Because I am a Hillary Clinton supporter, endorse her position on health care, and believe that a single-payer health care program is both unattainable and a distraction, several political allies have pronounced me no longer sufficiently progressive, or even unworthy of calling myself a progressive. Somewhere along the line, being progressive has apparently become synonymous with being for single-payer health care, rather than for universal health care. In fact, single-payer is a but one of many ways to achieve universal health care coverage, but it is not a necessary prerequisite. Let me be clear, if we were creating a health care funding plan from scratch, single-payer, or maybe even a national health insurance system like the UK, would definitely be the way to go. But we are not creating a health care funding system from scratch. And Vermont’s failed attempt to create a single-payer plan, in probably the most hospitable state in the nation, should be clear evidence of how difficult if not impossible it would be to create a national single-payer system.
When Bernie Sanders rightly criticizes the U.S. for not having universal health care while the rest of the developed world does, he is absolutely correct. But when he implies that that is because the U.S. does not have a single-payer system, he is absolutely wrong. Many countries with universal health care have achieved that without a singly-payer system. Some facts from obamacarefacts.com:
Germany, for instance, has more than 150 “sickness funds.” The Swiss and Dutch health systems look a lot like ObamaCare’s health-insurance marketplaces. In France, about 90 percent of citizens have supplementary health insurance. Sweden has moved from a single payer system to one with private insurers. It is worth noting that all these countries pay vastly less for drugs, surgeries or doctor visits than Americans do.
Interestingly, Bernie Sanders, on his website, calls his plan “Medicare for All” and promises that, under his plan, there will be no more premiums, co-pays, deductibles, or coverage limits. People on Medicare, however, actually pay Part B premiums, co-pays, and deductibles, with substantial coverage limits, and most people who can afford it also have supplemental Medicare plans for which they pay premiums. So Bernie is promising a plan that is far richer than Medicare. I just don’t see how the math will add up, and neither apparently does Bernie Sanders — for example, his initial plan envisioned savings of $324 billion on prescription drug costs when nationally, in 2014, we paid only $305 billion for those costs.
In my view, the Affordable Care Act has been one of the great achievements of the past 50 years. According to the CDC, the uninsured rate is down to 9%, from 14.4% in 2013 before the ACA took effect. 16.3 million more people have health insurance today than in 2013. Yes, something like 10% of Americans still do not have health insurance, as many as 29 million people, and many people with health insurance do not receive the health care that they need due to high co-pays and deductibles. And health care costs are still too high, although the ACA has reduced the increase in health care costs to the lowest rates in over 50 years. The ACA is a towering achievement, but much more needs to be done. When you compare the ACA to other Democratic achievements, however, like Social Security, there are plenty of similarities. Large groups of workers were initially excluded from Social Security — for example, domestic workers, farm workers, employees of non-profits, and the self-employed. Additionally, survivors did not receive benefits until 1939, disability benefits only became available in 1956, and there were no cost of living adjustments until 1975. Social Security is not just one of our proudest Democratic achievements, it is also a model of how we create social change and make improvements in peoples’ lives. Neither Rome nor Social Security was built in a day.
But the plain fact is that a single-payer health insurance plan has zero chance of getting through Congress. In fact, Democrats in the House have no ability to advance such a plan, and, should Bernie Sanders win the Presidency and leave the U.S. Senate, the Senate will have lost its only single-payer advocate. So it’s a pie-in-the-sky proposal, which, given the alternative, is not so bad — just imagine going back to 2009 and the horrible debate that we had about the ACA — death panels and the government takeover of health care, and how that energized the right-wing, gave birth to the Tea Party, and caused the loss of Democratic control of both houses of Congress. And it is so distracting when we could be talking about real changes to the ACA that would get the U.S. closer to universal health care coverage — like letting states create a public plan, allowing people to opt into Medicare at the age of 55, and letting Medicare use its bargaining power to negotiate prescription drug costs. The whole single-payer proposal at this time is not just a pipe dream — it is a distraction from the real work that we need to do to improve health care in this country.
To the extent that progressives define universal health care as single-payer health care, we are diverting attention from what can and will work — defending, improving, and expanding the Affordable Care Act. Being a progressive should be about getting things done, making peoples’ lives better, and creating a more perfect union. On the issue of health care, a progressive should be someone fighting to get to universal health care and not just someone who believes that it is only possible through a single-payer plan. Hillary Clinton and Bernie Sanders both meet that definition — I just find Hillary’s plan more realistic and attainable
Just wondering — is there anyone on BMG willing to give me back my progressive credentials?
Hillary has never been clear about what “expanding on/strengthening the Affordable Care Act” means to her. The ACA was never designed to achieve 100% coverage, and many people who gained health insurance through it are underinsured. That doesn’t mean it ‘s not a step forward, but there’s just a long way to go. I feel like I heard it mentioned once that Hillary supports a public option, but she rarely talks about it.
Bernie Sanders sees single payer as a goal. It’s not going to happen over night. He recognizes this. He’s co-sponsored legislation to address some of the remaining issues within the system (https://schakowsky.house.gov/press-releases/schakowsky-and-feinstein-introduce-health-insurance-rate-review-legislation1/) as well as challenging the system itself.
Until Democrats can take back the House (with votes to spare) and the Senate (with 60 votes, unless they plan to use reconciliation), an fix that Hillary proposes worth being called a “fix” will have the same 0% chance of passing as single payer does. So why not set the higher goals? Setting higher goals changes the terms of debate. It’s better to playing offense than defense, and so far Dems have only ever played defense at the ACA (and they often aren’t that good at it).
never once in all of Hillary’s attacks on Bernie, and assurances that she wants to “expand” ACA, does she explain a single solitary idea that she has to do that.
Does she want to increase subsidies, making it more attractive for people to purchase insurance? Does she want to increase the threshold that people would be eligible to claim subsidies, addressing the ‘donut hole’ of people who are too ‘rich’ to be eligible for subsidies, but too poor to afford insurance? Does she want to use some carrot/stick approach to get the red states that have denied the Medicaid Expansion to actually agree to it?
We don’t know, she doesn’t say.
When she finally decides to talk about these ideas, will she be answering the same questions she keeps trying to bash Bernie with re: single payer? IE, How does she plan to fund any of these ideas? How would she get them through a recalcitrant Congress? How would she expand the ACA without having to worry about Republican Governors? How could she tackle these questions without opening a contentious debate on health care?
We can’t even begin to guess, until she actually says what she wants to do.
We’ve had multiple debates where she could have chosen to express her plans, and explain her alternatives to single payer, but she hasn’t done it.
She’s made plenty of grossly misleading attacks that make it seem as if Bernie wants to take people’s health care access away, or would want to tax people to death, but she hasn’t actually had anything substantive to say about what she wants to do.
It makes you wonder if she has any plans to make health care better at all.
Soundbite solutions are attractive. In this case I happen to support what seems to be the simpler solution. Meanwhile her plan is here, which seems to focus on affordability which by definition expands access.
That’s the plan she’s offering while attacking Sanders’s plan as not specific?
That doesn’t address anything ryepower brought up.
Ok. How?
you and ryan have both been exposed. That’s the post.
You should ask that question to Sanders.
But Clinton has been clearer on an incremental path. I haven’t heard any specifics from Sanders. Listen to the debates, when asked for specifics Sanders just repeats generalities about inequalities. No answer. It disturbing to me that he still hasn’t provided anything of substance in his campaign.
Single Payer:
https://berniesanders.com/issues/medicare-for-all/
General spending plan:
https://berniesanders.com/issues/how-bernie-pays-for-his-proposals/
I actually think the Bernie healthcare page is not much more specific than Hillary’s. It’s got a lot of justification and not a lot of plan.
I do want to point out that many of Bernie’s proposals are well documented as actual bills he has introduced in the senate.
I think it is significantly more specific. One of the fundamental differences is that what a single payer plan is is known – the real issues are paying for it (which is described) and implementing (which is basically impossible in the current congress and industry control, and that is an area of profound weakness). “Expanding the ACA” is much less clear and also calls for much more specific clarity.
On the healthcare issue, I just think the meme about Sanders having no specifics and Clinton having a very specific plan does not hold much water.
The charges about whether the plan is realistic or politically or economically feasible are very strong and totally valid (and also a good area to keep hammering), but it’s much easier to understand what Sanders’s plan is given what has been released than what Clinton’s plan is.
isn’t actually being clearer. And whether you’re happy with the level of detail in Sanders’s plan that he’s posted online, and how he plans to pay for it, he gives us a vision of what he wants and how he wants to get it done.
Not a complete plan, but a vision — and I haven’t seen anything that give us a sense of the vision of Clinton’s incremental path, even on basic possible items like I’ve mentioned above. Nada, zip. That doesn’t really bode well for a candidate we’re to believe is serious on this issue.
As someone who works by contract and is technically self-employed, this stuff effects me more than almost anyone else. So I want these details. I’ve had to go without insurance post ACA from time to time because of holes in the program that effect millions of people like me, and let me assure you — it’s terrifying.
Simply saying things like “We need to get rid of the donut hole, for those who can’t afford insurance” or “We need to increase subsidies, so more people eligible for them choose to buy” or “We need to take a carrot and stick approach to get red states on board with Medicaid expansion” would suffice.
I’d even take zero-specific lines, like “I’ll be tough on Governors, making them agree to the Medicaid expansion.”
Really, just anything to get a sense of what she actually wants to do, because for the life of me I don’t even know.
in my title heading, in case anyone was confused.
Personally I do favor single-payer as the most morally and financially sustainable system, but I too am a Clinton supporter and understand where she is coming from. (Doesn’t yellowdogdem suggest you’re OK with any Dem over a GOPer? I keep forgetting whether that describes yellow dogs or blue dogs.)
Yellow Dog Dem is a term that originated in the South for voters who, it was said, would vote for a yellow dog before they would vote for a Republican.
So Blue Dogs is a reaction to that? I know it has some relation to the painting, but is it also an update of Yellow Dog?
PS. I never liked those guys. Though Gary Condit was the first time I ever heard of them, so maybe he’s not the best case study.
As I recall, the Blue Dog Dems were a conservative reaction to the “liberalism” of the Bill Clinton presidency. Yellow Dog Dems go back a long way, to when the South was securely Democratic.
It’s a play on he southern origins of yellow dog and because the founder Billy Tauzin (later a Republican defector) had paintings of blue hounds in his office.
Many (most?) later switched to being Republicans. Rep (later Sen) Phil Gramm of TX being the most notable.
The politicians weren’t willing to create a plan that would force drug companies to cut their prices, or force doctors and hospitals to charge reasonable rates for things like MRIs.
You’re right — single payer will be very expensive if the single payer plan is specifically banned from negotiating down costs and taking the greed out of the system.
But that’s not because we can’t have single payer in Vermont or the rest of the 49 states in this country, that’s because we can’t have single payer in Vermont or the rest of the 49 states if our politicians act with cowardice, refusing to stand up to the powerful, moneyed, special interests.
An additional problem that states face in trying to implement a single payer plan is funding it in an age of employment with cross border workers.
A progressive single payer system relies on a mix of progressive income taxes and sin taxes (alcohol and tobacco). When former Rep John McDonough made a valiant and remarkable attempt around 1992 to bring single payer to MA, there arose the problem of how to deal with people who worked in MA but lived in NH. Their income is taxed by MA but they would not be eligible for a state single payer plan. Given the vagaries of the 50 state ‘laboratories of democracy” that is at the core of our federal system, it is difficult to reconcile how cross border residents and workers can be incorporated into a single state plan.
Two starker examples of this difficulty are found in DC where most employees live in MD and VA, and in NYC, where many commute in from CT and NJ.
And then there are the problems caused by a federal protection racket for drug manufacturers and shipping controlled substances using the federal mail.
Nobody should blame little Vermont for not making single payer a raging success. The deck is stacked against them and every other state trying to do the right thing.
What makes health care so expensive in this country is two factors.
First the power of private for profit insurers to cherry pick patients, and then charge exorbitant premiums still with remaining deductibles, co-payments, and co-insurance. The other is a complex bureaucracy to handle multiple forms of plans. Blue Cross for instance has thousands of different policies depending on the subscriber.
On a few private occasions tried to cover Medicaid patients, but handed it back to state government because they could not make it work. Medicare became a reality because they are the hardest group to insure and make a profit. I am not opposed to private insurers being used, but they would have to follow strict rules, and be non profit. This is the German model.
However Medicare already exists, and it would the most efficient way to cover everyone. Besides taxes already pay for 65% of medical expense. How? If you add up Medicare, Medicaid or other state health programs, private insurance paid to government employees on all levers, and the VA, this adds up. That 65% is enough to get the job done. It would mean shifting tax revenue to a single entity and get broader coverage, lower drug costs, and no extra fees to pay.
Every developed country has achieved this in some form. There is no reason why it can’t be done here once the advantages are explained properly. Letting private companies run amok and saying the public be damned has to stop. Hillary is all about using private insurers without using the regulations necessary to prevent overcharging.
You should also know that all countries that use private insurers are non profits. Health insurance is used as a come on to sell their other products or specialty upgrades to their insurance. Basic policies are set in price, and must include certain services. The central government supplies the money for these policies, meaning this is really still a tax based program.
The Vermont plan failed because it was not a single payer. Several insurers were left retaining the bureaucracy that was at the nut of the problem. Drug pricing was also not attended to. To get a better picture of this failure it is explained here: http://goo.gl/5Ij2Ih
that Canadian Medicare is administered province by province which is how it originated in Saskatchewan. However there is a strict set of rules what each province must follow. Physician and other medical providers is negotiated province by province also.
But what all these plans have is a central payer that covers everyone with comprehensive coverage. The ACA fails in this regard, and its pricing structure is out of line with an efficient system.
I’ll stick with Bernie. What has happened to turn Americans’s “can do” spirit into “cant’s do” Americans.
I would also like to correct a few grammatical mistakes: the “is” should be “are”.
3rd paragraph–should be “On a few occasions private insurers….”
Just a couple of responses to your reply. I believe that the ACA has addressed the cherry-picking issue by something called guaranteed issue, where everyone gets the same insurance costs regardless of health status or demographic factors. And in Massachusetts, where health care costs may be the highest in the country, almost all of our insurers are non-profit.
I think that it is more our high cost of health care, rather than private insurers, that is driving up our health care spending. A single payer system is probably the best way to control costs because the single payer would have enormous bargaining power with health care providers, but there would have to be trade-offs somewhere in the system, and my guess is that the quality of care would go down for many people, while the wealthiest people would have their own supplemental coverage and be able to continue the kind of benefits that they have today.
Countries that have single payer spend about the same in services. It is the administrative parts of health plans that is dramatically cheaper.
What this phrase seems to mean, to Clinton at least, is universal health insurance. Lots of people who currently have health insurance are being forced into bankruptcy by health conditions. If insurance sucks, making it available to everyone is not good enough. My very old mother has a Tufts HMO. I wanted to get her into the local group practice that I use, but the HMO won’t pay them. Plans that will pay them either cost a lot more, or have huge exclusions. So she has to keep going to the less-than-great Harvard-Vanguard outfit that’s been mostly ignoring her long, slow decline.
Insurance is not a solution to our health-care problems; it’s a cause of them. Even if it costs the average taxpayer $500 more per year in taxes to implement single-payer, as has been predicted, that’s much cheaper than continuing to pay the insurance monkey. That monkey is a big reason we pay twice as much as the rest of the developed world and get inferior results. Now we have a chance to elect someone who wants to get rid of that broken system, and he’s opposed by someone who wants to tweak it — someone who’s been getting huge amounts of money from the insurance monkey. Guess how I’m voting.
I am just back from an urgent care appointment at my Harvard Vanguard center. I have had anything but great care and service there. I suggest trying to find another primary care physician for your mother. My primary care physician is really great at following up on all my health care issues. I have no stake in Harvard Vanguard, other than my long history as a consumer, dating back to the 1970’s and Harvard Community Health Plan.
I’m wondering if based on context you intended “nothing” rather than “anything” in your second sentence.
Thanks for pointing that out. I did intend to say “nothing”.
You don’t need anyone to give you credentials to be progressive. I am glad you have kept a sense of humor about it though.
I am sharp, tough, argumentative (there are lots of other words that have been used against me on BMG) but you don’t need to worry about somebody who challenges your credentials. Challenge you on particular ideas? Hell I hope you get praised when you make a good point and whacked if you make a bad one. I will do both, especially for a person who knows the diff between YellowDog and BlueDog, and did not need google to learn it.
My rules in here are short:
don’t lie;
only change your story if you acknowledge it (i.e. don’t pretend you said something different than what you actually wrote)
back up your story with facts.
Your posts fit into all of my standards so I hope we have a serendipitous meeting over a beer some place. Two nights ago I bent my elbow with a 28 year lumberjack-dressed NRA member, a college dropout, Sanders supporting laborer who is back to school to study child care. I am the same age as his grandfather, an old school suit and tie guy at almost all times.
I don’t like diversity because it is politically correct. I like it because it is good for the heart and soul. Everybody else who sat next to us at the bar loved our two hour conversation and prodigious consumption of food and ale (thank the gods that I have a driver).
I used to tell newcomers to the public policy arenas they should consider these 3 realities.
1. Public policy makers make different decisions when watched by their affected constituency.
2. Lobbying is just getting the right information (facts, message) to the right people (leadership and opinion makers inside and outside) at the right time. (before the final vote)
3, Public policy makers weigh opinion as equal to facts.
Not surprisingly I guess, it applies to activists in the electoral politicall arena as well. I spent years lobbying for health care reform in Massachusetts, and we’re still arguing the same points and facing the same reality. Except almost everyone has access to health care.
Sigh…
ACA is a little more than a base camp before the assault to the top of this mountain. It still concedes that health care is not a right. It still agrees that wealthy people ought to get better health care than poor people. It still lives in this bizzaro world where at 64 year of age, Medicare for me is out of the question, too far a reach, unrealistic; but on the morning of my 65th birthday, it’s perfectly natural and affordable. Our nation’s leaders have been pushing for health care as a citizen’s right since the days of Harry Truman.
President Truman called for the creation of a national health insurance fund to be run by the federal government.
The wealthy class launched a vicious attack against the bill, capitalizing on fears of Communism in the public mind.They characterized the bill as “socialized medicine”, and called Truman White House staffers “followers of the Moscow party line”.
Today, the same wealthy class is saying the same thing, more or less. It’s resonating with those of us who recall the cold war but to the younger generations who have seen national heath care actually working in all the developed nations of the world, it’s a hollow threat.
If a single-payer health insurance plan has zero chance of getting through Congress, then it’s time we got off our ass and changed Congress. A President Sanders would be a step in that direction. A President Clinton would be an admission of surrender to the idea that health care is a citizen’s right and instead ought to be something sold to us at a profit to others.
No, I am not giving up.
EDIT
I’m wondering what conclusions we can draw from Vermont’s failure to make the transition to single-payer? I haven’t started reading about it, but that experience seems relevant.