Bernie, single payer – and a little Hillary fact checking

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Photo: Marc Nozell via Flickr

Photo: Marc Nozell via Flickr

When Bernie Sanders released his single payer plan earlier this year, I expected many of the smart health policy writers on the left to shout “Hallelujah” – at long last, a serious presidential candidate who will give us Medicare-for-all.

To my surprise, most of them said, more or less, “Thanks, but no thanks.” It’s not that they wouldn’t like a single payer plan, in theory. Most would: it’s been a Democratic aspiration for decades. But they recognize it’s not going to happen in the immediate future. Or even in the not-so-immediate future.

Even Sanders himself acknowledged that himself in one of the early debates – back when single payer for him was a defining ideal – before Hillary Clinton elevated it into a policy plank that differentiated the dreamer from the do-er (in her vision at least). As Sanders himself has noted, single payer can’t happen unless or until the whole Washington-Campaign Finance-K Street influence is thoroughly reformed.

But there are other reasons. Not all Democrats want it – either because they think it’s not practical or because they’d prefer to improve Medicare before enlarging it. Or they simply just don’t think single payer is a great idea. Several economists who are quite sympathetic to Sanders’ basic goals say his numbers just don’t add up – he underestimates costs and overestimates savings. Many – as President Obama has said – think single payer would be great if we were creating a health care system from scratch, but we’ve got an employer-based, private-insurance system that’s decades old and even more firmly implanted because of some tax code changes favoring that form of health insurance in the 1950s. Such a change, involving nearly a fifth of the economy and millions of jobs, is extremely disruptive.

For those of you who think the political obstacles are overstated – it’s worth remembering that Democrats couldn’t get anything resembling single payer through Congress when Obama was elected and they had large majority in the House as well as a filibuster-proof majority in the Senate. They couldn’t even get approved a “public option” representing a sliver of single-payer within the ACA exchanges. And their fallback, the coops, had so many restrictions and caveats built in that half have failed and the other half right now aren’t doing so great.

For all the problems that remain in our health care system – cost, access, the millions who are still uninsured – which Sanders diligently has been bringing attention to, it’s sometimes easy to forget how much the ACA did change how the insurance industry operates. Plans must now offer a package of standard essential benefits, they must take everyone, sick and well, old and young. There are limits to profits and administrative spending under MLR (medical loss ratio). These are big, significant changes from the pre-2010 system, however imperfect the system remains – and we all know it remains imperfect indeed.

Below are some of the articles and essays, mostly from progressives, who don’t think Sanders plans add up or don’t think the timing is right. (I haven’t included more conservative writers, but just check National Review, Washington Examiner, etc., they’re easy to find.) I’ve also included some Mother Jones articles that are more supportive, as well as links to the major physician organization that backs single payer. There you will find some columns and articles in favor. I’ve also included an interesting piece by longtime AHCJ member Trudy Lieberman on the failures of the ACA, written several months before Sanders took off.

But before you start reading, here’s one more point that should be made in fairness to Sanders. Clinton keeps saying that Sanders would dismantle the protections of the ACA, CHIP, and Medicaid, undoing the gains and leaving people unprotected. Sanders, who did vote for the Affordable Care Act despite some ambivalence, has said clearly that he wouldn’t take away anything until he had something better to take its place. But Clinton persists in using this talking point. We’ll see if that changes.

3 thoughts on “Bernie, single payer – and a little Hillary fact checking

  1. Carla Johnson

    Thanks for collecting these articles in one place and for your informed perspective. Very helpful.

  2. Norman Bauman

    Thanks for a good bibliography and source list.

    I would suggest that the way to frame this story is to ask the question, “Why are other countries like Canada and the UK able to provide health care that has about the same outcomes and patient satisfaction as ours, at 1/2 to 1/3 the cost?”

    To answer that question, start with Lieberman’s article in Harper’s. She says that the fundamental flaw of our health care system is the control of our political system by drug companies, insurers, hospitals and doctors, who spend millions of dollars on lobbying.

    Jonathan Gruber, who is responsible for the Cadillac tax, said that “we don’t know how” to control health care costs. Actually, wrote Lieberman, Gruber really means, “we don’t know how under the constraints imposed by the system’s powerful stakeholders.”

    These powerful stakeholders not only contribute to political campaigns and PACs, but also hire congressmen and their staff members after they are voted out of office or retire.

    For example, consider Billy Tauzin, who as head of the House Committee on Energy and Commerce had a major responsibility for the Medicare Prescription Drug Bill, which prevented Medicare from negotiating or mandating drug prices. Tauzin then retired and was hired by PhRMA as a lobbyist for $2 million a year.

  3. Norman Bauman

    Here is the most complete statement I’ve seen by Hillary Clinton about her views on single payer.

    http://www.nytimes.com/2008/03/27/us/politics/27text-health.html
    An Interview with Clinton on Health Care
    Kevin Sack
    The New York Times
    March 27, 2008
    Q: Let’s talk for a minute about the formulation of your plan. I’m interested in how seriously you considered proposing a single payer system and at what point in that discussion did you decide to propose an individual mandate?
    MRS. CLINTON: You know, I have thought about this, as you might guess, for 15 years and I never seriously considered a single payer system….
    (more)

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