Tag Archives: Medicare For All

How Mainstream News Coverage Distorts the Policy, Politics, and Polling on Medicare For All

Jonathan Martin and Abby Goodnough discuss a brewing Democratic Party debate about Medicare For All in The New York Times. Does it mean a single-payer system in which the government covers everyone’s health care costs? Or is it just rhetoric intended to mean “I support a better health care system” without a commitment to challenging insurance industry power?

Martin and Goodnough helpfully note that only one of the five likely 2020 presidential candidates they discuss* is committed to a single-payer system: Bernie Sanders. But their article is also misleading in its discussion of Medicare For All policy, politics, and polling. Their errors are all too common in news articles and anyone wishing to responsibly cover politics over the next few years needs to correct them.

First, when it comes to the policy implications of Medicare For All, Martin and Goodnough characterize single-payer health care as a system “in which many would lose their current insurance options and pay higher taxes.” They fail to mention that the policy replaces people’s “current insurance options” with more expansive coverage that (under Sanders’ plan) eliminates premiums, copays, and deductibles. As pretty much every distributional analysis of proposed single-payer plans show, the vast majority of people will pay substantially less money in taxes plus health care costs under Medicare For All than they currently pay. The omission of these details is akin to implying Martin should have felt “uneasy” about losing his health insurance options and paying higher taxes in 2013 – without mentioning that he was replacing his insurance and making a higher income by moving from Politico to The New York Times.

sanders-tax-and-transfer-distributional-analysis

Similarly, in an attempt to support Michael Bloomberg’s claim that single-payer health care will “bankrupt” America, Martin and Goodnough cite a study from the Mercatus Center that “predicted [Sanders’ plan] would increase federal spending by at least $32.6 trillion over the first decade.” That study also predicted that combined private and public spending on health care in the United States – the most important number in health care cost estimates – would fall by $2 trillion, but Martin and Goodnough don’t mention that fact. As Matt Bruenig has documented extensively, it’s hard to read the numbers in the Mercatus report as anything other than an endorsement of Sanders’ plan.

Mercatus doesn’t want us to read their study that way, which brings us to the second way in which the Times article is misleading. Martin and Goodnough describe Mercatus as the “Mercatus Center of George Mason University,” giving it the imprimatur of impartial academic institution, when Mercatus is in reality a Right-wing think tank funded by the Koch family foundations. This neutral description is inconsistent with how the Times news pages describe other think tanks – they routinely call my old employer, the Center on Budget and Policy Priorities, “liberal” or “liberal-leaning” – and erroneously suggests to the reader that the concerns Mercatus raises come from an objective source.

Martin and Goodnough fail to provide key context for other political opinions, too. They write about how “moderates believe” that Medicare For All will “frighten” an important crop of general election voters, for example, but don’t note that these moderates have been consistently wrong about what voters care about. If there’s any lesson to learn from the 2016 election result, it’s that people’s beliefs about what makes politicians electable should be discounted – especially the beliefs of people who ignored electability evidence the last time around.

Third, Martin and Goodnough cherry-pick the Medicare For All polling data that makes their preferred case. They acknowledge that the term itself “has broad public support,” but they highlight how support for the policy drops “when people hear that it would eliminate insurance companies or that it would require Americans to pay more in taxes.” A result from the same poll that goes unmentioned? That support for the policy rises when people hear that it would “guarantee health insurance as a right for all Americans” or “eliminate all health insurance premiums and reduce out-of-pocket health care costs for most Americans.” Martin and Goodnough also cite a Gallup poll finding that “70 percent of Americans with private insurance rate their coverage as ‘excellent’ or ‘good’” without pointing out that the number jumps to 79 percent for Americans on Medicare or Medicaid.

What Martin and Goodnough get right is that “attitudes [about Medicare For All] swing significantly depending on…the details.” If you tell people that the policy will result in them losing their current insurance, paying higher taxes, and interacting with a bankrupt federal government, they’re less likely to support it. If you tell people the truth, however – that public insurance in the United States is well-liked and more cost-efficient than private insurance, that other countries with Medicare-For-All-type systems spend way less money while covering a much higher percentage of their populations than we do, and that, under a Medicare For All system, all but the richest among us will get better coverage while paying less than they do today – people are fully on board. We need our news media to start telling the truth.

*Update (2/4/19): Thanks to a reader comment, I updated this sentence post-publication to clarify that the Times did not discuss every likely 2020 candidate. Tulsi Gabbard, for example, may also be committed to a true single-payer system.

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Filed under 2020 Election, Health Care and Medicine, Media, 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 Election, Health Care and Medicine