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“Makes More Sense Than Critics Admit”: The Brave Politics Of Clinton’s Medicare Buy-In Proposal

Predictably, much of the commentary about Hillary Clinton’s newly expressed interest in making a Medicare buy-in option available to people near retirement age is treating it as another calibrated “move to the left” to head off Bernie Sanders or placate his supporters. The unstated assumption is that anything other than a full-on single-payer system (the only creditable progressive proposal, you see) is a half measure reflecting either political cowardice or corrupt kowtowing to private insurance interests.

Here’s the thing, though. People who love to cite polls showing the popularity of “Medicare for all” (the favored buzz-phrase for single-payer) should be aware that the popularity of the venerable retirement program is based on its current characteristics as an “earned entitlement” program for which working Americans pay payroll taxes and then, after becoming beneficiaries, premiums. The “buy-in” proposal, by targeting people who have (a) presumably been paying those same payroll taxes and will continue to do so until retirement if they are employed, and (b) will immediately pay relatively steep premiums (though not as steep, in most cases, as private insurance premiums), does minimal violence to the structure, financing and original purpose of Medicare. “Medicare for all,” once it is a tangible proposal rather than a bumper-sticker slogan, changes Medicare in all these respects, and might make it unrecognizable. The financing challenge alone for a single-payer system — which never much gets mentioned in the polling — makes the incremental approach, via a combination of Medicare, “Obamacare”-subsidized private insurance, and Medicaid, a much easier reach financially and politically.

Perhaps I’m wrong and perhaps Hillary Clinton is wrong in feeling this way. But one thing’s for sure: Expanding Medicare and providing a “public option” under Obamacare are not popular ideas in the private insurance industry. That’s certainly not the constituency Clinton is representing here. And anyone who doubts the political courage it takes to achieve universal health coverage incrementally, instead of just intoning “Medicare for all” until the walls fall down like Jericho’s, hasn’t been paying much attention the last quarter-century.

 

By: Ed Kilgore, Daily Intelligencer, New York Magazine, May 11, 2016

May 14, 2016 Posted by | Bernie Sanders, Hillary Clinton, Universal Health Care | , , , , , , , , | Leave a comment

“Change Takes Continuity”: Hillary Clinton Is The Change America Needs

Over the coming weeks and months, Democrats in caucuses and primaries around the country will choose between Hillary Clinton and Bernie Sanders to be the party’s nominee. Some are now casting the decision as one between “continuity” and “change,” with Clinton representing a continuation of President Obama’s agenda and Sanders representing a shift toward the transformational change that escaped Obama.

This binary is completely false.

Ours is a historical era in which continuity and change are one and the same. Obama ended the wars of the George W. Bush administration, normalized relations with Cuba, and prevented the ascent of an Iran armed with nuclear weapons. In the last week alone, his administration declined to renew licenses to coal mining operations on federal lands, declared a ban on solitary confinement of minors in federal penitentiaries, and ordered police departments around the country to give back military surplus equipment being misused by law enforcement. And on Tuesday, news came of the White House preparing to issue an executive order that would require any firm doing business with the federal government — virtually all giant corporations — to disclose its campaign contributions.

We need more of the same. We need the unbroken continuation of Obama’s domestic and foreign policies to bring about the laws, rules, and regulations that advance progress. It may not be “transformational,” but real change is rarely that sexy. It may not feel all kumbaya, but politics almost never does.

Let’s remember the Democrats saved the economy, passed the Affordable Care Act, and reformed Wall Street — with nearly unanimous opposition from Congressional Republicans. Since 2010, we have seen more job growth since no one remembers. More Americans have health insurance. And, while it took a while, the Dodd-Frank financial reforms are now being felt.

That’s real change.

Yes, wages are not what they used to be, health care is still run by private insurance companies, and Wall Street still rakes in more money than God. But those are not reasons to break the chain of real progress. Change takes continuity.

Consider Bernie Sanders’ call for “Medicare for all.”

In the hours before the final Democratic debate, Sanders released a plan for creating a single-payer health care system of the kind found in rich European countries that have managed to keep costs down while ensuring the right of all citizens to access to quality health care. Ever since Obama proposed health care reform that kept intact the role of private health insurance companies, the Democratic Party’s left wing has demanded nothing short of “Medicare for all.”

That’s fine. Most left-liberals would prefer that. But it doesn’t represent change so much as wishful thinking.

Hillary Clinton was not, during the debate, just wrapping herself in Obama. She was speaking the truth: Democrats can’t go back and restart the fight over universal health care because they have no hope of winning. Now is the time, however, for policy reforms addressing rising costs, insurance exchanges, and private profit. Yes, this is change by a thousand tweaks, but it is still change.

Is there a risk in voting for Clinton? Yes, of course. You don’t really know what kind of president you’re getting until she’s elected. But Hillary Clinton may be the exception. She’s long been in the public eye. We know her strengths as well as her weaknesses. Most important, we know she can be forced to listen to progressive demands. That cannot be said of Republicans.

I like Bernie Sanders and would support him in another context, and I don’t personally like Hillary Clinton. But my dislike isn’t as important as my country transcending the long conservative malaise that began before I was born.

 

By: John Stoehr, The Week, January 29, 2016

February 2, 2016 Posted by | Bernie Sanders, Democratic Primary Debates, Hillary Clinton | , , , , , , , , | Leave a comment

“Utopian Fantasy?”: Bernie Sanders’s Single-Payer Health Care Plan Failed In Vermont

When Sen. Bernie Sanders regales his campaign crowds with a portrait of The Way Things Are Going to Be, his “Medicare for All” program takes center stage. In a Sanders administration, the candidate promises, every man, woman, and child in America will share in a government-run, government-funded health-care system.

But the single-payer system that Sanders is evangelizing isn’t just a figment of progressive utopian fantasies. Single-payer health care has already been tried—and failed—in Sanders’s home state of Vermont, where the proposal collapsed under its own weight last year before it was ever implemented.

Deciding why it failed in Vermont is key to whether you buy into the candidate’s promise to extend the program nationwide.

According to critics, from The New York TimesPaul Krugman to USA Today’s editorial board, Sanders’s single-payer plan is something between a well-intentioned fool’s errand and a political pipe dream, an unrealistic idea that has been proven not to work in the senator’s own backyard.

But closer to home, activists say Vermont’s failure even to implement its plan for universal health care was a failing of political will, not the policy itself. In better hands, they say, the policy can still work. To know the difference, it’s important to understand how Vermont got so close to single-payer in the first place.

In 2011, the state’s Democrat-controlled legislature approved a government-run, government-financed health-care system for all Vermonters. The state’s new Democratic governor, Peter Shumlin, signed the bill into law after campaigning on a pledge to enact single-payer himself. A cost estimate of the program, known as Green Mountain Care, was ordered, but long delayed.

Elections came and went, including Shumlin’s own 2014 reelection, which was so close Vermont law required the final decision to go to the legislature after Shumlin failed to win a majority of the vote in November. As the state waited for the legislature to take up the election results, Shumlin announced that he would not pursue single payer after all when the long-awaited financial projections showed “the promise and the peril” of a single-payer system. The promise, of course, was a chance to give nearly every Vermonter reliable access to quality health care.

But the very real peril came in the cost for the program, an estimated $4.3 billion a year, almost the size of the state’s entire $4.9 billion budget. To make up for the $2 billion shortfall, taxes would have to go up, a lot. Businesses would see an 11.5 percent payroll tax increase, on top of whatever they chose to provide for employee health care, while individual income taxes could jump by up to 9 percent. The report recommended against moving forward “due to the economic shock and transition issues,” and Shumlin agreed.

“I wanted to fix this at the state level. And I thought we could,” Shumlin said in a statement issued with the financial report. But he called implementing single-payer health care in 2015 “unwise and untenable.”

Despite the ominous budget projections at the time, single-payer advocates now say they believe Shumlin’s decision was purely political.

“Right up to the last gubernatorial election, Gov. Shumlin was saying he was going to do everything he could to make single-payer health care a reality in the state. That was quite frankly why we didn’t run a candidate against him,” said Kelly Mangan, the executive director of the Vermont Progressive Party. “Almost immediately, he turned around and said, ‘Oh, yeah, we can’t afford single-payer health care. It’s not going to happen.”

Mangan described single-payer advocates today as “fatigued and very disheartened.” As Vermont’s state budget continues to be squeezed by Medicaid costs, she said the possibility of returning to the issue any time soon seems unlikely. She also worries that Vermont’s example will damage future prospects nationally. “I think it will have a ripple effect. People will use it as an excuse to do nothing by saying, ‘If they couldn’t do it there, then it can’t be done,’” she said.

Dr. Gerald Friedman, an economics professor at UMass-Amherst and a part-time Vermonter, has worked with Sanders to develop and calculate the cost of his plan and says the budget wasn’t the problem for the Vermont proposal. The governor was the problem.

“On the economics, it would have been cheaper, but the governor just lost the political will,” Friedman said.

But the professor acknowledged that any national health care proposal from Sanders would face the same political headwinds that Shumlin ran into. “It’s going to be a tough road, and Vermont is a lesson,” he said. “It’s unfortunate that it happened the way it did.”

Even with the Vermont debacle in the rearview mirror and Friedman’s own projections that Sanders’s “Medicare for All” would cost north of $14 trillion over 10 years, the politics of single-payer are still working for Sanders. The latest Kaiser poll showed 81 percent of Democrats favor a “Medicare for All” proposal, while 60 percent of independents favor it, too.

Clinton has dismissed Sanders’s proposal as unrealistic and a danger to the reforms that have already been enacted through the Affordable Care Act. That argument seems to be falling flat in New Hampshire, where the latest WMUR poll showed Sanders trouncing Clinton by nearly 30 points. But at least Clinton can count on some support when the campaign gets to Vermont. Gov. Shumlin, who will not run for reelection, has announced he’s with her.

 

By: Patricia Murphy, The Daily Beast, January 25, 2016

January 26, 2016 Posted by | Bernie Sanders, Single Payer, Universal Health Care | , , , , , , , | 1 Comment

   

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