A House committee hearing on paths to universal health coverage on Wednesday devolved into a fiery rhetorical battle between Democrats seeking an expanded public payer role and Republicans denouncing such moves as one-size-fits-all socialized medicine.
Both Democrats and Republicans on the House Ways and Means Committee agreed that the current $3.5 trillion system features unsustainable spending increases, imposes excessive administrative burdens for providers and patients, and leaves too many Americans without quality coverage and access to care.
The hearing focused on a range of Democratic proposals to expand coverage, reduce costs, improve quality of care and shrink healthcare disparities. They included Medicare for All, a federal public program with an opt-out, a federal public plan option, a Medicare buy-in for older adults, a Medicaid buy-in, and enhancements to the Affordable Care Act system such as expanded premium subsidies and reinsurance programs.
But lawmakers were intensely divided over whether the government should have an expanded role. Republicans warned that more government intervention would lead to higher taxes, rationed care and long waits.
Republicans argued the nation can't afford the projected $32 trillion, 10-year cost of Medicare for All. They particularly cautioned that proposals to pay all hospitals Medicare rates would lead to 40% payment cuts that would threaten the survival of many facilities, particularly those in rural areas. A recent Congressional Budget Office report supported some of their concerns.
The hearing foreshadowed a fierce political fight over healthcare during the 2020 elections, with Republicans citing the flaws of the ACA and Democrats invoking the Trump administration's and congressional Republicans' efforts to erase the law's protections for people with pre-existing medical conditions.
One witness, Dr. Don Berwick, a former CMS administrator in the Obama administration, expressed support for Medicare for All as the best way to move forward on universal coverage, cost reduction, population health improvement and overall quality improvement.
But he said, with the concurrence of several Democrats on the committee, that other measures to strengthen the ACA should be enacted while pushing for Medicare for All.
Those could include expanding premium subsidies, reducing hospital and prescription drug prices, and rolling back short-term health plans and other administration initiatives that undermine the ACA markets, Berwick said.
Other witnesses talked up state proposals to establish a public plan option, like the one recently enacted by Washington that would pay providers no more than 160% of Medicare rates.
But Grace-Marie Turner, president of the conservative Galen Institute, repeatedly warned that any of these Democratic proposals would lead to reduced access and quality of care for seniors, children, veterans and other vulnerable groups.
"Medicare for All and the derivatives would take us further down the slippery slope toward government control of healthcare, where vulnerable patients would have to fight even harder for access," she said.
The opening witness, Rebecca Wood, accompanied by her seven-year-old daughter Charlie, described the ordeal she went through in Virginia to get private insurance and Medicaid to pay for needed care for her daughter, who has serious medical issues related to her premature birth.
Wood said she had to fight to get her daughter taken off a 10-year waiting list for care. She blamed Virginia's underfunded Medicaid waiver system and an unresponsive private insurer, arguing that Medicare for All would solve problems like she and her daughter faced.
"It was a perfect storm of policy failures," she told the committee. "To address them all, Medicare for All would do an excellent job."
Her testimony posed a dilemma for committee Republicans, who each in turn thanked her and her daughter for attending the hearing and bemoaned the problems she faced in getting quality coverage and care.
"It's frightening when your child undergoes that," Rep. Vern Buchanan (R-Fla.) said. "What you faced was a failure of private insurance and a failure of government programs. The government didn't fund it."
He quickly pivoted to the infamous problems that occurred during the launch of the ACA's HealthCare.gov website in 2013.
"The rollout of the ACA was a disaster," Buchanan said. "I hope that never happens again in America. That frightens me. The people in my district don't trust this government to make life-or-death decisions about their healthcare."
Democrats blasted Buchanan and other GOP committee members for using that type of fearmongering rhetoric.
"Today's Republican condemnation of Medicare for All is in the great Republican tradition of opposing Medicare for anyone," Rep. Lloyd Doggett (D-Texas) said. "Their party is intellectually bankrupt, offering only nothing care.
Doggett said he could support a Medicare buy-in or other approaches short of Medicare for All. "This program won't be implemented overnight and will have to be phased in," he said. "We need to move our country forward with this basic right to healthcare."