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Harry and Louise Now Support Sanders’ Medicare-for-All Plan. With Good Reason.

In the Comments thread today to my post yesterday titled “Clinton Announces When She Will Disclose Her Healthcare Insurance Improvement Plan: She’ll announce it just as soon as the Republican presidential candidates tell us theirs,” reader Urban Legend wrote, as part of a several-paragraph comment:

While a single payer plan is superior in theory — and has been proven in practice — thought should be given to the extreme political danger of offering a program at this time that can and will be painted by Republicans as one that will destroy half a million jobs in many different states. There was more than spite in Joe Lieberman’s objection to the public option. Think Hartford, Connecticut, insurance capital of the country. We would see “Harry and Louise” in spades. (Look it up if you’re too young to remember, and see what happened to Congress in the following election in 1994.)

I responded:

Guys, I’ve pretty much given up on trying to convince Dem baby boomers and silent generationers that it’s no longer the ’80s and ’90s and that the Bernie-is-a-SOCIALIST thing would mean a George McGovern-like trouncing and a Repub sweep in congressional elections. Finally, that argument is no longer being made by the punditry; instead it’s now the reverse: Can Clinton beat Trump, given the public’s now-obvious anti-Koch-brothers-Republican-platform mood.

But I do want to respond to Amateur Socialist’s concerns about Harry and Louise, whom I remember quite well.

The reason for the success of the insurance industry’s anti-Hillarycare ad featuring the young couple Harry and Louise was that the essence of Hillarycare was that it would all-but-force people who had choose-any-doctors-and-hospitals-you-want insurance into HMOs or PPOs that limit the choice of doctors and hospitals to those in a network, sometimes a small network, especially back then, and that sometimes required a referral by a primary care doctor for access to a specialist.

Most people back then had employer-provided insurance that did not have those limitations.  Their insurance was like Medicare—usually like Medicare with a supplemental plan is now.  The problem back then was that there still were tens of millions of people who had no access to insurance, many of them because of preexisting medical conditions, and also that premiums had been skyrocketing. And suddenly many employers were no longer paying the entire premiums.

But of course now, very few employers provide insurance that does not involve healthcare networks.  And very few now pay the full premiums.  And most policies have much larger copayments and much larger deductibles.

These are the really big problems with the ACA’s marketplace plans, too.

And these are the problems that Sanders’ Medicare-for-all proposal would eliminate.  No provider networks, no large copayments, no large deductibles, and affordable premiums.

In other words, Harry and Louise would support the Sanders plan now.

Enough said on that, I would think.

The two paragraphs in Urban Legend’s comment that precede the one I quoted read:

I agree that the Thorpe alleged take-down of Sanders’ single payer proposal is ridiculous. As you say, you can’t expect a candidate to dot every i and cross every t in a broad campaign proposal. The experience of other countries indicates almost certainty that in the long run, everyone would come out ahead with a “Medicare for All” system.

And:

I disagree completely that Clinton has no proposals for healthcare. She has quite specific proposals, including tax credits up to $5000 to reduce co-pays and deductibles (which she says are excessive), efforts to reach 16 million people who are eligible for Medicaid (a single payer plan) but haven’t signed up, and revival of the public option, the primary purpose of which was to make a genuine non-profit, efficient insurance offering available and force insurance costs further downward through direct competition. Whether they are adequate or not is a matter of opinion, but it should not be said that she has no proposals. They are there for everyone with a finger and two seconds to see.

The first of those paragraphs refers to the main point of my post: the sheer silliness of Emory University healthcare economist Kenneth Thorpe’s most recent attempt at a takedown of the Sanders proposal. The second of the paragraphs—well, it’s meaning needs no background.

But it does raise this question: Why has there been no study by mainstream progressive economists about the costs of these proposals of Clintons’, and an explanation of why this would be better than a plan that would, among other things, significantly reduce what are now the very high premiums that employers now pay to private insurers and that employees themselves pay in contributions to the premiums costs and also in copayments and deductibles?

Paul Krugman, maybe?  Nah.

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Clinton Announces When She Will Disclose Her Healthcare Insurance Improvement Plan: She’ll announce it just as soon as the Republican presidential candidates tell us theirs. [Typo in sentence referencing Max Ehrenfreund’s Wonkblog post corrected 3/2 at 2:28 p.m.]

Paul Krugman has been incessantly complaining about some Sanders supporters who accuse him and other high-profile Sanders critics, especially academics, of conflict of interest. The Sanders supporters allege all manner of self-interested reasons for the Sanders animus, much of it (including Krugman’s) expressed with vitriol.

I’m not among the Sanders supporters who subscribe to the academics-who-want-a-position-in-the-Clinton-White-House general theory.  And making that charge against Krugman is ridiculous.  But there is one virulently anti-Sanders healthcare economist who I’m betting is motivated exactly by personal ambition: Emory University’s Kenneth Thorpe.*

Thorpe, a Clinton administration healthcare official, gets his Sanders’-single-payer-critique cred because he worked on the failed Vermont single-payer plan.  Just before it was about to begin being implemented last year, the governor, a supporter of the plan, agreed to kill it because it became clear that its costs would significantly exceed former projections.

Weirdly, the failure of the Vermont plan is used, by Thorpe and others, as evidence that single-payer could not be cost-effective nationally.  As if the tiny state of Vermont has the same contractual bargaining power, regulatory power, medical training funding power, and any other relevant power as the federal government has.

Thorpe recently made big news with a report that deconstructed the Sanders plan as little more than witchcraft in its cost savings and costs overall and in its costs to this or that entity—the federal government, the states, etc.  But in a January 29 response published at Huffington Post, two healthcare economists, David Himmelstein and Steffie Woolhandler—both with credentials at least as impressive as Thorpe’s—deconstructed the Thorpe deconstruction as, well, odd in light of certain facts.  Including several that Thorpe earlier had used.

Not to worry.  Thorpe last week came up with a new headline grabber, this one likely intended to respond to us Sanders supporters who think Sanders would do better in November against Trump than Clinton would.  (Or, it now seems likely, courtesy largely of elderly and middle-aged Southern African-Americans, will.)  It is an issue that this week has become red hot now that Trump is the probable Republican nominee.  And as of this week we Sanders supporters are no longer alone in thinking that Clinton is not quite the perfect candidate to compete against Trump.  According to the NYT, the Clinton campaign itself now shares our concern.

The Washington Post Wonkblog writer Max Ehrenfreund on February 25 summarized Thorpe’s headline grabber thusly:**

Sanders estimates a middle-class family of four would pay an annual premium of $466 under his plan, with no deductible or co-pays. Less affluent households would pay less than that, or nothing at all.

But for at least 72 percent of households enrolled in Medicaid — in which someone is working — the costs of Sanders’s plan would exceed the benefits, according to an analysis by Kenneth Thorpe, a public-health expert at Emory University.

That figure includes 5.7 million households, or 14.5 million people — among them, 4.2 million Hispanic recipients and 2.5 million black recipients. The requirements for eligibility for Medicaid vary widely by state, so that group includes some households living in poverty as well as some that are modestly better off.

How? Well:

“The vast majority of low-income Medicaid workers, who are probably predominantly minority, are going to end up paying more in terms of payroll taxes, and aren’t going to receive really any financial benefits,” said Thorpe, a former Clinton administration health official.

Many lower-income people are already insured or eligible for insurance under Medicaid, at least in the states that expanded the program under President Obama’s health-care reform. Many Medicaid beneficiaries also work, and those workers’ wages would likely decline due to the additional 6.2 percent payroll tax the proposal would levy on their employers.

The lengthy blog post is titled “Study: Bernie Sanders’s health plan is actually kind of a train wreck for the poor.”

That, presumably, is because of course Sanders could not, or at least would not, tweak the plan to remove the payroll tax for people who qualify for Medicaid under current federal law.  Because although the ACA is a very complex and very lengthy statute that took a year of drafting and amending to finalize, Sanders surely has thought of every possible issue and when that one came up he simply said, “Too bad.”

Sort of like Hillary Clinton, who regularly professes plans to build on Obamacare and move toward universal coverage for all—$10,000 deductibles?  No prob.—but who never hints at what her building plans are, and, curiously, is never asked.  Not by the likes of Thorpe or Krugman.  And not by the likes of anyone else I know of.

But she’s definitely working on a plan for that move-toward-universal-coverage thing, and, as with the release of the transcripts of her highly-compensated speeches to large finance-industry and other big-corporate players, she’ll give us a hint about how she plans to do that the very minute after the Republican presidential candidates outline their plans to move toward universal healthcare coverage.

Or instead, she could refer us to Thorpe.  Since he will again be a healthcare official in the Clinton administration.

*This entire paragraph was inadvertently deleted before the post was published. So now it’s back.  And the post makes sense!

____

UPDATE:  Reader J.Goodwin and I just exchanged these comments in the Comments thread:

J.Goodwin

March 1, 2016 6:08 pm

Is there a reason we should anticipate that it would be significantly different than the Health Security Act?

I.e. larger federal subsidies and a stronger employer mandate than the ACA?

 

Me

March 1, 2016 6:54 pm

I think it wouldn’t be anything at all, J.Goodwin. I think it’s outrageous of her to keep saying generically that she wants to build on the ACA without saying what she wants to do, yet criticize Sanders for his plan.

And I think it’s outrageous of the Hillary shillary economists brigade–Thorpe, but Krugman too, and probably others–for not mentioning that she has said nothing at all about what she has in mind, yet keeps saying she has, well, something in mind.

Then again, I don’t know why Sanders hasn’t pointed out that she’s taking a page out of the Republican playbook: just keep saying you plan to do something about the uninsured; just don’t say what that is.

Added 3/1 at 6:59 p.m.

_____

**Sentence edited and separated from preceding paragraph, to make sense. 3/2 at 2:19 p.m.

Gotta tell ya, Microsoft updated its Office 365 last week, and since then I’ve had nothing but big problems trying to write anything using Word.  With this post, two main parts were just missing from the post by the time I pasted it into AB’s new-post function. There was the mysteriously deleted paragraph that I reinserted last night, and there was a sentence between this now-edited one and the preceding paragraph, and they were two separate paragraphs, as they are now.

This post is not the only thing that the Word update has made very hard for me to write.  I am not happy about this, and do not look forward to calling Microsoft and having them FIX THE SETTINGS SO THAT I CAN USE WORD AGAIN.

Okay. Rant done.  Now back to trashing pols and economists.

I’m very grateful to Yves Smith for reposting this post at Naked Capitalism this morning, and I’ve now posted the following comment to the repost there:

POST SHOULD READ:

“… Not to worry.  Thorpe last week came up with a new headline grabber, this one likely intended to respond to us Sanders supporters who think Sanders would do better in November against Trump than Clinton would.  (Or, it now seems likely, courtesy largely of elderly and middle-aged Southern African-Americans, will.)  It is an issue that this week has become red hot now that Trump is the probable Republican nominee.  And as of this week we Sanders supporters are no longer alone in thinking that Clinton is not quite the perfect candidate to compete against Trump.  According to the NYT, the Clinton campaign itself now shares our concern.

“The Washington Post Wonkblog writer Max Ehrenfreund on February 25 summarized Thorpe’s headline grabber thusly:”

I just corrected the original post at Angry Bear and added a note at the bottom raging about Microsoft’s update to Office 365 that has caused big, big problems for me in drafting anything in Word.  In this case it mysteriously deleted an entire paragraph, which I reinserted last night, and also a sentence that had prefaced the one mentioning Ehrenfreund’s blog post and making clear that his post was about Thorpe’s latest attempt to take down Sanders’ healthcare plan, not about the Clinton campaign’s concerns about the strength of Trump’s candidacy and problems with her own.

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