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?