The health-care issue crystallizes the difference between Hillary Clinton and Bernie Sanders — and why Clinton and not Sanders should be the Democratic nominee.
Ideologically, both come from the same place: Health care is a right, not a privilege, and policy has to be to make sure everyone has access to affordable health care.
Medicare for All should have been the solution to begin with, when they were tearing up control of for-profit companies over who lives and who dies,
But Bernie is insisting on Medicare for All which should have been the solution to begin with, but was politically impossible for Obama.
By threading a narrow needle, Obama nonetheless achieved what presidents over a past century failed to accomplish: the Affordable Care Act.
Built upon conservative Republican principles that preserved free market (private health insurance as the gatekeeper to medical services), the ACA was about making health care accessible, through making health insurance affordable, cutting out preexisting conditions and the like.
The next phase is about making health care affordable and fair.
The ACA is far from perfect, but once Scott Brown became the 41st Republican senator, Obama, who had already invested almost half of his first term in accomplishing this one, transformative aim, at that point had to keep what the Senate had already adopted, he couldn’t afford to let the Republicans filibuster.
So not even a public option was an option and the anti-abortion Hyde Amendment had to be boldfaced into the act.
And that’s when the Democrats still had majorities of both houses, though the Republicans used their filibuster to shut down everything — Disclose Act, climate action, infrastructure.
A few short months later, with progressives staying home from the 2010 elections, the Republicans took over the House, and again, in 2014, with the lowest turnout since WWII, the Republicans took over the Senate.
Now, sanders is campaigning for universal health care — essentially Medicare for All. This is one part of his political revolution, which also includes overturning Citizen United (presumably to end the reign of right wingers in Congress), thereby unleashing all the other important elements of Sanders’ progressive agenda — free tuition at public colleges, tax reform that gets the wealthy and corporations paying their fair share.
Clinton makes a mistake when she uses the argument that Sanders’ Medicare for All plan will result in higher taxes for the middle class falls flat in a primary contest that hangs on who can best mobilize progressives (Sanders’ supporters).
Sanders counters that most will actually spend less on health care because they will no longer be paying insurance premiums.
Indeed, overhead for Medicare is 3 percent, while private insurance companies take 20% for administrative, marketing expenses and profit (a figure that ACA capped, before ACA, they added on 30 percent).
These are percentages of a pie, but to square apples with apples, Sanders points out that the U.S. has the highest health care spending of any industrialized country — it’s 18 percent of GDP — amounting to $9,000 per person, compared to $5,000 for the other advanced countries,
Yet, despite spending the most of any country on health care, outcomes in the U.S. hover at the bottom of the list.
Sanders would make Medicare for All possible with a 2.2 percent health-care premium, calculated under the rules for federal income taxes and a 6.2 percent health care payroll tax paid by employers, the New York Times reported. Sanders would also impose an estate tax on the wealthiest Americans and change the tax code to make federal income tax rates more progressive: individuals making $250,000 to $500,000 annually would be taxed at 37 percent; the top rate, 52 percent, would apply to those earning $10 million or more a year, a category that in 2013 included only the 13,000 households in the United States.
According to the New York Times, Sanders claims the plan would save $6 trillion over 10 years compared with the current system. (The Wall Street Journal is claiming it will cost $18 trillion).
Sanders says that under his plan, the “typical” family earning $50,000 a year would save nearly $6,000 annually in health care costs.
Presently, according to Sanders’ analysis, the average working family now pays $4,955 in premiums for private insurance and spends $1,318 more on deductibles for care that isn’t covered. Sanders said a family of four earning $50,000 would pay $466 per year to this program.
Businesses, according to Sanders, would save more than $9,400 a year in health care costs and that the average annual cost to the employer for a worker with a family who makes $50,000 a year would go from $12,591 to $3,100.
Sanders’s campaign said the plan would cost an estimated $1.38 trillion per year and that a family of four, taking the standard deduction, can have income of up to $28,800 and not pay the health-care tax.
Roberton Williams, a senior fellow at the non-partisan Tax Policy Center, estimated that the tax increase that Mr. Sanders is proposing would be the largest since World War II, increasing taxes by approximately $450 billion per year, according to the New York Times.
But, once again, this is money that is going toward health care, instead of funneled to insurance company.
The much more persuasive argument for Clinton is not whether or not Sanders’ plan would be a tax increase that the next Democratic president cannot afford to have the presidency and the country consumed with that battle all over again, when the Republicans will still likely control the House and whether the majority or minority in the Senate, have the means to derail anything a Democratic President does.
Sanders’ assertion that he will somehow bring both sides of the aisle together is really pie-in-the-sky (as Don Quixote-ish as his claim that he can accomplish gun regulation because he comes from Vermont, a state with virtually no gun control).
The idealism of “Hope and Change” and “changing the atmosphere in Washington” was more believable when Obama was running in 2008, but we now know how that movie turned out: Even with the country on the brink of economic collapse, the Republicans decided it was far more important to destroy Obama’s presidency than save the country from ruin, middle-class Americans from losing their jobs, their homes, their savings, their health care.
Obama could be forgiven his initial naïvete.
Sanders, who lived through those wars in the Senate, cannot, even if his popularity hinges on how consistent (even monotone) he has been. Ask him any question and he replies the same way.
Indeed, during the debate, true to form, Sanders couldn’t finish his pitch for universal health care without adding, “You know what it all comes down to? Do you know why we can’t do what every other country — major country on Earth is doing?
It’s because we have a campaign finance system that is corrupt, we have super PACs, we have the pharmaceutical industry pouring hundreds of millions of dollars into campaign contributions and lobbying, and the private insurance companies as well.”
Which of these do you think would have to come first?
A complete overhaul of the campaign finance reform, replacement of the lackeys that now populate Congress or Medicare for all and would that happen in Sanders’ first 100 days or would it take the first half of the first term? (the equivalent of God making the world in 6 days, having time on the 7th to rest.)
Frankly, tax reform such as Sanders would want (and is the basis for his plan for to implement Medicare for All) would remedy the glut-of-money-in-politics problem also because right now, billionaires and millionaires are buying elections with the windfall they save in lax taxes, so their political donations are more like an investment (using taxpayer money) in securing the policies that continue their status quo. It would also address his biggest complaint about income inequality.
So Medicare for All would be a backdoor way to achieve all of these big things, but it is chicken-and-egg, because whereas Republicans attacked Obamacare because they really don’t see health care as a right rather than a privilege, Sanders’ method of getting there rips at the very foundation of their power and elitism.
Clinton, who still has the scars from her brave and bold attempt to introduce universal health care in the 1990s (taking proper credit for getting the Children’s Health Insurance Program through which now covers 8 million children), was right when she pointed to how difficult it was to get through Congress, how the Republicans only the week before voted to repeal Obamacare for the 62nd time, and that ACA, while not perfect, has brought health care to 19 million Americans — the lowest uninsured rate in history – and would be even lower if Republican governors didn’t block the Medicaid expansion in their states, and what a can of worms would be opened if the next president wanted to propose such an overhaul of ACA, when even minor tweaks have prompted lawsuits, calls for impeachment, and votes to repeal.
“Now, there are things we can do to improve it, but to tear it up and start over again, pushing our country back into that kind of a contentious debate, I think is the wrong direction,” Clinton said at the debate.
Key elements of Hillary Clinton’s health care policy are to defend the Affordable Care Act, lower out-of-pocket costs including copays and deductibles; reduce the cost of prescription drugs; incentivize value and quality of care; expand access to rural Americans, such as telehealth reimbursement under Medicare, opening federally qualified health centers and rural health clinics, and having states streamline licensing for telemedicine; and defending women’s access to reproductive health care.
Clinton also is proposing $5 billion “moonshot” style research program to yield a possible cure for Alzheimer’s by 2025.
You know what, they’re both right, but she’s more right because of the politics.
Here’s my prescription to make a more universal and just health care system and address the accessibility as well as the affordability issues:
Universality:
Create a Public Option, which would wean the health care economy over to truly universal health care, which would exist along with the other private insurance options.
Create a Medicare Buy-In, as George McGovern proposed, beginning with age 55 or for people in their 50s who have lost a job or gone through divorce — the rate would be higher than if starting Medicare at 65.
Raise the cap on income subject to Social Security and Medicare taxes to $1 million (or some amount that makes sense) — indeed, the cap is eliminated altogether, the level of tax could probably be cut significantly to 1 percent, or else tie the amount to income, with the amount decreasing when you get to the 1 million stage- and if millionaires retire and don’t take Social Security, they can take a credit instead.
Accessibility:
The big concern among Republicans so fearful of “socialized medicine” is that if health care should actually be a right and not a privilege and accessible to all is that the system will be overrun. There are correctives for that, as well:
More doctors, nurses and clinics – which means opening up more schools, offering scholarships (or else a means of paying off student debt with working in clinics), creating new licensing programs and new positions such as physicians assistants to better divide up caremore telemedicine and technology
Health care cost:
Direct more investment (as Obama has done and Clinton proposes) into new therapies, ie. that yield more effective drugs because they work on specific genes (as the new cancer initiative would do)
Continue to focus on prevention and wellness – making diagnostics and checkups more available and linking to medical technology like wearable health monitors
Make the health market more transparent; require that providers give an estimate of what services will cost, and if expenses are beyond, that they justify the difference.
Make drug companies and health care providers subject to anti-gouging laws, with hefty fines if they are found
Legislate fairness in pricing for services and drugs (if truly a free market, supply/demand, you could charge millions of dollars for care to save a child’s life)
Most radical: turn Medicare on its head: make Medicare available up to the age of 65, allow people to put money away in Health savings accounts or purchase insurance and long-term care insurance along the way, so after 65, they can pay for their health services.
This benefits society because people have a better quality and more productive life during their most productive years.
And finally, just as in Florida – where you can see in some communities what Medicare for All would look like — there will always be VIP care and private doctors, just as in the United Kingdom, so money will still be a differentiator, but everyone will at least have basic care.
Obama learned the hard way in an 18 month drag-out battle (btw, Hillary was right in the 2008 campaign as she is now in predicting the problems he would have achieving his idealistic goals).
Obama tried to bring all sides together, too (remember that unprecedented meeting around a horseshoe table?), he tried to get the buy-in for Medicare for those 50-plus people thrown out of their jobs with no prospects and no way of getting health insurance, and a public option.
People were losing insurance by the hundreds of thousands each month. 23,000 people a year dying merely for the lack of access to health care.
How fast they forget. But Hillary Clinton, who still bears the scars from her noble effort to get universal health care in 1993, does remember. She remembers how it toppled Obama’s presidency.
I’m trying to imagine how Bernie Sanders would be more successful.
Republicans are rooting for Bernie to be the nominee because they know he is the more vulnerable candidate in a general election (Socialist! Brooklyn! Not Christian!).
The only reason Bernie has come so close to Hillary so far is #1 he was virtually unknown at the start (hence the 3 percent with nowhere to go but up), and No. 2 the Republicans haven’t even begun to level their attacks against him, while she’s had to endure constant barrage of all the candidates and the Congress and the radioheads to paint her as untrustworthy and a political opportunist (really? No one has been more faithful and true in her policy and ideological pursuits than Hillary.)
