: 29.7 million people are still uninsured, millions more have insurance plans that leave them underinsured, and for the most part, healthcare costs are growing faster than median income.

Besides Collins, Barkan, and Nahvi, the witnesses for the Democratic majority were Dean Baker, PhD, a senior economist with the Center for Economic and Policy Research, and Doris Browne, MD, MPH, the past president of the National Medical Association, which represents African American physicians and patients.

Republicans had 2 witnesses: Grace-Marie Turner, president of the Galen Institute, and Charles Blahous, PhD, a researcher at the libertarian Mercatus Center at George Mason University and author of a paper that analyzed the costs of Sanders’ previous Medicare for All bill.

Turner called employer-sponsored health insurance a “pillar” of the existing system and warned of long wait times for treatment in other countries and a lack of choice if patients were forced onto a single plan.

In his written testimony, Blahous said that “The additional federal costs of enacting the Medicare for All Act of 2017 would likely be somewhere within the range of $32.6-$38.8 trillion over its first ten years of full implementation, which at the time the study was conducted would be 2022-2031.” The costs would likely be on the higher end of the estimate, he said.

It is also not known how providers or hospitals would react if their rates were cut, he said.

Medicare for All advocates, like Barkan, said that the plan would deliver care, including vision, dental, reproductive, and mental health care, as well as long-term care, which was not included in previous versions of the bill—all with no premiums, deductibles, or co-pays.

Barkan’s ALS, diagnosed 3 years ago, requires 24/7 home health care, which costs $9000 a month and is not covered. To pay for it, he and his wife have turned to public appeals and fundraising. He also spoke about his health insurer, HealthNet, denying FDA-approved medications for ALS and a device to assist with breathing. The insurer relented after Barkan waged a public fight on Twitter and at the company’s office.

Blahous said generous health coverage, in turn, would drive higher utilization. “People do use more health services when insurance covers it,” he said.

Denials are “financially stupid,” said Nahvi, who recounted a female patient whom he diagnosed with a urinary tract infection, but her health plan would not cover the antibiotic he prescribed, which cost $300. She opted not to pay for it out-of-pocket, and returned 2 days later and was admitted to the hospital for sepsis. Another patient decided to treat his diabetes instead of his cardiac condition due to cost and had a heart attack. Both patients had insurance, he said.

Two Republican representatives on the committee, Representative Michael Burgess, R-Texas, and Representative Debbie Lesko, R-Arizona, questioned why the hearing was being held in the Rules Committee, which is chaired by Jim McGovern, D-Massachusetts.

“The Senate is not even going to hear this bill so I don’t even know why we are here but here we are,” said Lesko, who also used her time to raise the specter of undocumented immigrants receiving healthcare.

But it’s not that unusual, said McGovern. “It is the oldest committee in Congress,” he said, and it had also held hearings on the ACA and other legislation.