WASHINGTON ― The first congressional hearing ever on “Medicare for All” began with a moving moment Tuesday, as single-payer hero Ady Barkan delivered an impassioned speech through an emotionless computer voice.
Barkan, who is in the late stages of ALS, testified before the House Rules Committee using a text-to-voice computer program.
“Never before have I given a speech without my natural voice,” Barkan said. “Never before have I had to rely on a synthetic voice to lay out my arguments, convey my most passionately held beliefs, tell the details of my personal story.”
Barkan went on to share his story. Three years ago, he and his wife were at the beginning of a promising life together. “We had fulfilling careers, a wonderful community of friends and family, and a smiling, chubby infant boy,” Barkan said. “We could see decades of happiness stretching out before us. The sun was shining and there was not a cloud in sight. And then, out of the clear blue sky, we were struck by lightning.”
Barkan was diagnosed with ALS ― a debilitating neurological condition that has already robbed him of the ability to walk and now greatly limits his ability to even talk. It was the start of a challenging road for Barkan, not just with his illness but also with private insurers and the health care system.
The activist’s testimony was the highlight of a hearing on Medicare for All legislation introduced by Rep. Pramila Jayapal (D-Wash.). The hearing was surprisingly substantive and mostly free of partisan rancor, despite the unanimous Republican antipathy to single-payer health care and the split among Democrats about whether to embark on such an ambitious and contentious fight. Barkan’s remarks combined a strong emotional appeal with a command of the facts and an unflinching passion for the issue.
Crammed in one of the smallest committee rooms on Capitol Hill, Chairman James McGovern (D-Mass.) and ranking member Tom Cole (R-Okla.) helmed a hearing that allowed the expert witnesses, including Barkan, invited by both parties to be the focal point.
There was little grandstanding by committee members. This enabled the hearing to stay focused on the core Democratic arguments in favor of Medicare for All ― universal coverage, fair and equitable access to medical care for all Americans and cost savings ― and the Republican arguments against it ― higher government spending, tax increases and the end of private health insurance.
To illustrate the unfairness of the status quo, Barkan testified that his family currently spends about $9,000 per month out-of-pocket on home care, on top of the significant costs his insurance does cover. “The alternative is for me to go on Medicare and move into a nursing home, away from my wife and my son,” Barkan said. “So we are cobbling together the money, from friends and family and supporters all over the country. But this is an absurd way to run a health care system. GoFundMe is a terrible substitute for smart congressional action.”
Barkan noted that, “like so many others,” he and his wife have spent significant time fighting with their insurer, which has issued “outrageous denials instead of covering the benefits we’ve paid for.”
“We have so little time left together, and yet our system forces us to waste it dealing with bills and bureaucracy,” Barkan said.
Barkan then laid out reasons he thinks Medicare for All is the right solution for our health care system. First, Barkan said, Medicare for All could provide quality care to everyone. The plan would cover all medically necessary treatments, including long-term care, and do so without out-of-pocket costs. Insurers, he noted, wouldn’t restrict access to doctors and hospitals.
“We will no longer need to choose between paying the rent and filling a prescription,” he said. “It means we will no longer delay necessary care until it is tragically late and tragically expensive. It means that we won’t have to worry every year when our employer announces the new rates. It means that we can finally start to eliminate the atrocious racial and economic disparities that destroy so many lives, that rob our communities of so much dignity, that strip us all of our common humanity.”
And third, Barkan said, Medicare for All is the only way to make the health care system more efficient. “Over the past three years, I have seen firsthand how the current system creates absurdly wasteful cost-shifting, delays, billing disputes, rationing and worry. Administrative waste is costing us hundreds of billions of dollars every year.”
Medicare for All envisions the government negotiating directly with drugmakers to set prices. Barkan said that would eliminate “immoral price gouging” by pharmaceutical and device companies. “The fundamental truth is that too many corporations make too much money off of our illnesses, and they are spending gazillions of dollars lobbying and campaigning and fighting to stop us from building something better,” he said.
Barkan, who was added to the witness list partly because some single-payer advocates worried that there wasn’t a forceful enough advocate of single-payer on the panel, argued that cost savings were only possible through “a genuine Medicare for All system.” He said other proposals to increase health insurance coverage, such as a Medicare buy-in system, would not generate those administrative savings.
“Some people argue that, although Medicare for All is a great idea, we need to move slowly to get there. But I needed Medicare for All yesterday,” Barkan said. “Millions of people need it today. The time to pass this law is now.”
Barkan is one of only a few people to ever testify before Congress using a text-to-voice computer program. John DeWitt, an entrepreneur involved in making that technology a reality, testified twice in 1988 using a text-to-voice program to show off the automation. And another ALS patient, Eric Obermann, testified before the Senate in 2005 using a similar program. (Obermann died in 2010.)
Barkan himself has been very clear about his own health outlook. He believes this could be his last major travel, and he has written a book in advance of his death about how his illness awoke a sense of social justice in him.
“The ugly truth is this: Health care is not treated as a human right in the United States of America,” Barkan said Tuesday. “This fact is outrageous. And it is far past time that we change it. Say it loud for the people in the back: Health care is a human right.”
There were no Democrats at the hearing who disagreed, including Reps. Joe Morelle (N.Y.) and Donna Shalala (Fla.) who support universal coverage but have been skeptical of Medicare for All.
Among Democratic supporters of the Jayapal bill, including McGovern, the message aligned closely with Barkan’s: The current system is unfair and cruel to those who get sick and leaves everyone at risk of catastrophe even as it enriches for-profit health care companies and providers, problems a single-payer program would fix.
Democrats also acknowledged the major challenges to implementing Medicare for All, including raising taxes to finance generous, universal coverage and balancing the need to reduce health care costs while not bankrupting medical providers.
Republican members broke out their well-worn and poll-tested playbook for opposing greater government involvement in the health care system. GOP lawmakers emphasized the real trade-offs involved in abandoning the current health coverage system, such as all Americans needing to give up their current insurance plans, some if not all people facing higher taxes and the difficulty in cutting costs without risking access to medical providers and innovative treatments.
Republicans also employed scare tactics that have proved successful in the past by conjuring up images of lengthy waits for medical care.
House consideration of Medicare for All will continue. The Budget Committee is slated to take up the Jayapal bill next month, and the Ways and Means Committee will hold a hearing on an unspecified future date, The Hill reported Tuesday.
Jonathan Cohn contributed reporting. This story has been updated with more details from the hearing.