Saturday, February 27, 2016
Tuesday, February 23, 2016
Health Care Reform Articles - February 23, 2016
The Only Way the US Can Ever Get Affordable Health Care
Wednesday, 17 February 2016 00:00 By John Geyman, Speakout | News Analysis
Now that Bernie Sanders has brought forward his progressive agenda, including real health care reform through a single-payer universal Medicare for all program, the knives are out from the Republicans as well as Hillary Clinton to distort and discredit this option with false information.
Going forward, we have three basic alternatives to further reform our health care system: 1.) continue with the Affordable Care Act (ACA) with improvements as needed (which Clinton supports with barely a hint of what those changes might be); 2.) the Republican "plan," including repeal of the ACA and emphasizing market-based "fixes", such as health savings accounts, selling insurance across state lines, and further privatization of both Medicare and Medicaid; and 3.) National Health Insurance (NHI) through a Medicare for all plan, as currently embodied in HR 676, legislation pending in the House of Representatives.
Let's cut through the smoke and mirrors of the debate and compare each alternative in terms of costs, affordability, and what we get in terms of access, quality, and sustainability.
First, looking at costs, we have experience with market approaches to cost containment over the last three-plus decades - none have worked tocontrol either costs or prices. The ACA, with virtually no price controls, has given us, with various government subsidies, six years for private insurers, hospitals, drug companies, and others in the medical-industrial complex to expand their markets with minimal oversight.
Private healthinsurers have bulked up, consolidated, gamed the new "system" for profits and shareholder returns even as they complain of not making enough money and threatening to withdraw from the ACA's exchanges. (1) The CEO of the largest insurer, UnitedHealthcare, Stephen Hemsley, pocketed $66.1 million ($254,328 per day) total compensation in 2014. (2)
Republican policies have accelerated privatization of Medicare and Medicaid, adding higher burdens of administrative overhead and profits at public expense. Their policies are based on the concepts that markets can fix our problems and patients' demands are at the heart of inflatinghealth care costs. Hence their reliance on "consumer directed health care," with its high-deductible, low-value policies which have failed for many years.
You can't believe most of the claims that are being made about the costs of single-payer NHI. Clinton is saying that the middle class will be hit with a big tax increase without mentioning what patients and families will save and get with NHI. She says that Sanders' numbers for savings for typical American families under NHI "don't add up." (3) Some economists are also jumping on the bandwagon to discredit NHI. Paul Krugman, still thinks it is "not politically feasible" because of the political and economic power of the medical-industrial complex, and worries about "disruption for patients" with the ACA, but doesn't acknowledge the huge gains that NHI would bring with far more efficiency than our current multi-payer system. (4) Economist Kenneth Thorpe, an Emory University professor who served in the Clinton administration, claims that NHI would break the bank, and cost $1 trillion more a year than estimated as he grossly underestimated savings on overhead, drug costs, and other government expenses while assuming a grossly exaggerated increase in utilization by patients. (5)
Despite demagoguery on the issue, we have solid information on the costs - and savings - of NHI. The landmark 2013 study by Gerald Friedman, professor of economics at the University of Massachusetts, estimated that implementation of single-payer NHI will save $592 billion annually by cutting administrative waste of private insurers ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). Those savings would be enough to cover all the uninsured and provide comprehensive coverage for all other Americans, even including dental and long-termcare. Co-payments and deductibles will be eliminated, savings will fund retraining of displaced workers and phasing out investor-owned for-profit delivery systems over a 15-year period. (6)
How will this be paid for? Table 1 proposes a progressive financing plan under which 95 percent of Americans will pay less than they do now for insurance premiums, deductibles, co-payments, and out-of-pocket payments for health care. Only 5 percent of high-income Americans will pay more. The payroll tax will become the main health care tax for people with annual incomes below $225,000 - $1,500 for those with incomes of $50,000, $6,000 for those earning $100,000, and $12,000 for those with incomes of $200,000.
With NHI, all Americans will have full choice of doctors and hospitals, quality of care for the whole population will improve, bureaucracy will be sharply reduced, and we will finally have a more accountable and sustainable system. (7) Employers will be relieved of their burden of providinghealth insurance for their employees and may be able to convert some of their previous contributions to employer-sponsored insurance toemployees' forgone wage increases as they gain a healthier workforce and become more competitive in global markets. Physicians and otherhealth professionals will have a simplified billing system and more time for direct patient care.
We already pay much more in taxes each year for health care than we realize. In their just-published article in the American Journal of PublicHealth, Drs. Woolhandler and Himmelstein report that the US government, at taxpayer expense, is now paying 65 percent of the total annual tab for health care - $2.1 trillion last year, $6,560 per person, more per capita than people pay in taxes in any other advanced country with universalhealth insurance. As they report, much of this taxation is invisible to us, such as government spending to buy private health coverage for public employees and tax subsidies for private employer-sponsored insurance and other privately paid care. (8)
We have to recognize renewal of opposition to NHI for what it is - Clinton's conflicts of interest and involvement with Wall Street, despite her denials (e.g. $2.8 million in speaker fees from the health care industry between 2013 and 2015) (9); corporate media beholden to Wall Street; and a Republican consensus to block whatever President Obama does at every turn, without giving us any assurance that they will govern in the public interest.
This really is a perilous moment in the history of US health care. The ACA is fundamentally flawed - a bailout to a failing private health insurance industry and other corporate stakeholders in the medical-industrial complex. Tweaks around the edges of the ACA will never bring us cost containment in a sustainable way. If Republicans gain more control of Congress, and even the presidency in 2017, health care for much of our population will get much worse in terms of access, affordability, and quality. Research over many years has shown that the majority of Americans want NHI.
We have to come to grips that we cannot afford our present multi-payer financing system. There is more than enough money in the system to pay for it, but its waste and profiteering prevent us from getting what we are already paying for. We have to get the politics right to get the system we need - single-payer financing that we all can afford.
http://www.truth-out.org/speakout/item/34871-the-only-way-the-us-can-ever-get-affordable-health-care
Why privatizing the VA health care system is a bad idea
The Veteran’s Health Administration must fix major problems, but its integrated care system should be a model to learn from.
by Suzanne Gordon
Obamacare isn’t the only program at stake in the next election. The
future of the nation’s largest health care system — the Veterans Health
Administration — is also up for grabs. Republican candidates for
president, some with support from the Koch brothers-funded group
Concerned Veterans for America, are waging a campaign to demonize,
remake, and perhaps ultimately privatize the VHA. Marco Rubio wants to
“jolt the VA back to life,” by forcing it to compete with the private
sector. Donald Trump insists we should “empower our veterans to vote
with their feet,” which, he seems sure, will take them far away from the
nearest VA hospital.
Critics of the VHA have done a good job of erasing any memory of its successes from public consciousness. This is particularly ironic today, 70 years after the head of the Veterans Administration signed a memorandum affiliating veterans’ hospitals with academic medical centers. Since that time, the VHA has become “the largest single provider of medical training in the country,” according to the Association of American Medical Colleges, helping prepare over 70 percent of the nation’s physicians as well as members of more than 40 other health care professions. VHA researchers have helped pioneer innovations — the shingles vaccine, the implantable cardiac pacemaker, the first liver transplant — that benefit all Americans.
Of course, the VHA today has serious problems that can and must be
fixed, including a suicide prevention hotline that sent some callers to
voicemail, according to a recent report. An independent assessment
of the VHA conducted by MITRE Corporation, the Rand Corporation, and
others and released last year highlighted problems with top-heavy
management, cumbersome hiring processes, and delays in access to care in
some regions.
On the whole, however, the assessment also reported that the VHA’s 288,000 employees, including 20,000 physicians, are able to deliver high-quality care to the more than 6 million veterans who receive its services. “VA wait times,” RAND reported, “do not seem to be substantially worse than non-VA waits.” VA patients get care that is often higher quality than that in the private sector — with performance variation “lower than that observed in private sector health plans.” A study published recently in JAMA reported that men with heart failure, heart attacks, or pneumonia were less likely to die if treated at a VHA hospital rather than non-VHA hospital.
These successes are because the VHA has developed into the only nationwide fully integrated health care system in the United States. As such, it provides a model for other systems — one policy makers should be trying to learn from, not dismantle.
Integration affords veterans a level of care unavailable to most Americans, who remain subject to our fragmented private sector health care system. A VHA patient moving from Boston to San Francisco can get uninterrupted care from professionals with access to his or her medical records. The treatment veterans receive at the VHA’s more than 1,500 hospitals, community-based outpatient clinics, and other facilities is highly coordinated. For example, veterans seeing their primary care practitioner to discuss health problems — diabetes, say, or PTSD — can then walk down the hall and talk to a nutritionist about a diet, a pharmacist about how to correctly administer insulin, or a mental health professional. Because the VHA now recognizes that female veterans have special needs, they can often access care from dedicated women’s clinics. A recent study reported that women veterans have higher rates of screening for cervical and breast cancer when they see a specially designated women’s health provider.
You might think that the committees, commissions, and panels assigned to evaluate the VHA would be trying to bolster this system, focusing not only on its problems but also its strengths. Yet some seem intent on picking apart the VHA’s tapestry of comprehensive care thread by thread.
In an October essay in the New England Journal of Medicine,
the two leading members of a blue-ribbon commission charged with
evaluating the MITRE group’s assessment suggested that VHA primary care
could be spun off to the private sector. Gail Wilensky, a former head of
Medicare, and physician Brett Giroir wrote that the VHA’s model of
providing “comprehensive care” to veterans could be shifted to one
focused on specialized care, like treatment of traumatic brain injuries.
Others have suggested shifting audiology or optometry or mental health
to the private sector.
The problem is that veterans with brain injuries may also need a hearing aid or treatment for asthma or diabetes. These overlapping health problems can only be managed in a system in which primary care is, in fact, primary. Which is why improving and strengthening the integrated VHA system is something worth fighting for.
http://www.bostonglobe.com/magazine/2016/02/17/why-privatizing-health-care-system-bad-idea/2PyB5Dz36pdahjwVFr3p3M/story.html?s_campaign=email_BG_TodaysHeadline&s_campaign=
Critics of the VHA have done a good job of erasing any memory of its successes from public consciousness. This is particularly ironic today, 70 years after the head of the Veterans Administration signed a memorandum affiliating veterans’ hospitals with academic medical centers. Since that time, the VHA has become “the largest single provider of medical training in the country,” according to the Association of American Medical Colleges, helping prepare over 70 percent of the nation’s physicians as well as members of more than 40 other health care professions. VHA researchers have helped pioneer innovations — the shingles vaccine, the implantable cardiac pacemaker, the first liver transplant — that benefit all Americans.
On the whole, however, the assessment also reported that the VHA’s 288,000 employees, including 20,000 physicians, are able to deliver high-quality care to the more than 6 million veterans who receive its services. “VA wait times,” RAND reported, “do not seem to be substantially worse than non-VA waits.” VA patients get care that is often higher quality than that in the private sector — with performance variation “lower than that observed in private sector health plans.” A study published recently in JAMA reported that men with heart failure, heart attacks, or pneumonia were less likely to die if treated at a VHA hospital rather than non-VHA hospital.
These successes are because the VHA has developed into the only nationwide fully integrated health care system in the United States. As such, it provides a model for other systems — one policy makers should be trying to learn from, not dismantle.
Integration affords veterans a level of care unavailable to most Americans, who remain subject to our fragmented private sector health care system. A VHA patient moving from Boston to San Francisco can get uninterrupted care from professionals with access to his or her medical records. The treatment veterans receive at the VHA’s more than 1,500 hospitals, community-based outpatient clinics, and other facilities is highly coordinated. For example, veterans seeing their primary care practitioner to discuss health problems — diabetes, say, or PTSD — can then walk down the hall and talk to a nutritionist about a diet, a pharmacist about how to correctly administer insulin, or a mental health professional. Because the VHA now recognizes that female veterans have special needs, they can often access care from dedicated women’s clinics. A recent study reported that women veterans have higher rates of screening for cervical and breast cancer when they see a specially designated women’s health provider.
You might think that the committees, commissions, and panels assigned to evaluate the VHA would be trying to bolster this system, focusing not only on its problems but also its strengths. Yet some seem intent on picking apart the VHA’s tapestry of comprehensive care thread by thread.
The problem is that veterans with brain injuries may also need a hearing aid or treatment for asthma or diabetes. These overlapping health problems can only be managed in a system in which primary care is, in fact, primary. Which is why improving and strengthening the integrated VHA system is something worth fighting for.
http://www.bostonglobe.com/magazine/2016/02/17/why-privatizing-health-care-system-bad-idea/2PyB5Dz36pdahjwVFr3p3M/story.html?s_campaign=email_BG_TodaysHeadline&s_campaign=
Break Up the Insulin Racket
By KASIA LIPSKA
FEBRUARY 20, 2016
ONE of my patients — whom I will call Mrs. B — is a 78-year-old who has had Type 2 diabetes for over 30 years. She takes several injections of insulin each day. Her blood sugars have been running too high, but she doesn’t want to increase the dose of her insulin. She told me she simply can’t afford to.
Insulin has been around for almost a century. The World Health Organization considers it an essential medicine, which means it should be available “at a price the individual and the community can afford.” So why is this product increasingly too expensive for many Americans?
In the United States, just three pharmaceutical giants hold patents that allow them to manufacture insulin: Eli Lilly, Sanofi and Novo Nordisk. Put together, the “big three” made more than $12 billion in profits in 2014, with insulin accounting for a large portion.
What makes this so worrisome is that the big three have simultaneously hiked their prices. From 2010 to 2015, the price of Lantus (made by Sanofi) went up by 168 percent; the price of Levemir (made by Novo Nordisk) rose by 169 percent; and the price of Humulin R U-500 (made by Eli Lilly) soared by 325 percent.
To make insulin affordable, we need more competition. Nothing would do this faster than a “generic” form of insulin. (Technically, because insulin is made using bacteria, it should be referred to as a “biosimilar” instead of a “generic.”) Unfortunately, there isn’t one available in the United States.
This is true, in no small part, because the big three have cleverly extended the lives of their patents, making incremental “improvements” to their insulin. It’s not clear whether the newer insulin products are significantly safer or more effective than their predecessors, yet the strategy has been effective: There is no generic insulin, and over 90 percent of privately insured patients with Type 2 diabetes who are prescribed insulin get the newer and more expensive products.
But even a generic version of insulin might not solve all of Mrs. B’s problems. Something else is most likely contributing to the rising price of insulin: a very powerful and largely invisible group of middlemen, known as pharmacy benefit managers, or P.B.M.s.
Benefit managers negotiate with drug companies on behalf of insurers, such as employer plans and government programs like Medicaid and Medicare Part D. In theory, their job is to bargain for lower drug prices.
The hitch is that the biggest P.B.M.s are out to make a buck. They get “rebates” from drug manufacturers — payments based on sales or other criteria, which look suspiciously similar to kickbacks. The rebates are not publicly disclosed, but they are sizable. Industry analysts estimate that those payments, and other back-room deals, amount to as much as 50 percent of the list price of insulin.
HHS failed to heed many warnings that HealthCare.gov was in trouble
During the two years before the disastrous opening of HealthCare.gov, federal officials in charge of creating the online insurance marketplace received 18 written warnings that the mammoth project was mismanaged and off course but never considered postponing its launch, according to government investigators.
The warnings included a series of 11 scathing reviews from an outside consultant — among them a top-10 list of risks drawn up in the spring of 2013 that cited inadequate planning for the website’s capacity and deviations from usual IT standards. A few months before, then-Health and Human Services Secretary Kathleen Sebelius had hired another consultant to review the project and recommend ways to improve its management, but its advice was never shared with the technical staff working on the website.
The long trail of unheeded warnings is among the findings from an exhaustive two-year inquiry by HHS’s Office of Inspector General into the failings of HealthCare.gov, which crashed within two hours of its launch on Oct. 1, 2013. The failings tarnished the start of a central aspect of the Affordable Care Act — new insurance marketplaces for Americans who cannot get affordable coverage through a job — and embarrassed the White House, which championed the law.
The findings are contained in a “case study” to be released Tuesday. It represents the most penetrating look ever into what went wrong with the building of the federal insurance exchange and what was done to fix it. It is based on interviews with 86 employees of HHS, its Centers for Medicare and Medicaid Services (CMS) and companies that worked on the project, as well as on several thousand emails, memos, government contracts and other internal documents.
Many of the basic contours laid out in the 84-page report are, by now, familiar: Federal health officials failed to recognize the enormity of the undertaking, were disorganized and fragmented, were hampered by late and shifting ACA policies, had too little money, used poor contracting practices, and ignored problems until it was too late.
But the inquiry unearthed vivid details that have not been public. And it concludes that the central reason for the problems rested not with the shoddy work of vital IT contractors but with mismanagement by federal health officials carrying out this part of the law.
How a MaineCare expansion plan differs from past 5 failures
Posted Feb. 22, 2016
Gov. Paul LePage signs a veto letter he delivered to the Legislature instantly on May 23, 2013, after the Senate gave final passage to a bill that linked repayment of Maine's hospital debt with an expansion of Medicaid. Buy Photo
AUGUSTA, Maine — The Maine Legislature is about to embark — again — on another debate over whether the state should expand its Medicaid program under the provisions of the federal Affordable Care Act.
Sen. Tom Saviello, R-Wilton, teased his plan in December and is scheduled to release the details of his bill on Tuesday. Until then, Saviello isn’t talking about it other than to say expansion will benefit Maine in the long run.
“We can accomplish this task by learning from the other states that have extended this coverage,” said Saviello in a written statement Monday. “Increasing access to health coverage means increasing access to mental health counseling, drug addiction treatment and counseling and preventative health care, providing measureable cost saving and beneficial health outcomes across Maine.”
Little has changed since the five previous times since 2013 that legislators — mostly Democrats — tried but failed to expand Medicaid eligibility, notwithstanding vetoes from Gov. Paul LePage. Saviello’s fellow Republicans, who, in general, make up the opposition over fears that expanding Medicaid — known here as MaineCare — would be too expensive for future taxpayers, hold a majority in the Senate.
The new effort, sponsored by Saviello and backed by an array of progressive political groups and public health advocates, touts Medicaid expansion as a way for Maine to address a drug addiction crisis. And with a handful of Republican governors in other states changing their positions to allow Medicaid expansion, advocates say there is hope.
Here’s why:
Proponents framing this year’s version of expansion as a way to fight Maine’s drug crisis.
Ann Woloson, a policy analyst for Maine Equal Justice Partners, said Monday that she has not seen Saviello’s bill but understands that it samples from the highlights of other states’ expansion plans. Does that mean Medicaid expansion has a chance in Maine this year? Possibly.
“I do hope this year is different,” she said. “Substance abuse and addiction is not a partisan issue. It’s something that is affecting all of us.”
There is some evidence that expanding Medicaid under the Affordable Care Act — a plan under which the federal government has vowed to pay 90 percent of additional costs — eased costs in some other states’ criminal justice systems.
The State Reform Assistance Network, which is supported by the Robert Wood Johnson Foundation, is a proponent of expanding health care across the United States. The organization published a report in November that found Medicaid expansion in some states led to lower medical costs for treating prisoners, better drug relapse prevention rates when prisoners are released and lower recidivism.
The study claims that Colorado, Michigan and Ohio saw savings of $5 million to $13 million a year on criminal justice costs by expanding coverage that allowed low-income adults to access substance abuse and mental health treatment.
Democratic House Speaker Mark Eves of North Berwick said Medicaid expansion’s potential benefits in treating addiction could sway some lawmakers.
“What is different is that people are starting to make connections between the importance of Medicaid expansion and treatment as we fight the drug epidemic,” said Eves. “That is something that hasn’t been part of the conversation before and our law enforcement agencies tell us [expanding health coverage] is a critical piece of fighting this.”
Senate Minority Leader Justin Alfond of Portland said Saviello’s bill — though Alfond also hasn’t seen the details — uses a hybrid approach that melds signing up some Mainers for Medicaid while urging others to buy low-cost insurance on the private market.
“We’ve heard it all this session: Law enforcement and health care advocates all saying the same thing, that lack of access to health care is a barrier,” said Alfond. “Sen. Saviello is putting forth a new piece to the conversation. … I don’t know if that’s going to turn into votes or not but it’s definitely a different approach.”
But LePage is as opposed to it as ever.
Nobody’s more philosophically opposed to Medicaid expansion than LePage, and nothing has changed since his last veto.
His office rarely comments on legislative proposals in their infancy, but when Saviello announced his in December, the governor pounced with a radio addressreferring to Saviello and Sen. Roger Katz, R-Augusta — another expansion proponent — as “liberal politicians.”
He suggested they’re looking for votes in the 2016 election — even though the two moderates are among Maine’s safest legislators, each winning more than 70 percent of district votes in 2014 — saying he’ll veto such a proposal “every time electioneering politicians try to bring it up.”
His main argument is that it will bust Maine’s budget: Recently, he pointed to an October review by the Associated Press of 14 states that have seen Medicaid enrollment surge under expansion, with lawmakers worrying that costs may explode when federal aid decreases. LePage’s administration has rejected studies that say Maine could save money under expansion.
LePage and his lieutenants have argued aggressively against expansion, not just in Maine, but nationally: Health and Human Services Commissioner Mary Mayhew has warned New Hampshire and Florida lawmakers against expansion.
“It was the wrong thing to do then,” the governor said in his radio address, “and it’s the wrong thing to do now.”
It looks like there’s no way for the Legislature to break that stalemate.
Medicaid expansion has passed the Legislature before, but two-thirds majorities are needed to overturn LePage vetoes. Democrats have never been able to wrangle enough votes to do so. The last time it was tried in 2014, LePage’s veto was sustained by just four votes.
But Democrats held both chambers then. Now, Republicans have control of the Senate and have gained on House Democrats, who have just a nine-member majority.
It’s likely that an expansion plan would pass in the House, where Democrats are aligned in favor. But Republicans have a 20-14 edge in the Senate with one vacancy, so if only Saviello and Katz join Democrats in favor of expansion, it’ll fail and won’t get to LePage.
Senate President Mike Thibodeau, R-Winterport, who has opposed expansion, said Monday that he hasn’t seen details of Saviello’s plan and wants to wait until then to comment on it.
But Thibodeau acknowledged the proposal’s political uphill battle, saying he’s waiting to see “what the significant difference is between what he’s proposing and what we’ve already seen.”
“Unless there’s something significantly different, I would say that it would be highly unlikely to gain traction,” he said.
Saturday, February 20, 2016
Health Care Reform Articles - February 20, 2016
Media Attacking Single-Payer Are Getting Paid Under Current Health System
By With the first nomination contest only two days away, the corporate media reaction to Bernie Sanders’ surprisingly strong campaign, while not reaching Jeremy Corbyn-level hysteria, has reached a noticeable panic—one marked by let’s-not-upset-the-base qualified criticism and exquisitely curated concern-trolling. The most cynical argument being advanced is that Sanders’ support for a single-payer health program is a pie-in-the-sky fantasy, in contrast to the pragmatic incrementalism promised by Hillary Clinton.
Seth Ackerman over at Jacobin wrote a good breakdown Monday of these attacks, detailing why the gatekeeper left media’s handwringing over Sanders’ single-payer proposal is disingenuous ideology-policing rather than an objective analysis based on the actual policy merits of the plan. The arguments being made by critics—specifically Ezra Klein and Matthew Yglesias at Vox, and by the Washington Post—basically boil down to two objections: Sanders’ single-payer proposal is not “realistic” and too “vague.”
As well as debunking these two central claims, Ackerman notes the political convenience of pundits suddenly bashing single-payer who used to note its advantages. It’s smart and well worth a read as a policy primer, but there’s something lingering behind the anti-single payer arguments that goes beyond mere “base management” and pro-establishment bias.
Almost all of the outlets Ackerman references as pushing back on single payer are owned by large media corporations with sizable investments in private healthcare and its current neoliberal iteration, the Affordable Care Act. They have not just a political and ideological incentive to maintain private healthcare, but a tremendous financial one as well.
Washington Post Editorial Board
Owner and healthcare stakeholder: Jeff Bezos
After Sanders outlined his single-payer plan, the Washington Post issued an editorial (1/19/16) that ran through a laundry list of establishment gripes, the most telling of which was the idea that taxing the wealthy was “dubious”:
Put aside Mr. Sanders’ lack of political realism, or his dubious choice to tap the rich for huge amounts of revenue and spend it all, with nothing left for deficit reduction or the underfunded Social Security program.
Here we have two key features of an establishment hit job: First, deeply ideological assumptions casually asserted as self-evidently true, in this case that taxing the rich is “dubious”—a position that dovetails nicely with Bezos’ pocketbook and ideological disposition alike. It’s never explained why this is; it’s simply thrown out there as such by Serious Media outlet the Washington Post.
Then there’s the evergreen criticism of leftists that their policies are not “realistic,” that attempts to move too far to the left will alienate centrists and thus make passing laws impossible (though single-payer is routinely favored by a majority of Americans).
This is a gaslighting exercise meant to get people to argue against policies they believe are best, while embracing a logic that is infinitely regressive. If Sanders’ single-payer proposal is too radical, then certainly there’s something to the right of Clinton’s health platform that would render hers too radical as well. And something that would make that too radical, and so on.
This is why politics grounded in principle—rather than the current political mood—is pragmatic. No one is delusional enough to think Sanders is going to pass single payer on day one, but holding it as a party principle harms no one but those literal-minded enough to think candidate’s’ campaign positions are a guarantee of deliverables rather than an outline of goals.
The “realism” argument was repeated in another Washington Post story the day before (1/18/16), this one a nominally neutral reporting effort by Amber Phillips:
Most of Bernie Sanders’s Big Ideas Are Dead-On-Arrival in Congress. Do Democrats Care?
Notice the ideological assumptions posing as objective analysis:
Their most recent spat underscores the central division between the two candidates: Sanders is the candidate of grand proposals and political revolution—a word he spoke repeatedly Sunday night—while Clinton is more focused on pragmatism and building on what President Obama has already done.In other words, Clinton is the candidate who is more realistic about what can be accomplished in today’s divided political landscape. Sanders is aiming for more progressive ideas that would be much tougher to pass and implement—if not downright impossible, such as single-payer healthcare.
No evidence is provided, nor is the actual substance of the two plans dissected. Establishment ideology-policing is based, above all, on a tautology: Sanders’ plan isn’t realistic because serious people say it’s not, and we’re serious people so shut up.
Why America Is Moving Left
by Peter Binary
Over roughly the past 18 months, the following events have transfixed the nation.
In July 2014, Eric Garner, an African American man reportedly selling loose cigarettes illegally, was choked to death by a New York City policeman.
That August, a white police officer, Darren Wilson, shot and killed an African American teenager, Michael Brown, in Ferguson, Missouri. For close to two weeks, protesters battled police clad in military gear. Missouri’s governor said the city looked like a war zone.
In December, an African American man with a criminal record avenged Garner’s and Brown’s deaths by murdering two New York City police officers. At the officers’ funerals, hundreds of police turned their backs on New York’s liberal mayor, Bill de Blasio.
In April 2015 another young African American man, Freddie Gray, died in police custody, in Baltimore. In the chaos that followed, 200 businesses were destroyed, 113 police officers were injured, and 486 people were arrested. To avoid further violence, a game between the Baltimore Orioles and the Chicago White Sox was postponed twice, then played in an empty stadium with police sirens audible in the distance.
Then, in July, activists with Black Lives Matter, a movement that had gained national attention after Brown’s death, disrupted speeches by two Democratic presidential candidates in Phoenix, Arizona. As former Maryland Governor Martin O’Malley fidgeted onstage, protesters chanted, “If I die in police custody, avenge my death! By any means necessary!” and “If I die in police custody, burn everything down!” When O’Malley responded, “Black lives matter, white lives matter, all lives matter,” the crowd booed loudly. Later that day, O’Malley apologized. Donald Trump, who had ascended to first place in the race for the Republican presidential nomination while promising to represent the “silent majority,” called O’Malley “a disgusting little weak, pathetic baby.”
Anyone familiar with American history can hear the echoes. The phrase by any means necessary was popularized by Malcolm X in a June 1964 speech in Upper Manhattan. In the wake of Martin Luther King Jr.’s assassination in April 1968, Baltimore burned, as many cities did amid the racial violence that broke out every spring and summer from 1964 to 1969. In November 1969, in a speech from the Oval Office, Richard Nixon uttered the phrase silent majority. It soon became shorthand for those white Americans who, shaken by crime and appalled by radicalism, turned against the Democratic Party in the ’60s and ’70s. For Americans with an ear for historical parallels, the return of that era’s phrases and images suggests that a powerful conservative backlash is headed our way.
At least, that was my thesis when I set out to write this essay. I came of age in the ’80s and ’90s, when the backlash against ’60s liberalism still struck terror into Democratic hearts. I watched as Ronald Reagan moved the country hard to the right, and as Bill Clinton made his peace with this new political reality by assuring white America that his party would fight crime mercilessly. Seeing this year’s Democratic candidates crumple before Black Lives Matter and shed Clinton’s ideological caution as they stampeded to the left, I imagined the country must be preparing for a vast conservative reaction.
But I was wrong. The more I examined the evidence, the more I realized that the current moment looks like a mirror image of the late ’60s and early ’70s. The resemblances are clear, but their political significance has been turned upside down. There is a backlash against the liberalism of the Obama era. But it is louder than it is strong. Instead of turning right, the country as a whole is still moving to the left.
That doesn’t mean the Republicans won’t retain strength in the nation’s statehouses and in Congress. It doesn’t mean a Republican won’t sooner or later claim the White House. It means that on domestic policy—foreign policy is following a different trajectory, as it often does—the terms of the national debate will continue tilting to the left. The next Democratic president will be more liberal than Barack Obama. The next Republican president will be more liberal than George W. Bush.
A Novel Plan for Health Care: Cutting Costs, Not Raising Them
by Reed Abelson
As employees know all too well, health insurance companies have one surefire way to lower costs: Ask their customers to pay more.
Intermountain Healthcare, a nonprofit health system in Salt Lake City, is trying something virtually unheard-of: promising to sharply cut costs rather than pass them on.
Its new health plan, SelectHealth Share, is guaranteeing to hold yearly rate increases to one-third to one-half less than what many employers across the country typically face.
To help keep the rate increases roughly in line with a rise in consumer prices, Intermountain, which operates 22 hospitals and employs 1,400 doctors, says it will produce savings of $2 billion over the next five years.
Health systems and insurers are closely watching Intermountain’s rollout. It has established itself as a leading health system by tracking and analyzing costs and the quality of patient care, allowing it to improve treatments and reduce unnecessary expenses.
Intermountain’s plan is “the first innovative thing we’ve seen in a long time,” said Dave Jackson, managing partner for FirstWest Benefit Solutions in Orem, Utah. “Share has got everybody at the table — everybody’s got accountability and got things to do.”
Intermountain has already saved money by renegotiating the cost of surgical staplers, pitting a cheaper manufacturer against another and saving $235,000 a year. It saved $639,000 a year by ensuring that heart attack patients get into the catheterization lab within 90 minutes of emergency room contact, thereby helping patients recover faster.
Some systems might be more likely to reduce services or shrink their money-losing operations if they tried to guarantee a long-term lock on price increases.
But a few are heading in a similar direction to Intermountain’s, experimenting with ways that avoid the traditional piecemeal approach of fee-for-service care. The idea of locking in rate increases — Intermountain’s Share program sets the increase at approximately 4 percent — is particularly attractive to employers because coverage then becomes a predictable expense.
NYT Rounds Up ‘Left-Leaning Economists’ for a Unicorn Hunt
By Doug Henwood
Fair and Accuracy in Reporting
With Hillary Clinton ramping up her attacks on Bernie Sanders as a budget-buster—in the February 11 debate, she claimed his proposals would increase the size of government by 40 percent—the New York Times (2/15/16) offered a well-timed intervention in support of her efforts: “Left-Leaning Economists Question Cost of Bernie Sanders’ Plans.”
While the “left-leaning” is no doubt meant to suggest critiques from those who would be inclined to sympathize with Sanders, all the quoted economists have ties to the Democratic establishment. So slight is their leftward lean that it would require very sensitive equipment to measure.
Opinion pieces critical of Sanders often begin with a pledge of allegiance to his “impracticality.” This story, by Times reporter Jackie Calmes, is an “objective,” newsy version of that:
With his expansive plans to increase the size and role of government, Senator Bernie Sanders has provoked a debate not only with his Democratic rival for president, Hillary Clinton, but also with liberal-leaning economists who share his goals but question his numbers and political realism.
Though Sanders wants to increase federal spending on infrastructure, college tuition and childcare, as well as other programs, the bulk of his proposed increase would be for establishing a single-payer healthcare system, and that’s what Calmes’ piece focuses on. It would replace the current mix of multiple forms of public insurance (Medicare, Medicaid, state and local programs) and private insurance with a unitary federal system, much like what Canada has. It would not nationalize doctors and hospitals, as in Britain; only the payment side would be socialized. Sanders refers to it as Medicare for All, which is a simplification, but close enough for politics.
The liberal-leaning economists that Calmes rounds up suggest that Clinton may have been too modest in her accusation that Sanders wants to jack up the size of government by 40 percent. No, Calmes warns that “the increase could exceed 50 percent, some experts suggest, based on an analysis by a respected health economist that Mr. Sanders’ single-payer health plan could cost twice what the senator…asserts.”
As if that wasn’t scary enough, Calmes turns to mockery: “Alluding to one progressive analyst’s criticism of the Sanders agenda as ‘puppies and rainbows,’ Mr. Goolsbee said that after his and others’ further study, ‘they’ve evolved into magic flying puppies with winning Lotto tickets tied to their collars.’”
The theme of magic was further developed in a piece by New York Times op-ed columnist Paul Krugman, “My Magic Unicorn” (2/16/16), in which the word “unicorn” appears six times (not counting the headline). Krugman’s column, which denounces Sanders’ proposals as hopelessly unrealistic, refers to Calmes’ news story for support, a news story that itself reads like an op-ed in disguise.
The “Mr. Goolsbee” quoted in the story is Austan Goolsbee, who was a long-time adviser to Barack Obama before he became president, and then served on Obama’s Council of Economic Advisers. (During the 2008 campaign, Goolsbee was reported as having assured the Canadian government that Obama’s anti-NAFTA talk was “more reflective of political maneuvering than policy”—New York Times, 3/4/08.) Now Goolsbee teaches economics at the University of Chicago’s business school and is a consultant to hedge funds. A very left-leaning resume there.
And the “progressive analyst” who came up with the “puppies and rainbows” line is Ezra Klein, who in mid-January wrote a harshly disparaging piece, “Bernie Sanders’s Single-Payer Plan Isn’t a Plan at All,” on the website he co-founded, Vox (1/17/16). How times change: As long-time FAIR contributor Seth Ackerman showed in an incisive analysis (Jacobin, 1/25/16), Klein was once a strong proponent of a single-payer scheme.
In a 2007 piece for the American Prospect (4/22/07), Klein explored what he called “the best healthcare systems in the world,” including Canada’s, looking for lessons for the US. (Krugman liked the piece enough to put it on a 2012 syllabus for a Princeton class on the welfare state.) Klein’s conclusion, expressed in his opening sentence, was that while medicine is hard, health insurance is simple: We should emulate these other systems that achieve both universal coverage and cost control, like those of Canada, France, Germany and the UK. Though he now holds Sanders’ advocacy of single-payer in disdain, Klein specifically praised Canada’s single-payer system, citing a 2003 paper by Steffie Wooldhandler, Terry Campbell and David Himmelstein in the New England Journal of Medicine (8/21/03) that found that administrative costs were over three times as high in the US than in Canada, mainly because of the inefficiencies of private health insurance. Eliminate private insurance and you enjoy hundreds of billions in savings.
My Unicorn Problem
Let's dispense with myths about 'Medicare for all'
By Dave Zweifel
The Capital Times, Madison.com, Feb. 17, 2016
Is Vermont Sen. Bernie Sanders' idea to give Americans "Medicare for all" the bad idea that so many other politicians and media commentators claim it is?
As one who has editorially promoted a national single-payer health care system for the better part of my newspaper career, I suggest that most of the naysayers don't know what they're talking about.
The single-payer idea — and that's what Medicare is for Americans over the age of 65 — has been around since 1948 when Harry Truman was president. Truman viewed it as a needed complement to Franklin D. Roosevelt's social reforms, including the establishment of Social Security.
It's been proposed several times since, but the medical establishment, including the insurance and pharmaceutical powers, has become so entrenched and influential that Congress has never given it serious consideration.
It's curious that opposition to single-payer universal health coverage is a uniquely American malady. Our neighbor to the north, Canada, has had it for decades and Canadians like to point out that not one of their citizens has ever gone bankrupt because he or she got sick. We can't say that in the U.S., where tens of thousands of families have been financially devastated by unconscionably uncovered medical bills.
Meanwhile, our allies in Europe and other parts of the industrialized world long ago declared health care coverage a right of every one of their citizens. Yet most of our politicians and many citizens continue to demonize the idea. Even Obamacare, which has been a small step toward universal coverage, has been vilified, even though 11 million more people now have health insurance.
The nonpartisan Physicians for a National Health Program, which has been pushing for an American single-payer system for decades, a few weeks ago felt compelled to answer the misrepresentations that have popped up not only among the partisans running for office, but in several of the nation's newspapers whose editorial writers and columnists can't grasp what Sanders is talking about.
First, there's the canard that a single-payer system would cost American families bundles of money. As the physicians point out, in reality single-payer would pay for itself. By replacing hundreds of insurers and thousands of different private health plans, each having their own marketing, enrollment, billing, actuaries and other duplicated services, with a single, streamlined, tax-financed, nonprofit program, more than $400 billion in health spending would be freed up to guarantee coverage to all of the 30 million Americans currently still uninsured and to upgrade the coverage of everyone else, including eliminating deductibles and co-pays.
One study concludes that 95 percent of U.S. households would come out ahead.
There's also the claim that the American people are opposed to single-payer. A recent Kaiser Family Foundation survey showed that 58 percent of Americans support Medicare for all. That result jibes with other national surveys.
The biggest claim knocking the single-payer idea is that in the United States, it's unrealistic or "politically infeasible." There's no doubt that it would face considerable opposition, particularly from the private insurers, the pharmaceutical cabal, and others who profit handsomely off the current health care system.
But should the prospect of a tough battle to once and for all fix America's health care problems mean that the fight's not worth fighting? If that be the case, we still wouldn't allow women to vote, our elderly would still be living in poverty without a program called Social Security and there would be no Medicare even for folks over 65. They were all difficult fights, all considered unwinnable in their times, but the American people held their elected officials accountable and won those fights.
There's a reason health care costs per capita in the U.S. are nearly double the costs in other developed countries around the world. We've created a system that's inefficient and geared to maximizing profits for layer upon layer of bureaucratic administration.
A single-payer system would fix that. It's not, as so many like to claim, a complicated and expensive alternative, but the exact opposite.
The Capital Times, Madison.com, Feb. 17, 2016
Is Vermont Sen. Bernie Sanders' idea to give Americans "Medicare for all" the bad idea that so many other politicians and media commentators claim it is?
As one who has editorially promoted a national single-payer health care system for the better part of my newspaper career, I suggest that most of the naysayers don't know what they're talking about.
The single-payer idea — and that's what Medicare is for Americans over the age of 65 — has been around since 1948 when Harry Truman was president. Truman viewed it as a needed complement to Franklin D. Roosevelt's social reforms, including the establishment of Social Security.
It's been proposed several times since, but the medical establishment, including the insurance and pharmaceutical powers, has become so entrenched and influential that Congress has never given it serious consideration.
It's curious that opposition to single-payer universal health coverage is a uniquely American malady. Our neighbor to the north, Canada, has had it for decades and Canadians like to point out that not one of their citizens has ever gone bankrupt because he or she got sick. We can't say that in the U.S., where tens of thousands of families have been financially devastated by unconscionably uncovered medical bills.
Meanwhile, our allies in Europe and other parts of the industrialized world long ago declared health care coverage a right of every one of their citizens. Yet most of our politicians and many citizens continue to demonize the idea. Even Obamacare, which has been a small step toward universal coverage, has been vilified, even though 11 million more people now have health insurance.
The nonpartisan Physicians for a National Health Program, which has been pushing for an American single-payer system for decades, a few weeks ago felt compelled to answer the misrepresentations that have popped up not only among the partisans running for office, but in several of the nation's newspapers whose editorial writers and columnists can't grasp what Sanders is talking about.
First, there's the canard that a single-payer system would cost American families bundles of money. As the physicians point out, in reality single-payer would pay for itself. By replacing hundreds of insurers and thousands of different private health plans, each having their own marketing, enrollment, billing, actuaries and other duplicated services, with a single, streamlined, tax-financed, nonprofit program, more than $400 billion in health spending would be freed up to guarantee coverage to all of the 30 million Americans currently still uninsured and to upgrade the coverage of everyone else, including eliminating deductibles and co-pays.
One study concludes that 95 percent of U.S. households would come out ahead.
There's also the claim that the American people are opposed to single-payer. A recent Kaiser Family Foundation survey showed that 58 percent of Americans support Medicare for all. That result jibes with other national surveys.
The biggest claim knocking the single-payer idea is that in the United States, it's unrealistic or "politically infeasible." There's no doubt that it would face considerable opposition, particularly from the private insurers, the pharmaceutical cabal, and others who profit handsomely off the current health care system.
But should the prospect of a tough battle to once and for all fix America's health care problems mean that the fight's not worth fighting? If that be the case, we still wouldn't allow women to vote, our elderly would still be living in poverty without a program called Social Security and there would be no Medicare even for folks over 65. They were all difficult fights, all considered unwinnable in their times, but the American people held their elected officials accountable and won those fights.
There's a reason health care costs per capita in the U.S. are nearly double the costs in other developed countries around the world. We've created a system that's inefficient and geared to maximizing profits for layer upon layer of bureaucratic administration.
A single-payer system would fix that. It's not, as so many like to claim, a complicated and expensive alternative, but the exact opposite.
Dave Zweifel is editor emeritus of The Capital Times (Madison, Wis.). Contact him at dzweifel@madison.com.
Dirty little secret: Insurers actually are making a mint from Obamacare
by Michael Hiltzik - LA Times
r months now, headlines about the Affordable Care Act have focused on complaints from big insurers that they haven't been making money from individual insurance plans mandated by the act.
The big insurer UnitedHealth Group has even whined about losing so many millions it's thinking about withdrawing from the Obamacare marketplace as soon as next year. Others, including Anthem and Aetna, have mentioned that their exchange business isn't yet profitable, though they're not talking about pulling the plug.
Here's what they haven't been saying so loudly: They're making scads of money from Obamacare — so much that almost universally, they'reexpanding their participation.
What's the catch? The big profits have come not from the insurance exchanges, but via the ACA's Medicaid expansion, in which the largest insurers have been playing a major role. The same insurance executives who go out of their way to badmouth the ACA's individual exchange plans talk as though they can't get enough of the Medicaid business, especially its managed care component.
"Managed Medicaid continues to emerge as the ultimate long-term sustaining solution for states," United CFO Dave Wichmann told investors last month, adding that his company expected to compete for that business aggressively.
This trend not only underscores the diversity of healthcare solutions embedded in Obamacare, but may also point to its future. In Medicaid, as inMedicare, government is the single payer. It sets reimbursement rates for doctors and hospitals and sets enrollment terms so that members, once enrolled, stay enrolled.
Moreover, the programs are almost entirely free or at least very inexpensive for members. That ensures that they get a lot of healthy enrollees as well as those with heavy medical needs, a mix that makes the costs of the overall insurance pool relatively stable and predictable.
These factors and others eliminate many of the uncertainties that have bedeviled insurers in the exchange market, where the health profiles of customers have been hard to gauge and their movement into and out of health plans, sometimes to Medicare and Medicaid, has been vigorous.
"It seems that insurers are perfectly happy and prosperous competing in the markets where the government is the payer," observes Andrew Sprung on his Xpostfactoid blog. He's right. Anthem, which has been quietly grousing about the elusive profits in the exchange market, also has been buying up Medicaid insurers — acquiring Amerigroup, which operates Medicaid plans in 13 states, for nearly $4.5 billion in 2012, and Simply Healthcare, with nearly 200,000 Medicaid and Medicare members in Florida, for $1 billion last year.
Medicaid specialty insurers such as Wellcare and Centene have done especially well, as Bruce Japsen observed recently in Forbes. Medicaid managed care enrollment at St. Louis-based Centene grew last year by more than 20%, to 5.1 million members in 24 states.
"Clearly, 2015 was a banner year," crowed its CEO, Michael Neidorff, in a conference call last week. No dissing of Obamacare was heard on the call.
Executives in the Medicaid market expect continued growth as the last states holding out against the ACA's Medicaid expansion give in. The healthcare reform act was designed to offer health insurance to lower-income Americans by expanding Medicaid eligibility to cover all those with household income at or below 138% of the federal poverty line, or about $33,500 for a family of four. The federal government would cover states for 100% of the additional cost through this year, and no less than 90% after that.
This plan was broken up by the Supreme Court, which ruled in 2012 that the expansion could be only voluntary, not mandatory. Sixteen states — all controlled by Republican governors or legislators or both — are still resisting, but several original holdouts have given in to the opportunity to cover tens or hundreds of thousands of residents at virtually no cost to the state budget (see map below).This trend not only underscores the diversity of healthcare solutions embedded in Obamacare, but may also point to its future. In Medicaid, as inMedicare, government is the single payer. It sets reimbursement rates for doctors and hospitals and sets enrollment terms so that members, once enrolled, stay enrolled.
Moreover, the programs are almost entirely free or at least very inexpensive for members. That ensures that they get a lot of healthy enrollees as well as those with heavy medical needs, a mix that makes the costs of the overall insurance pool relatively stable and predictable.
These factors and others eliminate many of the uncertainties that have bedeviled insurers in the exchange market, where the health profiles of customers have been hard to gauge and their movement into and out of health plans, sometimes to Medicare and Medicaid, has been vigorous.
"It seems that insurers are perfectly happy and prosperous competing in the markets where the government is the payer," observes Andrew Sprung on his Xpostfactoid blog. He's right. Anthem, which has been quietly grousing about the elusive profits in the exchange market, also has been buying up Medicaid insurers — acquiring Amerigroup, which operates Medicaid plans in 13 states, for nearly $4.5 billion in 2012, and Simply Healthcare, with nearly 200,000 Medicaid and Medicare members in Florida, for $1 billion last year.
Medicaid specialty insurers such as Wellcare and Centene have done especially well, as Bruce Japsen observed recently in Forbes. Medicaid managed care enrollment at St. Louis-based Centene grew last year by more than 20%, to 5.1 million members in 24 states.
"Clearly, 2015 was a banner year," crowed its CEO, Michael Neidorff, in a conference call last week. No dissing of Obamacare was heard on the call.
Executives in the Medicaid market expect continued growth as the last states holding out against the ACA's Medicaid expansion give in. The healthcare reform act was designed to offer health insurance to lower-income Americans by expanding Medicaid eligibility to cover all those with household income at or below 138% of the federal poverty line, or about $33,500 for a family of four. The federal government would cover states for 100% of the additional cost through this year, and no less than 90% after that.
This plan was broken up by the Supreme Court, which ruled in 2012 that the expansion could be only voluntary, not mandatory. Sixteen states — all controlled by Republican governors or legislators or both — are still resisting, but several original holdouts have given in to the opportunity to cover tens or hundreds of thousands of residents at virtually no cost to the state budget (see map below).
Louisiana's new governor, Democrat John Bel Edwards, last month signed on to Medicaid expansion, reversing the opposition of his Republican predecessor, Bobby Jindal. That will bring coverage to as many as 300,000 residents.
Sprung observes that the experience of insurers in Medicaid, especially Medicaid managed care, shows how to expand publicly financed healthcare by offering "a program rather like Medicaid" to even more people. It might be open to all those with incomes below 200% of the poverty line and without access to employer-sponsored coverage, he suggests. The lowest-income enrollees still would get the plan for free or nearly free, and "higher income enrollees could buy in on a sliding scale. Because payment rates would be more like those of our current programs than like private ones, premiums and copays would be lower."
Sprung notes that the losers in this arrangement "would be not insurers, and not enrollees, but healthcare providers, for whom one more segment of the overall market would be paying government rates. But the individual health insurance market is relatively small — probably a bit under 20 million lives at present, potentially perhaps 30 million if plans were affordable enough to bring in those who are holding back at present. That's as compared to about 147 million in the employer sponsored market."
The real question is whether the healthcare system for these lower-income Americans could transition to this existing system without being tweaked in ways that erode its advantages. Leaving aside the ideological opposition to any Medicaid expansion in several states, some that have capitulated have done so by making the program more expensive for enrollees, albeit only modestly so — charging premiums and co-pays for some services, for example.
That could be a slippery slope. "Medicaid managed care works because you have a very large percentage of the overall market and nominal premiums," Larry Levitt of the Kaiser Family Foundation told Sprung. Any substantial raise in premiums would discourage healthier people from signing up — creating the same "skewed risk pool" that causes risk-management problems for insurers in the individual market, Levitt said.
Yet it remains the case that a very significant portion of the ACA's insurance provision is working so well that even the most loudly grumbling insurers are happy with it. It's single-payer, government-financed, yet administered by private insurers. Because its enrollee costs are so low, its value to them is higher in actuarial terms than even the average employer plan. Could it be the future?
Why Left-of-Center Wonks Are Skeptical of Bernie Sanders
by Neil Irwin
Bernie Sanders has a problem with the liberal wonkosphere — or, more precisely, the liberal wonkosphere has a problem with Bernie Sanders.
With every upward tick in Mr. Sanders’s poll numbers in the last few months, there has been a corresponding rise in a very specific type of commentary: Left-of-center policy experts and former staffers for Democratic officials have questioned his plans as unwise, unrealistic or both.
On Wednesday, it took the form of a joint letter from four people who led the White House Council of Economic Advisers during the Clinton and Obama administrations. They criticized projections by Gerald Friedman, an economist who has advised Mr. Sanders, of what the candidate’s policy proposals would achieve. Their comments were quickly echoed by the liberal economists Brad DeLong and Paul Krugman. The health care experts Kenneth Thorpe of Emory University and Henry Aaron of the Brookings Institution have also been tough on Mr. Sanders’s health care plan.
Behind the critiques: Mr. Sanders’s advisers have often worked off assumptions that their policies would sharply increase economic growth, reduce health care costs and create other salutary effects, making the policies in question look more affordable and desirable than they would with more cautious assumptions.
Most recently, Mr. Friedman projected a growth rate of 5.3 percent a year under a Sanders administration, compared with a Congressional Budget Office projection of 2.1 percent annual growth over the coming decade. Mr. Friedman, a professor at the University of Massachusetts-Amherst, also estimates that Mr. Sanders’s policies would bring an unemployment rate of 3.8 percent (the lowest since 1969) and 3.2 percent annual productivity growth (more than double the C.B.O. projection).
The former White House economic advisers find these numbers implausible. After all, a lot of policies look great and affordable if you assume they will generate incredible growth. They equate this to Republicans who argue that large tax cuts will not increase the deficit because they will unleash extraordinary economic growth.
But there may be something broader going on here beyond the specific disagreements about growth assumptions, or cost savings from a single-payer health system, or how to regulate the financial system.
Behind closed doors, among the left-of-center policy types who populate the congressional offices, executive agencies and think tanks of Washington, I’ve seen enough eye rolls when Mr. Sanders’s name comes up to suspect something more tribal is going on.
The wonkosphere vs. Bernie clash is not just a story of center-left versus left-left. It is also a clash between those who have been in the trenches of trying to make public policy for the last seven years versus those who can exist in a kind of theoretical world of imagining what public policy ought to be.
Suppose, for a moment, that you worked as a staff member to a Democratic member of Congress, or perhaps in the Obama administration, or in the world of academics and think tank experts advising both.
Perhaps you worked countless all-nighters on the language of the Affordable Care Act or the Dodd-Frank Act — or maybe you were at an agency trying to write the thousands of pages of regulations to institute those laws, or even an advocacy group trying to nudge all of the above to the left.
You know the compromises that were made back in 2010 and why — uniting 55 or 60 senators with wildly different political temperaments and local politics was really hard. You had to come up with a bill that could get a “Yes” vote from both a centrist like Joe Lieberman or Joe Manchin and, well, a democratic socialist like Bernie Sanders.
You’re convinced that those laws — much hated by both conservatives and the industries they overhauled — made the United States a better place, helping millions more people afford health care and reining in the financial industry. You know the laws aren’t perfect — but also believe that future presidents and Congresses should build on them, much as Social Security and Medicare are now much expanded from their original charters.
Now comes a man who has had to answer only to voters in the most liberal state in the nation, who has never had the responsibility to actually pull together the disparate center-left coalition that is the Democratic Party to enact concrete legislation.
When Mr. Sanders argues for scrapping Obamacare’s intricately constructed mix of private health insurance with public subsidies for a single-payer government program, he’s essentially saying your efforts were useless, hopelessly corrupted by the health insurance industry. Same with Mr. Sanders’s call to break up the largest banks, as opposed to the current approach of just regulating them more intensively.
Then, if you criticize Mr. Sanders’s plans, or question their political feasibility, his supporters assail you as a member of a corrupt establishment.
This isn’t just armchair psychoanalysis. The former congressman Barney Frank, an eponymous architect of the financial reform law, made his own version of this argument in a recent article for Politico.
Mr. Sanders “presents himself as not only free of responsibility for anything that happened during his tenure, but vigorous in his insistence that nothing that was done while he was there had any value in addressing the problems that he discusses,” Mr. Frank wrote.
“Many congressional Democrats, myself included, feel deep resentment at this wholly negative portrayal of our efforts,” he added.
No one would suggest that huge numbers of Democratic primary voters are taking their voting cues from former White House economists and think tank analysts. But if Mr. Sanders wins the nomination, a fascinating test for how he will govern will be whether he mends fences with left-of-center policy wonks — or views them as part of the problem of establishment thinking he is trying to overcome.
Varieties of Voodoo
by Paul Krugman
America’s two big political parties are very different from each other, and one difference involves the willingness to indulge economic fantasies.
Republicans routinely engage in deep voodoo, making outlandish claims about the positive effects of tax cuts for the rich. Democrats tend to be cautious and careful about promising too much, as illustrated most recently by the way Obamacare, which conservatives insisted would be a budget-buster, actually ended up being significantly cheaper than projected.
But is all that about to change?
On Wednesday four former Democratic chairmen and chairwomen of the president’s Council of Economic Advisers — three who served under Barack Obama, one who served under Bill Clinton — released a stinging open letter to Bernie Sanders and Gerald Friedman, a University of Massachusetts professor who has been a major source of the Sanders campaign’s numbers. The economists called out the campaign for citing “extreme claims” by Mr. Friedman that “exceed even the most grandiose predictions by Republicans” and could “undermine the credibility of the progressive economic agenda.”
That’s harsh. But it’s harsh for a reason.
The claims the economists are talking about come from Mr. Friedman’s analysis of the Sanders economic program. The good news is that this isn’t the campaign’s official assessment; the bad news is that the Friedman analysis has been highly praised by campaign officials.
And the analysis is really something. The Republican candidates have been widely and rightly mocked for their escalating claims that they can achieve incredible economic growth, starting with Jeb Bush’s promise to double growth to 4 percent and heading up from there. But Mr. Friedman outdoes the G.O.P. by claiming that the Sanders plan would produce 5.3 percent growth a year over the next decade.
Even more telling, I’d argue, is Mr. Friedman’s jobs projection, which has the employed share of American adults soaring all the way back to what it was in 2000. That may sound possible — until you remember that by 2026 more than a quarter of U.S. adults over 20 will be 65 and older, compared with 17 percent in 2000.
Sorry, but there’s just no way to justify this stuff. For wonks like me, it is, frankly, horrifying.
Still, these are numbers on a program that Mr. Sanders, even if he made it to the White House, would have little chance of enacting. So do they matter?
Unfortunately, the answer is yes, for several reasons.
Donald Trump in Triage Mode After Shocking Conservatives With Health Care Comments
He has broken with many Republicans on taxing the rich, threatening trade wars and keeping Planned Parenthood alive. On Friday, Donald J. Trumpfaced criticism for an even bolder act of conservative heresy: embracing the core tenet of the Affordable Care Act.
Mr. Trump has to date offered only bits and pieces of his health agenda, generally presenting a vow to repeal “Obamacare” and replace it with “something great.”
In a town-hall meeting hosted by CNN on Thursday night, he shared some more expansive views on the subject, and unlike most Republicans he did not call for removing the individual mandate that requires Americans to have health insurance.
Asked how people with pre-existing medical conditions would purchase insurance if the health law and the mandate were eliminated, Mr. Trump said, “I like the mandate.”
“So here’s where I’m a little bit different,” he continued. “I don’t want people dying on the streets.”Less than 24 hours later, Mr. Trump backed away from his remarks, proclaiming himself to be the fiercest opponent of the health law. It was the latest example of a candidate who has been impervious to inconsistencies again emerging unscathed from a misstep that would probably be damaging to anyone else.
The Affordable Care Act has sometimes put Republicans in an awkward position on the campaign trail. While the popularity of the law remains mixed nationally, many Americans have benefited from the aspects of the legislation that would be lost if it is repealed.
http://www.nytimes.com/2016/02/20/us/politics/donald-trump-in-triage-mode-after-shocking-conservatives-with-health-care-comments.html?action=click&pgtype=Homepage®ion=CColumn&module=MostViewed&version=Full&src=mv&WT.nav=MostViewed
America Is Moving Left
Republicans may have a lock on Congress and the nation’s statehouses—and could well win the presidency—but the liberal era ushered in by Barack Obama i
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