SUGAR The World Corrupted: From Slavery to Obesity By James Walvin 325 pp. Pegasus Books. $27.95.
Sweets have invaded the English language the way they have invaded our diet, with almost universally positive connotations. Sweet love, sweet people and sweet deals all suggest pleasant experiences, as do the sugary confections that grace our tables and fill our stores. James Walvin’s new book, “Sugar: The World Corrupted: From Slavery to Obesity,” will thoroughly disabuse you of such agreeable associations and may make you reluctant to reach for something sweet. Sugar, he shows, is a blood-soaked product that has brought havoc to millions and environmental devastation to large parts of the planet, premature death to the poorest populations in many parts of the world and huge health costs for societies from the United States to India. After reading this book the mere mention of sugar should make you think of slavery and cavities, imperialism and obesity — and remind you to check the label on the products you consume.
Walvin, the author of several books on slavery, takes his readers on a roller-coaster ride through 500 years of history. Sugar, he shows, was rare for most of human history, with sweetness largely derived from fruits and honey. Sugar was believed to have healing properties and in much of the world it was dispensed by apothecaries; consumption of small quantities of sugar was the prerogative of elites. Then, in the 16th century, Europeans seized large territories in the Americas and quickly dedicated much of that acreage to sugar cane. By killing off local inhabitants and enslaving Africans to do the backbreaking labor of tending the sugar plant, European settlers managed to build a huge production complex. Hungry for power and profit, they turned the fertile soils of Brazil, Barbados, Guadeloupe, Jamaica, St. Domingue and other places to the growing of sugar for European markets by slave labor, producing extraordinary wealth in cities like Bristol, Bordeaux and Boston, and unimaginable misery for millions of enslaved workers.
Sugar, Walvin argues, was the cutting edge of global capitalism, with the plantations among the largest business enterprises, the most significant sources of profit and, in light of their highly regimented discipline, the most modern work sites. As a major share of the total trade of both 18th-century France and Britain, sugar lubricated the world economy and provided nutrition to the growing number of people who worked in cities and industry. Sugar catalyzed some of the first waves of globalization — notably in British North America, which entered the world economy as a supplier of goods to the Caribbean sugar complex and a processor of its harvest. Boston, as much as Barbados, is sugar’s offspring.
As sugar streamed from the Caribbean, consumption grew. The European elite consumed ever-larger quantities — their rotting teeth in full view of their contemporaries, although discreetly hidden by their portraitists. By the 19th century, the working class in Europe and North America was sweetening its tea and coffee, and putting jam on its toast; by century’s end, it was breakfasting on sugary cereals. Fantastic quantities of sugar, in all its forms, kept stomachs full and workers productive. In 1770, rum — made from sugar cane — provided possibly one-quarter of the caloric needs of British North America. By the mid-20th century, the average annual consumption of sugar in Britain was an astonishing 110 pounds per person. “The fruits of slave labor,” Walvin writes, “had thoroughly permeated the Western world.” Even with slavery abolished in the British and French Caribbean, North Atlantic demand and investments allowed for another huge expansion of sugar slavery, this time in Cuba.
When slavery came to its slow end in the 19th century, the geography of sugar shifted. Brutalized indentured workers from India and China took up sugar production in Guyana and Fiji, Mauritius and Trinidad. Beet sugar producers in Germany and the American Midwest gained market share. And by the late 20th century, American corn growers were feeding huge quantities of high fructose corn syrup into global markets, enabling an ever-increasing quantity of sweeteners to be poured into soft drinks and cereals. Along the way, sugar turned out to be so important that governments came to regulate its production and trade, trying to secure inexpensive sugar for domestic markets and to bolster an ever more powerful food industry addicted to cheap sweeteners. Subsidies and tariffs, as well as imperial exertions on behalf of sugar-consuming industries, Walvin makes clear, shaped the global sugar market in ways that were good for industry and all too often harmful to workers and consumers. The result has been a wave of obesity that has moved at awe-inspiring speed across the planet — fattening up people from Europe to the United States, from India to Mexico, creating a global health crisis that suggests sugar is as toxic as tobacco. If current trends continue, Walvin observes, the majority of the British and American population may be obese by 2050.
“Sugar” is an entertaining, informative and utterly depressing global history of an important commodity. It takes its cues from histories of commodities like salt, tobacco and cotton and makes good use of the possibility inherent in this approach, especially the ability to link diverse developments in distant parts of the world over long time spans. It is less analytically sophisticated than some of its predecessors, and it enters a field — sugar studies — built on Sidney Mintz’s magnum opus “Sweetness and Power,” arguably the book that started the recent boom in commodity studies, and one that Walvin often cites. What Walvin adds to this literature is accessible prose and a more expansive view that focuses on the contemporary moment and, especially, the public health implications of a world addicted to sugar.
“Sugar” could have used another round of edits — it is maddeningly repetitive. Its numbers are often vague, and trajectories — of sugar consumption, for example — would be clearer if shown in a table or graph. Walvin’s arguments are morally forceful, but their lack of precision and specificity makes them analytically nebulous. “Sugar” also reads almost like two books — one focused on slavery, the other on obesity. And despite its global scope, the book remains beholden to a Eurocentric perspective that has little to say about pre-European systems of sugar production in Asia, glosses over the enormous expansion of systems of indentured labor in sugar-growing Asia, and is weak on sugar consumption in places like India, Barbados or Senegal — all currently suffering from a diabetes epidemic. Perhaps it is true, as Walvin asserts, that sugar tainted “all involved wherever it took root,” but how it tainted places and people, and who did the tainting, and how conditions changed over the past 500 years are often left unexplained, as are any resulting lessons we might learn.
By alerting readers to the ways that modernity’s very origins are entangled with a seemingly benign and delicious substance, “Sugar” raises fundamental questions about our world. It does not resolve all those questions, but it provides enough information for its readers to begin to see some answers and to see how troubling and disconcerting they are.
Medicare Advantage Is About to Change. Here’s What You Should Know.
Medicare Advantage plans will be allowed to cover adult day care, home modifications and other new benefits. But they may not be available to all enrollees every year.
by Paula Span - NYT - July 20, 2018
Did you fall in the bathroom and fracture your hip? Medicare, if you have it, will pay thousands of dollars for surgery to repair the injury and thousands more for your resulting hospital stay and rehab in a nursing home.
For decades, public health experts, doctors, patients and families have lamented this narrow, often counterproductive approach to older Americans’ health care.
“You don’t want somebody with asthma rushing to the emergency room with a breathing problem that could have been prevented with an air conditioner,” said Tricia Neuman, who directs the Medicare policy program at the Kaiser Family Foundation. Yet Medicare covers costly emergency medicine, not window units.
When Medicare’s open enrollment period begins on Oct. 15, the private insurers that underwrite Advantage plans — which already lure seniors with things traditional Medicare can’t cover, like eyeglasses, hearing aids and gym memberships — will be free to add a long list of new benefits.
Among those the Centers for Medicare and Medicaid Services will now allow, if they’re deemed health-related: Adult day care programs. Home aides to help with activities of daily living, like bathing and dressing. Palliative care at home for some patients. Home safety devices and modifications like grab bars and wheelchair ramps. Transportation to medical appointments.
“This will potentially help people stay in their homes longer and not have to go to institutions,” Seema Verma, the C.M.S. administrator, said in an interview. “You could provide a simple device or a home modification that could mean the world to a patient, but plans weren’t allowed to do that in the past.”
In 2020, thanks to Congress, the list of possible benefits could expand still further. Incorporated in the budget signed by President Trump, the Chronic Act is intended to help people manage conditions like heart failure and diabetes, in part by authorizing telehealth programs. It, too, will work through Medicare Advantage.
These actions could represent substantial change. Dr. Diane Meier, a geriatrician who directs the Center to Advance Palliative Care at the Icahn School of Medicine at Mount Sinai in New York, called them “a tectonic plate shift.”
“What I find most fundamental is the recognition, by C.M.S. and Congress, that this bright line between ‘medically necessary’ and things necessary to maintain health — like proper nutrition and transportation to a doctor’s office — is an illusion,” she said.
“Failure to invest in simple things like safe housing and transportation means you will invest in hospitalization and emergency room visits” at far higher costs, she added.
Yet celebration may prove premature. Many questions remain about how insurers will respond to the legislative opening.
“We have concerns about where all this is heading,” said David Lipschutz, senior policy lawyer for the Center for Medicare Advocacy. “The scales really are being tipped in favor of Medicare Advantage, with unknown consequences.”
A primer: Medicare Advantage funnels federal dollars to private insurers — United Healthcare and Humana dominate the market — who must cover all Medicare services but can also dangle a number of bonus benefits.
Dentistry, for instance. Original Medicare doesn’t cover it, but with Medicare Advantage, “some plans cover cleaning,” Dr. Neuman said. “Some cover cleaning and extractions. Some might cover a crown every five years.” Now, such extras could expand.
The plans — including premiums and benefits — already vary widely. Enrollees pay the monthly Part B premium ($134 this year, though higher income people pay more) and may pay an additional Medicare Advantage premium. Last year, according to Kaiser Family Foundation analysis, that ran an average $36 a month, including Part D drug coverage.
So Medicare Advantage plans may appear cheaper than standard Medicare combined with Part D and a supplemental Medigap policy — though with co-pays, deductibles and drug formularies, they may not be.
“The key trade-off is that they generally operate with a restricted network of providers,” Dr. Neuman said. Most involve health maintenance or preferred provider organizations.
The proportion of Medicare beneficiaries who opt for these plans has climbed steadily, nonetheless, to 33 percent last year from about 16 percent in 2006. In 10 years, the Kaiser Family Foundation calculates, that figure will reach 42 percent.
“The Medicare Advantage program is very successful,”Ms. Verma said. “We see consistently high marks for satisfaction.”
Additional benefits could accelerate that growth, and Ms. Verma said she hoped they would.
“When people look at making a choice between enrolling in Medicare Advantage or the traditional program, they’re going to see this as a tremendous opportunity,” she predicted.
The immediate changes may be modest. Because C.M.S. announced its new rules in April, and insurers had to submit proposals last month, “there was very little time for the plans to mobilize,” said John Gorman, a consultant for many Medicare Advantage insurers. He expects more significant differences in 2020 and beyond.
And then?
What particularly troubles skeptics is that these intended improvements completely bypass most Medicare beneficiaries — the two-thirds who have stuck with traditional Medicare.
You can see why it’s played out this way. Funding for Medicare Advantage programs is capped: C.M.S. provides a set amount, which private insurers can use to provide whichever supplemental benefits they choose, theoretically stoking competition. Any increased costs will be borne by the plans and their enrollees, not the federal budget
“Republicans have always been some of Medicare Advantage’s biggest boosters,” Mr. Gorman noted. “In effect, you’re shifting deficits onto the private sector.”
As for the remaining Medicare population, “advocates are hoping this provides a pathway to expanded services for all beneficiaries,” Dr. Neuman said.
But Ms. Verma said that could raise costs and would require Congressional action. Moreover, C.M.S. also relaxed the requirement thatAdvantage plans must provide the same services for all enrollees. Now, they can furnish benefits to those with certain health conditions, not to everyone.
Thus, a plan can tailor its offerings, providing adult day programs, say, only for people with dementia. “If you see a plan advertising certain supplemental services, that’s not necessarily a guarantee the services will be available to you,” Mr. Lipschutz said.
In fact, since the more flexible rules permit but don’t require any of these new benefits, and since insurers won’t reveal the particulars until October, it’s not yet clear what they will offer — or whether these changesmight weaken traditional Medicare.
Advantage plans could provide certain benefits one year, then withdraw them the next, in the same way that drug coverage shifts. As for providers, “who’s in-network and who’s not changes by the minute,” Dr. Meier said.
Once they enroll, few people ever switch. “People find it very tedious, and they have little confidence in their ability to understand how plans differ,” Dr. Neuman said.
Now, those choices will grow still more complicated. The independent counselors at the free State Health Insurance Assistance Programs should probably brace for waves of new clients.
“It’s all going to require experimentation,” Dr. Meier said.
Still, a move to more broadly support the health and well-being of an aging population could mark an important turning point.
“Could” is the key word. “It’s only a possibility,” Dr. Meier said. “But it wasn’t a possibility before.”
A Vote Expanded Medicaid in Maine. The Governor Is Ignoring It.
by Abby Goodnough - NYT - July 24, 2018
Medicaid expansion is also emerging as a potent issue in gubernatorial and congressional races in Florida, Georgia and Kansas, among others. Here in Maine, where supporters of expansion have sued the LePage administration over its failure to act, the legal conflict has spilled into the race to replace Mr. LePage, who is finishing his second term.
Janet Mills, the state’s attorney general, is also the Democratic candidate for governor. She refused to represent the administration in the court case, leaving it to a private lawyer from Boston.
Ms. Mills said in an interview last week: “If for some reason Medicaid expansion isn’t implemented in the next five and a half months, I will do it on Day 1.”
Her Republican opponent, Shawn Moody, a businessman, sides with Mr. LePage. His spokeswoman — who is Mr. LePage’s daughter, Lauren — said in an emailed statement on Thursday that if elected, Mr. Moody would “enforce the laws on the books, with appropriate funding from the legislature who under the constitution must pass all spending bills.”
Janet Mills, the state’s attorney general and also the Democratic candidate for governor. She has refused to represent the administration in the court case.Greta Rybus for The New York Times
A statement Ms. LePage recently shared with Maine reporters took a more colorful tone, saying in part, “Shawn will not risk the fiscal health of the state to expand welfare for nondisabled individuals, and will not support funding welfare by raising taxes, raiding the rainy-day fund, or using one-time budget gimmicks.”
On June 4, A Maine Superior Court judge last month ordered the LePage administration to submit a plan within a week for expanding Medicaid, chastising its “complete failure to act.” Unsurprisingly, the administration appealed, and the state’s highest court, the Maine Supreme Judicial Court, heard arguments Wednesday about whether the lower court’s order should be kept on hold, as Mr. LePage wants, until his appeal is resolved.
The question of how to pay for Medicaid expansion kept coming up, with the justices appearing reluctant to get involved.
Patrick Strawbridge, the lawyer representing the LePage administration, said the lower court had been wrong to order Mr. LePage to submit a plan binding his administration to pay its share for Medicaid expansion when the legislature hadn’t appropriated “a single penny” for it.
Lynnea Hawkins, with a 17-year-old son and a volunteer job, qualified for Medicaid, but without the expansion, she will lose coverage next year when he turns 18.Greta Rybus for The New York Times
That led James Kilbreth, a lawyer for the plaintiffs, to point out the legislature’s allocation last month of $60 million, using one-time surplus and tobacco settlement funds, to cover the first year of Medicaid expansion costs.
“You can’t have a circumstance in which the governor, after the legislature appropriates funds, is free to veto and veto and veto appropriations to fund the act,” Mr. Kilbreth said.
The legislature failed to override Mr. LePage’s veto of the spending bill because a bloc of House Republicans refused to join in. Mr. LePage has said he will not approve spending that raises taxes or relies on the state’s rainy day fund or “one-time funding mechanisms or budget gimmicks.” He recently suggested increasing a tax on hospitals to cover the state’s share of expansion costs — a funding stream that a number of other states that expanded Medicaid are using — but legislative leaders say they need to see a formal plan before deciding whether to support the idea.
Mr. LePage often points back to earlier state decisions to expand Medicaid, over a decade ago. Afterward, Maine struggled with budget shortfalls and fell behind on Medicaid payments to hospitals. After Mr. LePage took office, he paid the hospitals more than $200 million that they were still owed and reduced Medicaid eligibility. The new expansion would be different in that the federal government would pay significantly more of the cost.
Ms. Staples, the breast-cancer survivor who attended the oral arguments, works part time in food service at Bowdoin College. She pays $75 a month for subsidized private coverage through the Obamacare marketplace, plus a deductible, but is poor enough to qualify for Medicaid if it were expanded, she said. She gathered hundreds of signatures to help get Medicaid expansion on the ballot last year, then knocked on hundreds of doors to get out the vote as a member of the Maine People’s Alliance, a nonprofit organizing group. It was the first time voters anywhere got to decide the issue, and they approved it 59 percent to 41 percent.
“We shouldn’t have to be fighting this right now,” Ms. Staples said outside the marble-lined courtroom as throngs of summer tourists, oblivious to conflict, wandered the Old Port neighborhood outside. “We have 70,000 lives on the line here.”
Her friend Lynnea Hawkins, 38, said she relished the prospect of Mr. LePage going to jail over Medicaid expansion, however unlikely that might be. She has only a volunteer job, with the Maine People’s Alliance, where she and Ms. Staples both serve on the board. She qualifies for Medicaid now as the mother of a dependent child, but without the expansion, she will lose it next spring when her son turns 18.
“I want to be outside the jail with a nice chair and some popcorn, waving to him — ‘Bye, have fun!’” said Ms. Hawkins, who lives in Lewiston.
Lori Dwyer, the president and chief executive of Penobscot County Health Care, which runs nonprofit clinics in the Bangor area and treats 65,000 patients a year, 17 percent of whom are uninsured.Greta Rybus for The New York Times
Robyn Merrill, the executive director of Maine Equal Justice Partners, the advocacy group leading the lawsuit, said, “We don’t have an objective indication that anybody is going to have to go to jail.” But she added that if the Supreme Judicial Court ultimately enforced the lower court’s order and Mr. LePage still refused to budge, the plaintiffs would ask the court to find his administration in contempt.
Donna Wall, 61, a plaintiff in the lawsuit, is uninsured. She racked up $60,000 in debt after shattering her ankle when she fell on an icy sidewalk in Lewiston last December while delivering newspapers in the middle of the night, a job that paid her $150 a week.
A GoFundMe.com campaign raised more than $10,000 to help her. But Ms. Wall, who cares full time for her 20-year-old autistic twins and donates blood plasma for extra income, is eager for the security of Medicaid coverage. She applied for it on July 3, a day after the state was supposed to start covering the newly eligible population under the law.
“The governor has this preconceived notion that we’re lazy,” Ms. Wall said on Tuesday. “I would love for him to come and live with me a couple weeks, see what it’s like to take care of the boys.”
The expansion would cover anyone earning up to 138 percent of the federal poverty level, which equals about $16,700 a year for a single person and $34,600 for a family of four. Many health clinics that treat the poor are telling their patients to apply for Medicaid now even though they may not get coverage any time soon.
“We’re telling them to let us know if or when they get denied,” said Lori Dwyer, the president and chief executive of Penobscot County Health Care, which runs nonprofit clinics in the Bangor area and treats 65,000 patients a year, about 17 percent of whom are uninsured.
“Though I’m an incredibly optimistic person and always hold out hope,” Ms. Dwyer said, “I’m extremely discouraged.”
Last month, when Alexandria Ocasio-Cortez, a 28-year old political upstart and avowed socialist, upended a a powerful Democratic incumbent in a New York congressional primary, it helped return the word “socialism” to prominence in American political debates — though not necessarily in a good way.
Ocasio-Cortez quickly became a political punching bag for conservatives. Countless columns by conservatives and even moderate Democrats exorcised Ocasio-Cortez’s dystopian vision of an America in which everyone has access to health care, affordable housing, a quality education, paid sick and family leave, and a living wage.
Indeed, many of the criticisms of Ocasio-Cortez’s platform, which is not radical, not truly socialist, and is actually fairly popular, seems to boil down to that nasty nine-letter word, “socialism.”
Case in point, the bizarre meltdown experienced by conservative commentator Meghan McCain on the talk show “The View,” earlier this week.
McCain is no fan of socialism because . . . socialism is bad. Her proof is the country of Venezuela, which is experiencing a calamitous economic and social breakdown and has become a useful poster child for socialism-bashing conservatives. Never mind that many countries around the world have adopted the allegedly “socialist domestic policies” that Ocasio-Cortez is extolling — and have a citizenry that is happier, healthier, and more economically comfortable than in the United States. Socialism is bad. Period.
McCain cited two examples of the evils of big government socialism in America — the Post Office and the Veterans Administration. She could hardly found a stranger duo.
These are two of the most successful and well-run government institutions in America. When it comes to the former, I defer to Post Office evangelist Paul Waldman, a writer for The Washington Post and The American Prospect. The Post Office, he writes, “will come to your house, take a letter that you’ve written, move that letter by truck or plane or boat thousands of miles as far as it needs to go, and deliver it to the person you’ve sent it to, all in just a few days.”
It delivers 149 billion pieces of mail a year, which is half the mail in the world. And how much does this extraordinary service that we all take for granted cost? Forty-nine cents.
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If you wanted to build a mail service from scratch and keep prices as low as they are, it would be impossible — and certainly unprofitable. Only the government can do something like this.
What about the VA? In recent years, the agency has been buffeted by scandals, but in reality, it is one of the best-run health care systems in the country. According to a 2016 Rand Corporation study, the quality of care at the VA is “equal to or better than care delivered in the private sector.”
The VA is ahead of the curve when it comes to use of electronic medical records, evidence-based medicine, and top-notch behavioral health programs.
Indeed, one of the strangest elements of the socialism debate revolves around health care. Medicare, the health insurance program for the elderly, is one of the most popular government programs in the country (the only one more admired is another big government socialist initiative, Social Security). Beyond its popularity, Medicare is also more efficient than private health insurance.
How many Americans have warm and fuzzy feelings about their health insurance company? How about your cable company, your mobile provider, your airline, or your bank? How many Americans think these are well-run organizations, responsive to customer needs and highly efficient? One might even argue that government-run institutions, not burdened by the pursuit for profit, are better position to provide the most essential public services.
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But for McCain, the issue with socialism is less about the provision of government services and more about the possibility that a larger role for government will mean higher taxes. Considering that McCain’s family has a fortune of more than $200 million and just saw their taxes cut — including the estate tax, which will likely impact Meghan McCain — I understand her concerns.
And let’s face it, for many Americans, just hearing the word socialism is like waving a red flag in front of a bull. But when you get past the loaded political rhetoric and look at the so-called socialist ideas being pushed by Ocasio-Cortez and other left-leaning Democrats, what you have are policies that are consistent with existing government programs that Americans actually like. If implemented, these policies might even bring enormous benefits to millions of Americans.
You don’t have to be a card-carrying socialist to believe that access to health care, affordable housing, a quality education, sick leave, and family leave are net positives and that the government can often provide those services better than the private sector. You just need to believe in facts.
WASHINGTON — The Trump administration is hitting back against advocates of “Medicare for all” even as the proposal gains momentum among left-leaning Democrats in this election year.
Alex M. Azar II, the secretary of health and human services, said on Thursday that the administration had a vision for “reforming the American health care system” that would shrink, not expand, the federal role.
In a speech at the conservative Heritage Foundation, Mr. Azar said that Medicare could barely afford to keep its current commitments. “Medicare is running out of other people’s money, and those other people happen to be our children,” he said.
Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, was even more pointed in her criticism.
Medicare is meant for “a very specific population,” older Americans and people with disabilities, Ms. Verma said on Wednesday in a speech at the Commonwealth Club in San Francisco. Offering it to every American would not only strain the finances of Medicare, but also “run the risk of depriving seniors of the coverage” they have, she said.
“Ideas like Medicare for all would only serve to hurt and divert focus from seniors,” Ms. Verma said, predicting that, “in essence, Medicare for all would become Medicare for none.”
Senator Bernie Sanders, independent of Vermont and a leading champion of Medicare for all, dismissed the criticism.
“Medicare has worked extremely well for our nation’s seniors and will work equally well for all Americans,” Mr. Sanders said. “It is extremely concerning that the person charged with administering Medicare would rather throw 32 million Americans off the health insurance they have than join every major nation on earth and guarantee health care as a fundamental right.”
The Congressional Budget Office estimated that a bill to repeal much of the Affordable Care Act, supported last year by President Trump and other Republicans, would have increased the number of people who are uninsured by 32 million.
Mr. Sanders is the chief sponsor of a bill, the Medicare for All Act, that starts by declaring, “Every individual who is a resident of the United States is entitled to benefits for health care services.” The bill would greatly reduce consumers’ out-of-pocket costs. The secretary of health and human services would establish a “national health budget,” set payment rates for health care providers, negotiate prices to be paid for prescription drugs and establish lists of covered drugs.
Fifteen Democratic senators have signed on as co-sponsors of Mr. Sanders’s bill. They include potential candidates for president in 2020 like Senators Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California and Elizabeth Warren of Massachusetts.
Democrats are already emphasizing the matter in midterm election campaigns.
“Health care is going to be the biggest issue in 2018,” said Senator Chuck Schumer of New York, the Democratic leader. “It is far more important to the vast majority of Americans than any other issue.”
In the House, 70 Democrats announced last week that they had formed a Medicare for All Congressional Caucus to build the case for such legislation. A bill to achieve that goal has been endorsed by 120 House Democrats, or about 62 percent of the party’s members in that chamber.
Representative Pramila Jayapal, Democrat of Washington and a leader of the Medicare for All Caucus, said Trump administration officials seemed “blind to the fact that a majority of Americans support expanding, not weakening, health care.”
A single-payer health care system would be much simpler and could save hundreds of billions of dollars a year, Ms. Jayapal said.
A study by a team of researchers at the Urban Institute in 2016, when Mr. Sanders was running for president, estimated that an earlier version of his plan could increase national health spending by a total of $6.6 trillion over 10 years. The proposal would shift spending from the private sector and states to the federal government, so, it said, federal spending could increase by $32 trillion over 10 years.
Mr. Sanders takes issue with those estimates. The cost would depend, in part, on how much the government paid for care provided to new beneficiaries. The Urban Institute team assumed that payment rates would be like those currently used in Medicare.
The Trump administration mobilized a major effort last year to persuade Congress to repeal the Affordable Care Act. Just days before a climactic Senate vote in late July, Energy Secretary Rick Perry circulated a newspaper column urging Congress to “repeal this crushing law,” and his department posted a message on Twitter drawing attention to his column.
The Government Accountability Office, a nonpartisan investigative arm of Congress, ruled on Thursday that the Twitter post violated federal law because the Energy Department was not authorized to spend money for that purpose.
Mr. Perry could not show any “reasonable and logical relationship between tweeting about health care and the purposes” for which Congress provided money to his department, said Thomas H. Armstrong, the general counsel of the Government Accountability Office.
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