Tag Archives: health care

Written in 2017, Relevant in 2018 and Beyond

With the year drawing to a close, and because I like lists, I wanted to highlight the ten pieces I wrote in 2017 that I believe remain most relevant for 2018 and beyond.

#10: The Trump administration’s ongoing attack on workers (The Washington Post, August 30)
Donald Trump pledged during his campaign, that, with him in office, “the American worker will finally have a president who will protect them and fight for them.” In this piece, Jared Bernstein and I tick off a multitude of ways in which this promise has turned out, predictably, to be false. The list has gotten longer in the time since we went to press (check out Jared’s recent interview of Heidi Shierholz on how the Trump Labor Department is trying to help employers steal workers’ tips), and it will be important to continue to shine a light on team Trump’s anti-worker actions in 2018.

#9: The Paul Ryan Guide to Pretending You Care About the Poor (Talk Poverty, November 20)
Speaking of the disconnect between Republican politicians’ rhetoric and their actual actions, this satirical piece outlined the way in which Paul Ryan sells his help-the-rich-and-punish-the-poor agenda as the opposite of what it actually is. With the Republican tax cut for rich people signed into law, Ryan has already trained his sights on eviscerating programs that help the poor. Don’t let anyone you know fall for how he’ll spin it.

#8: Why Medicaid Work Requirements Won’t Work (The New York Times, March 22)
Elected officials who share Ryan’s disdain for poor people will likely try to add work requirements to their states’ Medicaid programs in 2018. Here, Jared and I explain why that policy’s main effect is just to deprive people of needed health care.

#7: Seattle’s higher minimum wage is actually working just fine (The Washington Post, June 27)
The Fight for $15 has been incredibly successful over the past few years; 29 states (plus DC) and 40 localities now have minimum wages higher than the federal minimum. Yet the not-so-brave quest some economists and politicians have undertaken to hold down wages for low-wage workers continues unabated, and they jumped all over a June study of Seattle’s minimum wage increase to proclaim that workers are actually better off when we allow businesses to underpay them. A closer look at the study, of course, reveals that it proves nothing of the sort, so keep this rebuttal handy for the next raise-the-wage fight you find yourself engaged in.

#6: Below the Minimum No More (The American Prospect, May 30)
Abolishing sub-minimum wages is the next front in the minimum wage wars; while many jurisdictions have raised the headline minimum wage, most have failed to satisfactorily address the exemptions in minimum wage law that allow businesses to exploit tipped workers, workers with disabilities, and teenagers. It’s about time we had one fair minimum wage for all workers, as this piece explains.

#5: Protect the Dreamers (The American Prospect, September 28)
Republican Senator Jeff Flake claims that he voted for the Republican tax bill after “securing…commitment from the [Trump] administration & #Senate leadership to advance [a] growth-oriented legislative solution to enact fair and permanent protections for #DACA recipients.” In this piece, Jared and I note how a clean Dream Act is the only approach that politicians who truly care about helping immigrants would find acceptable; Flake must be held accountable for supporting it. State lawmakers should also be pressured to take the steps we outline to combat the xenophobia emanating from the White House.

#4: U.S. Intelligence Agencies Scoff at Criticism of Police Brutality, Fracking, and “Alleged Wall Street Greed” (34justice, January 9)
To date, there is at best remarkably weak evidence behind many prominent politicians’ and pundits’ claims about Russian interference in the US election. I read the report that is the basis for many of these claims when it came out in January and, as I noted at the time, it’s almost comically propagandistic. Some Democrats’ disregard for actual facts when it comes to allegations of Russian hacking and “collusion” is troubling, as is the McCarthyite climate in which people who challenge the Democratic Party Establishment are accused of being secret agents of Vladimir Putin. Those who would prefer a more reality-based Russia discussion in 2018 would do well to take a half hour to watch Aaron Maté interview Luke Harding about this topic.

#3: Amen for Alternative Media (34justice, May 2)
An obsession with Russia conspiracy theories is far from the mainstream media’s sole problem. The problem also isn’t a paucity of Republican journalists, as the May/June issue of Politico posited. Instead, as my response to Politico discusses, the mainstream media’s problem is one of subservience to power. Independent media are doing the public a great service by exposing us to information and viewpoints often absent from corporate cable and major newspapers, and it is essential that we fight to protect and promote independent media in the years ahead.

#2: The Progressive Agenda Now: Jobs and Medicare for All (The American Prospect, April 3)
Given Republican control of the presidency and both chambers of Congress, one would be forgiven for urging social justice advocates to focus their energies on policy defense. But that would be a mistake, as Jared and I note in this column, both because the best defense is sometimes a good offense and because, if we want to enact the policy millions of people need, we must lay the groundwork for that policy as soon as possible. There is much more beyond a federal job guarantee and Medicare for All that we have to flesh out and advocate for, but those two big policy ideas wouldn’t be too shabby a start.

#1: We Don’t Need No “Moderates” (34justice, July 29)
Putting the right politicians in power is the prerequisite for enacting most of the policy changes we need to see. Those who tell you that “moderate” or “centrist” politicians are more “electable” than social-justice-oriented politicians are wrong, and there is never a good reason – never – to advocate for the less social-justice-oriented candidate in a Democratic primary. The results of the 2017 elections only underscore this point. It’s time we got to work electing true social justice advocates to positions of power.

Happy reading and happy new year!

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Filed under 2018 Elections, Labor, Poverty and the Justice System, US Political System

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