Clinton has received more money from the pharmaceutical
industry than any other candidate from either party in the 2016 election cycle.
Clinton's statements on single-payer include some myths
that have long been perpetuated by the right.
Other "developed" nations spend about half as
much on health care as the US and cover everyone.
By Michael Corcoran,
Truthout | News Analysis
[…]
In 2003, Barack Obama said he
was a "proponent of a single-payer, universal health-care plan," but
as president he refused to even engage in a discussion on the issue
when he was working to pass the Affordable
Care Act (ACA) in 2009-10.
But at least Obama took the same approach as most
establishment Democrats and merely ignored an idea that would save the country billions, while covering every single American, regardless
of employment or ability to pay. Hillary Clinton, however, hasn't ignored the
policy in recent months on the campaign trail. Instead, despite broad popular
support for Medicare for All, Clinton has declared war on single-payer health
care.
Bernie Sanders, who just released his
Medicare for All plan on January 17, has made single-payer a
"central axis point in the campaign," as MSNBC's Chris Hayes described it, and helped to push the subject
into the national debate. So, when new polls revealed Sanders to be in a dead heat with
Clinton in early primary states, Clinton took the offensive. She began a campaign to attack single-payer, painting it as something
that would burden middle-class families, empower right-wing governors and put
Americans' health insurance at risk by dismantling every major health-care
institution in the country.
Clinton's claims are either patently false or incredibly
misleading. By presenting them to a national television audience during
interviews and the debates, she may be doing more damage to the single-payer
movement than the pharmaceutical and insurance companies could ever hope to
achieve.
She is making these claims largely to Democratic primary voters, who
support Medicare for All at a rate of 81 percent, but could be misled by a politician
whom many of them trust and admire.
"It is conceivable that the continued negative
critiques - especially of the fearmongering variety - could have a deleterious
impact on popular opinion," Dr. Adam Gaffney, a physician and health-care
writer, told Truthout.
Worse yet, Clinton almost certainly knows she is wrong. Her
experience with health-care reform has made her familiar with the economics of
single-payer, according to documents that were belatedly made public
by the Clinton Library in 2014. It is hard to ignore the fact that she has received more money from the
pharmaceutical industry than any other candidate from either party in the 2016
election cycle, or that the health industry paid her $2.8 million in speaking fees between 2013 and 2015.
History will no doubt remember that the United States was,
for a time, the only "developed" nation
on the planet that didn't guarantee health care to its people as a right. And
Clinton's name will now forever be associated with this shameful fact.
A Window of Opportunity
There is good news in this story. The reason Clinton - and several of
her liberal allies in politics and media - have engaged in this misinformation campaign
is because she knows Sanders' proposal for Medicare for All is one of several
reasons why many voters are choosing him over her. Plus, the challenges
single-payer supporters now face also provide an opportunity to educate the
public about this type of reform.
"Single-payer is at the center of the political
discourse in a manner it hasn't been for years," Gaffney said. "We
should view the renewed single-payer debate as a window of opportunity to
advance our vision of a more egalitarian health-care system." And this,
Gaffney maintains, requires hard work in educating the public, "because
the naysayers have such larger microphones."
Indeed, Clinton's falsehoods will reach a massive audience.
Sanders has refuted many of these in interviews and in debates, but it is an
uphill battle.
Clinton is a status quo politician with great power. And her
campaign is being covered by corporate media that have long been deferential to
power and the status quo.
But, while Clinton has the larger microphone and a
compliant media at her elbow, those who support a single-payer plan have the
facts on their side.
Virtually all of the credible data about the economics of
public health care demonstrate, incontrovertibly, that single-payer would
improve health outcomes, cover everyone and lower costs.
And many dedicated activists are trying to help spread the word. National
Nurses United, for instance, has come out strongly in favor of this plan and is organizing around the
country to explain its merits to voters.
"Finally, a real plan from a leading presidential
candidate that will guarantee health care for every American, just as every
other major nation has done," National Nurses United executive director
RoseAnn DeMoro said in a statement. "Instead of being held hostage to a
corporate system based on profits and price gouging, with Sanders' Medicare for
All plan we can finally have a system based on patient need, with a single
standard of quality care for all, regardless of ability to pay, race, gender,
age, or where you live. That's a beautiful thing."
Countering the Distortions
Clinton's statements on single-payer include some myths
that have long been perpetuated by the right: for example, the idea that it is
unaffordable. Other allegations are strange and new, seemingly aimed at
confusing voters. Let's address a few of the myths:
Myth 1: Single-payer is unaffordable and would burden the middle class.
This is a classic example of how a politician can take a
fact out of context to manipulate the truth. Hillary Clinton has continually
attacked Sanders for planning to raise new taxes on middle-class families, in
part, to fund his Medicare plan. This is true and Sanders has never denied it.
Of course, when Clinton makes this critique, she fails to
add important context. Any increase in taxes would be offset by a reduction in
out-of-pocket health-care expenses (on premiums, co-pays and deductibles) that
would dwarf any added taxes. For Clinton to argue that Medicare for All would
burden middle- and working-class families requires her to advance the
nonsensical argument that giving $2 to an insurance company is a better deal
than paying $1 in taxes.
Of course, the savings are actually much greater than that.
Gerald Friedman, an economist from the University of Massachusetts Amherst who
has been examining the economic impact of single-payer for many years, shared
his calculation with Truthout, showing that there would be a total savings of
$277 billion in the first year of Sanders' Medicare for All plan.
"For a middle-class family of four with an income from
wages of $50,000 and an employer-provided family plan of an average price, the
Sanders program would save $5,807, or 12 percent of income," Friedman
concluded, factoring in both taxes and out-of-pocket expenses.
If Clinton thinks a family of four would suffer by saving
the equivalent of 12 percent of their income because it would involve paying a
little more to the government and a whole lot less to some private insurance
company, she should explain why that is.
It is also worth noting that the savings estimated by
Friedman are totally consistent with the disparities shown when US health-care
costs are compared with countries that have universal public health care. For
instance, in Canada, which has a system very much like the Medicare for All
plan proposed by Sanders, per capita health-care spending is $4,445, while the country spends 11.4 percent of its GDP on health care and insures
everyone. Meanwhile, the United States spends $8,223 per person on health care annually, spends 17.6 percent of its GDP on health care and leaves
about 13 percent of its population without any insurance at
all.
Similar disparities exist between the United States and
every one of the other nations in the Organization for Economic Cooperation and
Development (OECD) - all 35 of which have some kind of universal public
health-care system. As of 2012, the average OECD country spends $3,268 per capita on health care and 9.5 percent of its GDP on health expenses. In other
words, other nations classified as "developed" by the United Nations spend
about half as much on health care as the United States and cover everyone.
Moreover, in studies done by the World Health Organization and the Commonwealth Fund, the United States has been ranked
poorly in terms of health outcomes when compared to other nations in the OECD.
Myth 2: Sanders' policy would roll back the progress won
from the Affordable Care Act and dismantle institutions such as Medicare.
In a video attacking Sanders, Chelsea Clinton made the following
statement: "Sen. Sanders wants to dismantle Obamacare, dismantle the CHIP program [Children's Health Insurance Plan],
dismantle Medicare, dismantle private insurance."
It is ironic that a few months earlier at the CBS debate on
November 14, 2015, Clinton accused Sanders of "impugning my integrity,"
when he correctly pointed out that she has received millions of dollars from Wall Street donations and speaking fees. Yet, in this video by her daughter, Sanders
is basically portrayed as a right-wing villain who wants to deprive everyone of
health care.
How to respond to a critique that claims Sanders wants to
dismantle Medicare? His plan - and just about every other single-payer bill (HR 676) he
co-sponsored in the House of Representatives for years - does the exact
opposite. Sanders' plan expands Medicare to cover everyone. Medicare is
effectively a single-payer system for people over 65. Because it doesn't have
to deal with countless private insurers, it has only 3.6 percent in
administrative waste, compared to private insurance, which has about 31 percent
in administrative waste. Canadian health care, incidentally, has less than 2 percent administrative
waste.
And while many of the provisions of the Affordable Care Act
would become needless if single-payer were passed, Medicare for All would serve
to achieve the two major goals that the ACA failed to accomplish: It would make
insurance universal and dramatically reduce costs, which under the ACA are rising
at an unsustainable rate. Some customers on the ACA's
exchanges have faced 20 percent increases, according to The New York Times.
To accuse Sanders of dismantling CHIP is an especially
dirty trick since it implies that he wants to deprive children of health
insurance. But, of course, children - and all other Americans - would have
insurance in a Medicare for All system. "Yes, Chelsea,
President Sanders would dismantle Obamacare, the CHIP program - and, indeed,
the entire system of private health insurance.
And good riddance to it,"
said Friedman in an essay on Dollars and Sense. "Instead of
relying on a patchwork of programs and a leaky safety net, under the Sanders
plan, everyone would have health insurance, guaranteed regardless of
employment, without copayments or deductibles, and with free choice of
provider."
Myth 3: Sanders' plan would give all the power to the
states, empowering right-wing governors to control health policy.
This argument was made by Clinton at the debate in Iowa in November 2015 and gave her the
chance to link Sanders to the right-wing governor of that state, Terry
Branstad, who is not a popular figure among Iowa Democrats. But the claim is
baldly untrue. As Sanders' plan
states - and in keeping with the very principle of single-payer health
care - the system is "federally administered."
"Governors have nothing to do with Medicare,"
said John McClaughry, vice president of the Vermont-based free-market think
tank the Ethan Allen
Institute, in an interview with Truthout. "They can't touch it. This
is a pretty galling argument, if you ask me."
It is ironic, in light of this attack, that one of
Clinton's primary arguments against Medicare for All is that it would roll back
the gains of the ACA. Yet, one indisputable shortcoming of the ACA is that, due
to a Supreme Court ruling, right-wing governors have been
able to opt out of the provision for Medicaid expansion,
which has been a major source of frustration for Obama, and the millions of Americans who
are deprived of insurance.
With Friends Like These ... Clinton's Liberal Enablers
Clinton has been a major force in Washington for a long
time and as a result she has a number of loyalists who are willing to add
credibility to the misinformation she is spreading about universal health care.
For instance, former presidential candidate and staunch Clinton supporter Howard Dean, who now serves as a corporate lobbyist for Dentons, has taken
to engaging in his own fearmongering on single-payer. On January 13, Dean
appeared on MSNBC to argue that Sanders' health plan could result
in "chaos" and that "trying to implement it would in fact undo
people's health care." Oddly, Dean did not make note of his stated support for single-payer as recently as 2009.
Dean is hardly alone in offering Clinton cover. Paul
Krugman, the popular progressive economist and New York Times columnist, seems
to always defend Clinton's policies - something of which Clinton often reminds
voters. After the YouTube debate, Krugman penned an essay where he flatly stated that
"Bernie Sanders is wrong about [health care] and Hillary Clinton is
right." The reason? Because the ACA "is the signature achievement of
the Obama presidency" and "spending political capital" trying
for single-payer would be a poor use of time, he writes.
Krugman's attempt to argue that the ACA is transformational
legislation falls flat. He writes, "It more or less achieves a goal -
access to health
insurance for all Americans - that progressives have been trying to
reach for three generations." Try putting that on a bumper sticker.
Even if Krugman feels Medicare for All is not a worthwhile
pursuit for Democrats, does that really mean "Hillary Clinton is
right," as he claims? Clinton didn't simply argue, as Krugman did, that
pursuing Medicare for All was a waste of political capital. Instead, she argued
the plan would jeopardize health insurance for the whole country.
Krugman knows this isn't true. He acknowledges, unlike
Clinton, that the savings from single-payer would offset any tax increase. But
when he says (emphasis added) "it would be difficult to make that case to
the broad public, especially given the chorus of misinformation you know would
dominate the airwaves," he is unwittingly describing Hillary Clinton
herself.
The list of Clinton loyalists in the media goes on. Ezra
Klein predictably took the side of the mainstream Democratic Party when he
mocked Sanders for offering "a puppies-and-rainbows approach to
single-payer." Jonathan Chait of New York magazine recently wrote "The Case Against Bernie Sanders," which
describes Sanders' health-care policy as one that "uses the kind of
magical-realism approach to fiscal policy usually found in Republican
budgets." This is false. The economics of single-payer have been
well studied. But Chait is the same guy who called the
Affordable Care Act "the greatest social achievement of our time." It
certainly makes for a better bumper sticker than Krugman's milquetoast
description of the law, but both are guilty of hyperbole in regards to a law
that is more noteworthy for what it fails to do, than for what it accomplishes.
"I find the critique from many liberal commentators
highly unconvincing," Gaffney said. "For instance, both Krugman and
Ezra Klein have charged that the plan doesn't specify what would be covered and
what wouldn't. Of course choices on 'medical necessity' will need to
be made, but this is already happening today under Medicare!"
"The same approach could be adopted to those under age
65," he added. "This isn't interstellar travel."
The Challenge Before Health-Care Activists
The path to single-payer is not interstellar travel, but it
has been a long road for activists who have been fighting for this reform for
decades. They have long been ignored and kept to the sidelines, while
compromised politicians continue to maintain a private system that treats
health care as a commodity to be sold for profit.
Yet, as Bernie Sanders and Hillary Clinton bang heads on
the issue in the coming weeks, for the first time in a while, single-payer
activists aren't standing on the sidelines. They are in the middle of a major
national debate about why the United States should rid itself of the notorious
distinction of being the only nation in the OECD that allows sick people to go bankrupt or
die due to lack of insurance.
[…]
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