Posted on
Feb 16, 2016
Hillary Clinton wants
incremental improvement in Obamacare to fix its imperfect and increasingly
costly collaboration between the federal government and insurance companies.
Bernie Sanders wants Medicare for all—Berniecare—with Americans given full
medical benefits financed by a moderate tax increase for most people and
heavier taxes for the rich.
Clinton would take a baby
step, Sanders a leap into a brighter future—risky as all leaps are, but worth
it if it succeeds.
As professor Gerald Friedman
of the University of Massachusetts Amherst—an architect of the Sanders
plan—said in a 2013 speech, “You don’t get change incrementally. ... We ...
can’t cross the chasm in two steps. To make the change, we need the big leap,
and these big leaps happen only occasionally [in the] few times in history we
have had the type of movement that forces the powers that be to make a giant
change.”
While nothing can make being
sick pleasant, the Sanders plan, as outlined in the presidential
candidate’s website, would make the ordeal considerably less stressful.
Berniecare would cover
hospital treatment, outpatient treatment, visits to primary physicians and
specialists and long-term and palliative care. Such care would provide patients
with relief for the symptoms and pain—mental and physical—of a serious illness.
It would provide for vision,
hearing and oral care, as well as treatment for mental illness and substance
abuse. It would pay for prescription drugs and medical equipment. Gone would be
worries about finding a physician within your insurance company’s network.
Patients wouldn’t be billed for copays or for deductibles—the amount you now
pay before health insurance kicks in.
Sanders estimates this would
cost $138 trillion a year. Financing would consist of:
● A 6.2 percent tax on
payrolls, less than what employers now pay for workers’ health insurance. A Kaiser Family Foundation/Health Research & Educational
Trust survey found that employers paid an average of $12,591 in 2015 for an
employee’s health insurance, compared with $8,167 in 2005.
● A tax of 2 percent per
household on employee income. This too would be less than what families now
pay, according to Sanders’ website. The Kaiser/HRET survey found that workers
paid an average of $4,955 a year in premiums for workplace health insurance
plans in 2015, compared with $2,713 in 2005. So this would be a plus for the
middle class.
● Taxes on the affluent would
rise substantially. Those earning between $250,000 and $500,000 would pay a 37
percent income tax, compared with the present 33 to 39.6 percent. Income taxes
would be 43 percent for those earning up to $2 million, 48 percent for those
earning up to $10 million and 52 percent for high earners above that—big boosts
from the current top rate of 39.6 percent. Capital gains would be taxed, along
with dividends. Various tax breaks for the wealthy would be eliminated.
Hillary Clinton disputes these
figures. At the Clinton-Sanders debate Thursday night, she said, “If you’re
having Medicare for all, single-payer, you need to level with people about what
they will have at the end of the process you are proposing. And based on every
analysis that I can find by people who are sympathetic to the goal, the numbers
don’t add up, and many people will actually be worse off than they are right
now.”
“That is absolutely
inaccurate,” replied Sanders. “Please do not tell me that in this country,
if—and here’s the if—we have the courage to take on the drug companies and the
medical equipment suppliers, if we do that, yes, we can guarantee health care
to all people in a much more cost-effective way.”
While the Affordable Care
Act—Obamacare—has been Barack Obama’s most significant domestic achievement, it
is riddled by flaws the president accepted in order to win the support of
insurance companies and other medical industry titans. So far, it has covered
12,654,178 people, according
to ACA Signups.net, which estimates that enrollments are climbing toward
the 13 million mark.
These people could very well
lose their insurance coverage if the Republicans win the presidency, retain
control of the Senate and House and keep their promise to dismantle Obamacare.
That won’t happen if either
Clinton or Sanders wins. A Sanders victory will mean much more if he persuades
Congress to go along. That’s a big if. But the plan’s range of care and the
ease of obtaining care would mean better lives for millions. Physicians would
be available to all. The mentally ill and addicts would be treated instead of
jailed. Dental care would be covered. Drug prices would be limited. The misery
of deductibles and copays would disappear.
None of this is unusual in
other major industrial nations.
There will be many complex
arguments about financing such a plan, just as there were over the Affordable
Care Act. Having followed the conception, painful birth and near death of
Obamacare, I know that enacting Medicare for all would be much more difficult.
The medical industry, including the insurance companies, would fight it every
inch of the way. Helping them would be Wall Street, whose institutions
engineered the mergers of insurance companies, medical device makers and
hospitals that are creating price-fixing monopolies. Their lobbyists and
political consultants would hammer away at the tax increases needed to finance
the Sanders plan, their path to congressional offices greased by big campaign
contributions. What they wouldn’t mention is the savings in administrative
costs and insurance payments that would benefit consumers.
Success of “Berniecare” may
seem as unlikely as Sanders winning the presidency. But a year ago, the idea of
Sanders in the White House was considered not only unlikely but laughable. And
look at him now.
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