Pages

Tuesday, October 20, 2015

Health Care Reform Articles - October 20, 2015

Bernie Sanders, Democratic Socialist Capitalist

by Josh Barro

In last week’s Democratic Party debate, Bernie Sanders stuck up for the idea that Americans are prepared to elect a democratic socialist, which is how he describes himself. “We’re gonna win,” he said, when the moderator, Anderson Cooper, pressed him on his electability under any kind of socialist label.
This led Hillary Rodham Clinton to defend capitalism, saying, “We would be making a grave mistake to turn our backs on what built the greatest middle class in history,” though she allowed the need to “rein in the excesses of capitalism.”
The weirdest thing about this fight is that Mr. Sanders, a Vermont senator, is not really a socialist. Or at least, if he is a socialist, he is also, at the same time, a capitalist.
“I think Bernie Sanders’s use of the word ‘socialism’ is causing much more confusion than it is adding value,” said Lane Kenworthy, a professor of sociology at the University of California at San Diego. Mr. Kenworthy, who recently wrote a book called “Social Democratic America” and thinks about these sorts of things for a living, offered a suggestion: “He is, if you want to put it this way, a democratic socialist capitalist.”
Ugh. Do we have to put it that way? In addition to being a mouthful, that still seems as if it’s going to confuse a lot of people.
After all, Mr. Sanders does not want to nationalize the steel mills or the auto companies or even the banks. Like Mrs. Clinton, he believes in a mixed economy, where capitalist institutions are mediated through taxes and regulation. He just wants more taxes and more regulation than Mrs. Clinton does. He certainly seems like a regular Democrat, only more so.
“It’s not socialism, it’s social democracy, which is a big difference,” said Mike Konczal, an economic policy expert at the left-wing Roosevelt Institute. Social democracy, Mr. Konczal noted, “implies a very active role for capitalism in the framework.”
Social democracy, Mr. Sanders will have you remember, is not what they were up to in the Union of Soviet Socialist Republics. It’s the little-of-this, little-of-that philosophy of parties like Labour in Britain or the Social Democrats in Germany. Such parties have abandoned their past support for the nationalization of industry and have presided for long periods over economies that certainly appeared capitalist to visiting American tourists, albeit with higher taxes than we have in the United States.
Mr. Sanders himself emphasizes the “democratic” part of democratic socialism, and promised in last week’s debate that “we’re gonna explain what democratic socialism is.” He cited Denmark, which has very high taxes, very generous social programs and a robust economy driven by private capital investment, as an example of a place that does social democracy really well. (Though, as Matt Yglesias at Vox noted, Denmark’s Social Democrats have been out of power for 11 of the last 15 years while the country’s policies have continued to look pretty social democratic, further highlighting the difficulty of figuring out who’s really a socialist or not, or what.)
Mr. Konczal laid out four hallmarks. You might be a social democrat if you support: a mixed economy, that is, a combination of private enterprise and government spending; social insurance programs that support the old and the poor; a Keynesian economic policy of government borrowing and spending to offset economic recessions; and democratic participation in government and the workplace.
If that’s what social democracy is, it’s not obvious what the term would add to the American political lexicon. Most Democrats would tell you they support all four of those things. So would quite a few Republicans.
Mr. Sanders said on the campaign trail this week that police and fire departments are “socialist institutions,” as are public libraries. He noted that Social Security and Medicare, which are very popular with Americans, are “socialist programs.” This, again, is more confusing than clarifying. If supporting Social Security and public firefighting makes you a social democrat, the term does nothing to distinguish Mr. Sanders from his opponents.
“When you look at the policies, there’s a way to see it as Bernie has cranked up Hillary’s agenda to 11,” Mr. Konczal said. To wit: Mrs. Clinton favors preserving Social Security with some enhancements for the poorest beneficiaries, while he wants to raise taxes on the rich to expand it in ways that could add $65 per month to the average benefit. This, like most political debates, is a disagreement about how far to turn the knobs when adjusting policy; it does not seem to call for a separate ideological label.
That said, Mr. Konczal did offer one difference between Mr. Sanders’s and Mrs. Clinton’s worldviews that is of kind rather than degree. This is decommodification: the idea that some goods and services are so important that they ought to be removed from the market economy altogether.
The idea behind the Affordable Care Act, and behind Mrs. Clinton’s approach to tinkering with Obamacare, is that quality health insurance should be affordable to everyone, and that people who can’t afford it should be given subsidies to buy it. For a democratic socialist, that’s not good enough; instead, health care should simply be provided to everyone without charge, removing the profit motive from health care.
But even this is a matter of degrees. Mr. Sanders favors Medicare for all: a single-payer health care system, with the federal government as the sole insurer. This would remove the profit motive from health insurance but not from health care, which could continue to be provided by private doctors and hospitals, often working on a for-profit basis. Mr. Sanders is not proposing to go further, like Britain, and have doctors work directly for the government. Nor does he appear inclined to decommodify broad swathes of the economy; in other countries, even conservatives often endorse special, less-marketized rules for health care than for other sectors.
This distinction is real, but it’s not clear to me that it merits Mr. Sanders his own ideological label. So when Mr. Kenworthy, the California professor, proposed the “democratic socialist capitalist” label to me, I responded by asking how that’s different from being a very liberal Democrat.
“I don’t think there is a difference,” he said. As such, I hope Mr. Sanders is not too offended if I simply describe him as “very liberal.”

WHAT IS A DEMOCRATIC SOCIALIST? BERNIE SANDERS TRIES TO REDEFINE THE NAME.

DES MOINES — When Sen. Bernie Sanders came to speak in Iowa a few months ago, Drake University student Ian Miller snagged a seat on the stage. It was a close-up look at a historic campaign: After decades where socialists were the enemy, a “democratic socialist” had come to town as a serious candidate for president.
What a moment, right?
Right?
“Remind me what a socialist is?” Miller said last week. 
A friend, Nik Wasson, tried to explain: “A socialist is someone who believes the government needs to be involved in a lot of aspects of the economy, and social issues as well.”
Senator Bernie Sanders (I-Vt.) has been making waves as the only democratic socialist running for president. Here’s what you need to know about being a democratic socialist and how it’s different from socialism. (Alice Li/The Washington Post)
“Okay,” said Miller, who was born in 1995. “Well, knowing what ‘democratic’ means — and now, knowing again what ‘socialist’ means,” he approved of the combination. “[Sanders] might want to see government have a heavier hand in certain policies,” he said, but “he wants everyone to have a say in it.”
Sanders’s remarkable success this year — in spite of his label as a socialist — is due to a mix of good politics and great timing.
Twenty-four years after the end of the Cold War, many Americans no longer associate socialism with fear or missiles — or with failure, food lines or empty Soviet supermarkets. A word that their elders saw as a slur had become a blank, open for Sanders to define.
And this year, Sanders (I-Vt.) has tried to define it with an eye toward a moderate audience.
He has called for huge growth in government regulation and spending. But he has stayed away from classic socialist ideas, like government takeovers of private industry. And, in his speeches, Sanders has talked about socialism in modest, solidly American terms: It’s nothing more than the pursuit of fairness in a country now rigged by the rich.
So far, it’s worked — but Sanders still hasn’t had to face an opponent determined to use socialism against him.
“What democratic socialism means to me,” Sanders said during a recent speech in New Hampshire, “is having a government which represents all people, rather than just the wealthiest people, which is most often the case right now in this country.”
Until recently, the word “socialist” occupied a special place in American politics: Along with “liar” and “hypocrite,” it was a rare insult so low-down that it couldn’t even be used on congressmen.

U.S. Health Care Could Be More Like Denmark’s

by Steffie Woolhandler

The United States isn’t Denmark, but it can, like Scandinavia, implement changes to its health care system that save money, cover everyone and help us live longer.
In the 1950s, U.S. health statistics were world class: infant mortality rate among the lowest, life expectancy among the highest, and health costs about average. One by one, other nations — not just Denmark and Sweden, but Australia, Britain, Canada and Taiwan, to name a few — adopted national health programs. By the end of the 20th century, the U.S. was the lone hold out for private, for-profit health insurance, and its health statistics lagged behind dozens of countries. Meanwhile, costs soared to twice the average in other wealthy nations.
For Americans, national health insurance would mean comprehensive coverage, a free choice from a smorgasbord of any doctor or hospital and lower costs. Other countries have seen huge savings by evicting private insurers and the reams of expensive paperwork they inflict on doctors and hospitals.  Aetna keeps 19 cents of every premium dollar for overhead and profit, leaving only 81 cents for care. And U.S. hospitals devote 25.3 percent of total revenue to administration, reflecting the high cost of collecting patient copayments and deductibles, and fighting with insurers.
Obamacare will direct an additional $850 billion in public funds to private insurers, and boost insurance overhead by $273.6 billion. Yet it will leave 26 million uninsured and similar numbers with such skimpy coverage that a major illness would bankrupt them. Most Americans have coverage that limits their choice of doctors and hospitals, and inflicts steep financial penalties when they stray "out-of-network" by accident or necessity. 
In contrast, insurance overhead in single-payer programs (and fee-for-service Medicare) takes only 1 percent to 2 percent. In these programs, hospitals don't need to bill each patient; they're paid a lump sum budget, the way we fund fire departments, sharply cutting hospital administrative costs. Moving to a single-payer system would save about $400 billion annually on paperwork and administration — enough to ensure every American top coverage.
Messages like "We are not Denmark" insist we put blinders on and refuse to learn from others. That reasoning would have us ignore innovations like vaccination or CT scanners (British inventions), echocardiograms (a Swedish one) or cardiac stents(first used in France). A single-payer reform — like the one advocated by the 20,000 members of Physicians for a National Health Program — could save thousands of American lives each year. That's as American as apple pie.

A New Attack on Health Care Reform

A Small Indiana Town Scarred by a Trusted Doctor

No comments:

Post a Comment