“Sanders’ ‘Medicare For All'”: The Devil Is In The Details
Bernie Sanders is a proud and self-described socialist, a veteran Vermont senator who wants to bring some European ideas to the United States. One of those ideas is a single-payer health care system: a government-funded program in which the patient bears little to no cost. Sanders describes it as “Medicare for all.”
It’s an excellent idea. The United States is the richest country in the world, and it ought to grant every citizen guaranteed access to doctors and hospitals. That’s what Canada, Japan and the countries of Western Europe have all done.
But Sanders is vague — and his supporters quite naive — about the prospects of bringing a single-payer system to the United States. He insists that he could accomplish that in a prospective first term “if many millions of people demand it.”
Here’s the rub: They won’t — at least not in the systematic and sustained manner that would be required to bring about that sort of, well, revolutionary change to the American medical-industrial complex.
There’s a reason that the U.S. doesn’t have “Medicare for all”: politics. Do Sanders and his supporters remember the epic battle to pass the Affordable Care Act?
Democrats have been trying to pass a version of universal health care since the days of Franklin Delano Roosevelt. But conservatives have fought every proposal that would increase access for ordinary Americans, including Medicare; Ronald Reagan, then a neophyte political activist, toured the country campaigning against it.
Bill Clinton made universal health care a cornerstone of his presidential campaign in 1992, and he appointed his wife, Hillary, to head a task force to propose legislation after he won. They tried mightily to pass it, but conservatives denounced it, and the insurance industry spent millions to defeat it.
That’s why President Barack Obama brought the insurance industry on board when he started toward the Affordable Care Act. He knew he needed their support to have a prayer of passage. So the ACA preserves the business of selling health insurance through private companies.
Still, it has helped millions of families; nearly 9 million more Americans had health insurance in 2014 than the year before, according to government data. Moreover, the ACA prevents insurance companies from banning patients because they are sick and prohibits insurers from placing “lifetime caps” on the amount of money any person can collect for health care.
Would a single-payer plan have been even better? You bet. But listen to Obama’s former aide, David Axelrod, describe the difficulties of trying to pass such a proposal.
“I support single-payer health care, but having gone through health reform, we couldn’t even get a national consensus around the public option! It was Democratic votes that were ultimately missing on that issue,” Axelrod remembered. (The public option was a proposal for a government-run health insurance plan to compete with private health insurers.)
History shows that Obama and his allies spent months trying to make the ACA more palatable to conservatives to entice a few GOP votes. Actually, the mandate requiring that all adults have health insurance was originally a conservative idea. While the federal government provides subsidies to help families with modest incomes buy insurance, it doesn’t pay the full cost. (Obamacare also sets aside billions for states to expand Medicaid, but the Supreme Court made that optional, and many states have refused to expand.)
Still, the ACA did not get a single Republican vote in the end — not one. Republicans are still trying to repeal the law, taking more than 60 votes in Congress and going to the Supreme Court with challenges. Most of those Republicans will be easily re-elected to Congress.
Given recent history, it’s clear that Sanders’ plan would face very long odds — and that’s before details become clear. The Vermont senator proposes an extraordinary range of patient care — dental and vision coverage, mental health care, long-term care — while, he says, saving trillions of dollars. Many health care experts say that can’t be done, so health care spending would likely increase. You don’t have to be a conservative voter to fear where that would lead us.
If Vermont’s audacious senator has a plan for overcoming an ultraconservative GOP caucus in Congress, a right-leaning U.S. Supreme Court, and millions of voters who still flinch from the word “socialist,” he ought to lay it out. It would be quite a revolutionary plan, indeed.
By: Cynthia Tucker Haynes, Pulitzer Prize Winner for commentary in 2007: The National Memo, February 13, 2016
“LePage Vetoes Medicaid Expansion For All The Wrong Reasons”: Maine’s Paul LePage Is One Uninformed And Paranoid Governor
Maine’s Democratic state House Speaker, Mark Eves, noted the circumstances this week surrounding Medicaid expansion. “We have a bipartisan plan for life-saving health care for tens of thousands of Mainers,” he said. “It creates jobs, it save lives, it saves money.”
All of this happens to be true. Every state north of Virginia has either embraced Medicaid expansion or is working towards doing so – except Maine, where Gov. Paul LePage (R) refuses to cooperate. More than 60,000 low-income Mainers would benefit from the policy, on top of the economic and fiscal benefits, but the Republican governor nevertheless vetoed Medicaid expansion yesterday.
The measure also would have established a managed care system for all 320,000 beneficiaries, an effort to control costs in the $2.5 billion program, which is Maine’s version of the Medicaid health insurance program.
Under the Affordable Care Act, also known as Obamacare, the federal government offered to reimburse states for 100 percent of the cost of expansion for at least three years, then gradually reduce reimbursements rates to about 90 percent.
But in his veto message to the Legislature, LePage wrote that Maine could neither afford expansion nor trust the federal government to deliver on its promises.
The rejection didn’t come as a surprise, and Democratic state lawmakers will try to override LePage’s veto. By all accounts, however, they face an uphill climb – some GOP state lawmakers are on board with the policy, but probably not enough to generate a two-thirds majority.
But what was somewhat surprising was just how awful LePage’s defense was. The governor, struggling in his re-election bid this year, had plenty of time to come up with a credible rationale for blocking Medicaid expansion, but he didn’t come up with much.
“It is shortsighted to think federal funds will always be available, especially after watching the federal deficit climb and witnessing continual delays and changes from Washington,” he said in a statement.
I realize that Paul LePage sometimes struggles with policy details, but there are some rudimentary facts he should probably understand before telling 60,000 people they can’t have health insurance.
For example, if LePage is “watching the federal deficit climb,” he’s not watching closely enough. The federal deficit isn’t climbing; it’s shrinking. In fact, in recent years, we’ve seen the fastest deficit reduction than at any point since World War II. Does LePage not know that? Maybe he should have looked it up before issuing his statement?
What’s more, LePage is convinced federal funds may not “always be available” to finance Medicaid expansion. In other words, he’ll refuse the funds now because maybe, someday, far off in the future, Washington won’t offer the funds they’re promising to provide.
Sorry, 60,000 struggling Mainers. You can’t have access to affordable medical care because your governor is paranoid about a fiscal situation that may or may not materialize at some point.
These are the best arguments the governor’s office could come up with after having months to prepare?
By: Steve Benen, The Maddow Blog, April 10, 2014
“ACA Enrollment Tops 6 Million”: The Imminent Implosion Of The Affordable Care Act Has Been Cancelled
The expectation all along was that health care enrollment through the Affordable Care Act would spike shortly before the March 31 deadline. As of this afternoon, those expectations are very much in line with reality.
More than 6 million people have signed up for health insurance on the new exchanges, a number that signals a tremendous last-minute surge, the White House said Thursday.
President Barack Obama told volunteers and navigators helping sign people up that 1.5 million people visited HealthCare.gov on Wednesday – the highest-traffic day yet. Officials have said they logged more than a million visits each day so far this week.
Remember, this total only refers to consumers who’ve signed up for private coverage through exchange marketplaces. It doesn’t include Americans who’ve gained coverage through Medicaid expansion. For that matter, clearing the 6-million milestone is an important threshold, but there’s still time remaining in the open-enrollment period and it’s not unrealistic to think we’ll see 6.2 million by next week.
“We are seeing near-record numbers of consumers coming to check out their options and enroll in coverage. Yesterday alone, we had 1.5 million visits to HealthCare.gov and took more than 430,000 calls at our 24/7 call center,” said Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services.
As of March 1 – not quite four weeks ago – 4.2 million Americans had enrolled through exchanges, suggesting we’ve seen nearly two million consumers sign up in less than a month.
It’s easy to forget, but this seemed like a pipe dream last fall. In October, the first month of the open-enrollment period, just 106,185 consumers signed up for insurance through an exchange – causing Republicans to not only celebrate, but to openly mock the system by noting a variety of sports venues that hold more than 106,185 attendees.
It was obviously proof, we were told at the time, that the Affordable Care Act itself was “hurtling toward failure.”
Oops.
The enrollment totals must seem literally unbelievable to Republicans, who managed to convince one another that the ACA is not only catastrophically flawed, but on an inevitable road towards imploding.
Indeed, as Paul Krugman noted earlier today, “[P]eople in the GOP are still working with a completely wrong narrative — namely, that Obamacare is failing, and that these are desperate ploys to save a sinking ship. The reality is quite different: enrollments have clearly surged in the final month…. How will the GOP respond when the numbers come in?”
I don’t know the answer to that question, but I suspect it’ll have something to do with Benghazi.
To reiterate a point from early February, those who say they hate “Obamacare” won’t want to hear this, but the imminent implosion of the Affordable Care Act has been cancelled.
What’s more, this is less of a comeback story than a story of normalcy and effective governance. There was a fair amount of panic in November – remember the pieces that predicted “Obamacare may destroy all of liberalism forever”? – but there were plenty of voices counseling patience. There were problems, but they were surmountable. There were elements that were broken, but they could be fixed.
The recent progress, in other words, isn’t some remarkable fluke the White House achieved through a Hail Mary pass. Rather, what we’re seeing now is progress many of us expected to see all along.
By: Steve Benen, The Maddow Blog, March 27, 2014
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