Tag Archives: single-payer

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

What’s Wrong with the Democratic Party

Two things that happened this week illustrate much of what’s wrong with the Democratic party.

First, Hillary Clinton campaign spokesman Brian Fallon doubled down on Clinton’s commitment, voiced at the last Democratic debate, to avoid any tax increases at all on the “middle class.”  Second, the Service Employees International Union (SEIU) endorsed Clinton for president.

Taken together, these events demonstrate a long-term problem that plagues Democrats and prevents the growth of a truly power-balancing agenda: the prioritization of political opportunism over principled policymaking.  Despite the presence of an increasingly viable progressive alternative, Democrats continue to lean against their own interests in the mistaken belief that it will help them win elections. Then they wonder why we’re stuck with rising inequality and a political system rigged against the majority of the population.

For starters, Clinton’s and Fallon‘s attacks on Sanders’ single-payer health care proposal were wildly misleading.  Fallon cited a scary-sounding statistic about the cost of Sanders’ plan when it would actually save Americans significant amounts of money: taking private insurers out of the mix would lower overall health care costs and thus boost disposable income for most Americans.  Clinton gave a similarly disingenuous description of Sanders’ plan at the debate – she said Sanders would “eliminate Medicare” when he would actually expand it (in fact, Sanders frequently touts his plan as “Medicare for All”).

Fallon is right to insist that “the wealthiest Americans finally start paying their fair share” – higher taxes on the rich could raise a sizable amount of money and are an appropriate first step – but it’s unlikely that policymakers could make the investments America needs without at least some additional contribution from the bottom 96 percent of families, the members of which, at least in Fallon’s mind (see table FINC-07), are all apparently included under the heading of “middle class.”  (It’s also relevant that Sanders, much to Donald Trump’s chagrin, is far more committed to making the wealthy “pay their fair share” than is Clinton, perhaps because wealthy donors bankroll Clinton’s campaign.)

Social Security and Medicare, two of our most important and effective government programs, are financed by payroll taxes that hit the actual middle class, as would be paid family leave legislation introduced by Senator Kirsten Gillibrand (of which Sanders is a co-sponsor).  Complaints about taxes that pay for these sorts of programs are supposed to come from Republicans, not the Democratic frontrunner.  The Clinton campaign’s anti-tax rhetoric obscures the fact that social spending is well worth taxpayer dollars; it lends credence to attempts to gut government revenue sources and slash important programs.

Unions can’t be fans of such rhetoric, as it spells trouble in the long-run for both their members and the disadvantaged populations for whom they advocate.  Compared to Clinton, Sanders also has a much better record and equivalent or better policy positions on just about every issue that unions care about.  Yet the majority of national unions to endorse so far have jumped on the Clinton bandwagon (the exceptions are National Nurses United and the American Postal Workers Union).

Why are unions endorsing the candidate less in sync with their interests?  The most likely reason is (what they believe to be) political pragmatism.  It’s natural to want to be remembered as early allies and to want to be as involved as possible in Clinton’s policymaking process; especially if they believe a Clinton victory to be inevitable, unions may view an early endorsement as the best way to curry favor with and influence the platform of the eventual nominee.

This perspective isn’t crazy; the American Federation of Teachers in particular, the first major union to endorse Clinton, has almost certainly had a hand in Clinton’s “evolving” rhetoric on education policy.  Union endorsements probably also played a role in Clinton’s reversal on the Trans-Pacific Partnership.

At the same time, the unions’ political calculus undermines progressive goals.  It sends a terrible message to both Clinton and the Democratic Establishment: that even in the primary, unions care more about backing the anointed frontrunner than they care about working for candidates who actually fight for their values.  As Glenn Greenwald observed several years ago:

There’s a fundamental distinction between progressives and groups that wield actual power in Washington: namely, the latter are willing (by definition) to use their resources and energies to punish politicians who do not accommodate their views, while the former unconditionally support the Democratic Party and their leaders no matter what they do…Any self-interested, rational politician — meaning one motivated by a desire to maintain power rather than by ideology or principle — will ignore those who behave this way every time and instead care only about those whose support is conditional.

Union support for Clinton is also misguided because Sanders can definitely win both the primary and the general election.  He’s significantly more popular than Clinton among independents, White voters, and young people and has better overall net favorability ratings.  While Sanders is currently much less popular than Clinton among Black and Latino voters, that’s in large part due to a lack of exposure and name recognition.  As Cornel West notes, his support should grow “once Black [and, I’ll add, Latino] people find out who Brother Sanders is.”

This year’s primary election is, in many ways, a referendum on the soul of the Democratic party.  Will the party’s main virtue continue to be what it isn’t (as crazy as the Republicans)?  Or will the Democrats begin to live up to the principles they purport to stand for?  We won’t know for at least a few months, but in the meantime, both the Clinton campaign and union leaders should take a long, hard look in the mirror.

lesserofevils

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Filed under 2016 Presidential Election, Labor, US Political System

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