Pete for America
For Immediate Release
July 20, 2019

VIDEO: Mayor Pete Lays Out His Plan for Supporting Seniors at the AARP Forum in Iowa

ON INCREASING SOLVENCY OF SOCIAL SECURITY:

I have a very personal stake in making sure that Social Security and Medicare are there when you retire and when I retire -- and if you look at the numbers, that won't happen without some adjustments.

At the same time, I think there's a little bit of scare tactics going on to make us think that we have no choice but to trim benefits when actually, if we make some common sense decisions around properly funding Social Security in particular, we will be able to make it sustainable. [...]

For example, if we just elevated the cap on the level of income eligible for payroll taxes from $135,000 to the $250,000 neighborhood, that would go a long way towards sustainability on the Social Security side.


ON LOWERING COST OF LONG-TERM CARE:

I learned about this the hard way when we were sitting at the beginning of this year with the social worker when my dad became very ill. And you know I make decisions for a living but I didn't really understand some of the decisions that you're confronted with until, as so many families are, we were facing this.

And basically the message we got from the social worker was: the best way to make this affordable is to spend your entire life savings so that you are now low income enough that you qualify for Medicaid and then that will pick it up. That is no way to run aging in the most advanced country in the world. [...]

I think there are several things we need to do in order to make it possible for, for care to be affordable but also for people to be able to age with dignity and comfort for as long as possible in their homes...It's things like making sure that we invest in the right kind of public transportation, that we unlock the power of telemedicine to help reach people wherever they are....an intergenerational service corps that could work with seniors on things like installing features that would allow them to stay in their home longer.

That includes making sure that we have better pay in the field: one of the reasons that I support an increase in the minimum wage because so many health care workers are at minimum wage, and there's a crisis of recruiting people to work in long term care. Another thing we have to do is we have to have an insurance system to help manage these costs. I would make it part of my Medicare-For-All-Who-Want-It plan.


ON IMPROVING THE VA:

We know the VA needs work, we know we need to reduce wait times, we know we need to increase accessibility. Actually, the biggest interaction I’ve had with the VA was being part of an effort to deliver a larger clinic to our own community, which did a lot of good. Because you don’t want people to have to drive hours to get basic care, which is why I think it’s fine for there to be some measure of choice to, you know, get a prescription filled or something if you got the sniffles.

But fundamentally, we cannot move down this road of privatization that would leave the VA unrecognizable relative to what so many veterans count on, even as we know we've got to fix it and improve it.

 
ON MENTAL HEALTH:

Well first of all, we have got to break the silence on mental health, and it's starting to happen, but we've got a long way to go. And it starts at the top. I mean some of this is a policy question, making sure we have actual mental health parity in coverage, whether we're talking about the VA or whether we're talking about the health insurance system more broadly, but a lot of it is just the way we talk about these things. [...]

So maybe we say that you can get coverage for mental health, but you can't find a provider where you live. Until we fix that, with adequate resources and a culture that says it's OK to talk about this and necessary to deal with it, we are going to continue to see struggles -- especially in communities where providers are so sparse.


ON AN INTERGENERATIONAL ALLIANCE:

I had the unique experience of being mentored in many ways by people who I had also hired. And the diversity in many ways including age in our administration made it a more effective administration. [...]

And what I think is so remarkable now is a lot of issues where there's very strong generational energy in the activism...The remarkable thing is whether it's that youth-led movement or the Women's March or others, as I see in the pictures from before, young people taking to the streets. But instead of them going out there to fight their parents and grandparents, a lot of times I see their parents and their grandparents at their side cheering them on. [...]

And I think we need to build that in the moment we're being divided and wedged off against the other in so many different ways.


ON NEGOTIATING DRUG PRICES:

By the way, when I talk about the government's negotiating power I don't only mean Medicare, I also think that private payers should be able, if they want to, to have the Health and Human Services Secretary empowered to conduct those negotiations.

And, when you get to the really extreme cases of pharmaceutical companies misbehaving -- I mean in ways that are really just putting the squeeze on people, seniors or otherwise, who are just trying to get through life and are forced to choose between basic necessities and life-saving medication, or cutting back on dosage because it's unaffordable -- when it reaches a certain point where it's clearly abusive, then we have to have a government empowered to act on that.



Full transcript below:


Question: My name is Nancy Wright. I am an educator at a public school, nearing retirement. My husband and I both have preexisting health conditions and we want to make sure Medicare and Social Security will be there for us and others when we retire. What are your plans for protecting our Social Security and Medicare?


Pete Buttigieg: Terrific. Well first of all, thanks for choosing a career in public education. I married an educator, so I get an education about education every day, and it's really important work. And I have a very personal stake in making sure that social security and Medicare are there when you retire and when I retire -- and if you look at the numbers, that won't happen without some adjustments. At the same time, I think there's a little bit of scare tactics going on to make us think that we have no choice but to trim benefits when actually, if we make some common sense decisions around properly funding Social Security in particular, we will be able to make it sustainable. Again, not only for when you retire, but when I do as well, and beyond. For example, if we just elevated the cap on the level of income eligible for payroll taxes from $135,000 to the $250,000 neighborhood, that would go a long way towards sustainability on the Social Security side. The Medicare side is a little bit of a different picture because the reality is, we just won't get there without also figuring out a way to lower costs. But in a country that spends more of its dollar on bureaucracy relative to patient care than pretty much any other developed country when it comes to health care -- and doesn't have the results to show for it -- we know that we can do more about containing costs without reducing people's access to care if we undertake measures that range from more of a public health approach to deal with the conditions that drive health before you even get to the doctor's office, plus making sure more people have access to health care coverage to begin with, which is why I believe we need to move towards universal health care, and making sure that we do some of the maybe less glamorous work under the hood to make the system more efficient. But if we take those steps, as well as making sure that those who are in the best position to be able to afford to contribute do so, we should be able to enjoy the current or better levels of benefits from Social Security and Medicare for a very long time. Thank you.


Question: Mr. Mayor, you said you support a public option under the Affordable Care Act. What would be the role of public insurance under your plan? Roughly 180 million people still have private insurance. How does your plan treat them?


Pete Buttigieg: So, my expectation is that a quality public plan -- I would call it Medicare-For-All-Who-Want-It. So you take a version of Medicare, you put it on the exchange, and you make it available for people to buy into if they want to. My expectation is, that's not only going to be expanding availability of coverage, but it's actually going to be better. It's going to be cheaper. And the reason I believe that is, if you look at different developed countries, ones that have that kind of robust public involvement, have more cost effective care than we do. And so it is a chance to demonstrate that that public option will provide the kind of efficiencies that we were just talking about. It's also one last dare though, to the corporate world, to come up with something better than they have. If they do, great. I'm not counting on it. And so I think what will happen overtime is that this will become a very natural glidepath toward a Medicare for All environment -- not by flipping a switch and banishing the private sector, but just by putting something better on the table and letting people figure it out for themselves.


Question: How long do you think that process takes?


Pete Buttigieg: Long enough that we are going to have to undertake cost cutting in the years through that transition. It's not going to be a two year thing. But that's OK, because more and more people will see that they've got options. And if you're not in a hurry to get rid of what you've got, that's fine with us.


Question: And Medicare Advantage, Medicare Part D, both covered by private insurers under the Medicare umbrella, do you continue with private insurers for those sort of supplemental plans?


Pete Buttigieg: Only if they can deliver in a way that is better than what we can provide on the public side. But it's a good example of why -- and again, there's a little bit of politics going on around this, just a little right (laughter), the truth is, even in countries that do have something like Medicare for All, or something much further, which we're not proposing, like outright socialized medicine like they have in England -- even there, there's still a private sector. There are still private clinics and private insurance. This is not about abolishing a huge part of the American economy. This is about how to make sure that we can get coverage and care without leaving Americans to the tender mercies of the for-profit system.


Question: Let's talk about the more immediate future and the already existing Affordable Care Act. Until you get this ramp going, do you increase the subsidies?


Pete Buttigieg: We should, because again, we can't wait to get all the way to where we want to go to make sure more Americans are covered. But look, it's not just a matter of increasing the subsidies. The Affordable Care Act is under attack. This is very personal for me, my mother in law gets chemotherapy that her life depends on -- it's for skin cancer, the thing looks like a tube of toothpaste, but it costs thousands of dollars for every treatment -- and they've got a mom and pop landscaping business, so there's no way she would have health insurance without the Affordable Care Act, and this president, this administration, they are doing everything that they can to undercut it. And so first of all, it's do no harm. Let's stop taking apart the foundations of the ACA, then let's fortify it, but let's not let it be an excuse for inaction on the bigger project of extending health care to all.


Question: One of the previous candidates who participated in this forum said, “If the party embraces Medicare for All, Republicans will paint us as socialists, and it will doom the party’s chances in 2020. You’ve mentioned the discussion among Democrats, do you have that concern?

 

Pete Buttigieg: So, my position is a little more moderate because I think it’s the right thing to do, but here’s my take on the politics of it. If we adopt a platform that’s way out to the left, they’re going to say we’re socialists. If we adopt a more moderate or conservative platform, they’re going to say we’re socialists, so we might as well just do what we think is right, make the case for it, and then let them do what they want.

 

Question: Have you ever, as a veteran, have you ever used the VA health system? What was your, if so, what was your experience?

 

Pete Buttigieg: No, but I have used the military health care system and it was excellent. Everything from getting a dental situation fixed with remarkable speed, like, I told the doc something was wrong and I had something a couple weeks ahead, coming up in a couple weeks ahead with my civilian dentist, and 40 minutes later I was a little sore and I was walking out of there and the problem was fixed. I didn't know what happened to me exactly but... (laughter). So, look, the idea of the VA system is that there are some things that, first of all, this is not a gift, this is a promise. This is America keeping a two-way promise that was made between someone who made that commitment to the country and the country making that commitment back. Secondly, different wars have different wounds, and we, just as a country, wouldn’t know what we now know about Agent Orange, or about traumatic brain injury coming out of things like the Iraq War, if it weren't for the specialized care that only the VA is able to deliver. We know the VA needs work, we know we need to reduce wait times, we know we need to increase accessibility. Actually, the biggest interaction I’ve had with the VA was being part of an effort to deliver a larger clinic to our own community, which did a lot of good. Because you don’t want people to have to drive hours to get basic care, which is why I think it’s fine for there to be some measure of choice to, you know, get a prescription filled or something if you got the sniffles, but fundamentally, we cannot move down this road of privatization that would leave the VA unrecognizable relative to what so many veterans count on, even as we know we've got to fix it and improve it.

 

Question: And the mental health aspect of, especially the current wars, is severe. How, is the VA doing enough to deal with that? And how do you manage with the severe mental health issues in the civilian population?

 

Pete Buttigieg: Well first of all, we have got to break the silence on mental health, and it's starting to happen, but we've got a long way to go. And it starts at the top. I mean some of this is a policy question, making sure we have actual mental health parity in coverage, whether we're talking about the VA or whether we're talking about the health insurance system more broadly, but a lot of it is just the way we talk about these things. Because the reality is, every family is impacted -- I mean, we're talking about something that will affect one in four, one in five Americans in their lifetime. And while sometimes we put parity on the books, it's not actually happening in reality. So maybe we say that you can get coverage for mental health, but you can't find a provider where you live. Until we fix that, with adequate resources and a culture that says it's OK to talk about this and necessary to deal with it, we are going to continue to see struggles -- especially in communities where providers are so sparse.

 

Question: You mentioned that twenty-something and thirty-something Americans really don't have confidence that the Social Security system may be there when they reach retirement age. Would you consider raising the retirement age because people of those cohorts are living perhaps longer than the current generation?

 

Pete Buttigieg: I don't think that's the answer. We can, again, if we choose to, fund a Social Security system that is sustainable and that will be there for us--

 

Question: By lifting the cap on income?

 

Pete Buttigieg: For example. Now that being said, I think we should take a bigger look at how we organize benefits, from retirement savings to, beyond Social Security, employer based retirement savings, to vacation, family leave, sick leave -- all of these things -- because we are still designed around the idea that you could have one employer for your whole career. And for my generation, or folks younger than me, we're likely to change professions more often than my parents changed job titles. And so it makes less and less sense to have anything, from health insurance to the way you get your vacation paid, organized around the idea that you're going to spend your whole career in one place.

 

Question: So then do you create a government system whereby the employee and the employer contribute and then it's portable wherever you go-- does then, the government manage that money?

 

Pete Buttigieg: Yes, I believe it works better if the government offers to house it, but there has to be an employer and employee contribution. And stay tuned for more-- as the youngest candidate in the race, I am actually excited to be the one talking a lot about retirement, so we'll be sharing more on how we view that in the future. But you mentioned that word portable, and it's so important because people are moving around between employers. And I would also add to the word portable, the word prorated. And what I mean by that is, you know, if you're driving Uber 7 hours a week and that's part of how you put together a living, then 7 divided by 40 ought to be how much that helps with your retirement and your vacation pay. And we haven't gotten there, but we are going to have to quickly if we want our benefits system to keep up with where the economy is headed.

 

Question: You're on the record, I believe, as supporting allowing Americans to import prescription drugs from other countries. How do you ensure the safety of those products, given that there's been some high profile cases of legitimate pharmacies having to pay multi-million dollar fines for importing basically fake drugs?

 

Pete Buttigieg: Well, I believe the FDA is up to the task if we are committed to supporting the FDA in its enforcement capabilities. I mean, right now, far too many of our agencies are run by folks who don't seem that serious about holding industry accountable, right? I'm being diplomatic here. And yet, I'm absolutely convinced that a country that has delivered the standard of consumer product safety that we expect, can apply that to things like imported drugs.


Question: Are there other ways that you would look at to try to reduce the cost of prescription drugs?


Pete Buttigieg: Absolutely. First of all, and I'm guessing there's not much daylight among us Democrats running for president on this, but just in case it's not clear that I believe this: the government should be able to negotiate drug prices with drug companies. So I think that's important. I think we do need a cap on out of pocket expenses and we require to that. By the way, when I talk about the government's negotiating power I don't only mean Medicare, I also think that private payers should be able, if they want to, to have the Health and Human Services Secretary empowered to conduct those negotiations. And, when you get to the really extreme cases of pharmaceutical companies misbehaving-- I mean in ways that are really just putting the squeeze on people, seniors or otherwise, who are just trying to get through life and are forced to choose between basic necessities and life saving medication, or cutting back on dosage because it's unaffordable-- when it reaches a certain point where it's clearly abusive, then we have to have a government empowered to act on that. That's including being able to use our power to look at the intellectual property that's behind that in cases of extreme abuse and use that as a way to get them to the table for the kind of arbitration that I think will actually lower prices.


Question: And what do you make of the argument that those kinds of things, especially the patent restrictions, would chill innovation that insurance companies are not going to be put as much money into research and development? Not insurance companies, pharmaceutical companies.


Pete Buttigieg: Yeah look, I support-- if you invent a wonder drug I want you to be rewarded for it. And a lot of experiments don't work out, and that's one of the reasons why you use the profits from the drugs that work well to cover the costs of all the things that didn't work out. That's fine, but look at the rate at which profits have grown and look at the rate in which investment in research has grown. Guess which one's higher. It's the profit line. This is not about saying you can't make a profit. This is about saying you cannot harm people unnecessarily by manipulating the patent system like making a little cosmetic change that isn't even real and then saying, "ope, we've got to start the clock all over on the patent." It's in cases of abuse that we need that kind of enforcement power.


Question: I want to move on but just one really quick question. Should the federal government be in the business of manufacturing generic medication?


Pete Buttigieg: Potentially. There are certainly cases where it seems that the private sector cannot deliver quality, affordable drugs. And usually when we talk about a public option we're thinking about the public option for insurance, but if we zoom out and think about it we've got public options on lots of things in this country. A library is a public option. A community run swimming pool is a public option among different ways you could get access to a swimming pool. And we should think a little more broadly about where public options are appropriate in order to fill some kind of gap, some kind of hole in the market that is working well in some areas but not in others.


Question: Pew Center research indicates that the younger you are, the more you support the legalization of marijuana. Would you as president have the FDA I guess legalize the sale of medicinal marijuana in the corner pharmacy? Would you legalize it for recreational purposes?


Pete Buttigieg: I would. And while it's true that a lot of this is viewed as a young person’s issue, if you look at the average age of those who rely on medical cannabis it's actually I believe in the 50s.


Question: In Iowa it's currently 57.


Pete Buttigieg: Ok. So I think that tells you something. And I don't do this lightly. I don't recommend smoking anything, but not only are there important medical uses, but we've just hit the point as a country where there are a lot of offenses, including I think a lot of nonviolent drug offenses, where the way we responded to it, the incarceration, is actually doing more harm to society and costing us more than the offense itself did. It's not about saying everything is-- it's not about ignoring public health consequences and questions around things like the use of marijuana, it's about asking whether we've made the right set of choices as a society to help make ourselves healthier and better off. And when it comes to American drug policy, I don't think anybody can look at it and say that it's working well. And when you add to that the racial disparities around the way it's been applied, we clearly have to undertake a very deep redesign of how we think about this and many other drugs.


Question: How does your health care plan deal with the significant, I mean sometimes back breaking costs of long term care? It could be as much as $100,000.


Pete Buttigieg: Well, I think there are several things we need to do in order to make it possible for, for care to be affordable but also for people to be able to age with dignity and comfort for as long as possible in their homes. Some of this is actually separate from what we would call a long term care system. It's things like making sure that we invest in the right kind of public transportation, that we unlock the power of telemedicine to help reach people wherever they are. I've proposed a national service program that tries to create the same bonds that I got to from military service with other Americans but without having to go to war to get them. So the idea is to create a million opportunities for service so that it became just the norm where you graduate high school and first thing you do, whether you're going to college or going into the workforce, when you're applying the first question you get is about your service year. And what that has to do with this is one of the elements of that would be an intergenerational service corps that could work with seniors on things like installing features that would allow them to stay in their home longer. But there's also no question that we've got to be able to deal with the long term care system. That includes making sure that we have better pay in the field: one of the reasons that I support an increase in the minimum wage because so many health care workers are at minimum wage, and there's a crisis of recruiting people to work in long term care. Another thing we have to do is we have to have an insurance system to help manage these costs. I would make it part of my Medicare-For-All-Who-Want-It plan. You would be able to have that kind of coverage. And I learned about this the hard way when we were sitting at the beginning of this year with the social worker when my dad became very ill. And you know I make decisions for a living but I didn't really understand some of the decisions that you're confronted with until, as so many families are, we were facing this. And basically the message we got from the social worker was: the best way to make this affordable is to spend your entire life savings so that you are now low income enough that you qualify for Medicaid and then that will pick it up. That is no way to run aging in the most advanced country in the world.


Question: In reading through your national voluntary service program it appears that you would give people the opportunity to expand broadband service.


Pete Buttigieg: Yes.


Question: Do you think there is additional regulation of the industry necessary in that many Iowans who have access even to high speed aren't buying it because it's too expensive?


Pete Buttigieg: So this is another example of, when I said earlier I'm a fan of public options in more than just health care-- a friend of mine who is the Mayor of Chattanooga, Tennessee found that there was a similar issue in terms of access to broadband in his community. And so they just set up a municipal option. And the remarkable thing about the track record of these is the, when that's on the table, the private operators wind up becoming a lot more competitive in their pricing when they've got that kind of competition. And so yes regulation may be part of the answer but I think competition may be the better part of the answer and we should look at what that can do to deliver broadband to areas where it's either not available at all or not affordable for too many.


Question: There are millions of Americans who are fighting for equal rights in various ways. The age discrimination has been illegal for a long time and yet it's one of the more prevalent types of discrimination face in the workplace. If you're president what do you do to make sure people have equal opportunity in the workforce no matter how old they are?


Pete Buttigieg: I do think we need to beef up the enforcement of those provisions. I don't think an employer ought to ask how old you are when you're applying for employment. Age bigotry is real. It doesn't get talked about as much.


Question: They don't have to ask really do they? I mean it's pretty easy to find out.


Pete Buttigieg: But the point is they should be able to demonstrate that is not impacting a decision. And in our, in my administration, well I came in very young so it was inevitable I guess that many of the people who, senior people who reported to me were also considerably older than me. And I had the unique experience of being mentored in many ways by people who I had also hired. And the diversity in many ways including age in our administration made it a more effective administration. And we're trying to do the same thing in my campaign. And that extends to the whole alliance of supporters we're trying to build. It's intended to be a generational alliance because, you know I saw a friend of mine joke the conditions our country is living in right now is like God punishing our generation for ever telling our parents we were jealous that they got to live through the '60s. But the '60s was characterized by generational conflict, right? And what I think is so remarkable now is a lot of issues where there's very strong generational energy in the activism-- I'm thinking for example of the March for Our Lives and the way young people have taken to the streets to ask the generations in charge, basically say, "you've got to do more to keep us safe." The remarkable thing is whether it's that youth lead movement or the Women's March or others, I see as I see in the pictures from before, young people taking to the streets. But instead of them going out there to fight their parents and grandparents, a lot of times I see their parents and their grandparents at their side cheering them on. And it's really an inspiring thing-- really important thing to see. And I think we need to build that in the moment we're being divided and wedged off against the other in so many different ways, I think we have a chance to model something completely different, and obviously I'll seek to do that in my administration, but I hope that voters will observe that I'm also doing that in the way that our campaign works.


Question: Ok, would you like to take your remaining time to wrap up?


Pete Buttigieg: Sure, and I see from the little iPad there that I have about 20 seconds left so I'll try to respect the limit.


Question: You can go.


Pete Buttigieg: Let me just, first of all thanks so much for your work and for the opportunity to be here. I'll just close by saying what I might have said if there were an opening statement which is to explain what I'm doing, because this is admittedly not a traditional candidacy. The reason I'm running is that I think we're running out of time to do things differently. And the choices we're going to make right now I believe will decide what the next 30, 40, 50 years are going to look like. There are these moments that come along once in a while in history and I think we're in one of them; where on everything from climate to immigration to retirement to our economy to just the way we treat each other, the choices we're about to make now are going to decide how we handle these changes happening around us. The changes are happening with or without us. The president's message, Make America Great Again, is trying to get people to believe that you can just stop all of the changes that are happening. It doesn't work that way. The political, social, economic, technological changes beneath our feet are only getting faster. The question is: can we master those changes before they master us? And I believe we can. And the well being of my generation depends on figuring out how we can. But again, what I see in our campaign and what I'm so thrilled to be building is a generational alliance to get those solutions in place before we lose the chance. And I'm asking Iowans and I'm asking everybody who cares about where our country is headed to join me on that path. And I hope we'll have a chance to see you more on the trail. Thanks so much.