Latest / CareTalk: Healthcare. Unfiltered. / Ro Khanna on What's Wrong With Medicare Advantage

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Ro Khanna on What's Wrong With Medicare Advantage · CareTalk: Healthcare. Unfiltered.

• 0:00
  - [David] California Congressman Ro Khanna says, Medicare Advantage is just private insurance that profits by denying coverage.
• 0:06
  He recently introduced legislation to stop private insurers from using the word Medicare in plan names and advertising.
• 0:13
  As a third term Silicon Valley based progressive Congressman Khanna focuses on democratizing the digital economy and advancing US leadership on climate, human rights, and diplomacy around the globe.
• 0:25
  Welcome to CareTalk.
• 0:26
  I'm David Williams, President of Health Business Group.
• 0:29
  - [John] And I'm John Driscoll the President of Walgreen South.
• 0:31
  Welcome Ro and we look forward to exploring your ideas not just on healthcare and Medicare but your whole platform to integrate technology to help make the United States a more equitable and frankly growth company country that includes all of us.
• 0:48
  So welcome to the show.
• 0:49
  - [Khanna] Thank you, John, thank you, David.
• 0:51
  Congratulations on the success of the podcast.
• 0:53
  You get more streams than most members of Congress get, so I appreciate it.
• 0:57
  - [David] No problem.
• 0:58
  I mean, I think the first question is what's right about Medicare?
• 1:03
  Now, what's wrong with Medicare Advantage?
• 1:05
  - [Khanna] Well, what's wrong with Medicare Advantage is that people who are signing up for it think they're getting Medicare but they're critical differences.
• 1:15
  First is they're in network doctors and outta network doctors, that doesn't exist in Medicare.
• 1:21
  So if you have Medicare, you can basically go to any doctor, any hospital that you need.
• 1:26
  When you have Medicare Advantage, you're restricted.
• 1:29
  Second, Medicare Advantage, a lot of people sign up for it because it covers dental and vision.
• 1:33
  It's one of the reasons we need to expand that for Medicare.
• 1:36
  And a lot of times the premiums are cheaper in the short term, but at the, if you get a catastrophic illness, many people then face huge costs and sometimes even denial of benefits.
• 1:50
  And this has been documented.
• 1:52
  And then third, of course it's costing the United States taxpayers a lot more money because the New York Times had a whole story about how people are being categorized as sicker than they actually are and these private companies are making money off it.
• 2:06
  So Mark Pocan and I just said, if you wanna provide that, that's fine, but don't call it Medicare, it's something totally different.
• 2:13
  - [John] So what do you think the prospects are Ro of renaming the program 'cause that would, there's an enormous brand value in Medicare.
• 2:22
  - [Khanna] The prospects are probably not great given that the insurance companies will fight hard but it should give us a signal if the private insurance companies are fighting so hard to be called Medicare, it's probably not that bad of politics to have Medicare for everyone.
• 2:36
  I mean they've probably spent millions of dollars on market research and guess what they found out, people like Medicare, that's why they wanna be called Medicare.
• 2:44
  So the idea that we should give everyone Medicare in this country with having supplemental private insurance by the way, so you're not eliminating private insurance, you still have supplemental private insurance but everyone has basic Medicare seems to me a very logical thing that the country should do and we should get there by extending to 60, 55, 50 and so on until we can get universal coverage.
• 3:09
  - [David] Medicare for All was a big topic during the Democratic primary presidential primary last time around.
• 3:15
  And then it sort of faded from discussion.
• 3:17
  Do you see it having legs in Medicare for All as something that that kind of comes back at some point as a real kind of point of policy?
• 3:24
  - [Khanna] I do because we spend about 19% of our GDP on healthcare costs.
• 3:27
  This is a huge reason that American companies are competing with one arm tied behind their back.
• 3:35
  In part led to some of the offshoring of our production is deepen in case of written in deaths of despair.
• 3:41
  It is one of the biggest causes for the stagnation of wages of the working class.
• 3:46
  If you look at the wage stagnation, almost all of it can be explained because the employers are paying that money into health insurance.
• 3:54
  GE CEO famously said that he has to pay more in healthcare than he does in terms of buying the steel for his products.
• 4:03
  And you have this case where you have massive company CEOs but managing healthcare companies as opposed to the companies that they're supposed to be running.
• 4:13
  So it's a huge competitive disadvantage for the United States, not to mention the personal cost and the fact that we should be treating people with dignity regardless of the job they have.
• 4:25
  So, eventually I think we will get there but it's gonna take a lot more of political mobilization.
• 4:32
  - [David] Is there an argument though that the inflation that is really burdening the country and honestly creating a competitive advantage isn't really being driven by the insurance companies.
• 4:43
  It's the core inflation of an incredible healthcare sector, but that doesn't seem to be able to get its arms around its own costs while we still to your point, leave a lot of people either undercover or not covered at all.
• 4:57
  I mean, how do you get at that that core inflation that's kind of crushing or sort of certainly putting a clamp on the competitive ability of our economy to grow and to kind of create jobs and profits?
• 5:09
  - [Khanna] Well I think it's complex.
• 5:11
  Obviously the reasons for American cost being high, one of it of course is that we do have incredible innovation in the best healthcare.
• 5:17
  So I do wanna acknowledge that, that there is something that has very high end healthcare even though those outcomes aren't the best for everyone.
• 5:27
  But then you look at something like American sickness where it's documented that this is partly hospital costs, it's partly the cost of pharmaceuticals, it's partly the insurance costs at every step.
• 5:41
  There are costs in the system that are leading us to pay some of the highest healthcare costs even though we don't have the best medical outcomes on average.
• 5:55
  And so my view is that a Medicare for All system it's not gonna fix everything but it will help drive some of those costs down.
• 6:03
  - [David] So Medicare obviously has a great brand name.
• 6:05
  It's also kind of pricey compared with Medicaid which is this program for people of lower income.
• 6:11
  And I wonder whether there might be a better way to get to universal coverage, might be through more of like a Medicaid for All at least that that is sort of the floor for universal coverage.
• 6:22
  That's a lot of what the expansion during the Affordable Care Act relied on.
• 6:26
  And I wonder if that might be a better one even if the brand isn't as sexy.
• 6:30
  - [Khanna] Well, the advantage of Medicaid is that it covers long term care and a lot of times as you know if someone is unfortunately Alzheimer's or dementia, they end up bankrupting themselves on Medicare and then end up getting covered on Medicaid.
• 6:42
  And there are aspects of Medicaid that are attractive but the reimbursement rates for Medicaid I don't think are sustainable.
• 6:49
  So you would need to dramatically increase the reimbursement rates and there are a lot of doctors who or take Medicaid only if they're required.
• 6:58
  But I don't think that it's a sustainable thing just on reimbursement.
• 7:05
  Whereas Medicare, many doctors are perfectly happy to take Medicare.
• 7:10
  Now, we have to be candid like you know you're tying to hospitals much of the money they're making is still on the private insurance, the Medicare rates aren't sufficient to pay for all the profits, a lot of it comes from the private insurance.
• 7:23
  Some of that would be reduced because of Medicare negotiation but we have to have a conversation about where the Medicare reimbursement rates are to make it universal.
• 7:33
  - [John] Yeah, it would be really hard today, seeing on one of the hospital boards to trade that system where so much of the profitability is coming from the private side.
• 7:43
  But I wanted to just double click on David's idea.
• 7:46
  I know you're not crazy about managed Medicare and MA but is there a possible solution to extend the coverage we need for the underinsured and maybe to take some version of that Medicare managed care and extend it more into the employer space where there are still a lot of gaps in the system where people are hitting the system who are underinsured or not insured at all.
• 8:11
  Is there a compromise opportunity there Ro, or do you think there's just too much you don't like about the managed care system that those parties'cause it strikes me that that might be a platform that you could extend to cover and avoid those.
• 8:24
  I mean, you brought up the Deaton and Case data, it's pretty terrifying how many deaths of despair there are and some of them are with people who would never get treatment because they still don't have coverage, they're individuals in small businesses or they're underinsured.
• 8:41
  And is there a possible compromise solution where you leverage managed care and as part of the deal, get them to cover a lot of those folks who are currently undercover today?
• 8:52
  One of the things that David and I have kicked back and forth is, is there a public private partnership where you could extend some version of either the exchange plans which are managed care for typically populations that look a lot like Medicaid populations but are one tick up in terms of less risk but also still very low income or Medicare managed care which is a richer benefit, but require those plans if they're gonna participate in the Medicare in the post 65 world to start covering those other levels of folks who are currently underinsured in the 50 to 65 or in small business that are currently being overcharged.
• 9:29
  Is there a way to take the program where there is some bipartisan support and extend it into areas where the insurance market isn't working very well?
• 9:38
  - [Khanna] Yeah, but the question is why not just then extend Medicare to them?
• 9:41
  I mean I guess they, what is the advantage, you're saying that you're gonna require sort of the private companies that are managing Medicare then to make sure they're taking patients who may be sick or may not have coverage and presumably not charge them outrageous premiums or deductibles but isn't that just ultimately the.
• 10:09
  - [John] Well, really, it's extending the idea of Obamacare to require the a lot of those plans to file on the exchanges and then extend the exchanges.
• 10:17
  It would really be to take that idea, the elements of which were embedded initially in Obamacare and make it more of a requirement.
• 10:26
  To your point, the Medicare Advantage market is a very rich market, it's where a lot of the insurers are finding most of their growth and while they're growing off of federal budget, is there a way to get them to actually extend more affordable coverage to other parts of the market and that would be the idea.
• 10:43
  - [Khanna] Sure, I mean I think that would be progress.
• 10:45
  I mean, I would support something like that in terms of a legislation if that was strengthening and building on the Affordable Care Act.
• 10:55
  But I think ultimately both in terms of a simplicity of an idea and in terms of something that's gonna have lasting effect is what we ought to be doing is figuring out how do we extend Medicare as much as possible.
• 11:14
  - [David] So Ro, if you hadn't already figured it out, John is quite fixated on healthcare and it's sort of like a one track mind which I guess is good'cause we need help on it but you do a lot of broader things as well and I'd love to explore that a little bit both in their relationship to healthcare and then overall.
• 11:28
  So certainly on like the environment and climate has been a big area of focus for you.
• 11:33
  I understand as it, you know, related to Inflation Reduction Act fairly instrumental in keeping that alive, those pieces in there.
• 11:41
  Where do we stand from an environment and climate standpoint?
• 11:44
  Is there cause for hope?
• 11:46
  Can Congress do anything about it?
• 11:47
  - [Khanna] Well, I think the President Biden deserves a lot of credit with the Inflation Reduction Act.
• 11:51
  I mean, that's a massive win.
• 11:53
  $300 billion over 10 years, the largest climate investment in solar and wind and batteries and the components for the clean energy economy.
• 12:04
  We are going to really see a lot of clean manufacturing come back to the United States and it's gonna take a significant dent on our emission.
• 12:13
  So, a lot of the implementation matters how the funding is distributed, the planning and coordination on solar panels and the different phases of production but I'm quite hopeful about the impact this bill is gonna have.
• 12:28
  - [John] Just extending it back to some your own ideas Ro, one of the things I found really moving in your book was talking about the deindustrialized towns not just in the Midwest, but in your own home state of Pennsylvania and your real desire to kind of redistribute not money, but jobs and opportunity into a lot of those communities by leveraging technology.
• 12:51
  Do you see much progress for those projects?
• 12:54
  I mean, we've got an amazing CHIPS Act passed in terms of reinvesting in the US.
• 13:00
  I mean, is that a down payment on something we're gonna see that's gonna hopefully create more opportunity in those areas because that I think, solving that problem I think is fundamental to changing the political culture we've got right now of fear.
• 13:18
  And I think you obviously felt it very personally in your own memoir and reflections there and have been part of it in terms of the Endless Frontier Act and the CHIPS Act.
• 13:27
  I mean, where do you see that going?
• 13:29
  - [Khanna] Well, I appreciate that, John.
• 13:30
  I think we made a strategic mistake as a country to offshore a lot of our production.
• 13:35
  I mean, we didn't invent the automobile in America.
• 13:37
  We figured out the mass production, we didn't invent the jet engine, we figured out the mass production yet we invented the solar panel and the semiconductor and we allowed the production to leave.
• 13:47
  Production is fundamentally tied to innovation.
• 13:50
  And by losing our manufacturing base in a way that Germany didn't, in a way that South Korea and China have not it has hurt the working class in America, it has hurt factory towns and communities across the country and there was no effort at place-based policy for economic revitalization.
• 14:08
  There are two opportunities.
• 14:09
  One, the 25 million new digital jobs, many of 'em that don't require college degree, that pay twice the median average, these can be done from almost anywhere.
• 14:17
  You don't have to leave your hometown to be able to get one of these good paying jobs and we should be intentional about doing that.
• 14:25
  And we're working, I'm working with Google to partner with community colleges, HBCUs, land grant institutions to pay people a stipend and then get a $65,000 job after an 18 month credential where the private sector is involved in the credentialing to help solve that.
• 14:42
  But more broadly, we can bring new production back.
• 14:44
  We're much more productive, 90% more productive than China because of 3D printing, because of digital technology.
• 14:52
  We're even more productive than Germany.
• 14:54
  And given this productivity advantage, given the new innovation processes if we have surgical intervention in financing from the government to supplement private sector financing and investment in the workforce, I think we can see new production come back to America across the country.
• 15:13
  And both of those things can build a more productive nation and help heal some of the divisions that are exacerbated because of economics.
• 15:23
  - [John] Ro's actually gone deep in geeking out on what kind of investments and tests we could actually create in deindustrialized or rural areas.
• 15:33
  But I guess for me what's interesting about that congressman is your notion of that there's hope for a progressive capitalism or a capitalism that's progressive.
• 15:46
  Whatever side of that you wanna take.
• 15:48
  Do you wanna make the argument for that?
• 15:50
  Because I think it's a pretty lonely hill you're preaching from.
• 15:54
  - [Khanna] Well, I believe that there are two aspects of what I call progressive capitalism which is the title of the paperback version of the book.
• 16:02
  But let me say first.
• 16:04
  Look, a value of market, so the deep down is the value of human freedom, right?
• 16:08
  I mean imagine if the government made every decision, if the government in the collective will made every decision and now you're an entrepreneur you're someone like Steve Jobs or you have a small business or you have a restaurant, do you really have to subject any transaction you're doing, any interaction you're doing to the collective will of a community that would suppress your own freedom?
• 16:29
  So markets are the freedom to transact it in our own ideas, our own initiatives with other human beings.
• 16:37
  And that's something that we're celebrating and that's why I celebrate markets and free enterprise.
• 16:43
  But to participate in a market, how can you do that if you don't have healthcare?
• 16:47
  How can you do that if you don't have education?
• 16:49
  How can you do that if you don't have nutrition?
• 16:51
  How can you do that if you didn't live in a safe community?
• 16:55
  So that's what I mean partly by progressive capitalism that you have to have the investments in your fundamental development as a human being to participate in a market.
• 17:09
  - [David] Ro, you talked about the importance of freedom, how that works with various approaches.
• 17:14
  We're all concerned about the health of our democracy and some of us are sort of ringing our hands about what to do about it.
• 17:20
  You have specific proposal related to term limits both in Congress and the Supreme Court as well.
• 17:26
  I'd just love to hear your thoughts about that and how it ties in with the rest of your program and philosophy.
• 17:31
  - [Khanna] Well, I appreciate that.
• 17:33
  I believe that the Supreme Court has been disconnected from the facts of American life.
• 17:39
  I mean you have people on there who were on the court appointed 40, 50 years ago and they're unelected.
• 17:47
  That wasn't the founding intent.
• 17:49
  And so I have a proposal that says Supreme Court justices should serve no more than 18 years on the Supreme Court.
• 17:56
  There's still judges for life, tenured for life and they can go to a lower court but every president should get two appointments.
• 18:05
  This would depoliticize the court and it would make the court more responsive to individuals.
• 18:11
  I've also suggested 12 years for house members and and senators though I'm flexible on what that duration should be.
• 18:18
  American democracy depends upon renewal, upon new voices emerging.
• 18:24
  Whether you adopt formal term limits or not, one of the challenges has been that new voices in this country have had a very hard time breaking through.
• 18:34
  We need to be more intentional in creating opportunities for young people.
• 18:38
  When I ran for Congress, the party endorsed against me all three times, the entire party was against me.
• 18:46
  One of the things I say about President Obama,'cause they say well why was he not more for the Democratic party?
• 18:51
  Remember the party was against Obama when he ran for Congress.
• 18:55
  They were against Obama when he ran for the Senate.
• 18:57
  They were against Obama when he ran for the presidency, they had lined up with Hillary Clinton.
• 19:02
  So, it's the greatest talent of modern times, he had to fight the party three times for his ascent.
• 19:07
  Something is fundamentally broken and the parties need to do a better job of getting next generation folks involved with our democracy.
• 19:15
  - [David] I'm glad I asked that question.
• 19:17
  It's one that we don't usually have a chance to talk about on CareTalk.
• 19:21
  So I think we're gonna wrap it up right there.
• 19:23
  I'm David Williams, President of Health Business Group.
• 19:25
  - And I'm John Driscoll, the President of Walgreens Health.
• 19:28
  If you liked which you heard or you didn't, please subscribe on your favorite service.
• 19:32
  (upbeat music)