Tag Archives: health care

Bernie Sanders-Style Health Care Would Be a Big Win for Low- and Middle-Income Americans

Bernie Sanders just released his new proposal for a single-payer health care system.  As former US Labor Secretary Rob Reich notes, Sanders’ plan would be “a huge advance over what we have now.”  Reich’s summary:

It builds on the strengths of Medicare. Like Medicare, it’s universal — separating health insurance from employment, and enabling people to choose a health care provider without worrying about whether that provider is in-network: All they’d need do is go to the doctor and show their insurance card. No more copays, no more deductibles and no more fighting with insurance companies when they fail to pay for charges.

Through a single national insurance system, we’ll no longer be paying for the marketing and advertising of private for-profit health insurers, nor their giant executive salaries, or their complex billing systems. Government will negotiate fair prices with drug companies, hospitals, and medical suppliers.

The plan’s release came right before the fourth Democratic debate and after a week of attacks from the Hillary Clinton campaign, which had been simultaneously complaining about not having plan details and distorting the details of a similar proposal Sanders introduced in the Senate in 2013.  Even those sympathetic to Clinton have labeled these attacks “questionable” or “genuinely strange,” while those willing to more accurately describe her team’s “GOP fear tactics” have noted that they are “wildly misleading,” “flagrantly mischaracterizing,” “mostly false,” “nonsense,” “disingenuous,” “stupid,” and “dishonest.”  Sanders’ plan would expand Medicare, not “dismantle” it; cover more people, not “strip millions” from coverage; ensure that insurance is provided in every state, not “empower” governors to “take [it] away;” and save most Americans lots of money, not “cost” them.

That last point in particular deserves more emphasis, as it’s one about which Clinton appears to have been lying outright.  Speaking to George Stephanopolous about single-payer health care on Wednesday, January 13, Clinton said: “Every analysis that I’m aware of shows it’s going to cost middle-class families and working families.”  Yet I have never seen such an analysis, and every analysis I am aware of says the exact opposite: that most families would gain big from a switch to a Sanders-style health care system (as Sanders explained at the debate, their savings from not having to pay premiums anymore would outweigh any increased taxes they would have to pay to fund the program).

Consider, for example, a 2013 analysis of the Expanded and Improved Medicare For All Act from UMass-Amherst economist Gerald Friedman.  Physicians for a National Health Program called this bill and Sanders’ old plan (which, despite Clinton’s suggestion to the contrary at the debate, is not all that different from his new one) “simply two expressions of the one single payer concept;” Clinton spokesman Brian Fallon agreed that the two bills were “similar” in a recent interview.  As shown in the graph below, Friedman estimated that everyone in the bottom 95% would see their after-tax incomes rise under such a proposal.  Fallon is clearly familiar with this analysis – he selectively referenced parts of it in the interview linked above – and it’s been the most common citation for cost estimates that Clinton herself has used; it’s near impossible to believe that Clinton was not “aware of” it.

Friedman HR 676

Distributional analysis, from UMass-Amherst economist Gerald Friedman, of a 2013 proposal for single-payer health care.

Friedman now estimates that, “[f]or a middle-class family of four with an income from wages of $50,000 and an employer-provided family plan of an average price, the Sanders program would save $5,807, or 12% of income.”  Similarly, the Sanders campaign had previously estimated that his old plan would have saved a typical family between $3,855 and $5,173.  PolitiFact argued that employers might respond to the financing scheme in that plan by reducing workers’ paychecks, but still estimated, even under pessimistic assumptions, that “the average family would save $505 to $1,823 a year.”

There have also been analyses of proposed state-level single-payer health care plans.  A proposal in Vermont in 2001 would have saved an estimated $995 on average for families making between $50,000 and $75,000 a year, while a proposal in California in 2006 would have saved families in that same income range an estimated average of $2,942 (the poorest families – those making less than $10,000 a year – would have saved an estimated average of $608 in both states).

Each of these analyses indicates that Bernie Sanders-style single-payer health care is a major win for low- and middle-income Americans.  It’s theoretically possible that Clinton both isn’t “aware of” any of them and that she and Fallon are sitting on credible analyses that say something different, but I’d give that possibility much lower odds than Martin O’Malley winning the Democratic nomination.  And while Clinton shifted gears slightly at the debate in response to Sanders’ new plan, many of her comments, like the assertions that Sanders would “tear [the Affordable Care Act] up” and that Democrats “couldn’t get the votes for” a public option during the ACA debate, were still extremely misleading.

This conversation about single-payer health care has become a perfect window into the choice facing Democratic primary voters.  After receiving millions of dollars from the health insurance industry, Hillary Clinton no longer supports the type of truly universal health care coverage she backed in the early 1990s.  Instead, she has attacked Bernie Sanders’ support of such a plan with very similar tactics to those she herself decried in 2008 as “right out of Karl Rove’s playbook” (see video below).  These attacks, besides being dishonest, undermine key Democratic values.

On the other hand, Bernie Sanders has a consistent record of fighting for those values.  He rejects money from special interests and believes, as his new proposal reiterates and he said at the debate, that health care is a right that “should be available to all of our people.”  As he also pointed out, the real question isn’t whether single-payer health care is desirable – it’s quite clearly “a pretty good deal.”  The more pertinent question is “whether we have the guts to stand up to the private insurance companies and all of their money, and the pharmaceutical industry.”

Sanders certainly does.  Let’s hope the voters choose wisely.

Update (5/29/16): The Tax Policy Center issued an analysis of Sanders’ overall proposals on May 9.  While headlines have tended to focus on their estimates of how much the plan would increase the national debt – estimates which other analysts sharply dispute – less attention has been paid to the fact that the Tax Policy Center also found, consistent with every other analysis above, that Sanders’ plans would bring large benefits for low- and middle-income families.

Sanders Tax and Transfer Distributional Analysis.png

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Filed under 2016 Presidential Election, Medicine

The Shutdown: Blame Republicans but Watch the Democrats

I wrote an email to my political mailing list on August 21, 2011 entitled “Does the White House have Power?”  At that time, many mainstream Democrats insisted that Barack Obama was an innocent victim of an intransigent Congress, that he ardently supported progressive priorities like a public health care option and higher taxes on wealthy Americans but had little leverage to make those ideas a reality.

Glenn Greenwald thoroughly debunked that claim on several occasions, as my email at that time documented.  I revisit this issue now because the current government shutdown is yet another proof point that the White House has power.  Both the Democratic Party as a whole and Barack Obama specifically exercise that power when they care about policy outcomes.

House Democrats just initiated a procedural motion called a discharge petition to try and end the shutdown without compromising on Obamacare.  The strategy pursued by the White House and Democratic congresspeople during the current Obamacare debate has been not to appease, but to message, over and over again, that fringe Republicans are to blame for the shutdown – Republican demands are unreasonable and unpopular.  Though many journalists predictably pretend that Democrats and Republicans are equally to blame for the shutdown, the majority of Americans recognize the Republicans are at fault.  Obama’s appropriate response to the current Republican demands illustrates that he at the very least could have taken similar action during the original health care debate in the first few years of his presidency and during the “fiscal cliff” debate at the end of 2012.  Instead, as Paul Krugman wrote at the beginning of this year, “he gave every indication of being more or less desperate to cut a deal.”

If Republicans had followed through on their threats in those debates, there would have been some suffering, no doubt.  But there’s suffering because of the current shutdown, and while it’s regrettable, we sometimes may have to stomach short-term loss for long-term gain.  In the current debate, the Democrats are suggesting implementation of Obamacare, a plan originally conceived by Congressional Republicans and the Heritage Foundation in the early 1990s and loved by the insurance industry, is worth this short-term suffering.  And it may be – my dad, who helps lower-income people gain access to health care, likes to remind me that Obamacare should improve the lives of millions of people, which is no small matter.  If that’s your mindset, though, you probably should have supported the Republican plan in the 1990s and you should also probably give George W. Bush and Republicans in Congress some credit for Medicare Part D, which, like the Affordable Care Act, expanded coverage to people who didn’t previously have it while enriching private industry.

Whatever your thoughts about Obamacare, make no mistake about this fact: the White House has power.  Obamacare in its current form is exactly what Obama and the Democrats desired.  By their own admission, the Obama Administration didn’t want a single-payer health care plan that would benefit more Americans to become a reality.  Despite his rhetoric to the contrary, Obama worked hard to keep the public option out of the Affordable Care Act.  He pressured progressives like Dennis Kucinich to adopt a more conservative bill while journalists insisted, when Ben Nelson and Joe Lieberman were holding up a better bill, that Obama was powerless to influence congresspeople.  In addition, Obama never really wanted higher taxes on the wealthy or prosecutions of white-collar criminals who torpedoed the economy; he’s extremely cozy with moneyed interests.  If he actually believed in the progressive ideals to which he pays lip service, we would have seen a lot more of his current messaging a long time ago.

As Greenwald wrote in the summer of 2011, “[t]he critique of Obama isn’t that he tries but fails to achieve certain progressive outcomes and his omnipotence should ensure success.  Nobody believes he’s omnipotent.  The critique is that he doesn’t try, doesn’t use the weapons at his disposal: the ones he wields when he actually cares about something (such as the ones he uses to ensure ongoing war funding — or, even more convincing, see the first indented paragraph here).”  None of the Democrats’ or Obama’s behavior diminishes the Republicans’ responsibility for the shutdown.  But I hope watching the shutdown saga unfold is instructive for people who over the past five years have repeatedly excused the Democratic Party’s poor policy outcomes as the products of a weak office.

Update: The deal the Democrats eventually got provides further evidence that Obama could have done much, much more during the early years of his presidency.

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Filed under US Political System