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Sighhhh. [Addendum added.]

Beverly Mann | January 20, 2016 1:52 pm

Healthcare

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Politics

Taxes/regulation

Sarah Kliff has a very helpful account of Vermont’s attempt to create a state-level single-payer health care system, and why it failed. It’s a bit like the old joke about the farmer, asked for directions, who says “Well, I wouldn’t start from here.”

The point is not that single-payer is a bad idea. It is that given where the U.S. is now, achieving the kind of low costs we see in other countries would involve imposing large losses on many stakeholders, including people with generous policies, health care providers, and more — which is the point I’ve been making. The gains would almost surely be bigger than the losses, but that’s not going to make the very hard politics go away.

— Paul Krugman, Lessons From Vermont, today

I don’t have time right now to read Kliff’s piece, so I don’t know whether she, like Krugman, says that Sanders’ single-payer plan precludes the purchase by employers for their employees, or by individuals, of separate, private-insurer, supplemental policies?

Medicare-for-all means Medicare for all. Or something close enough to it to allow separate, private-insurer, supplemental policies. Just like real Medicare does!

As an aside, I do wish Krugman would address the candidate he champions’ campaign tactics, especially regarding healthcare insurance but also about … well … things.

Gotta run.

—-

ADDENDUM: By Noni Mausa in the Comments thread:

Noni Mausa / January 20, 2016 6:59 pm

Canada here. I had a good professional job for 20 years, which included a generous supplemental health policy. Having been retired for 15 years (!) that means that for at least 35 years public and private coverage have rolled along smoothly side by side here.

Still haven’t read the Kliff piece. But, for the life of me, I don’t understand the basis of this claim that Sanders’ single-payer proposal precludes the availability of supplemental healthcare policies. Or precludes employers from providing them as benefits. Or whatever these folks are saying.

It sounds like a classic canard, to me.

49 Comments

ilsm says:

January 20, 2016 at 6:25 pm

Stakeholders are not the object function of the system. Krugman and Kliff seem more worried about the deck hands who are arranging the deck chairs on the Titanic so the folk in steerage go down with a “tidy” ship. It is the folk in steerage we need to take care of.

Stakeholders are participants who have “interests” in the system in which they participate. Some stakeholders make money off the system, and have a limited connection to the outcomes or public good the system delivers.

If you are worrying stakeholders such as insurers or gold plan enthusiasts you are denying the public good in favor of protecting the special interests of stakeholders which are not connected to outcomes.

DoD’s wretched acquisition system makes sure stakeholders are profitable despite the fact the weapons are useless……………

Talk of “stakeholders or deck hands” in the context of the US health care macro system is worrying about goring the wrong ox.
Noni Mausa says:

January 20, 2016 at 6:59 pm

Canada here. I had a good professional job for 20 years, which included a generous supplemental health policy. Having been retired for 15 years (!) that means that for at least 35 years public and private coverage have rolled along smoothly side by side here.
Bruce Webb says:

January 20, 2016 at 7:44 pm

I haven’t read Sanders plan in full either. But everything I hear about it mirrors the Conyers -Kucinich Medicare for All Plan (HR 676) which in fact would have made all forms of private insurance illegal. That is employers would not have been allowed to buy insurance or on my reading even supplemental insurance for their employees or executives at least for services delivered in the U.S.

Which is to say that the most prominent version of Medicare for All and the one pushed by the folks in and around FireDogLake just as one example was very decidedly NOT Medicare for All.

“Medicare-for-all means Medicare for all. ”

Unless it doesn’t. I read HR676. It’s title was “Medicare for All” its content wasn’t. And it shared NOTHING with the “Medicare for All” bill introduced for decades by Kennedy and Dingell.

The truth is you can’t tell a book by its cover. And not always by its title. You got to read it through.
Beverly Mann says:

January 20, 2016 at 7:54 pm

Noni, I just added your comment as an addendum to my post, and said:

“Still haven’t read the Kliff piece. But, for the life of me, I don’t understand the basis of this claim that Sanders’ single-payer proposal precludes the availability of supplemental healthcare policies. Or precludes employers from providing them as benefits. Or whatever these folks are saying.

“It sounds like a classic canard, to me.”
Beverly Mann says:

January 20, 2016 at 7:57 pm

Bruce, I can pretty well assure you that Sanders’ plan–neither the current one nor the one he proposed in 2013–prohibits private supplemental insurance policies. Nor, probably, would that even be constitutional.

What an absurd proposal by Conyers and Kucinich. I can’t imagine the point of it.
Jerry Critter says:

January 20, 2016 at 9:14 pm

I see “Medicare for All” as providing a baseline for everyone. It covers basic needs, but not everything in the book, as Medicare does for seniors. Supplemental plans can provide additional coverage at an additional cost…as with Medicare.

The rich will always have better healthcare either through supplemental plans or simply paying out of pocket. It’s one of the benefits of being rich, like being able to afford a yacht instead of a rowboat. But, you can still catch fish off the back of a rowboat. You just have to supply the power.

The idea is to supply everyone with basic healthcare, not put them up at the Ritz for New Years Eve.
Warren says:

January 20, 2016 at 10:18 pm

Beverly, you cannot start arguing that banning supplemental insurance would be unconstitutional, since the U.S. constitution doesn’t give the U.S. government the Power to provide insurance in the first place.

Jerry, the question is, what’s “basic”?
- Bruce Webb says:
  
  January 21, 2016 at 12:05 am
  
  Warren you Myron, the supplemental insurance is not provided by the government in the first place or the last place. It is a commercial product sold by insurance companies to private individuals and corporations. You got your basic premise upside down, backwards and inserted.
Jerry Critter says:

January 20, 2016 at 11:18 pm

What’s basic? Oh come on! How about current Medicare coverage?
Bruce Webb says:

January 21, 2016 at 12:02 am

https://berniesanders.com/wp-content/uploads/2016/01/Medicare-for-All.pdf

“The Plan

BETTER COVERAGE
Bernie’s plan would create a federally administered singlepayer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.”

This is a vastly expanded version of Medicare, which doesn’t cover much of palliative or long-term care and even less of vision, hearing and oral health.
- Bruce Webb says:
  
  January 21, 2016 at 12:09 am
  
  WHAT IT MEANS FOR PATIENTS
  
  As a patient, all you need to do is go to the doctor and show your insurance card. Bernie’s plan means no more copays, no more deductibles and no more fighting with insurance companies when they fail to pay for charges
  
  This doesn’t look like Medicare either: no copays, no Part B premium, no drug expenses at all. In fact it is hard to see what a Supplemental would pay for. Except boutique type surgeons and private luxury hospital rooms. All the other standard things you buy a supplemental for are covered.
  - Bruce Webb says:
    
    January 21, 2016 at 12:16 am
    
    Maybe there would be no strict bar on the sale of Supplementals. For whatever they would cover. But it seems like the costs would no longer be deductable. And so might as well be paid out in straight compensation. Let executives pay for their own luxury rooms.
    
    Savings from health tax expenditures.
    Revenue raised: $310 billion per year.
    Several tax breaks that subsidize health care (health-related “tax expenditures”) would become obsolete and disappear under a single-payer health care system, saving $310 billion per year. Most importantly, health care provided by employers is compensation that is not subject to payroll taxes or income taxes under current law. This is a significant tax break that would effectively disappear under this plan because all Americans would receive health care through the new single-payer program instead of employer-based health care
    
    Hey it is one thing to defend Sanders. But this whole “it must be a canard and I don’t even have to take two minutes to read an eight page PDF” is kinda weak. And I would use stronger language if it was anyone but an AB colleague. It took me no time at all to track this document down and not much more to look at it.
    
    And it looks a HELL of a lot like Conyers-Kucinich.
    Having read both.
Marko says:

January 21, 2016 at 12:09 am

I haven’t studied the Sanders plan or other Medicare-for-all proposals closely , but I’d be surprised if any of them seriously propose banning private insurance companies from providing supplemental coverage.

What they might propose – and what I’d fully support – is that such Cadillac add-ons not be subsidized by the government , i.e. no deductibility or other tax preferences for either individuals who choose to purchase such plans or businesses who choose to provide them for some employees.
Bruce Webb says:

January 21, 2016 at 12:23 am

Marko what would you need a supplemental for? Given the breadth of coverage Sanders proposes?

And yes you would be surprised. https://www.govtrack.us/congress/bills/109/hr676/text

Under Conyers-Kucinich it would be ILLEGAL for any for-profit entity to provide ANY covered services.

b)

Portability

Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.
(c)

No cost-sharing

No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.
103.

Qualification of participating providers
(a)

Requirement to be public or non-profit
(1)

In general

No institution may be a participating provider unless it is a public or not-for-profit institution.
(2)

Conversion of investor-owned providers

Investor-owned providers of care opting to participate shall be required to convert to not-for-profit status.
Bruce Webb says:

January 21, 2016 at 12:26 am

Sanders’ plan doesn’t seem to go that far. Then again it is not in legislative language.

But if it walks like H.R.676 and quacks like H.R.676 there is at least a debating position that it might be something like H.R.676.

Seems to me the arguments to the contrary smack too much of “No real Scotsman” than anything. “Bernie wouldn’t do THAT”. Maybe not. But it is not a canard until you can prove that it is.
- Bruce Webb says:
  
  January 21, 2016 at 5:34 am
  
  http://www.dailykos.com/story/2016/1/17/1470934/-Sanders-Health-Care-Plan
  
  Not written by me. But by someone who believes in reading and analyzing texts. I didn’t actually read or analyze THIS dKos text in detail and so in the interest of consistency have to disclaim adherence to each and every claim until I test them. But man does it skim well.
  - Bruce Webb says:
    
    January 21, 2016 at 5:43 am
    
    And BTW lets be clear. On balance I am in favor of Bernie’s Plan. But a perfectly fair descriptor of it is “Socialized Medicine” while a ridiculously misleading descriptor is “Medicare for All”.
    
    Is this BETTER than Medicare? Well it WOULD be. Then again to my knowledge I am the only Angry Bear Contributer that openly identifies as a Social Democrat. Which is not to say as a Democratic Socialist. As these things go I am closer to President Roosevelt in 1940 than then Vice President Henry Wallace. (In many ways the least known key American political figure of the 1940s, aka as Vice President WHO? https://en.wikipedia.org/wiki/Henry_A._Wallace).
Bruce Webb says:

January 21, 2016 at 12:35 am

https://www.govtrack.us/congress/bills/109/hr676

78 cosponsors (77D, 1I)

Gosh, I independent signed on to Conyers-Kucinich. Who out of the vast pool of Independents could THAT be?

Sanders, Bernard “Bernie” [I-VT0]
(joined Jun 7, 2005)
Marko says:

January 21, 2016 at 7:26 am

I’m not at all surprised. Private coverage is allowed for uncovered services , which , for the upper 1% , could end up being quite extensive , depending on tastes , vanity , etc. Here’s what it says :
……
104.Prohibition against duplicating coverage
(a)In general
It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.

(b)Construction
Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary.
…….
So , for example , a private company might offer a policy that covers breakthrough cancer therapies that are not yet approved under the govt plan , like , e.g. , the procedure Steve Jobs went through for his cancer , where extensive DNA profiling was done with no compelling evidence that it would be of benefit. Whether the rich would choose to buy an expensive supplementary policy rather than paying out of pocket is an unknown , of course , but if there;s a market , someone will fill it. Cosmetic procedures is one obvious area where the private sector might fill in holes in coverage.

I don’t think this is a problem , as long as it’s not subsidized by taxpayers. The rich can pamper themselves on their own dime.
JF says:

January 21, 2016 at 9:06 am

Uniform Commerce Power can be a plenary exercise – all forms of related insurance COULD be made nullities by the public’s law in order to promote a uniform commerce system.

But it makes no sense to do that. In fact it would be one of the transitional compromises to allow current health insurers to offer re-insurance like products.

For instance, the public’s coverage would most likely use evidence based, guidelines to define its coverage. This means that some therapy suggestions by clinicians will push the envelop, so to speak, by attempting to use new interventions, meds, supportive services, or what ever – with costs that would also exceed the guidelines for the diagnoses or diagnosis. The public will want that pushing of the envelop to continue (even if it sets a very dynamic approach to updates to the guidelines or wide lattitude on the boundaries above the guidelines). But this means that an accepting person would face a financial issue as the public would only reimburse the providers based on the guidelines – this is a classical depiction of a financial risk that can be addressed by a financial insurance product (that wraps around the public’s laws).

Yes, only the well-healed or very risk adverse would buy such insurance, but that is OK.

There are other non-coveraged aspects of chronic care management, for instance, that may also be an area of new financial insurance business – all good that these would continue.
JF says:

January 21, 2016 at 9:23 am

The bills need to be written to cover CARE, not just “medical” care allowing proper guidelines to ensure coverage for supportive care services even though it may be provided by someone other than a medically-licensed person. Drop the adjective “medical” except in those provisions where the intent is to focus on licensed medicine itself. This silliness of using the term “medical” has been a drag on improved care and outcomes in the US for some time, in my opinion. The test under this law would be whether the therapeutic outcomes for the covered person meets the goals of a proper guideline.

The prohibition on duplicate coverage subsection needs to be re-written:

“Private health insurance that duplicates the coverage under this Act is a nullity. Persons who offer or sell such insurance are subject to criminal and civil actions under [reference the sanction and due process subsections in the legislation], subject to action under the statutes for Consumer Financial Protection (cite USC), with qui tam suits permissible under (cite USC you want to use).”

Or something like that – duplicates are nullities, so if they are marketed or sold they would be for the purpose to taking money from people almost facially – the deterrence should be plain. I’d even mention RICO in the legislative debates just to make sure people get the message.

Note that wrap-around insurance by its very definition means there is no duplication (though this would be tested by cases/controversies).
Noni Mausa says:

January 21, 2016 at 11:14 am

So much is covered up here in Canadaland, that one can go months or years without having to shell out for anything. Exceptions include routine dental care, eye care (glasses, prescriptions and evaluation, but cataract surgery is covered,) some medications, and psychological (but not psychiatric) care. There are other items too, my knowledge is not comprehensive.

So employer benefit plans might offer those things, and would be seen as real treats, not merely access to services the rest of the world considers to be essentials.
- Bruce Webb says:
  
  January 21, 2016 at 11:33 am
  
  Except that all those are covered under BernieCare.
  
  Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatment
  
  Not much left for the Supplemental.
  
  Medicare covers much the same range as that in your CanadaLand and excludes the same things. Which is why (among others) this is NOT Medicare for All.
Beverly Mann says:

January 21, 2016 at 12:00 pm

Whoa there, Bruce. You misunderstood my post, which was about Krugman’s statement that, based on the experiences of other countries, Sanders was way overestimating the cost savings from a single-payer system. This would mean either that taxes would have to be raised much more than his plan proposed or benefits would have to pared significantly from what his plan is proposing. Fair enough. But he then said that among the stakeholders who would fight this would be people who have generous plans. Most of them, of course, get those plans as employment benefits.

My post was critical of his claim that these people would have to forego these generous plans. THAT was the canard. My point was that if employers are saving significant amounts of money by paying a much lower premium to the government than they’re now paying to private insurers, they could take some of those savings and private supplemental insurance. This would be true, probably, even though the cost of the supplemental insurance would not be tax-deductible, since the cost of the premiums paid to the government plus the cost of the supplemental policies probably would be no higher, and probably would be less, even without a tax deduction for the supplemental plans, since so much of the costs of healthcare would be covered by the single-payer plan.

So the employees who now have generous plans would be losing no benefits.

As for Sanders’ support of the Conyers-Kucinich plan, the bar to supplemental insurance surely would be amended out of it if the plan had received actual consideration in Congress. Sanders supported the basic bill, not necessarily everything in it.
- Bruce Webb says:
  
  January 21, 2016 at 7:51 pm
  
  Where is the argument supporting your criticism of “his claim that these people would have to forego these generous plans”. If I say the plain text of Conyers-Kucinich would outlaw those generous plans, that Bernie was a co-sponsor of Conyers-Kucinich, and that everything in the summary of Bernie’s plan is consistent with Conyers-Kucinich then the burden is on you to attack on of those three premises before attacking the conclusion that Krugman has made a “canard” that is a knowingly false and defamatory claim.
  
  Krugman may be wrong on this point. But to demonstrate that would take some knowledge, and specific knowledge of Sanders’ actual plan, knowledge you say you don’t have and by making the judgement “canard” suggest you don’t even need.
  
  Well you do need that knowledge. I say that Sanders plan would make supplemental policies illegal. Or at least make that claim. Prove that I am first: wrong, and then second: purposely lying. That is exactly what you did to Krugman. Sorry you didn’t meet the burden of proof. Would supplemental policies even be LEGAL under Sanders? And would that make any financial sense for any company as opposed to simply paying the equivalent amount in straight taxable compensation? You wave those questions away.
Warren says:

January 21, 2016 at 2:49 pm

“[The] supplemental insurance is not provided by the government in the first place or the last place.”

I never said it was. If it were, it would not be “supplemental”, would it?
Warren says:

January 21, 2016 at 2:50 pm

Ah, you explain yourself in another comment:

“Not written by me. But by someone who believes in reading and analyzing texts.”
- Bruce Webb says:
  
  January 21, 2016 at 7:43 pm
  
  Warren you said that since government provision of insurance might be unconstitutional they would have no business regulating supplemental insurance. That is backwards. That the government is somehow barred from providing a product in interstate commerce would not mean that the Commerce clause was abrogated in regards to that sector. If anything it would be enhanced.
urban legend says:

January 21, 2016 at 3:36 pm

But the fundamental objection to undertaking an effort to launch a single-payer plan is that we have other, more important and politically achievable fish to fry. The focus now must be on full employment and raising incomes. Raising the minimum wage, a multi-hundreds of billions infrastructure repair and modernization plan — including a permanent increase in employment in that sector — and eliminating legal obstacles that employers can manufacture to prevent unionization are the things that can accomplish those priority needs, and while they will not be easy and will require expenditure of political capital, they could be achievable with a Democratic Congress and administration.

Talking right now about a politically non-achievable goal like single-payer is, indeed, a distraction from those priorities. What would not be a distraction and would be politically advantageous right now is reviving talk of a public option. Medicare-for-All — as an option that can be purchased in competition with private insurers on the exchanges — is one such version that almost certainly would be very popular.

A no-brainer that would address one of the most serious political vulnerabilities of ACA — the high cost of not-very-good plans (high deductions and co-pays) for older Americans who are hardly wealthy but do not qualify for tax credits (a 3:1 ratio is permitted) — would be to let anyone over 50 who does not have employer-based insurance buy into Medicare in the exchanges. That insurance would be have to be funded by premiums instead of taxes, just as Medicare is partly funded now by premiums. But even if initially age-limited, that would be a serious start on a genuine public option, and it is hard to see how that would not be extremely popular in November — a defining difference between a Democrat and a Republican.

If a public option for a non-profit plan run more efficiently by government (without multi-million dollar management compensation) eventually drives private insurers out of competition in the exchanges and solely into supplementing the gaps in Medicare, then we will have effectively moved to single-payer.
Lyle says:

January 21, 2016 at 4:29 pm

On the buying into medicare: Given that today the total cost of medicare runs over 1000 a month, 454 a month for part a for thos who are not eligible for the no cost version, 380 to 400 for part B, plus part D plus medigap its not clear that a pay into medicare would make sense unless the rates are less, or do you raise the age increase in private insurance to make the medicare rates attractive (say to 5x or more)?
Warren says:

January 21, 2016 at 8:16 pm

“[You] said that since government provision of insurance might be unconstitutional they would have no business regulating supplemental insurance.”

I said nothing of the sort. Here is what I said:

“[You] cannot start arguing that banning supplemental insurance would be unconstitutional, since the U.S. constitution doesn’t give the U.S. government the Power to provide insurance in the first place.”

I said that she cannot argue constitutionality of one thing (banning supplemental insurance), when the Constitution does not give Congress the Power to do the very thing that might provoke that ban (single-payer insurance).

If you ignore the Constitution to get single-payer, you cannot complain that some part of it you don’t like is unconstitutional.
Jerry Critter says:

January 21, 2016 at 8:49 pm

Warren – “…since the U.S. constitution doesn’t give the U.S. government the Power to provide insurance in the first place.”

Medicare is government provided insurance. Are you saying that Medicare is unconstitutional? We’ve had it for over 50 years and it has survived all challenges.
Beverly Mann says:

January 21, 2016 at 9:55 pm

You’re exactly right about Warren’s comment, Bruce. His claim is a non sequitur.

But your own claim that if Sanders’ proposal says nothing about supplemental insurance, it bans it, because 11 years ago Sanders was among several House members that signed onto a bill written by two others that included a side provision that barred supplemental insurance makes no sense even if the supplemental-insurance issue does NOT arise in an important sense only if, as Krugman contends, in order to be affordable with only the tax increase in Sanders’ bill benefits would have to be much less generous than what Sanders is saying he is proposing. But it does.

If the final bill ends up providing less generous benefits than people with generous employer-provided policies have—and therefore less generous benefits than the Conyers-Kucinich bill did—why on earth would that bill include a provision barring supplemental insurance?

Maybe you or Krugman know something that isn’t obvious to me, or (likely) obvious to Sanders, but a bill that has only current Medicare-level benefits surely would not ban private supplemental insurance. Sanders is trying to expand healthcare insurance covered—not narrow it. And since Sanders is neither Conyers nor Kucinich, and since there would be no reason to ban private supplemental insurance even if the single-payer coverage in the final bill IS generous enough to make supplemental insurance irrelevant, it’s very unlikely, in my opinion, that Sanders would be proposing, or is proposing now, a bar to private supplemental insurance.

I can’t imagine why you would think he is. Or why he would want to.
- Bruce Webb says:
  
  January 21, 2016 at 11:58 pm
  
  The reasoning behind Conyers-Kucinich is sound enough. If you prohibit the profit motive in insurance and insist that every American gets the same level of care in all circumstances then the opportunties for the Rich to Starve the Beast even as they provide for their own (i.e. today’s system in brief) is undercut. We had a system before PP/ACA that saw employers systematically cutting coverage while shifting costs to everyone OUTSIDE THE CORPORATE SUITE. Even as they provided ever more lavish Cadillac Plans for favored executives. The Cadillac tax and limits on deductibility were originally aimed at this cohort and not to bear, as they did, on certain union members who had traded pay raises for more affordable and comprehensive coverage.
  
  Conyers-Kucinich just took this leveling process to the extreme – No American could get better health care than the least American. At least not in America. There were no provisions against medical tourism. And Sanders wasn’t among “several”, because 78 out of 230 so is not that.
  
  “If the final bill ends up —“. Well that is a hypothetical. Which is doubled down by claims that you don’t even need to read the preliminary legislative proposal. You say “but a bill that has only current Medicare-level benefits surely would not ban private supplemental insurance”. But even Sanders’ bare bones proposal offers benefits that far exceed “current Medicare-level benefit” including vision, dental and hearing (which are limited to actual medical emergencies under Medicare) and long term care (which is covered by Medicaid and only after forcing people to strip their assets). Bernie is NOT proposing Medicare for All. He is proposing a much more expansive set of benefits that would have ZERO COST SHARE by beneficiaries. No deductibles, no co-pays and no substantial exclusions.
  
  “If the Final Bill ends up—“. If my Grandmothers had wheels they could have been buses. But they didn’t, because humans don’t start out with wheels. So it is only fair to see where Bernie’sbill start out. And they start from a couple places that make the possibility of supplementals problematic. Your entire arguments starts from the position “Bernie wouldn’t do that” which we could label the “No True Sanders” argument.
  
  You say “Sanders is trying to expand health care insurance”. Bernie says no such thing. Not unless you stretch the meaning of “insurance” beyond all reasonable bounds. Is a Public Library “book insurance”. Is the FBI “anti-crime insurance”? No such things are considered public goods supplied by the public fisc. Government services. Don’t start from your conception of Bernie. Start from Bernie’s words and past actions and move forwards from there.
Warren says:

January 21, 2016 at 11:14 pm

“Medicare is government provided insurance. Are you saying that Medicare is unconstitutional? We’ve had it for over 50 years and it has survived all challenges.”

OK — I challenge you. Where does the Constitution give Congress the Power to provide medical insurance?
- Bruce Webb says:
  
  January 21, 2016 at 11:36 pm
  
  Where does the Constitution give Congress the Power to provide an Air Force? A Space Program? Exactly what enumerated power covers the NSA’s ability to target overseas communications by tapping telephone wires, cables and electronic signals.
  
  Warren this is dumb. Governments at all levels have been providing for the poor and especially the elderly poor for generations. In England this was done right around the time of the American Revolution by government imposed taxes on land coupled with government enforced religious tithes. That had to be paid to the Established Church whether you were a professed member or not. But the point is that government support for the General Welfare has been baked into the cake for hundreds and even thousands of years, only the manner, mode, size and financing has changed. Exactly nobody thought that State and County poorhouses were some wild innovation that were outside the scope of government. That this fundamental government obligation was taken over by the Feds and put on a contribution basis was little more than a change of form and finance. Trying to deploy originalist/enumerated powers arguments is the domain of Tea Party cranks. Perhaps you could join your fellow delusionists at Breitbart.com.
Warren says:

January 21, 2016 at 11:16 pm

“[Why] on earth would that bill include a provision barring supplemental insurance?”

Because it wouldn’t be FAIR if rich people could buy supplemental insurance.
Warren says:

January 22, 2016 at 7:35 am

“Where does the Constitution give Congress the Power to provide an Air Force?”

It doesn’t. That’s why it should still be the Army Air Corps. It could be argued that an Air Force provides for the Common Defense of the States, but since it can do that just as well being the Army Air Corps, there’s not much reason for it to be separate. The Marine Corps is not separate from the Navy, so why should the Air Force be separate from the Army?

“A Space Program?”

Provides for the General Welfare of the States, in a similar way that the FAA, NOAA, and FEMA do. Since we also use NASA for military satellite launches, our space program also provides for the Common Defense of the States.

“Exactly what enumerated power covers the NSA’s ability to target overseas communications by tapping telephone wires, cables and electronic signals.”

Provides for the Common Defense of the States.
JimV says:

January 22, 2016 at 9:43 am

(Paraphrased:) “Why wouldn’t single-payer allow supplemental insurance?”

Answer: because then it wouldn’t be single-payer, would it?

Ms. (Dr.?) Mann, your heart is in the right place, but like me, you sometimes forget to think twice or more times before you post.
Beverly Mann says:

January 22, 2016 at 9:22 pm

Really? Single-payer doesn’t mean insurance provided to everyone, with the same benefits to everyone? It means something else?

Medicare isn’t single-payer, because of the availability of supplemental insurance? Canada isn’t single-payer, for the same reason? I mean … who knew?!
Beverly Mann says:

January 22, 2016 at 9:29 pm

Yup, Warren. Can’t imagine how there can be that whole huge body of statutes known as the Federal Code, when the Constitution itself encompasses the only body of law that is constitutional. Those parts of the Constitution that say that Congress must enact, or Congress may enact, various types of laws are just there as distractions.
Warren says:

January 22, 2016 at 9:56 pm

Don’t be silly, Beverly. The U.S. Constitution delegates certain powers to the U.S. government, with the rest retained by the States and the People.
- Bruce Webb says:
  
  January 23, 2016 at 5:12 am
  
  Yes Warren but which powers and when and with what limit? Does the General Welfare Clause despite being repeated twice really have no power at all? Does the Commerce Clause really allow the Federal Government to interfere with States’ Rigthts under the Tenth Amendment in the way it has been intepreted? Does the Navigable Waters clause really allow the immense leveraging that allows the Corps of Engineers, FEMA and EPA to regulate any transient stream or wetland hydrologically connected to some river somewhere that would float a boat?
  
  Smart libertarians and originalists have answers to those questions. And there we have you who can only pose ones in the form “I am the Tenth Amendment who Are You”
  
  Elevate your fucking game. I need a worthy opponent. And the ghosts of MG, FA, CoRev and the Cantabrigian are calling out to you.
  - run75441 says:
    
    January 23, 2016 at 6:12 am
    
    Bruce:
    
    A tad weary are we? from the looks of it Bev agrees also.
Jerry Critter says:

January 22, 2016 at 10:01 pm

Warren – “The U.S. Constitution delegates certain powers to the U.S. government, with the rest retained by the States and the People.”

That may be your reading of the constitution and maybe it is even correct, BUT it is not reality. Constitutionally is what th Supreme Court says it is. You may not like it, but that is our current reality.

Live with it!
Warren says:

January 23, 2016 at 7:29 am

You are quite correct, Jerry. When we have Supremes who say, It’s not a tax, so we can rule on it, but it is a tax so it’s constitutional, then the Constitution means nothing to them.

It is THAT reality — that all three branches of government disregard the Constitution to get what they want — is the reality that people need to see.

Only if people see that reality, and care enough about our country to set aside their person desires for government largess, will we be able to elect people who put the country first.
Warren says:

January 23, 2016 at 7:41 am

“Governments at all levels have been providing for the poor and especially the elderly poor for generations.”

Which the STATE government are supposed to do. The States did not delegate that Power to the U.S. government. If you think otherwise, then please quote the passage in the Constitution where they did.

“[Which] powers and when and with what limit?”

Article I, Section 8:

The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;

To borrow Money on the credit of the United States;

To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;

To establish an uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States;

To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures;

To provide for the Punishment of counterfeiting the Securities and current Coin of the United States;

To establish Post Offices and post Roads;

To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries;

To constitute Tribunals inferior to the supreme Court;

To define and punish Piracies and Felonies committed on the high Seas, and Offences against the Law of Nations;

To declare War, grant Letters of Marque and Reprisal, and make Rules concerning Captures on Land and Water;

To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;

To provide and maintain a Navy;

To make Rules for the Government and Regulation of the land and naval Forces;

To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;

To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;

To exercise exclusive Legislation in all Cases whatsoever, over such District (not exceeding ten Miles square) as may, by Cession of particular States, and the Acceptance of Congress, become the Seat of the Government of the United States, and to exercise like Authority over all Places purchased by the Consent of the Legislature of the State in which the Same shall be, for the Erection of Forts, Magazines, Arsenals, dock-Yards, and other needful Buildings;—And

To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.

“Does the General Welfare Clause despite being repeated twice really have no power at all?”

Of course it does — as I mentioned before, FEMA and the FAA are clear examples of providing for the general welfare of the States. The Interstate Highway System is another classic example (although that was actually done under the auspices of the Common Defense of the States, providing easier troop and materiel transport).

“Does the Commerce Clause really allow the Federal Government to interfere with States’ Rigthts under the Tenth Amendment in the way it has been [interpreted]?”

Which particular interpretation?

“Does the Navigable Waters clause really allow the immense leveraging that allows the Corps of Engineers, FEMA and EPA to regulate any transient stream or wetland hydrologically connected to some river somewhere that would float a boat?”

Refresh my memory — WHAT “Navigable Waters Clause”?

You might want to “up your game” by actually READING the Constitution, and not just making things up.
EMichael says:

January 24, 2016 at 10:14 am

Nothing quite as enlightening as reading Warren’s interpretation of the Constitution.

Though I am not sure what it enlightens……….
Robert L Bell says:

January 27, 2016 at 6:32 pm

The issue, it seems to me, is not policy but politics. Regardless of what the program details might or might not be, the most enthusiastic of the Bernie supporters have married themselves to the most literal minded version of SINGLE PAYER NOW! and they have demonstrated a willingness to shoot anyone who does not immediately get on board the bandwagon.

That kind of thing makes for a steel edged band of true believers, but does not bode well for an effective coalition to govern the country.