The critical point that Paul Waldman highlights, perhaps unwittingly, about the healthcare debate between Clinton and Sanders
Back when I was in college, a professor in one of the science courses I took in order to fulfill the Liberal Arts Science requirement made the point—maybe specifically in refutation of Creationists, although I don’t remember—that it is scientists, not those who contest and try to interfere with scientific discoveries, who will ultimately prove or disprove scientific theory.
A blog post this morning by Paul Waldman in the Washington Post about the healthcare insurance debate between Clinton and Sanders, which I just read, reminded me of that professor’s observation. Waldman says:
Clinton’s theory of change is practical, realistic and born of hard experience. But it’s also not particularly inspiring. It takes opposition from Republicans as a given and seeks to avoid direct confrontation with certain powerful interests. It’s essentially the same theory Obama operated on in 2009, when his administration set about to co-opt the insurance and pharmaceutical industries instead of fighting them. And it worked — after half a century of Democratic failure on health care, they passed sweeping reform.
Sanders’s theory of change starts from the unspoken presumption that the ACA was in its own way a failure, because it didn’t change the system enough — there are still people left out, and though costs have been reined in, we still spend far more than countries with single-payer systems, and always will as long as we have a system based in private insurance. The problem with Sanders’s theory, however, is that it’s vague on getting from where we are to where he wants to go. He talks about the need to “stand up” to special interests and create a “revolution,” but standing up isn’t a plan.
Lest any of my friends supporting Sanders call me a squish, I’d note that I’ve been touting the benefits of single payer for years. In various forms it has been tried and worked far better than our system in every other advanced country in the world. In places like France or Germany or Japan, everyone is covered, the quality of care is as good or better than what Americans get, and it costs dramatically less than our bloated, inefficient system. But — and it’s a big “but” — moving from our current system to a single-payer system would be an extremely complicated endeavor, both practically and politically. If you tried to do it all at once, the opposition from both Republicans and the affected industries would make the fights over Bill Clinton’s and Barack Obama’s health-care plans look like nap time at the preschool.
But that doesn’t mean Sanders’s ideas about health care should just be dismissed. It’s no accident that he’s getting the support of millions of idealistic Democrats. He’s a radical, in the traditional sense of the word as one who gets to the root of things.
A real primary debate needs the elements that both Sanders and Clinton provide: on one hand, a fundamental examination of what drives the system and a vision that speaks to the party’s essential values, and on the other hand, a realistic assessment of what the next president can accomplish. That’s why even though they have a profound disagreement on health care, both of them are right.
Sanders, though, isn’t really vague that major restructuring of how political campaigns are financed in this country is a prerequisite to enactment of a single-payer, Medicare-for-all system, and that a prerequisite to that in turn is massive involvement in our electoral system by people who want these.
But Waldman’s post illustrates exquisitely that the point my long-ago professor made about scientists is true also about Bernie Sanders’s candidacy.
I’m not a scientist, man. But I applaud and support them. As I do, now, Bernie Sanders. For similar reasons.
If you can’t find some business interests interested in paying only 6.5% of salaries for employee healthcare coverage, you’re not looking very hard. That’s already a significant cost reduction for businesses that offer healthcare. Foodservice and retail won’t be happy, but most everyone else will.
Trump said he supported single payer but it won’t fit the USA.
Hillary equals Trump on single payer!
Sanders would not take “no” for an answer.
Aside from sounding like Trump on health Hillary don’t sound much different on keeping the US’ perpetual, multi trillion dollar fumble fest, aka bombing them to the stone age to make them stop being terrorists, in the middle east going keeping the royals and Sunni terrorists safe from Iran.
At least on MLK Day the US should dream the impossible dream……
Would Bernie beat the Congress into submission?
This all points out the importance of the Public Option to start with: it would have served as the fall back for cases of market failure by private insurance.
For example it is pretty clear and always has been that there is no money in providing rural health care. Under PP/ACA in its final form you essentially have to force some private insurer into that market, with a Public Option you could let people fall back into what would be a (not exactly) seamless tapestry of Medicaid, VA, Indian Health Service, Medicare and new Public Option that would cover everybody and HAVE a Single-Payer even if it WASN’T Single-Payer as most people define that.
Meanwhile rich urbanites would still have a choice of dozens of competing plans. Even as the Public Option moved from ‘default’ to ‘de facto’ for much of the country. In that scheme every market ‘abandoned’ by private insurance is a win for Single-Payer.
And Bernie would set a goal.
Medicare was officially the Social Security Act of 1965. Because it was part of the original vision. It just took a full generation to come to be.
Would Bernie get Medicare for All enacted in his first year? No. Could he get it or something like it embedded at the heart of future Democratic Party Platforms as a clearly expressed aspiration? I think he could, If he won on that. If he doesn’t it won’t.
But people are too willing to turn that into a tautology. That because it won’t, he doesn’t. That goes right against the rhetorical success of Truman’s Fair Deal and Kennedy’s New Frontier, neither of which reached their goals in their presenters and promoters terms. But were important for all that.
The question I would put to Sanders: Hospitals say that they loose money on medicare patients and make it up by charging those with insurance under 65 more. If they are being truthful how many hospitals would your plan drive out of business, or force major modifications to. How many physicians would retire if they could only get medicare reimbursement rates?
Now perhaps then you move to a model like the Japanese system, where once a year the providers and the government negotiate fees,
I agree with Bruce , and Krugman too , I guess. A better strategy for Bernie would have been a focus on the Public Option , and he could have used it to hammer Obama ( and indirectly , Clinton , as O’s cheerleader ) since Obama initially ran on the public option issue and then threw his supporters under the ACA bus.
Sanders wouldn’t even need to explain that Public Option would ultimately lead to Single Payer. The media would make that clear to people who couldn’t figure it out for themselves , soon enough.
“and then threw his supporters under the ACA bus.”
The actual facts are there. No need to make stuff up which does nothing but hurt progressives.
Damn!, liberals are the worst team mates in the world.
EMichael, exactly, Ben Nelson and Joe Lieberman were never voting for the public option. The republican party would have filibustered the bill and without the 60 votes nothing happens. We as liberals certainly seem able to fall on our swords in the most unique ways.
I agree. There is another important aspect to this. Rather than make the same mistake as the Clinton administration did and write the healthcare bill, Obama had Congress (all Democrats as Repubs were stonewalling Obama from day 1) write the healthcare bill. Even so, this was not enough for Lieberman and a few more of the blue dogs who were looking for concessions for their states or favorite businesses
Lyle, quite a number of rural hospitals went under, with tragic results—they were the only hospitals within a range of, say, more than 100 miles—after the ACA kicked in, in states that refused to agree to the Medicaid expansion, because the Medicaid program as structured before the ACA had included substantial subsidies to hospital apart from the Medicaid benefit to individual recipients that paid ER bills and such. The ACA switched that part, and only that part as I understand it, to the Medicaid expansion provision in the ACA, presumably as encouragement to states to adopt the Medicaid expansion.
In other words, it was the federal government that was keeping many hospitals afloat, and still is in states that accepted the Medicaid expansion.
Look, in every other modern-economy, Western-style democracy in the world, the government funds the country’s hospitals as part of the country’s healthcare system. The hospitals do just fine in countries—which is all of them, I believe—that have that system.
As for doctors, I have no idea how many would leave the profession if their incomes were cut. But, without question, this country needs more medical schools and more residency positions; that’s been the real bottleneck in the medical field. There are large numbers of people graduating from college with premed credentials who aren’t accepted to medical school because of the small number of medical schools and small class sizes. And there are many more who would get the premed credentials if they thought they had a decent chance to get into med school—and would have a way to fund it.
Which brings me to this: Medical school should be tuition-free. At public and private universities alike. This would be a really inexpensive way to eliminate one big reason that justifies the sometimes-exorbitant fees doctors charge. The government should pay off young doctors’ current medical school loans, and, in my opinion, during the financial transition period should offer physicians stipends to compensate somewhat for lost income.
Many doctors, especially so-called primary physicians—internists, family practitioners, pediatricians—while they have comfortable incomes, don’t make huge amounts of money. Specialists, especially surgical specialists, do, mostly, I believe. I have the greatest respect for them and for all competent and dedicated physicians. But maintaining the huge fees many of them charge just cannot justify the huge costs of healthcare in this country.
What strikes me as absolutely necessary—the Clinton administration’s failure to do so in 1993, and the Obama administration’s failure to do in 2009, were respectively fatal and deeply harmful to the effort—is to place one of the most accomplished healthcare economists at the helm of structuring the plan: Princeton’s Uwe Reinhardt. There are a few, but only a very few, others who could play the role well. That Bill Clinton put his wife, who had no background whatsoever in this, as head of his administration’s effort, and that Obama mostly just delegated the entire project to Congress, were foreseeably awful decisions.
There is no question, in my opinion, that physicians’ groups must be major players in this process. But the issues you raise are not insurmountable obstacles, or should not be—any more than they were in any of the other many countries that have excellent universal healthcare whose costs are far lower than the costs of this country’s current system.
Lets keep it accurate as it is not just Medicaid: “We estimate that in 2013, $53.3 billion was paid to help providers offset uncompensated care costs. Most of these funds ($32.8 billion) came from the federal government through a variety of programs including Medicaid and Medicare, the Veterans Health Administration, the Indian Health Service, Community Health Centers block grant, and Ryan White CARE Act (Figure 4). States and localities provided $19.8 billion, and the private sector provided $0.7 billion.”
In total, these sources of government funding offset about two-thirds of the cost of providing uncompensated care to the uninsured population ($53.3 billion available in funds to cover $84.9 billion in uncompensated care). With an additional $10.5 billion in charity care that was provided by office-based physicians, there remains $21.1 billion in uncompensated care that is not covered by government funding or physician charity care. http://kff.org/uninsured/report/uncompensated-care-for-the-uninsured-in-2013-a-detailed-examination/
While the Clinton administration wrote Hillarycare, Congress wrote the PPACA. Insurance companies are notorious for writing thorough insurance plans while economists are not. Medicare pays ~80% of hospital and 90% of office visits.
I am sure there are cases, but the only physicians I have seen that have left the business have gotten into the business of owning practices and facilities related to medical care.
I don’t think anyone has to worry about many doctors leaving the practice of medicine.
” We as liberals certainly seem able to fall on our swords in the most unique ways. ”
Sounds like a man speaking from experience.
Most of us manage to avoid those sword-related mishaps , but we all get thrown under the bus occasionally. When that does happen , the smarter liberals try to learn how and why , so as to prevent the next “accident” . ( Others just keep slurping the Kool-Aid , what-me-worry style ) :
NY Times Reporter Confirms Obama Made Deal to Kill Public Option
THE DEAL WITH THE HOSPITAL INDUSTRY TO KILL THE PUBLIC OPTION
“So progressives are now in revolt. Mr. Obama took their trust for granted, and in the process lost it. And now he needs to win it back.”
So , did he ?
Do you trust him ?
I sure as hell don’t.
So let me get this straight. Obama made a secret deal to kill the public option that everyone in the entire USA with an IQ above single digits knew had no chance to become law the day after the elections in November, 2008.
Little fen scary.
I am agreeing with you in my BS statement.