Thursday, January 14, 2016

Clinton Says Bernie Sanders Would Take Health Care From Millions

Over the last few weeks Hillary Clinton’s campaign has been hitting fast-rising rival Bernie Sanders over his longtime advocacy for single-payer health care. That's a system in which everybody, or almost everybody, gets insurance directly from a government-run "Medicare for all" program.

The Clinton campaign's assault on Bernie Sanders over health care got more intense this week as Hillary Clinton's daughter, Chelsea, made the claim Sanders intends to dismantle Medicare and Medicaid -- and "strip millions and millions and millions of people of their health insurance."
But in 2008, Clinton decried the notion that a fellow Democrat would attack another for proposing universal coverage. Health care was also a major issue in the 2008 Democratic primaries. At the time, Clinton supported an individual mandate requiring everyone buy a commercial health insurance policy or pay a fine, as was eventually enacted in the Affordable Care Act, otherwise know as Obamacare. Then Preisdential candidate Barack Obama did not at the time support the individual private insurance mandate.

When Obama's 2008 campaign sent mailers to Ohio voters, warning them Clinton would force every single person to buy health insurance, Clinton called it a tactic "right out of Karl Rove's playbook." In other words, it was something that Republicans would do to Democrats, not what Democrats should do to each other. "It is not only wrong, it is undermining core Democratic principles," she said. "Since when do Democrats attack one another on universal health care?"“I thought we were trying to realize Harry Truman’s dream."

Watch the video, uploaded to YouTube on Feb 23, 2008, of Hillary Clinton calling out Barack Obama for raising her mandated health care position in a campaign mailer.

Actually, Truman’s dream was not to establish a private health insurance mandate. Instead, he called for a single-payer - Medicare for all - health care system where all Americans contributed taxes and then were covered by federal health insurance when they fell ill.

The United States is the only industrialized county on earth that does not provide healthcare to all its citizens through some variation of a single-payer Medicare-for-all-like system. The U.S. has a version of it in Medicare, which serves the elderly and disabled. Many progressives have long advocated extending Medicare to every citizen.

During his Senate career, Sanders has repeatedly introduced single-payer legislation -- most recently in 2013, when he introduced the American Health Security Act. And while Sanders has also voted for less ambitious measures, including the Affordable Care Act, he has always envisioned those initiatives as incremental steps toward a single-payer system.

Because Sanders' version of a single-payer health coverage system envisions a state-base program, similar to the state-base coverage system implemented in the Affordable Care (Obamacare) Act, or the state run Medicaid system, Clinton and her campaign surrogates claim hostile Republican state Governors could thwart his plan. That may or may not in fact be true, depending on how Medicare for all legislation is written. But what Clinton never adds is that Sanders' scheme would also impose regulations, limiting state leeway over who to insure and what kind of coverage to supply.

Poll: Most Americans want to replace Obamacare with single-payer — including many Republicans

Clinton's attack is predicated on a bill that Sanders introduced in the Senate in 2013 that would have set up national single-payer. The bill would have required each state to set up its own single-payer program. A federal board would oversee these state programs and take charge of any that don’t meet whatever requirements it lays out. All federal programs – Medicare, Medicaid, SCHIP – would have been folded into these state-run ones.

In a way, Sanders’ bill was structured a little like Obamacare, with each state having the option of setting up a marketplace exchange to sell insurance plans, and the federal government operating one large exchange for consumers in states that don’t want to run their own. Since it would have moved even further to the left than the ACA, obviously it was dead on arrival in Congress.

WaPo: Senator Harkin: We should have done single payer health reform
Veteran Democratic Sen. Tom Harkin (Iowa) has a less-than-glowing review of the Affordable Care Act — which he helped write and pass in 2010 — and in his final days in Congress is suggesting that Democrats should have considered scrapping the bill altogether.
“We had the power to do it in a way that would have simplified health care, made it more efficient and made it less costly, and we didn’t do it,” Harkin reportedly told The Hill in a piece published Wednesday. “So I look back and say we should have either done it the correct way or not done anything at all.”

He added: “What we did is we muddle[d] through and we got a system that is complex, convoluted, needs probably some corrections and still rewards the insurance companies extensively."

Harkin stressed that key components of the law were necessary and important, including protections for people with pre-existing conditions and allowing grown children to stay on their parents’ health insurance policies until age 26.

But looking back at the early years of the Obama administration, Harkin said Democrats should have pursued “single-payer right from the get-go or at least put a public option. … We had the votes to do that and we blew it."

Such comments aren't exactly new from Harkin, who has spoken about the ACA with critical optimism in the past. “I like to think of this bill as like a starter home. It is not the mansion of our dreams. But it has a solid foundation ... [and] plenty of room for additions and improvements,” he wrote in the Huffington Post in 2010.

As the veteran lawmaker prepares for retirement at the end of the month, Harkin's unfavorable appraisal of the ACA highlights the extent to which Democrats are distancing themselves from the law five years after it was signed by President Obama.

New York Sen. Chuck Schumer, who has publicly supported the law in the past, also spoke out against it in November during a speech at the National Press Club. Schumer faulted congressional leaders and the Obama administration for focusing on health-care reform instead of economic issues during the president's first years in office.

"After passing the stimulus, Democrats should have continued to propose middle-class-oriented programs and built on the partial success of the stimulus," he said. "But unfortunately, Democrats blew the opportunity the American people gave them. We took their mandate and put all of our focus on the wrong problem — health-care reform."

Indeed, Democrats locked in tight reelection campaigns during the 2014 cycle went to great lengths to downplay their involvement with the ACA. Nearly all of those Democrats lost their seats in November in a GOP wave largely motivated by anti-Obama sentiment.

Harkin — chairman of the Senate Health, Education, Labor and Pensions Committee — didn't speak directly to the electoral consequences the bill may have had, but he did take issue with the compromises made as the bill was being negotiated.

“There’s this old saying: ‘If you have the votes, vote. If you don’t, talk.’ We had the votes but we talked,” he said.
Chelsea Clinton recently warned that single-payer would “dismantle Obamacare, dismantle the CHIP program, dismantle Medicare and private insurance.” In the past, Hillary Clinton has said that Sanders’ plan would hike taxes on the middle class. During a campaign appearance in New Hampshire this week, Chelsea Clinton offered a version of these arguments -- but went a little further.

(3/11/09) Bill Clinton debates the merits of a pure,
universal single-payer health care model
vs. a free mkt, privately insured system.

"Sen. Sanders wants to dismantle Obamacare, dismantle the [Children's Health Insurance Program], dismantle Medicare, and dismantle private insurance," she said, according to an account from NBC News. "I worry if we give Republicans Democratic permission to do that, we'll go back to an era -- before we had the Affordable Care Act -- that would strip millions and millions and millions of people off their health insurance."
It's true, under a single-payer Medicare for all system, most people would drop the commercial insurance they buy today from for-profit insurance corporations. But that's because everyone would convert to the new government-based Medicare-like insurance. And while the transition from the old system to a new one would likely be complicated, the whole point of a single-payer plan is to make sure that coverage is simpler, more comprehensive, more reliable, and ultimately cheaper than the current for-profit-based insurance system is today.
If anything, a single-payer plan like the one Sanders envisions would result in more coverage than current arrangements would allow.

The Affordable Care Act has produced a historic reduction in the number of people without coverage, but something like 9 or 10 percent of Americans remain uninsured. One reason is that the system depends upon people signing up for insurance. The Sanders bill states quite explicitly that "every individual who is a citizen of the United States is entitled" to insurance, and then requires the states to enroll people automatically.

As a moderate Democrat, Clinton has long been skeptical of a single-payer plan, even though the program is a priority issue for much of the progressive base of the Democratic Party.
"I have thought about this, as you might guess, for 15 years and I never seriously considered a single-payer system," she told The New York Times in a March 2008 interview.

Her argument against it was, in part, political. Selling such a plan would be hard because most Americans "become very nervous about socialized medicine," she said. "They don’t really know that Medicare is a single-payer system," she added. "They don’t really think about that."
In September 2015, the Wall Street Journal published an article headlined "Price Tag of Bernie Sanders's Proposals: $18 Trillion."

That $18 trillion headline was intended to conjure images of red flags to scare people and tell them that Sanders will spend America into bankruptcy. Research by Gerald Friedman, Professor of Economics, University of Massachusetts at Amherst, was cited in the Wall Street Journal story about Bernie Sanders's proposals for government spending. Friedman responds to that story below.
While the Journal correctly pegged federal spending for Sanders health care bill - HR 676 (a single payer health plan) - at $15 trillion over ten years, it neglected to report that by spending on such a program, the U.S. would save nearly $5 trillion over ten years in reduced corporate health insurance profit taking, reduced health care administrative overhead, lower pharmaceutical and device prices, and a lower rate of medical cost inflation.

These financial savings would be felt by businesses and by state and local governments who would no longer be paying for health insurance for their employees; and by retirees and working Americans who would no longer have to pay for their health insurance or for co-payments and deductibles. Beyond these financial savings, HR 676 would also save thousands of lives a year by expanding access to health care for the uninsured and the under insured.

The economic benefits from Senator Sander's proposal would be even greater than these static estimates suggest because a single-payer plan would create dynamic gains by freeing American businesses to compete without the burden of an inefficient and wasteful health insurance system. As with Senator Sanders' other proposals, the economic boom created by HR 676, including the productivity boost coming from a more efficient health care system and a healthier population, would raise economic output and provide billions of dollars in additional tax revenues to over-set some of the additional federal spending.

Because of the nearly $10 trillion in savings, it is possible to fund over $4.5 trillion in additional services while still reducing national health care spending by over $5 trillion. With these net savings, the additional $14.7 trillion in federal spending brings savings to the private sector (and state and local governments) of over $19.7 trillion.
Compared to what we’re currently spending, however it's labeled, Medicare-for-All, universal health care, or single-payer health care, it would save us at least $17 trillion over 10 years, and probably more.

In order to demonstrate this, we just need a couple of numbers. The first number is how much we currently spend on health care per year.

National Healthcare Expenditure (NHE)

This is a number called the National Healthcare Expenditure (NHE). NHE measures everything we spend on health care — both public and private. In 2015, the NHE was $3.2 trillion or $9,990 per person per year.

That $9,990 per person makes us the most expensive healthcare system in the world. It was this way before the Affordable Care Act (ACA) as well. In 2013, the Organization for Economic Co-operation and Development (OECD) calculated the average worldwide healthcare spend per person at $3,453.

Back to our number: $3.2 trillion in 2015. It increased to $3.4 trillion in 2016.

Growth rate

As you can see, the amount of spending per year doesn’t stay the same. It grows on a yearly basis. So the second number we need is the growth rate.

According to the study titled “National Healthcare Expenditures, 2016-2025: Price Increases, Aging Push Sector to 20 Percent of Economy,” health care costs in the United States are estimated to grow at an average annual rate of 5.6 percent from 2016 to 2025.

If we apply this growth rate over 10 years, and add up the costs, our current healthcare system will cost $49 trillion.


$49 trillion (current system) — $32 trillion (single payer) = $17 trillion in savings.

Over a 10-year period, universal health care or a single-payer system would save $17 trillion.

Yes, you read that right … universal health care would cost $17 trillion less over 10 years. A universal health care system would save us $1.7 trillion a year.

What’s the problem then?

The problem is that certain industries have very powerful lobbies. And these industries spend a lot of money on advertising to make sure that additional $17 trillion goes to them.

The corporate special interest group Foundation for Economic Freedom (FEE), a group that helped make Milton Friedman a name people recognize, used the exact same numbers we’ve been discussing to write “Bernie-Care Would Cost $32 Trillion, Twice What Sanders Claimed.”

You’re not going to believe this, but nowhere in the article do they mention that it would also save us $17 trillion over our current system. Instead they focus on how federal spending would increase.

Excerpt from the Urban Institute’s analysis of Bernie Sanders’ single payer plan. The first column is an estimate for 2017, the second for 2017-2026. Over 10 years roughly $22 trillion of private spending moves to public spending.

You know why federal spending would increase? Because we wouldn’t be paying for insurance out of our own pockets. The reason for the increase is simply that private spending moves to public spending. As illustrated in the excerpt from the Urban Institute’s analysis of universal health care, roughly $22 trillion of private spending on health care moves to public spending. Overall, however, we’d spend $17 trillion less over 10 years and we could insure everyone.

In fact, in every first-world nation that has socialized medicine–whether it be a heavily regulated multi-insurer system like Germany, single-payer like Canada, or a purely socialized system like the United Kingdom–-it costs less. A lot, lot less, in fact: While healthcare eats up nearly 18 percent of U.S. GDP, for other nations, from Australia and Canada to Germany and Japan, the figure hovers around 11 percent. (It’s no wonder that smarter capitalists like Charlie Munger of Berkshire Hathaway are bemoaning the drag on U.S. firm competitiveness from high healthcare costs.) Nor are healthcare results in America anything to brag about: lower life expectancy, higher infant mortality and poor scores on a wide range of important public health indicators. Why does socialized healthcare cost less? Getting rid of private insurers, which suck up a lot money without adding any value, would result in a huge savings, as much as 15 percent by one academic estimate published in the American Journal of Public Health. When the government flexing its monopsony muscle as the overwhelmingly largest buyer of medical services, drugs and technology, it would also lower prices-–that’s what happens in nearly every other country. The barrier to universal healthcare is not economic but political. The next time someone tells you we need to reform health care, show them how we could easily save $17 trillion to $19 trillion if we just did what every other developed country in the world does when it comes to health care.

The meat of the Wall Street Journal article, which started the media questioning of just how Bernie Sanders was going to pay for his proposed “Single Payer Health Care” stated that America would have to spend $15 trillion over the next decade. This seemed like a reach as every single single-payer health system in the world is cheaper than the current American health care system.

What the Wall Street Journal did not report is that $15 trillion in national health spending over 10 years would represent a massive savings for the United States. Right now we spend at twice that rate for health care. According to the Congressional Budget Office, in fiscal year 2013 alone, the U.S. spent $2.8 trillion on total health expenditures, not including the $250 billion tax break employers get for providing health insurance to their workers. Even with the tax break, providing health insurance for employees, for those U.S. employers who do provide health coverage, costs a pretty penny.

Accounting for the cost of private insurance company administrative and marketing expenses, multi-million dollar executive salaries and Wall Street profit taking, and pharmaceutical and device prices in health care, then extending that out for 10 years - on our current trajectory - we will spend more than $30 trillion, compared to the $15 trillion of a single-payer plan, which would totally supplant it.

The entire point of a single-payer health care plan, aside from covering everyone in the country, is to minimize costs, by reducing administrative bureaucracy, the profit motive and middlemen. It costs far less than the current system, which spends more per capita than any developed health system in the world.

That represents a giant savings for the nation, for employers as well as individuals. Friedman’s analysis, which is literally called “How we can afford a national single-payer health plan,” makes this point repeatedly. Assuming that single-payer is paid for through progressive taxation, people would spend far less for their health coverage than they do today, if the Wall Street Journal’s explicitly stated numbers are correct.

Robert Reich, a political economist, said so many people asked him to explain if Sanders’ plan would balloon the federal deficit - and dash the dreams of Sanders supporters everywhere - he felt it necessary to respond. Reich said the WSJ’s claim was “bogus” because they dropped a scary number with no further analysis of the impact such policies would have on the country.

Robert Reich explains:
Bernie’s proposals would cost less than what we’d spend without them. Most of the “cost” the Journal comes up with—$15 trillion—would pay for opening Medicare to everyone. This would be cheaper than relying on our current system of for-profit private health insurers that charge you and me huge administrative costs, advertising, marketing, bloated executive salaries, and high pharmaceutical prices. (Gerald Friedman, an economist at the University of Massachusetts at Amherst, estimates a Medicare-for-all system would actually save all of us $10 trillion over 10 years).
In fact, Americans already pay four times more for private health insurance and other social services than people pay in taxes for the same services in democratic socialist countries. So when people claim, “Socialist countries pay high taxes!” We can set them straight and say, “We pay higher prices to fund greedy fucks’ lavish lifestyles.”

Robert Reich continued:
“The savings from Medicare-for-all would more than cover the costs of the rest of Bernie’s agenda—tuition-free education at public colleges, expanded Social Security benefits, improved infrastructure, and a fund to help cover paid family leave – and still leave us $2 trillion to cut federal deficits for the next ten years.

“Many of these other “costs” would also otherwise be paid by individuals and families — for example, in college tuition and private insurance. So they shouldn’t be considered added costs for the country as a whole, and may well save us money.”
Think about the implications that shifting the burden of paying for expensive services like health care and education off the backs of the working class and businesses will have on our economy.

The working class are the drivers of the economy. They are far greater in number and spend most of their money on products and services in order to cover their basic needs.

Allowing them to keep their money in regards to insurance, child care and college puts more money in their pockets to spend. When the working class has more money to spend, they spend it, or they save it for rainy days and retirement. This creates greater consumer confidence and better financial security, and those at the top also fare well, because now more people are buying up their products and services. The demand for these products and services creates a need for more jobs, and voila, the economy is strong.

Lastly, Robert Reich says:
“Finally, Bernie’s proposed spending on education and infrastructure aren’t really “spending” at all, but investments in the nation’s future productivity. If we don’t make them, we’re all poorer."

“That Rupert Murdoch’s Wall Street Journal would do this giant dump on Bernie, based on misinformation and distortion, confirms Bernie’s status as the candidate willing to take on the moneyed interests that the Wall Street Journal represents.”
So Robert Reich thinks that Sanders has the one percent scared out of their wits because his message is resonating so well. Rupert Murdoch can’t seem to scare people with the word “socialism” any longer, now he’s trying a more nuanced approach by spreading misinformation that our national debt will skyrocket under Bernie which will “cost” everyone more money when it won’t, because he really doesn’t want Americans to figure out that trickle-down economics is a sham.

But, Americans are waking up and realizing that their government belongs to them, not the rich, and that when the working class is stronger the country gets stronger. A weak country is apathetic and will relinquish control to those with self-serving agendas. Bernie Sanders has started a political revolution, regardless if he becomes the democratic nominee or not, and it has the greedy class of this country scared out of their wits because they see the majority of Americans are now fighting to take back that control — and that’s a good thing.

Robert Reich has a new book called Saving Capitalism which hit shelves last Sept.

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