Thank you, everybody for coming. Continue to enjoy your lunch. Im tim carney, a visiting fellow here at American Enterprise institute as well as being the commentary editor at the Washington Examiner. We are here to talk about health care but i want to ask a a specific question about health care. Its a question that some people on the Free Enterprise side, the freemarket conservative or libertarian side dont always ask, who benefits. I think sometimes people on the right or right of center are uncomfortable with that question in policy debates because they say why should it matter who benefits . We see Elizabeth Warren will say tax cut is bad because rich people benefit. But i think its actually a very important thing to talk about. One influences are debates gif you remember in the 2008 campaign and the passage of obamacare, barack obama thought it was important to point out that he was battling the Health Care Sector, that he was battling the drug drugmakers or he was battling the insurers. Very important and interestingly, he was not telling the truth when he said that. It shaped the way obamacare turned out, that the hospitals and drugmakers were largely behind it, or they got to craft certain principles. It helped us understand why the bill became what it did. Its less surprising that weve seen hospital consolidation when you realize the big hospitals were supporting lots of the provisions in this bill. So following who benefits from something tells us very important things. Today where logical to talk about medicare for all and the main way that gets pics is this is something that will benefit all patients come, can argue is that it will cost taxpayers. Theres a lot more going on than that and thats what we will talk about. But not just medicare for all. Other freemarket conservative health care reforms, and got some people appear experts in that i first talked about obamacare and who benefits from all these. And maybe the answer simply the patients. Maybe the answer is special interest. And then the corollary of courses who suffers from these policies . We have an excellent panel to discuss it. First, age cunningham is a Health Care Reporter who writes a newsletter for the washington post, a former colleague of mine from the Washington Examiner. Michael cannon, and you guys i think receive their full bios so i will just give a brief summary. Michael is the health care guy at cato and jim capretta is one of the leading health care guys here at aei. Im going to start with medicare for all and just ask paige, from what you see from your reporting from how you see different people playing around, in various medicare for all proposals, who do you think benefits, thinks theyre going to benefit, et cetera . What you see on this. Was how much time do we have . It could be a really complex proposal and i think it can plant in a lot of ways for different parts but in general when you look at the consumer its going to be lower and middle income consumers that are going to benefit because what were talking about is increasing taxes on businesses on employers, and the wealthy to pay from a comprehensive set of benefits for low income. I think particularly people that could benefit from a more copies of medicare for all people who been left behind by obamacare which is a people that are about 300, 400 federal poverty level, a little higher who may be eligible for very limited subsidies in the marketplaces but our speedy sorry, thats like a 60,000 income for a for a couple . Sixty 35, 000, and those of folks i think that recognize to really still be struggling to afford the Health Insurance and the Affordable Care act didnt really help because of course the cost of private Health Coverage keeps going up, subsidies are not enough to blunt those cost for these consumers. And, of course, i i guess you could say the losers are the top 10 or so of income earning americans who would have to pay for this. Industry, industry has really come out against medicare for all. Theres this partnership has been formed where pharma has come together with hospitals and the doctors were involved in this and they left over the summer but they had really been fighting medicare for all proposal. I think it could be a mixed bag for doctors and hospitals, depending on how this could be hashed out there on the one hand, you would, they would get more patient because you would reach universal coverage. They would have more people seeking the services but at the same time they would be paid less, probably closer to medicare rates which are significantly lower than what they get under private plans. Drugmakers probably would be pretty bad for them because the government would have a much stronger role in determining how much they could be paid, and Health Insurers are also really opposed to this because under bernies plan basically envisions no role for them going forward. I think thats white scene of a industry push back. I will leave it there. Thanks tim. I agree with much of what paige said but i think, it includes a lot of low income people who think they would benefit from medicare for all program. Certainly most of the tax increases are being borne by higher income people and there are subsidies to people are not getting subsidies now, and those folks might see little, out of the pocket and more health care coming their way. They might think they benefit but lets also think that some of the ways in which some of the costs they bear or what they lose. They are losing any philly to choose their own Health Insurance plan because according to Bernie Sanders under his plan the government will provide health care to everybody and jeff no choice of Health Insurance plans. They will outlaw private Health Insurance. Youre losing your right to choose your own health plan. You are also going, people with lower incomes will lose because the impact when i would be felt by the people are paying those taxes. I do believe in order to pay for medicare for all system you have to text anybody can raise a voice taxes. No one would be an income tax increases. But even if your taxes go up by relatively little, the fact that Bernie Sanders would have to raise 16 trillion dollars over ten years, means that the economy is going to take a terrible hit. Collecting one dollar in taxes doesnt cost one dollar. It cost 1. 30, or even at them margin up to two dollars. That additional increment is lost economic productivity. The President Council of economic advisers put out a report where they made estimates, estimated that taxes would go up by 18,000 per household under an medicare for all plan by 2022. 18,000 in additional taxes per household. But the economy would experience somewhat Slower Growth as a result of that additional tax burden, that Household Income would be 17,000 lower than it was, that what otherwise would be without additional taxes. And even the lower income households would suffer because they would be less activity unless job creation, less growth. I dont think you can say though income people will do well under an medicare for all proposal. Because taxes dont you start the people who are paying those taxes. Beyond that, i think patients would also suffer because when you enroll anyone in the medicare program, you dont get any of the benefits of competition that you get right now between, theres not much competition, but theres some competition between different ways of organizing and financing the delivery of health care. You do get some competition between totally feeforservice payment and other Payment Systems or ways of paying doctors and hospitals. We do see the feeforservice has number of problems. It encourages unnecessary services, unnecessary admissions and so forth. We see spillover effects were other Payment Systems or insurers play a more aggressive role in managing utilization. You do see a reduction in unnecessary expenditures, not only among the patients that those efforts are targeted at but even among the feeforservice population that have to compete with those, with all those other ways of paying for health care. You get rid of all of that competition and the spillover effects that come from competition. Patients would suffer. The big winners under an medicare for all system would be, first, a politician to decide how much we pay in taxes at how to spend all that money of hours. And as a result the lobbyists who already health care has only for the past 20 years let all industries in terms of expenditures on lobby. The lobbyists will make a bonanza when we go from the Government Purchasing 50 of the health care in the United States, the Government Purchasing something much closer to 100 . There will be much more opportunities for lobbyists to make money influencing how that money spent so they will be the big winners. Jim . Thanks, tim, for having me on the panel. This doesnt make him change his mind but i agree with basically everything michael just said. I wont repeat all those points, all very good points. I think a couple things to note about medicare for all. Whats the point of the program . The point is to bring the allocation of all the resources and Health System into government control basically. And so as michael indicated the big loser here really in the first or analysis is anybody who they who is a wage earner basically because the incidence of financing will move more heavily towards incomebased taxation of some kind even payroll taxes income tax or some way of taxing the broad middle class. Senator sanders admits that, and that means you end up taxing wages to some degree more than they are taxed now. I definition this will be a heavier burden on earned income. Which is not necessary a good thing for the economy, for all the reasons michael just articulated. I think the other point though is who is the winner comes may be people are going to get health care more, maybe they have very low wages, no wages, you know, people end up in a more free direct provision type system. So when he first or analysis there might be some level of winning for the population as was indicated previously. The big dynamic here really is something that occurs over five, ten and 20 years, which is what happens when the government becomes the control of all the resources. At almost uniformly throughout the world when a system is run this way, it leads to price setting by the government which by definition leads to supply restrictions and less competition. Sort of basic economics are, if a government sets the price below the large market clearing level, people will stop supplying it. Thats just a reality. What happens when that occurs . That meets people have to wait longer to get the care they want. So who loses under the situation . Basically, and this takes a long time to develop, so you could enact medicare for all, this will notice for 15 or 20 years, but eventually it will happen and what happens is people wait longer for care and theres less innovation because you bless incentive to bring forward things that the government is controlled the price for pics of who loses under that . It is basically sick people. And so i think here you have to understand that why is there push back against medicare for all . Its mainly because people worry about what he would do to the quality of health care overtime, particularly for people who need a lot of intensive care and would benefit from innovation come having the best people go into medicine, all the things that happen when its less controlled by the government and happen to a lesser degree when its is controlled by the government. This this is the hard real medicare for all which is, one of the one of the point which is very important, is a lot of cost of nationalized government controlled system are off the books. The way to measure whether that something is causing something is usually done in the financial term but how do you measure what people have to wait longer or there is no innovation that wouldve occurred otherwise . Something didnt get made that wouldve helped the patient if someone had incentive to invest in a 15 and 20 years ago. Those are off the book costs that occur in uk and canada and ultranationalist systems that are not measured and they are artificially lowering the costs come suppose it cost of the system. They cost more because people would pay more if they could get the services faster, but they cant. Theres a whole dynamic year of a lost opportunity with medicare for all that it think is very important to understand. Can i push back to just make this point . This is a point senator sanders often makes an argument for medicare for all. Its easy to criticize would look at the polls but keep in mind where Current Health care system looks like. The point he often makes is people are already paying more money out of pocket. Look at employersponsored coverage, the average premium now for employers is 20 grand the year for a family, costs have been growing faster than inflation for a long time. If you look at, there was an analysis of the medicare for all plan and even it concluded it would be a reduction in both National Health spending and personal Health Spending by two to 4 if you want to medicare for all system. Heart of the point he often tries to make is okay, you talk about all these costs, but at the end of the day, these services are being paid for by somebody. What we will fight but is not necessarily were cost which is cost that are going to be borne by the government versus directed by the consumers. I want to clarify this. For some reason i think bernie and warren have both make this argument never make it very clearly, and you did make it clearly there, but just to emphasize what, if you take taxes paid that go to health care and you compare it to the premiums that i pay and the premiums that the Washington Examiner paid, hes saying why do i care whether its coming out of my wages can come in out of my paycheck coming out of my taxes . Its a redistribution and so the higher wage people will be paying more and the lower wage people will be getting more health care than they used to. Whats wrong with that argument . You might notice the difference if your taxes go up and your friends whatever which your brother might not have a job because the economy is not growing the way it would have if if you are paying for premiums instead of taxes. But more broadly speeded which brother . I know which one. We all know which. We all have that brother. But more broadly than that, i think its a mistake to say that the medicaidis study says that under, or the mckay to center concluded the scent of proposal would save money. Because what they said was if you take all of the Bernie Sanders plans at face value and assume their plaussible, and yes, that is how the numbers work out. But it is politically infeasible for the sanders plan or that congress would enact the medicare for all plan that would reduce prices by the amount that senator sanders envisions, then it is not possible say that a america for all plan would reduce them would reduce the prices that Health Care Providers get paid and, therefore, would be a wash for most people in terms of taxes going up by no more than premiums go different taxes would go up by much more because, and this gets back to something jim mentioned. Yes, if the governor sets the price too low, then you get shortages and whatever everyone assumes medicare sets the price is too low. Medicare often sets the price is to either the bob is that there are always too low. Its that they could be too low, too high, the government has no idea and adult self correct. They are just as often too high, and so, thats what all that money, like hundred Million Dollars per year that is being plowed into lobbying on health care in washington, d. C. It is going to do, its being invested in lobbying for usually higher payments to Health Care Providers. This is my question when we say drugmakers will probably lose and hospitals are worried they will lose, we just think again about how obamacare happened or about how we generally see the sausage gets made in washington. I want to tell a plausible story about medicare for all could pass, which is that when we get a senator warren and tries to do this and she fails but she does what george w. Bush doesnt has a good midterm and the jets a bigger democratic majority, just like industry reacted in 2008 right after obama won, the insurance lobby came out and said hey, we will cover existing conditions, limit our price discrimination based on age, communittee rating stuff as long as you cover everybody. They cut a deal and so you could see the hospitals, the drugmakers, the doctors, i dont know about the insurers but you can see the provided cutting a deal and saying just give us can to make sure you pay us enough and we will go along with that. So then you get a medicare for all that industry signs up for. Is that the fantasy . Obamacare happens so lends plausibility the idea the same thing happened with medicare for all. But its hard to describe how much heavier of it medicare for all would be because theres no way the insurers get on board with medicare for all, first off. Unless maybe they do what senator kamala harris, in which case we have to buy off the Insurance Companies, right . And you could buy up all the hospitals and all that but youre still talking about removing hundred 75 million americans from their private employersponsored health plan and you would have to put something in there for employers who would be worried about all of the workforce disruption that would, if people didnt have to stay with her jobs anymore. The number of people you would have to buy off, and thats what youre talking about, it could happen if government by soft enough people that that drives up the cost of a medicare for all plan. You make a good point about what with the rates be because t