MICHEL MARTIN, HOST:
What would you ask a presidential candidate if you had the chance? We're giving some undecided voters across the country that chance as part of NPR's Off Script series. This past week, I flew to El Paso, Texas, to meet former congressman Beto O'Rourke and two local voters. O'Rourke picked the place - L&J Cafe, a favorite local spot where his family used to go for Tex-Mex when he was growing up and where he now takes his kids.
BETO O'ROURKE: The green chili chicken enchiladas are absolutely amazing. You cannot go wrong if you order that.
MARTIN: There was a lot to talk about besides the food. For example, what does O'Rourke have to say to those who fear an overcrowded Democratic field will end up hurting the party's chances next year?
O'ROURKE: I say have no fear. We are many months from the Iowa caucus. And we both know the history of presidential primary polling and the candidates who were in the single digits at this time in their given presidential election pursuit.
MARTIN: There was also a little time for some lighter questions, like what kind of hype music does O'Rourke like to play before a big rally?
O'ROURKE: "Baba O'Riley" by The Who...
(LAUGHTER)
O'ROURKE: ...Off the album "Who's Next" - don't know if you've heard it.
RUBEN SANDOVAL: I actually have it on vinyl.
O'ROURKE: You do.
SANDOVAL: Right on. Yeah - one of the best songs ever.
MARTIN: Joining us at L&J Cafe were two Texas voters, both registered Democrats, who say they have not decided who they want as the party's nominee. Connie Martinez is a college student who will be getting to vote for president for the first time next year, and Ruben Sandoval, who teaches civics, political science and social studies in high school and community college in El Paso. They had lots of questions for O'Rourke on gun violence, immigration and many other issues. Here is one part of our conversation focusing on health care - which, for people in El Paso, also involves the border with Mexico, as Ruben explained.
SANDOVAL: So many of us have to cross into Juarez, Mexico, in order to get our prescriptions at a lower cost because even though we have insurance, the cost is still too high. And so why is Americans who - we have to cross into Juarez, which, by the way, is a very dangerous city, and the traffic and the lines can be pretty horrendous. Why can't we get it through our own insurance?
MARTIN: And I'm glad you raised that because everybody doesn't have the option of going to Juarez to get - however inconvenient to get cheaper prices. And, in fact, it isn't just prescription prices that are going up. We just have data this week saying that the premiums, even for people covered by private insurance, are at an all-time high. So the question is, what is your plan to bring down these out-of-pocket costs?
O'ROURKE: I think we first need to look at why it's so expensive to purchase medication or to pay your premium or afford your copay or bridge your deductible right now. A lot of that has to do with the current administration undermining the Affordable Care Act and trying to remove protections, remove subsidies. We've seen extraordinary inflation over the last three years in all the cases that you describe.
But specific to the pharmaceutical industry, this is a challenge that preexisted the Trump administration. Our Congress prevented Medicare by law from using its leverage and its purchasing power to drive down the cost to bargain for lower prescription medication costs. If we were to do that, not only would Medicare beneficiaries realize gains, but so would Medicaid, VA, Tricare and private insurance beneficiaries as well.
So our proposal - allow Medicare to use its leverage to bargain for lower costs. Allow Americans to buy in Mexico or Canada or the European Union as long as we have the same level of quality and due diligence for the medications that are sold. If you can find them cheaper somewhere else, then you should be allowed by law to purchase them.
MARTIN: Connie, do you want to get in this? Because I sure do.
(LAUGHTER)
CONNIE MARTINEZ: So I - like, since I am only 20, I'm still very dependent on my family. But I do agree with you, Ruben, where it's been very difficult for people of the working class, people who are educated to, you know, go to the doctor - something as simple - where, you know, even in my personal life, it's, like, oh, I can't go to the doctor for a while until, you know, money comes in because it does get so expensive. So I think it's really interesting about your...
MARTIN: Can I just ask Connie a question? You're saying you can't go to the doctor. Why - because the co-pays are too high?
MARTINEZ: The co-pays are too high. You know...
MARTIN: So even though you have insurance...
MARTINEZ: Yes.
MARTIN: You still find yourself hesitating to go to the doctor...
MARTINEZ: And there's...
MARTIN: ...When you need to go because the out-of-pocket costs are still...
MARTINEZ: Yes.
MARTIN: ...Too high.
MARTINEZ: The out-of-pocket cost is too high. The insurance doesn't cover enough where - you know, even though I don't know if you guys could tell, but I have braces, and there's times where it's a battle of, do I go to the doctor, or do I, you know, eat for the next week? And it's just very difficult because, you know, my family is educated. My mother's a teacher. My father works as well. And even though we're not in the low-income classes or anything, there's times where we're making sacrifices that shouldn't really be happening with everything that they've done for us.
MARTIN: Well, thanks for letting me get in your business.
MARTINEZ: No - no, you're fine.
MARTIN: Because, Congressman, this is the question that has come up over and over again on the debate stage and that a lot of people are interested in. The people who say that they support single-payer - how do you bring the costs down? So the question is, how do you with your dual system get the objective that we're looking for here?
O'ROURKE: Yeah. I like that you brought up costs because it's not an inexpensive proposition to guarantee everyone in this country health care - primary health care, prescription medication health care, mental health care - in a state whose largest provider of mental health care is the county jail system right now - reproductive health care so that every person can make their own decisions about their own body and have health care that allows them to do that.
But far more expensive than doing that is the status quo. It costs us $110 to lock someone up who for their schizophrenia or bipolar disorder or clinical depression literally in Texas gets arrested on purpose. And this is not an uncommon thing. It's not right. It's immoral. It's unconscionable. But it's happening in this state. For a fraction of the cost, we could provide world-class outpatient mental health care either through an employer-sponsored health care plan or a Medicare for America plan that we've described where if you're uninsured or cannot afford your co-pays today, you can enroll in that program and not have to worry about a co-pay every time you go to the doctor or to the therapist or to a family planning provider.
MARTIN: Tell me how the arithmetic works, though. Are you saying that bringing more people into your Medicare for America plan will do what? I mean, how does it increase the - how does it decrease the overall costs? Because it seems to me you still have two dual administrative systems - one for private insurance and one for the publicly funded option that you're talking about. So how does that bring costs down overall?
O'ROURKE: When tens of millions of Americans are now able to go to a doctor and don't receive their care on an emergency basis in the ER, when those with mental health care challenges are able to see a therapist or a psychologist or a psychiatrist instead of getting arrested on purpose, we as taxpayers save in the billions of dollars when you look at this over the next 10 to 20 years. You're right. Private insurance has a higher administrative cost - something like 16% compared to Medicare's 2%.
We envision that most of the millions of our fellow Americans who are uninsured today will enroll in Medicare. And that's a saving over private insurance. But I also want to make sure that I'm listening to our fellow Americans, tens of millions of them. Many of the members of unions who fought for health care plans that they like, that work for them and their families - if they want to keep them, I want them to be able to make the choice to be able to do that. And yes, over the long term, this country saves. This country produces better health care outcomes.
MARTIN: OK. But some of your fellow Democratic candidates have identified specific funding streams. They say there's - particularly Elizabeth Warren. She said specifically, a tax on the highest earners. You're not prepared to identify...
O'ROURKE: Yes.
MARTIN: ...A specific funding source for this.
O'ROURKE: Sure I am. If we took a corporate tax rate that under the $2 trillion Trump tax cuts, the benefits of which flowed to corporations, flowed to the very wealthiest in this country - if we took that corporate tax rate that had dropped from 35 to 21% back up just to 28%, we would generate hundreds of billions of dollars over the next 10 years. If we were to tax returns on capital at the same rate that we tax ordinary wage income, the income that is being earned by our server here at L&J, we would generate hundreds of billions of dollars.
And yes, if we were to add a transactions tax on Wall Street transactions, a wealth tax to address the fact that you have the greatest divide in wealth inequality in this country's history right now in 2019, not only would we generate the revenue to be able to pay for these programs - we would also address something that is a threat to our democracy and a threat to everyone in this country - being able to see a future for themselves and their kids in this country. So yes, we can pay for this. And those are the streams that we would look at.
MARTIN: That was Beto O'Rourke, former congressman from Texas running for the Democratic nomination for president speaking with me and undecided voters Connie Martinez and Ruben Sandoval at L&J Cafe in El Paso, Texas. We'll have much more from this conversation this week across NPR programs. And you can find all of the conversations that are part of our Off Script series with presidential candidates at npr.org/offscript.
(SOUNDBITE OF THE WHO'S "BABA O'RILEY") Transcript provided by NPR, Copyright NPR.
