Bernie Sanders: Why We Need Medicare for All
by Bernie Sanders - NYT - September 13, 2017
This is a pivotal moment in American history. Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right? Or do we maintain a system that is enormously expensive, wasteful and bureaucratic, and is designed to maximize profits for big insurance companies, the pharmaceutical industry, Wall Street and medical equipment suppliers?
We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while tens of millions of people suffer because they can’t get the health care they need. This is not what the United States should be about.
All over this country, I have heard from Americans who have shared heartbreaking stories about our dysfunctional system. Doctors have told me about patients who died because they put off their medical visits until it was too late. These were people who had no insurance or could not afford out-of-pocket costs imposed by their insurance plans.
I have heard from older people who have been forced to split their pills in half because they couldn’t pay the outrageously high price of prescription drugs. Oncologists have told me about cancer patients who have been unable to acquire lifesaving treatments because they could not afford them. This should not be happening in the world’s wealthiest country.
Americans should not hesitate about going to the doctor because they do not have enough money. They should not worry that a hospital stay will bankrupt them or leave them deeply in debt. They should be able to go to the doctor they want, not just one in a particular network. They should not have to spend huge amounts of time filling out complicated forms and arguing with insurance companies as to whether or not they have the coverage they expected.
Even though 28 million Americans remain uninsured and even more are underinsured, we spend far more per capita on health care than any other industrialized nation. In 2015, the United States spent almost $10,000 per person for health care; the Canadians, Germans, French and British spent less than half of that, while guaranteeing health care to everyone. Further, these countries have higher life expectancy rates and lower infant mortality rates than we do.
The reason that our health care system is so outrageously expensive is that it is not designed to provide quality care to all in a cost-effective way, but to provide huge profits to the medical-industrial complex. Layers of bureaucracy associated with the administration of hundreds of individual and complicated insurance plans is stunningly wasteful, costing us hundreds of billions of dollars a year. As the only major country not to negotiate drug prices with the pharmaceutical industry, we spend tens of billions more than we should.
The solution to this crisis is not hard to understand. A half-century ago, the United States established Medicare. Guaranteeing comprehensive health benefits to Americans over 65 has proved to be enormously successful, cost-effective and popular. Now is the time to expand and improve Medicare to cover all Americans.
This is not a radical idea. I live 50 miles south of the Canadian border. For decades, every man, woman and child in Canada has been guaranteed health care through a single-payer, publicly funded health care program. This system has not only improved the lives of the Canadian people but has also saved families and businesses an immense amount of money.
On Wednesday I will introduce the Medicare for All Act in the Senate with 15 co-sponsors and support from dozens of grass-roots organizations. Under this legislation, every family in America would receive comprehensive coverage, and middle-class families would save thousands of dollars a year by eliminating their private insurance costs as we move to a publicly funded program.
The transition to the Medicare for All program would take place over four years. In the first year, benefits to older people would be expanded to include dental care, vision coverage and hearing aids, and the eligibility age for Medicare would be lowered to 55. All children under the age of 18 would also be covered. In the second year, the eligibility age would be lowered to 45 and in the third year to 35. By the fourth year, every man, woman and child in the country would be covered by Medicare for All.
Needless to say, there will be huge opposition to this legislation from the powerful special interests that profit from the current wasteful system. The insurance companies, the drug companies and Wall Street will undoubtedly devote a lot of money to lobbying, campaign contributions and television ads to defeat this proposal. But they are on the wrong side of history.
Guaranteeing health care as a right is important to the American people not just from a moral and financial perspective; it also happens to be what the majority of the American people want. According to an April poll by The Economist/YouGov, 60 percent of the American people want to “expand Medicare to provide health insurance to every American,” including 75 percent of Democrats, 58 percent of independents and 46 percent of Republicans.
Now is the time for Congress to stand with the American people and take on the special interests that dominate health care in the United States. Now is the time to extend Medicare to everyone.
Sanders will introduce universal health care, backed by 15 Democrats
by David Weigel - The Washington Post - September 12, 2017
Sen. Bernie Sanders (I-Vt.) will introduce legislation on Wednesday that would expand Medicare into a universal health insurance program with the backing of at least 15 Democratic senators — a record level of support for an idea that had been relegated to the fringes during the last Democratic presidency.
“This is where the country has got to go,” Sanders said in an interview at his Senate office. “Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way, the only way to do it is Medicare for All.”
Sanders’s bill, the Medicare for All Act of 2017, has no chance of passage in a Republican-run Congress. But after months of behind-the-scenes meetings and a public pressure campaign, the bill is already backed by most of the senators seen as likely 2020 Democratic candidates — if not by most senators facing tough reelection battles in 2018.
The bill would revolutionize America’s health-care system, replacing it with a public system that would be paid for by higher taxes. Everything from emergency surgery to prescription drugs, from mental health to eye care, would be covered, with no co-payments. Americans under 18 would immediately obtain “universal Medicare cards,” while Americans not currently eligible for Medicare would be phased into the program over four years. Employer-provided health care would be replaced, with the employers paying higher taxes but no longer on the hook for insurance.
During a campaign rally in May 2016, Sen. Bernie Sanders (I-Vt.) called for health coverage for all Americans. "Health care is a right for all people," he said. (AP)
Private insurers would remain, with fewer customers, to pay for elective treatments such as plastic surgery — a system similar to Australia, which President Trump has praised for having a “much better” insurance regime than the United States.
But the market-based changes of the Affordable Care Act would be replaced as Medicare becomes the country’s universal insurer. Doctors would be reimbursed by the government; providers would sign a yearly participation agreement with Medicare to remain with the system.
“When you have co-payments — when you say that health care is not a right for everybody, whether you’re poor or whether you’re a billionaire — the evidence suggests that it becomes a disincentive for people to get the health care they need,” Sanders said. “Depending on the level of the copayment, it may cost more to figure out how you collect it than to not have the copayment at all.”
As he described his legislation, Sanders focused on its simplicity, suggesting that Americans would be happy to pay higher taxes if it meant the end of wrangling with health-care companies. The size of the tax increase, he said, would be determined in a separate bill.
“I think the American people are sick and tired of filling out forms,” Sanders said. “Your income went up — you can’t get this. Your income went down — you can’t get that. You’ve got to argue with insurance companies about what you thought you were getting. Doctors are spending an enormous amount of time arguing with insurers.”
Republicans, bruised and exhausted by a failed campaign to repeal the Affordable Care Act, were giddy about the chance to attack Democrats and Sanders. At Tuesday’s leadership news conference, Sen. John Barrasso (R-Wyo.), a medical doctor, crowed that Sanders’s bill had become “the litmus test for the liberal left” and that Americans would reject any costly plan for universal insurance coverage.
“Bernie Sanders’s home state had passed a similar plan,” Barrasso said, referring to a failed 2014 campaign for universal health care in Vermont. “They realized they would have to double the taxes collected on the people of that state to pay for it because it was so financially expensive.”
Sanders acknowledged that the plan would be costly but pointed to the experience of other industrialized countries that provided universal coverage through higher taxes. The average American paid $11,365 per year in taxes; the average Canadian paid $14,693. But the average American paid twice as much for health care as the average Canadian.
“Rather than give a detailed proposal about how we’re going to raise $3 trillion a year, we’d rather give the American people options,” Sanders said. “The truth is, embarrassingly, that on this enormously important issue, there has not been the kind of research and study that we need. You’ve got think tanks, in many cases funded by the drug companies and the insurance companies, telling us how terribly expensive it’s going to be. We have economists looking at it who are coming up with different numbers. ”
In 2016, when Sanders challenged Hillary Clinton for the Democratic presidential nomination, high cost estimates and the idea of wiping out private insurers kept many Democrats from embracing universal health care. While support for Sanders’s proposal has risen from zero to 15, several Senate Democrats are proposing alternate plans for Medicare or Medicaid buy-ins, and Democratic leaders caution that their party will take no one-size-fits-all position.
“I don’t think it’s a litmus test,” said House Minority Leader Nancy Pelosi (D-Calif.) of Medicare for All. “I think to support the idea that it captures is that we want to have as many people as possible, everybody, covered, and I think that’s something that we all embrace.”
Many supporters of Sanders have contradicted Pelosi, portraying his plan as popular — 57 percent of Americans support Medicare for All, according to Kaiser Health News — and efficient. Our Revolution, founded by Sanders, has urged Democrats to sign on; Justice Democrats, created after the election to challenge Democrats in primaries if they bucked progressive values, has asked supporters to call their senators until they endorse the bill. And a web ad paid for by Sanders’s 2018 Senate campaign, asking readers to “co-sponsor” his bill, attracted more than half a million names.
As of Tuesday night, just one senator from a swing state had done so. Sen. Tammy Baldwin (D-Wis.), who as a member of the House had backed Rep. John Conyers Jr. (D-Mich.)’s Medicare for All bill, wrote a Tuesday op-ed for the Milwaukee Journal Sentinel to confirm that she was on board. The Republican Party of Wisconsin, which has struggled to find a first-tier challenger for Baldwin next year, was quick with a statement: “Senator Tammy Baldwin Embraces Radical $32 Trillion Health Care Takeover.”
The $32 trillion figure was based on the Urban Institute’s analysis of Sander’s 2016 campaign plan. The new bill was different — and so was the confidence Democrats had as they embraced it.
“With this reform, we would simplify a complicated system for families and reduce administrative costs for businesses,” Baldwin wrote.
Kelsey Snell contributed to this report.
Editor's Note:
-SPC
OPTIONS TO FINANCE MEDICARE FOR ALL
Introduction
Today, the United States spends more than $3.2 trillion a year on health care. About sixty-five percent of this funding, over $2 trillion, is spent on publicly financed health care programs such as Medicare, Medicaid, and other programs. At $10,000 per person, the United States spends far more on health care per capita and as a percentage of GDP than any other country on earth in both the public and private sectors while still leaving 28 million Americans uninsured and millions more under-insured.
Today, health care spending in the U.S. accounts for nearly 18 percent of our Gross Domestic Product (GDP) and is on track to total over 20 percent of GDP over the next decade. It is projected that if we do nothing and maintain our current dysfunctional system that we will spend $49 trillion over the next decade on health care. That would be an incredible burden on businesses, working families, and the entire economy.
The most cost-effective and popular solution to this health care crisis is to guarantee health care as a right through a Medicare-for-all single-payer health care system.
Today, the traditional Medicare program only spends two percent of its costs on administration. That’s less than one-sixth the administrative costs of private health insurance companies.
Today, the United States spends more than $3.2 trillion a year on health care. About sixty-five percent of this funding, over $2 trillion, is spent on publicly financed health care programs such as Medicare, Medicaid, and other programs. At $10,000 per person, the United States spends far more on health care per capita and as a percentage of GDP than any other country on earth in both the public and private sectors while still leaving 28 million Americans uninsured and millions more under-insured.
Today, health care spending in the U.S. accounts for nearly 18 percent of our Gross Domestic Product (GDP) and is on track to total over 20 percent of GDP over the next decade. It is projected that if we do nothing and maintain our current dysfunctional system that we will spend $49 trillion over the next decade on health care. That would be an incredible burden on businesses, working families, and the entire economy.
The most cost-effective and popular solution to this health care crisis is to guarantee health care as a right through a Medicare-for-all single-payer health care system.
Today, the traditional Medicare program only spends two percent of its costs on administration. That’s less than one-sixth the administrative costs of private health insurance companies.
Studies have found that our federal government could save up to $500 billion per year on
administrative costs by moving to a Medicare for All, single-payer health care system.
Moreover, the United States pays, by far, the highest prices in the world for prescription drugs because Congress has done nothing to regulate the price of medicine. If the U.S. joined the rest of the industrialized world and negotiated with the pharmaceutical companies to lower prices, our country could save up to $113 billion per year.
Moreover, the United States pays, by far, the highest prices in the world for prescription drugs because Congress has done nothing to regulate the price of medicine. If the U.S. joined the rest of the industrialized world and negotiated with the pharmaceutical companies to lower prices, our country could save up to $113 billion per year.
As the wealthiest country in the world, we have a variety of options available to support a
Medicare for All single-payer health care system that guarantees high quality, affordable health
care as a right, not a privilege, to every man, woman, and child in this country. This paper
explains just some of the policies that could provide revenue to finance Medicare for All. Under
every single one of these options the average American family will save thousands of dollars a
year because they will no longer be writing large checks to private health insurance companies.
If every major industrialized nation on Earth can make health care a right, provide universal coverage to all, achieve far better health outcomes in terms of life expectancy and infant mortality, while spending far less per capita than we do, it is absurd to suggest the United States of America, the wealthiest nation in the history of the world, cannot do the same.
In my view, there needs to be vigorous debate as to the best way to finance our Medicare for All legislation. Unlike the Republican leadership in Congress which held no hearings on their
If every major industrialized nation on Earth can make health care a right, provide universal coverage to all, achieve far better health outcomes in terms of life expectancy and infant mortality, while spending far less per capita than we do, it is absurd to suggest the United States of America, the wealthiest nation in the history of the world, cannot do the same.
In my view, there needs to be vigorous debate as to the best way to finance our Medicare for All legislation. Unlike the Republican leadership in Congress which held no hearings on their
disastrous bill which would have thrown 32 million off of health insurance and dealt with one-
sixth of the American economy, it is our intention to get the best ideas we can from economists,
doctors, nurses, and ordinary Americans. Below are a number of options to begin that
discussion. Under each and every one of these options the average American family will end up
in a better financial position than they are under the current system.
Options to Save Families and Businesses on Health Care Expenses
7.5 percent income-based premium paid by employers Revenue raised: $3.9 trillion over ten years.
Businesses would save over $9,000 in health care costs for the average employee under this option
In 2016, employers paid an average of $12,865 in private health insurance premiums for a worker with a family of four who makes $50,000 a year. Under this option, employers would pay a 7.5 percent payroll tax to help finance Medicare for All – just $3,750 – a savings of more than $9,000 a year for that employee.
During the four-year transition period to guarantee health care as a right, millions of workers will have the option to transfer from their employer-provided health care to the new Medicare for All system. As workers shift into the new system, employers will be required to pay either 75 percent of what they are currently paying for health care costs for each of their employees who enroll in Medicare for All, or the 7.5 percent payroll tax, whichever is higher.
An employer’s first $2 million in payroll would be exempt from this premium protecting small businesses throughout the country.
4 percent income-based premium paid by households Revenue raised: $3.5 trillion over ten years.
The typical middle class family would save over $4,400 under this plan.
Last year the typical working family paid an average of $5,277 in premiums to private health insurance companies. Under this option, a typical family of four earning $50,000, after taking the standard deduction, would pay a 4 percent income-based premium to fund Medicare for All – just $844 a year – saving that family over $4,400 a year. Because of the standard deduction, families of four making less than $29,000 a year would not pay this premium.
Savings from Health Tax Expenditures Revenue raised: $4.2 trillion over ten years.
Several tax breaks that subsidize health care would become obsolete and disappear under Medicare for All. The biggest health expenditure is the preference that excludes employer-paid premiums from payroll and income taxes. This is a significant tax break that would be eliminated under this plan because all Americans would receive health care through the new
Options to Save Families and Businesses on Health Care Expenses
7.5 percent income-based premium paid by employers Revenue raised: $3.9 trillion over ten years.
Businesses would save over $9,000 in health care costs for the average employee under this option
In 2016, employers paid an average of $12,865 in private health insurance premiums for a worker with a family of four who makes $50,000 a year. Under this option, employers would pay a 7.5 percent payroll tax to help finance Medicare for All – just $3,750 – a savings of more than $9,000 a year for that employee.
During the four-year transition period to guarantee health care as a right, millions of workers will have the option to transfer from their employer-provided health care to the new Medicare for All system. As workers shift into the new system, employers will be required to pay either 75 percent of what they are currently paying for health care costs for each of their employees who enroll in Medicare for All, or the 7.5 percent payroll tax, whichever is higher.
An employer’s first $2 million in payroll would be exempt from this premium protecting small businesses throughout the country.
4 percent income-based premium paid by households Revenue raised: $3.5 trillion over ten years.
The typical middle class family would save over $4,400 under this plan.
Last year the typical working family paid an average of $5,277 in premiums to private health insurance companies. Under this option, a typical family of four earning $50,000, after taking the standard deduction, would pay a 4 percent income-based premium to fund Medicare for All – just $844 a year – saving that family over $4,400 a year. Because of the standard deduction, families of four making less than $29,000 a year would not pay this premium.
Savings from Health Tax Expenditures Revenue raised: $4.2 trillion over ten years.
Several tax breaks that subsidize health care would become obsolete and disappear under Medicare for All. The biggest health expenditure is the preference that excludes employer-paid premiums from payroll and income taxes. This is a significant tax break that would be eliminated under this plan because all Americans would receive health care through the new
Medicare for All program instead of employer-based health care. The exclusion for
contributions to cafeteria plans and the medical expense deduction will also be eliminated.
Options to Make the Wealthy Pay Their Fair Share
Make the Personal Income Tax More Progressive Revenue raised: $1.8 trillion over ten years.
Another option is to reform the personal income tax system by strengthening progressive income tax rates, taxing capital gains and dividends the same as work income, limiting deductions for the wealthy, taxing carried interest as ordinary income, and requiring derivatives to be marked to market.
o Progressive income tax rates.
Under this plan the marginal income tax rate would be:
§ 40 percent on income between $250,000 and $500,000.
§ 45 percent on income between $500,000 and $2 million.
§ 50 percent on income between $2 million and $10 million. (In 2014, only 136,000
households, the top 0.1 percent of taxpayers, had income between $2 million and $10
million.)
§ 52 percent on income above $10 million. (In 2014, only 16,700 households, just 0.02
percent of taxpayers, had income exceeding $10 million.)
o Taxing capital gains and dividends the same as income from work.
Warren Buffett, the second-wealthiest American in the country, has said that he pays a lower effective tax rate than his secretary. This is because he receives most of his income from capital gains and dividends, which are taxed at a much lower rate than income from work. This option would end the special tax break for capital gains and dividends on household income above $250,000, treating this income the same as income earned from working.
Taxing all income received by the rich at the same rates would simplify the tax code and eliminate the opportunities to game the system by making other types of income appear to be capital gains or dividends. The Congressional Budget Office estimates that 68 percent of the benefits of the special income tax rates for capital gains and dividends went to the richest one percent of Americans in 2013.
o Limit tax deductions for the wealthy.
Wealthier households are able to take advantage of various itemized deductions that generally do not provide any benefit to lower income workers. Under this proposal, itemized deductions would be capped at 28 percent for households making over $250,000. In other words, for every dollar in tax deduction a high-income household could save at most 28 cents. This limit would replace more complicated and less effective limits on tax breaks for the rich.
Options to Make the Wealthy Pay Their Fair Share
Make the Personal Income Tax More Progressive Revenue raised: $1.8 trillion over ten years.
Another option is to reform the personal income tax system by strengthening progressive income tax rates, taxing capital gains and dividends the same as work income, limiting deductions for the wealthy, taxing carried interest as ordinary income, and requiring derivatives to be marked to market.
o Progressive income tax rates.
Under this plan the marginal income tax rate would be:
§ 40 percent on income between $250,000 and $500,000.
§ 45 percent on income between $500,000 and $2 million.
§ 50 percent on income between $2 million and $10 million. (In 2014, only 136,000
households, the top 0.1 percent of taxpayers, had income between $2 million and $10
million.)
§ 52 percent on income above $10 million. (In 2014, only 16,700 households, just 0.02
percent of taxpayers, had income exceeding $10 million.)
o Taxing capital gains and dividends the same as income from work.
Warren Buffett, the second-wealthiest American in the country, has said that he pays a lower effective tax rate than his secretary. This is because he receives most of his income from capital gains and dividends, which are taxed at a much lower rate than income from work. This option would end the special tax break for capital gains and dividends on household income above $250,000, treating this income the same as income earned from working.
Taxing all income received by the rich at the same rates would simplify the tax code and eliminate the opportunities to game the system by making other types of income appear to be capital gains or dividends. The Congressional Budget Office estimates that 68 percent of the benefits of the special income tax rates for capital gains and dividends went to the richest one percent of Americans in 2013.
o Limit tax deductions for the wealthy.
Wealthier households are able to take advantage of various itemized deductions that generally do not provide any benefit to lower income workers. Under this proposal, itemized deductions would be capped at 28 percent for households making over $250,000. In other words, for every dollar in tax deduction a high-income household could save at most 28 cents. This limit would replace more complicated and less effective limits on tax breaks for the rich.
Make the Estate Tax More Progressive
Revenue raised: $249 billion over ten years.
Currently the estate tax only applies to the wealthiest 0.2 percent of Americans. In other words, 99.8 percent are not impacted by this tax. Under this option, the estate tax would return to the exemptions that were in effect in 2009 and rates would be made more progressive. Specifically, the plan would exempt the first $3.5 million of a single person’s estate and the first $7 million of a married couple’s estate.
The existing flat 40 percent estate tax rate would be replaced with the following progressive rates:
o 45 percent for the value of an estate between $3.5 million and $10 million.
o 50 percent for the value of an estate between $10 million and $50 million.
o 55 percent for the value of an estate in excess of $50 million.
o An additional 10 percent surtax would apply to estate value in excess of $500 million
($1 billion for married couples). Further, the proposal:
o Closes loopholes for “grantor retained annuity trusts” (GRATs) and other types of trusts and valuation techniques that have allowed the Walton family of Wal-Mart and other billionaires to save over $100 billion in taxes since 2000; and
o Increases existing protections for farmland and conservation. Establish a Wealth Tax on the Top 0.1 percent
Revenue raised: $1.3 trillion over ten years.
Over the past several decades America has experienced an explosion of wealth
concentration. Today the wealthiest 0.1 percent – just 160,000 households – own nearly the same amount of wealth as the bottom 90 percent. Meanwhile, a report from the Institute on Policy Studies concludes that America’s 20 richest individuals now own more wealth than the entire bottom half of the American population.
This severe inequality threatens to warp our democracy by concentrating too much power in the hands of a tiny elite. It also holds back our economy, funneling resources to a few families rather than creating the broad base of middle-class consumers that can drive economic growth.
This option would establish an annual 1 percent federal wealth tax on the net worth of the wealthiest 0.1 percent of U.S. households. The tax would apply to net worth exceeding $21 million for a household. That means a household with $21.5 million would pay 1 percent of $500,000, or $5,000.
Close the Gingrich-Edwards Loophole and Create Parity for Wealthy Business Owners Revenue raised: $247 billion over ten years.
Currently the estate tax only applies to the wealthiest 0.2 percent of Americans. In other words, 99.8 percent are not impacted by this tax. Under this option, the estate tax would return to the exemptions that were in effect in 2009 and rates would be made more progressive. Specifically, the plan would exempt the first $3.5 million of a single person’s estate and the first $7 million of a married couple’s estate.
The existing flat 40 percent estate tax rate would be replaced with the following progressive rates:
o 45 percent for the value of an estate between $3.5 million and $10 million.
o 50 percent for the value of an estate between $10 million and $50 million.
o 55 percent for the value of an estate in excess of $50 million.
o An additional 10 percent surtax would apply to estate value in excess of $500 million
($1 billion for married couples). Further, the proposal:
o Closes loopholes for “grantor retained annuity trusts” (GRATs) and other types of trusts and valuation techniques that have allowed the Walton family of Wal-Mart and other billionaires to save over $100 billion in taxes since 2000; and
o Increases existing protections for farmland and conservation. Establish a Wealth Tax on the Top 0.1 percent
Revenue raised: $1.3 trillion over ten years.
Over the past several decades America has experienced an explosion of wealth
concentration. Today the wealthiest 0.1 percent – just 160,000 households – own nearly the same amount of wealth as the bottom 90 percent. Meanwhile, a report from the Institute on Policy Studies concludes that America’s 20 richest individuals now own more wealth than the entire bottom half of the American population.
This severe inequality threatens to warp our democracy by concentrating too much power in the hands of a tiny elite. It also holds back our economy, funneling resources to a few families rather than creating the broad base of middle-class consumers that can drive economic growth.
This option would establish an annual 1 percent federal wealth tax on the net worth of the wealthiest 0.1 percent of U.S. households. The tax would apply to net worth exceeding $21 million for a household. That means a household with $21.5 million would pay 1 percent of $500,000, or $5,000.
Close the Gingrich-Edwards Loophole and Create Parity for Wealthy Business Owners Revenue raised: $247 billion over ten years.
This option closes the Gingrich-Edwards loophole which allows individuals who own and run an
S-Corporation to game the system and avoid paying payroll taxes by claiming some income as
business profits. Under current law, these business owners are required to report a “reasonable”
amount of salary income and pay the appropriate amount of payroll tax. However, many times
these individuals deliberately under-report a reasonable salary in order to avoid these taxes.
Additionally, this option would ensure that all business income of high-income people would be subject to the existing 3.8 percent tax to fund Medicare, either through the net investment income tax or the additional Medicare tax on earned income. These taxes were designed to ensure that high-income people pay the 3.8 percent Medicare tax on all income, regardless of the
source. However, some business income slips through the crack and is not subject to either tax. This proposal would close that loophole.
Options to Make Wall Street and Large, Profitable Corporation Pay Their Fair Share
Impose a one-time tax on currently held offshore profits Revenue raised: $767 billion over ten years.
For years corporations have been avoiding paying their fair share of taxes by stashing their cash in the Cayman Islands and other offshore tax havens where there is no corporate income tax rate. This situation has become so absurd that one five-story office building in the Cayman Islands is the “home” to close to 20,000 companies.
Today corporations hold a staggering $2.6 trillion offshore in order to avoid paying taxes in the U.S. Under current law, a corporation does not pay corporate taxes on these profits until it sends, or “repatriates”, the money back to the U.S. This option would require these companies to pay a one-time tax now, based on what they owe under current law.
Impose a Fee on Large Financial Institutions Revenue raised: $117 billion over ten years.
Today, the six major financial institutions in this country have over $10 trillion in assets, equivalent to 56 percent of our entire GDP. The largest financial institution, JP Morgan Chase, has received more than $22.2 billion in tax breaks since 2008. Meanwhile, during the financial crisis, JP Morgan Chase received a $391 billion bailout from the Federal Reserve. It is time that Wall Street start paying its fair share in taxes. One option would be to impose a fee of seven basis points (.07 percent) on covered liabilities of financial institutions with $50 billion or more in total assets, as proposed by President Obama.
Repeal Corporate Accounting Gimmicks Revenue raised: $112 billion ten years.
This option would eliminate the “last-in, first-out” (LIFO) accounting method that allows corporations to manipulate their inventory and make it appear like they have lower profits. They do this by deducting the higher cost of newer inventory, rather than the lower cost of older
Additionally, this option would ensure that all business income of high-income people would be subject to the existing 3.8 percent tax to fund Medicare, either through the net investment income tax or the additional Medicare tax on earned income. These taxes were designed to ensure that high-income people pay the 3.8 percent Medicare tax on all income, regardless of the
source. However, some business income slips through the crack and is not subject to either tax. This proposal would close that loophole.
Options to Make Wall Street and Large, Profitable Corporation Pay Their Fair Share
Impose a one-time tax on currently held offshore profits Revenue raised: $767 billion over ten years.
For years corporations have been avoiding paying their fair share of taxes by stashing their cash in the Cayman Islands and other offshore tax havens where there is no corporate income tax rate. This situation has become so absurd that one five-story office building in the Cayman Islands is the “home” to close to 20,000 companies.
Today corporations hold a staggering $2.6 trillion offshore in order to avoid paying taxes in the U.S. Under current law, a corporation does not pay corporate taxes on these profits until it sends, or “repatriates”, the money back to the U.S. This option would require these companies to pay a one-time tax now, based on what they owe under current law.
Impose a Fee on Large Financial Institutions Revenue raised: $117 billion over ten years.
Today, the six major financial institutions in this country have over $10 trillion in assets, equivalent to 56 percent of our entire GDP. The largest financial institution, JP Morgan Chase, has received more than $22.2 billion in tax breaks since 2008. Meanwhile, during the financial crisis, JP Morgan Chase received a $391 billion bailout from the Federal Reserve. It is time that Wall Street start paying its fair share in taxes. One option would be to impose a fee of seven basis points (.07 percent) on covered liabilities of financial institutions with $50 billion or more in total assets, as proposed by President Obama.
Repeal Corporate Accounting Gimmicks Revenue raised: $112 billion ten years.
This option would eliminate the “last-in, first-out” (LIFO) accounting method that allows corporations to manipulate their inventory and make it appear like they have lower profits. They do this by deducting the higher cost of newer inventory, rather than the lower cost of older
inventory, resulting in lower profits and lower taxes. Democrats and Republicans have both
supported repealing LIFO in various budget and tax reform proposals.
How the Bernie Sanders Plan Would Both Beef Up and Slim Down Medicare
by Margot Sanger-Katz - NYT - September 13, 2107
In his big new single-payer health care bill, Senator Bernie Sanders says he wants to turn the country’s health system into “Medicare for all.” But his bill actually outlines a system very different from the current Medicare program.
The Sanders plan envisions changing Medicare in two important ways. First, it would make it more generous than it has ever been, expanding it to cover new types of benefits and to erase most direct health care costs for consumers. Those changes would tend to make it more expensive.
But it also would put the Medicare program on the sort of diet it has never attempted. Those changes, still in sketch form in the legislation, are in many ways the heart of its long-term overhaul plan. The changes are intended to make the health care system more affordable, but the details could have big effects on what sorts of care might be developed and made available.
Medicare, the 52-year-old health insurance program for older people and the disabled, is enormously popular. Structured as an essentially open-ended entitlement, Medicare establishes a menu of covered medical treatments at certain prices, and then pays doctors and hospitals whenever a beneficiary uses them. The total amount that Medicare spends increases depending on how many people enroll, and how many medical services they use. So far, there is no real cap on how much money Medicare can spend.
The Sanders plan — which has no near-term chance of advancing with Republicans in power — would change that. Most crucially, it would expand the program so that every American would eventually get insurance from Medicare instead of private companies or other public programs. The employer health insurance system, the Affordable Care Act exchanges and most of Medicaid would be eliminated.
Mr. Sanders says that the transition to the Medicare program would achieve several goals: It would ensure universal coverage, it would improve the affordability of health care for many Americans and it would save the country money.
Whether it can achieve that third goal depends a great deal on how the new Medicare-for-all system would be managed, and the Sanders plan leaves a lot of those details unclear for now. Covering everyone would not, by itself, make the health care system in the United States as inexpensive as those of other nations with universal health care systems. That sort of cost control would require its own set of policies and difficult choices.
In his news conference introducing the bill on Wednesday, Mr. Sanders focused his ire on insurance and drug companies, two profitable sectors of the health care system. But insurance and drug company profits don’t make up the bulk of America’s health care spending. Single-payer advocates argue that the simplicity of a single, government payer would reduce paperwork and office staff, and that is almost certainly true. But most spending in the health care system is on medical care from doctors and hospitals — and squeezing savings there may be harder.
To get savings from those areas might require reducing doctors’ pay or hospitals’ numbers of medical professionals. It could require eliminating some medical treatments that are currently offered. Even cutting spending on pharmaceuticals would have ripple effects, potentially limiting access to new or expensive treatments, or reducing investment in new technologies.
The bill specifies that Medicare would be run with an annual budget, leaving government officials to decide how to make the country’s medical spending conform to such totals every year. It also says that the government should evaluate the effectiveness of different medical treatments. Such a system has precedent: Several countries, including Canada and Britain, establish health care budgets that must be met and assess the value of medical services to determine what should be covered.
But such budgets and limits have been politically toxic in the United States, where politicians have been reluctant to say that the government should restrict care. The Affordable Care Act established a theoretical limit on spending per Medicare beneficiary, establishing a board that would reduce costs if a cap were met. But that board, assailed as a “death panel,” has never been called upon to make such choices, for no members have ever been nominated to it.
Mr. Sanders sells the bill as a broad expansion of care, by ensuring that all Americans have similar, broad benefits and little financial exposure to medical bills. At Wednesday’s event, he stood flanked by several prominent Democratic co-sponsors and medical providers who offered testimonials about how a Medicare-for-all plan would improve access to needed health care.
The plan increases the generosity of Medicare substantially. It adds coverage for dentistry, optometry and audiology care, not part of the traditional program. It also eliminates premiums, deductibles and most co-payments for medical care, which are significant costs for many people.
The size of the Medicare budget is also unspecified. In part, that’s because the Sanders bill does not establish a funding mechanism for its planned overhauls. In a separate white paper, Mr. Sanders’s office spells out some possible revenue sources, including increases to payroll taxes, and to high-end income taxes and some corporate taxes. But those funding streams, politically risky in their own right, would need to be debated and measured before the realistic scale of the Medicare-for-all budget would be clear.
This different Medicare would face the push and pull of expanded reach and fixed means: one that would tend to increase the cost to the government for care, and one devised to reduce it. Just what sort of Medicare program results would depend on the government that runs it.
The Democrats have become socialists
by Dana Milbank - The Washington Post - September 14, 2017
When Bernie Sanders launched his bid for the Democratic nomination, he was often asked whether he, a democratic socialist, would actually become a Democrat. Now, more than a year after he ignited a movement with his unsuccessful bid, that question is moot. The Democrats have become socialists.
This became official, more or less, Wednesday afternoon, when Sanders rolled out his socialized health-care plan, Medicare for All, and he was supported by 16 of his Senate Democratic colleagues who signed on as co-sponsors, including the party’s rising stars and potential presidential candidates in 2020: Elizabeth Warren. Cory Booker. Kamala Harris. Kirsten Gillibrand.
Several of them dutifully joined Sanders, who is threatening another presidential run himself, at the rollout event in one of the largest hearing rooms on Capitol Hill and praised the guru of the single-payer movement for government-run universal health care.
“I’m all in on this. Thank you, Bernie,” said Sen. Jeff Merkley (Ore.).
Gillibrand (N.Y.): “I will be standing with Bernie.”
Sen. Bernie Sanders (I-Vt.) released a campaign video introducing his plan to implement a single payer health care system "to guarantee health care for all people." (Sen. Bernie Sanders)
Warren (Mass.): “I want to say thank you to Bernie for all that you have done.”
“The reason we have a chance to achieve” single-payer health care, said Sen. Richard Blumenthal (Conn.), “is because of advocates like Bernie Sanders and Elizabeth Warren.”
This is a dramatic shift. In 2013, when Sanders introduced similar legislation, he didn’t have a single co-sponsor. By contrast, you could have been forgiven for thinking Wednesday’s rollout, with Sanders, Warren, Booker, Harris and Gillibrand testing their messages, was the first Democratic cattle call of the 2020 campaign. There were a couple hundred liberal activists in the room (many of them veterans of the Sanders campaign and a few wearing “Join the Political Revolution” Sanders T-shirts) and another 50 in an overflow room.
This embrace of an unabashedly socialist position by the Democrats delights nobody more than the original socialists, the Democratic Socialists of America. David Duhalde, the group’s deputy director, was one of the first in line for the event, carrying a Medicare-for-All sign.
“Socialism has been most successful in this country when its ideas have been adopted by other parties,” he said, listing the enactment of labor laws, Social Security and Medicare. But “this is a high water mark,” he said.
In the short term, I’ve argued, this development is a bad thing for Democrats. The nation’s focus has been on divisions among Republicans and their inability to enact any sort of agenda under President Trump. The single-payer issue highlights Democratic divisions and united Republicans.
Notably, only one Democrat who faces a competitive reelection, Sen. Tammy Baldwin (Wis.), signed on with Sanders. The socialized-medicine bill is popular with the Democratic base but is a liability for Democratic candidates in the swing districts and Republican states that Democrats need to win to retake the House and Senate.
Play Video 3:23
What is single-payer health care? Here's what you need to know.
With support growing for universal health coverage, just what does "single-payer" mean? Here's a deep-dive into what a single-payer health-care system would look like, and the arguments for and against it. (Jenny Starrs, Danielle Kunitz/The Washington Post)
The divisions were on display Wednesday: As Harris spoke, a member of the left-wing group Code Pink held up a large cutout of the head of Sen. Dianne Feinstein (D-Calif.), who is up for reelection and doesn’t support the Sanders bill. Beneath Feinstein’s photo were the words “Healthcare Denier.” (Luckily for Democrats, Sanders told The Washington Post’s David Weigel that he doesn’t plan to make the issue a litmus test.)
The Republican National Committee, seizing the rare opportunity to play offense, sent out a news release and a video attacking the plan: “Legislation does NOT include how to pay for the $32 trillion program. . . Plans of 156M(!!) Americans would be upended.” And Sen. Lindsey O. Graham (R-S.C.), announcing yet another attempt at repealing Obamacare on Wednesday, tried to use the Sanders plan to revive the moribund effort. He said his bill was Republicans’ “best and only chance” to prevent single-payer health care.
It’s not hard to see Graham’s prophecy coming true over time, particularly if Republicans, unable to replace Obamacare, continue to sabotage the program and let it fall apart, leaving millions without health care. Republicans have another problem fighting single-payer care now. Because they called Obamacare “socialized medicine,” even though it’s a market-based plan, they have nothing worse to fire at Democrats for embracing the real thing.
Sanders lost the nomination battle to Hillary Clinton (who favored a more incremental approach to health care and gives the single-payer debate little mention in her new book about the campaign). But he seems to be winning the war over the direction of the Democratic agenda. Sanders now has 35 percent of the Senate Democratic Caucus, and some of the biggest names in the party, embracing his call. So when he predicts, as he did Wednesday, that “this nation, sooner than people believe, will in fact pass a Medicare-for-All, single-payer system,” it doesn’t sound as crazy as it once did.
Single-payer won’t pass now. But its popularity proves our morals are changing.
by Adam Gaffney - The Washington Post - September 13, 2017
Single-payer universal health care — once cast as a radical daydream — has moved with staggering swiftness from purported fantasy to palpable possibility. Today, Sen. Bernie Sanders (I-Vt.) released his long-awaited single-payer bill, and a slew of senators now numbering in the double digits have announced their support. This bill will serve as a potent Senate counterpart to Rep. John Conyers Jr.’s (D-Mich.) single-payer bill, now co-sponsored by 117 representatives — a historic and unprecedented majority of House Democrats. Far from being an impossibility, the idea that we might create a right to health care is starting to feel like an inevitability.
Just last week none other than former senator Max Baucus — a central player in drafting the Affordable Care Act and a previous foe of single-payer reform — embraced single-payer as the next step. As Baucus, quoted by the Bozeman Daily Chronicle, put it: “It’s going to happen.”
But is it? Probably not tomorrow. The regressive right-wing government that recently came within a hair’s breadth of repealing the ACA and gutting the existing health-care safety net — an undertaking it could attempt again — is rather unlikely to pass sweeping single-payer legislation anytime soon. So why do bills like this one deserve any attention?
For one reason: because aspirations structure reality. And also because this political epoch will end, and with it the intensely unpopular presidency of Donald Trump, which will one day be a distasteful memory. Political change will thus invariably — even if only for a while — make transformative reform possible. And when it does, bills like that of Conyers and Sanders might move from ambition to achievement at a hurried pace.
This has happened before. Shortly after World War II, in 1945, the British Labour Party won a historic parliamentary victory, a contest tantamount to a mandate for a new Britain in which — as historian Donald Sassoon has written — the “citizenship rights which had been the rallying cry of the liberal-democratic condition … would be supplemented by new socio-economic rights” — including the right to health care. The following year, the Labor Parliament passed the National Health Service Act, and two years after that, the National Health Service went into operation: Everyone in that nation thereafter gained access to free, comprehensive health care — an advance that can be described without hyperbole as a civilizational breakthrough.
Circumstances there were, of course, unique. Could something similar happen in the United States? It could — and it has. In 1964, Democrats swept the congressional elections, and the following year, Lyndon B. Johnson signed Medicare and Medicaid into law. Implementation of Medicare was even more rapid than that of the NHS: Within a year of the law’s signing, 99 percent of the nation’s seniors were enrolled in the universal part of the program.
There is simply no good reason (much less some titanium law of nature) that precludes us from universally expanding Medicare today, which is precisely what some of its architects had in mind decades ago. Nor must this necessarily hinge on some historic electoral sweep: As Baucus’s astonishing single-payer turn demonstrates, when activists transform the narrative around an issue — when they push a policy to center-stage — smart politicians will follow.
Feasibility, of course, is a separate issue from desirability — and what Americans desire is what is quickly changing, as our values evolve.
The gaps in the U.S. health-care system are simply too large to be plugged by the half-measures on offer. Even with the ACA, 28 million — or nearly 9 percent of the nation — remains uninsured. Single-payer would fix that, but covering the uninsured is far from its only goal: What single-payer is uniquely well-suited to do is reduce inequalities imposed by income, race, gender and a host of other factors.
Economic inequality and health inequality are deeply interwoven in 21st-century America. It was for a good and humane reason that the architects of the NHS — like the designers of the Canadian public health-care system — envisioned a universal program with “no charges, except for a few special items,” as an explanatory leaflet sent to each and every residence in Britain shortly before the launch of the service put it. By covering everyone, while also eliminating co-payments and deductibles — as both bills prudently do (with the exception of prescription drugs in the Sanders’ bill) — we ensure that all receive care depending of their health needs, not their wealth.
But there are also some particularly American health-care inequalities — in race and gender — that must be addressed, and that single-payer could do much to diminish. For instance, today, Hispanics and blacks remain uninsured at substantially higher rates than whites. Moreover, it seems likely that racial minorities — in light of vastly lower average household wealth — are also harder pressed, dollar for dollar, by deductibles or co-payments, as noted in the Harvard Public Health Review.
And additionally, for all the enormous good done by Medicaid, its lower rates of provider payments sometimes contribute to a lower level of access, longer waits for appointments, and — in some instances — effective health-care segregation for the program’s mostly minority participants. Such inequities could be mitigated with a truly universal, single-tier program.
Then there are gender inequalities, namely inadequate access to reproductive health care, especially abortion. Admittedly, a number of policy reforms are needed in this area, but single-payer could make an enormous difference. For a variety of reasons, even insured women can face major barriers in obtaining abortions, and very infrequently rely on private insurance: In 2008, a mere 12 percent of women obtaining an abortion used private insurance to cover the cost, according to the pro-choice Guttmacher Institute. A single-payer program that included access to comprehensive reproductive health care while overriding Hyde — as Sanders’ bill appears to do — would represent an important step toward greater gender equity in health care.
Thus, taken together, the raison d’etre of single-payer reform, are primarily ethical, and only secondarily economic. Indeed, rising support for single-payer should be seen as part of a larger shift toward more egalitarian values on a host of social and economic issues in America, including on gender and racial equity. At single-payer’s core is the age-old principle of basic human equality, translated to the arena of health. “Health care is a basic human right,” Sen. Elizabeth Warren wrote in an email to her supporters (quoted in Vox) announcing her support of Sanders’ bill, “and it’s time to fight for it.”
The movement for universal health care is, of course, an old one, with many defeats in the past. “Our new Economic Bill of Rights,” Harry S. Truman once said while advocating for a national health insurance program shortly after World War II, “should mean health security for all, regardless of residence, station, or race — everywhere in the United States.” But while Cold War-era scare tactics doomed that effort, they need not sink this one. The sheer popularity of single-payer (53 percent of Americans favor it) and the number of serious politicians now behind it show that we’re changing as a country — for the better.
https://www.washingtonpost.com/news/posteverything/wp/2017/09/13/single-payer-wont-pass-now-but-its-popularity-proves-our-morals-are-changing/?
Medicare for All or State Control: Health Care Plans Go to Extremes
by Robert Pear - NYT - September 14, 2017
WASHINGTON — In one Senate office building, some of the leading lights of the Democratic Party gathered Wednesday to embrace what was once a proposal only of the far left: a huge expansion of Medicare, large enough to open the popular, government-run health program to all Americans.
In another Senate office building, a smaller but equally adamant group of Republican senators stood together to take one last stab at dismantling the Affordable Care Act. They proposed instead to send each state a lump sum of federal money, along with sweeping new discretion over how to use it.
Important elements in both parties are trying to move beyond President Barack Obama’s health care law, which has always been a complicated, politically difficult mix of government and private health insurance. But they are moving in radically different directions.
The proposals appeared to have only one thing in common: Neither is likely to be enacted any time soon.
Senator Bernie Sanders of Vermont, the onetime candidate for the Democratic presidential nomination, proposed what he called “a Medicare-for-all, single-payer health care system,” and he said 16 Democratic senators supported it. Those included Elizabeth Warren of Massachusetts, Cory Booker of New Jersey, Kirsten E. Gillibrand of New York and Kamala Harris of California — all names on the list of possible candidates for president in 2020.
“Instead of wasting hundreds of billions of dollars trying to administer an enormously complicated system of hundreds of separate insurance plans, there would be one insurance plan for the American people with one single payer,” said Mr. Sanders, the ringmaster of an event that felt like a political rally, with banners and placards, consumers and patients, labor union members, nurses in red T-shirts and an audience full of fans who applauded, whooped and hollered.
Heading in the other direction were several Republican senators, led by Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, who would take money spent under the Affordable Care Act and give it to states in the form of block grants.
Their proposal was the last gasp of Republican efforts to undo the Affordable Care Act. Those efforts, which seemed sure of success in January, appeared to meet a dead end on the Senate floor in late July, when Republicans could not muster even a simple majority for a repeal bill. Mr. Graham’s gathering had the feel of a health policy discussion at a conservative think tank.
While Mr. Sanders was joined by possible presidential contenders, Mr. Graham and Mr. Cassidy were accompanied by two lower-profile senators, Dean Heller of Nevada and Ron Johnson of Wisconsin.
“The only thing stopping us from having this idea debated on the floor of the United States Senate is lack of leadership,” Mr. Graham said, pleading for help from President Trump and the Senate majority leader, Mitch McConnell of Kentucky.
An hour later Mr. Trump issued a statement saying, “I sincerely hope that Senators Graham and Cassidy have found a way to address the Obamacare crisis.’’
Under the Graham-Cassidy proposal, money would be distributed to states based on a complex formula. The regional cost of living would be one factor, but the sponsors acknowledged that higher-spending states like Massachusetts would receive less than under current law.
The block grant would replace federal money now being spent under the Affordable Care Act for the expansion of Medicaid, for premium tax credits and for subsidies that reimburse insurers for reducing out-of-pocket costs for low-income people.
The Graham-Cassidy bill would repeal the Affordable Care Act’s requirements for most Americans to have coverage and for larger employers to offer it. And it would make deep cuts in Medicaid.
But time is running out on the bill. After Sept. 30, the Graham-Cassidy legislation would lose procedural protections that allow passage in the Senate with a simple majority, rather than the 60 votes often required for major legislation.
Even with those protections, Senator John Cornyn of Texas, the No. 2 Senate Republican, said he had seen no evidence that the bill had the votes needed to win approval in the Senate in the next two weeks. And he noted that it had not been analyzed by the Congressional Budget Office, which could take a week or two to estimate how much the bill would cost and how many people would lose or gain coverage.
Mr. Sanders said he was prepared for a long battle to establish health care as a right. (That was supposedly a goal of the Affordable Care Act.) His bill could serve as a political manifesto and a possible campaign platform for progressive candidates.
That so many Democrats are embracing it is a milestone. About 60 percent of House Democrats have endorsed a “Medicare for all” bill introduced by Representative John Conyers Jr., Democrat of Michigan.
But Democratic leaders in the House and the Senate are steering clear, saying their immediate concern is to protect coverage under the Affordable Care Act, which still faces attacks from Republicans.
Mr. Sanders’s bill would expand Medicare, one of the nation’s largest, most popular entitlement programs. The federal government would establish an annual budget for covered health care services. Medicare’s benefit package would be expanded to include coverage of dental care, vision services and hearing aids. The bill would also cover “comprehensive reproductive, maternity and newborn care, including abortion,” according to a summary prepared by Mr. Sanders’s office.
The federal government would establish a standard list of covered drugs, and the secretary of health and human services would negotiate prices with drug companies.
Mr. Sanders did not say how he would pay for his bill. He issued a list of a dozen financing options, which included higher tax rates for high-income people and “an annual 1 percent federal wealth tax on the net worth of the wealthiest one-tenth of 1 percent of U.S. households.’’
The Sanders bill would eliminate deductibles and most other out-of-pocket costs for consumers, but the government “may impose limited co-payments for prescription drugs in order to encourage the use of lower-cost generic drugs.”
Under the bill, Medicare — now available to people 65 and older and to some younger people with disabilities — would be expanded over four years. In the first year, Medicare would be opened to children through age 18 and to adults from 55 to 64. The eligibility age would be reduced to 45 in the second year and to 35 in the third year, with “every resident of the United States” entitled to benefits in the fourth year.
That would bring huge changes to the health care system, affecting many people who are content with the coverage they have. More than 150 million people under the age of 65 have employment-based coverage. The Sanders bill would separate health insurance from employment, shrinking the role of employers and insurance companies.
Employer-sponsored plans could not duplicate benefits provided by Medicare, but could offer extra benefits.
Mr. Sanders predicted that “insurance companies, drug companies and Wall Street won’t like this legislation,” and he was right.
David Merritt, an executive vice president of America’s Health Insurance Plans, a lobby for insurers, said: “Whether it’s called single-payer or Medicare for all, government-controlled health care cannot work. It will eliminate choice, undermine quality, put a chill on medical innovation and place an even heavier burden on hard-working taxpayers.”
Governors Rally Around Health Law Fixes as White House Pushes Repeal
by Robert Pear - NYT - September 7,2017
WASHINGTON — Governors from both political parties told Congress on Thursday that they supported immediate action on modest, bipartisan steps to repair the Affordable Care Act without repealing it, even as the Trump administration continued to encourage efforts to dismantle the law.
Testifying at a hearing of the Senate health committee, governors from Colorado, Massachusetts, Montana, Tennessee and Utah endorsed proposals to stabilize health insurance markets by providing federal money for continued payment of subsidies to insurance companies to offset the cost of discounts provided to low-income people.
They also urged Congress to give states more latitude to modify some insurance requirements in the Affordable Care Act and to devise their own coverage programs. The subsidy money and the flexibility for states are the two main components of a bipartisan consensus emerging in the Senate.
“Congress should take steps now to prevent the total collapse of the health insurance market” by providing money for the “cost-sharing” subsidies, said Gov. Bill Haslam of Tennessee, a Republican.
Gov. Steve Bullock of Montana, a Democrat, said, “If this committee is genuinely concerned with stabilizing the individual marketplace, the most important step it can take in the near term is ensuring funding for the cost-sharing reduction payments for at least the next two years.”
The governors — three Republicans and two Democrats — agreed that Congress should simplify and expedite the process for states to get waivers from the federal government for innovative state health programs. In particular, they expressed interest in programs under which states would help insurers pay the largest claims. Alaska and Minnesota have passed laws to establish such reinsurance programs, which they say are lowering premiums below what they would otherwise be.
Senator Lamar Alexander, Republican of Tennessee and the chairman of the health committee, is working with the senior Democrat on the panel, Senator Patty Murray of Washington, on legislation that would finance the cost-sharing subsidies through 2018 and perhaps 2019 as well.
The Republican push to dismantle major provisions of the Affordable Care Act collapsed on the Senate floor in late July, but some Republicans insist that it is not dead.
Senator Bill Cassidy, Republican of Louisiana, said on Thursday that he had White House support for a bill that would repeal much of the Affordable Care Act and replace it with lump-sum payments to states that could be used for a variety of health insurance programs.
Mr. Cassidy said Vice President Mike Pence was encouraging senators and governors to support the proposal for block grants, which he drafted with Senator Lindsey Graham, Republican of South Carolina.
Kellyanne Conway, a top adviser to Mr. Trump, said on Fox News: “The president is ready. He’s ready with pen in hand to sign health care reform if, say, Graham-Cassidy moves forward. A lot of the governors seem to be supportive of that.”
Describing his proposal, Mr. Cassidy said: “Every American, no matter where that American lives, will ultimately get about the same amount of money to support health care. Right now four states get 37 percent of all the money that is spent on behalf of the Affordable Care Act. We equalize that.”
Mr. Cassidy said his bill was being drafted so it could be approved in the Senate with a simple majority, rather than the 60 votes usually required for major legislation.
But Mr. Cassidy and his bill face long odds. The procedural device that allows Republicans to sidestep a Democratic filibuster on health care will not be available after Sept. 30, little more than three weeks from now, the Senate parliamentarian said last week.
Mr. Cassidy has not finished writing the bill, no committee has held a hearing on it, and the Congressional Budget Office would need to analyze it — a task that could take two weeks — before the Senate could vote on it.
Optima Health, a Virginia-based insurer, announced on Wednesday that it would limit its participation in the individual insurance market next year, raising the possibility that people in dozens of Virginia counties might not have any insurance options. Senator Tim Kaine, Democrat of Virginia, said the announcement showed the urgent need for congressional action and the uncertainty caused by the Trump administration’s threat to stop the cost-sharing subsidies.
Mr. Kaine said he would not support Mr. Cassidy’s proposal for a block grant because it “really penalizes Virginia.” Gov. Charlie Baker of Massachusetts, a Republican, also spoke out against it.
“The proposal would dramatically negatively affect the commonwealth of Massachusetts,” Mr. Baker said. “We’re talking billions and billions of dollars over the course of the next four or five years.”
Mr. Baker said the formula for distributing block-grant funds ignored the fact that Massachusetts was a high-wage state with relatively high health care costs.
Insurers that want to participate in the federal insurance marketplace are supposed to sign contracts with the federal government by Sept. 27. The fifth annual open enrollment period, when consumers can sign up for coverage, is scheduled to start on Nov. 1 and end on Dec. 15.
To shore up insurance markets before then, Mr. Alexander said, lawmakers will need to compromise.
“It’s pretty easy to be for extending the cost-sharing payments,” Mr. Alexander said. But “to get a Republican president, a Republican House and a Republican Senate just to vote for more money won’t happen in the next two or three weeks unless there’s some restructuring” of insurance market regulation to address Republican concerns.
'Groundbreaking': Democratic Co-Sponsors Rush Aboard Bernie's Medicare for All Train
by Jessica Corbett - Common Dreams - September 12, 2017
A quarter of Democratic Caucus members in the U.S. Senate have now signed on as co-sponsors of Sen. Bernie Sanders' (I-Vt.) Medicare for All bill, which he plans to introduce Wednesday, signaling a shift among party lawmakers, who may be swayed by recent polling that has indicated a majority of Americans and more than two-thirds of Democrats favor a single-payer national healthcare system.
As of this writing on Tuesday afternoon, the 12 co-sponsors are:
Sens. Tammy Baldwin (D-Wis.)
Richard Blumenthal (D-Conn.)
Cory Booker (D-N.J.)
Kirsten Gillibrand (D-N.Y.)
Kamala Harris (D-Calif.)
Mazie Hirono (D-Hawaii)
Ed Markey (D-Mass.)
Jeff Merkley (D-Ore.)
Brian Schatz (D-Hawaii)
Elizabeth Warren (D-Mass.)
Sheldon Whitehouse (D-R.I.)
Tom Udall (D-N.M.).
Richard Blumenthal (D-Conn.)
Cory Booker (D-N.J.)
Kirsten Gillibrand (D-N.Y.)
Kamala Harris (D-Calif.)
Mazie Hirono (D-Hawaii)
Ed Markey (D-Mass.)
Jeff Merkley (D-Ore.)
Brian Schatz (D-Hawaii)
Elizabeth Warren (D-Mass.)
Sheldon Whitehouse (D-R.I.)
Tom Udall (D-N.M.).
Last weekend, Sen. Patrick Leahy said he is "likely to support" the bill, but he has not yet come out as a co-sponsor.
As senators lined up to pledge their support on Monday and Tuesday, it became clear that since Sanders made single payer central to his 2016 presidential campaign, the political needle has indeed shifted.
Sharing a Politico piece titled "Democratic foes of Trump flock to single-payer ahead of 2020"—which references predictions that any potential 2020 challenger to President Donald Trump will need to support single payer to win over voters—Students for National Health Program enthusiastically welcomed the surge of endorsements while journalist and activist Shaun King called the shift "a groundbreaking development."
In a Washington Post news analysis, entitled "The dam is breaking on Democrats' support for single player," Aaron Blake noted how during last year's Democratic primary season, "Hillary Clinton dismissed single-payer as 'a theoretical debate about some better idea that will never, ever come to pass.' Fast-forward a year, and it's leading Democratic presidential hopefuls like Clinton that are spearheading this."
Supporters of Sanders and a Medicare for All healthcare system have deemed the coming legislation a "litmus test" for Democrats. Though Sanders, in an August interview with the Post, disagreed that the bill would serve as litmus test, he was quick to point out the growing support for a single-payer system, and added: "as more and more Americans come on board, it will become politically possible."
The litmus test theory could be tested before 2020. Baldwin is up for re-election in Wisconsin in 2018, which makes her announcement that she's co-sponsoring the bill a "big deal," said MoveOn.org Washington Director Ben Wikler.
Even Sen. Joe Manchin (D-W.V.), whom Bloomberg calls "the Senate's most conservative Democrat," told the outlet on Tuesday that he is open to considering single payer. Manchin, like Baldwin, is up for re-election next year.
Despite the widespread support from the public, and now a substantial number of Sanders' fellow senators, some lawmakers have said they first want to see the bill, while others have overtly declined to support it. Based on what they've told Capitol Hill reporters this week, Sens. Chris Van Hollen (D-Md.), Ron Wyden (D-Ohio), Bob Casey Jr. (D-Penn.), and Chuck Schumer (D-N.Y.) remain undecided.
Sen. Tim Kaine (D-Va.) told Vox's Jeff Stein that he prefers a healthcare program that allows people to pick between a government-run program and private insurers, and Sen. Dianne Feinstein, claiming "the cost of single payer is enormous," said she too supports a public option instead of Medicare for All.
Sen. Sherrod Brown (D-Ohio)—typically known for his progressive stances—said he's focusing on his own healthcare bill and will not co-sponsor Sanders' bill. However, Brown also said in a statement to Politico that he's "always been supportive of Medicare for All," implying he may not oppose the legislation once it's introduced.
Sen. Debbie Stabenow (D-Mich.), who's sponsoring the "Medicare at 55 Act" with Brown, also said she wants to focus on their bill, while Sens. Claire McCaskill (D-Mo.) and Jon Tester (D-Mont.) both told The Hill's Peter Sullivan on Tuesday that they will not support Sanders' proposal.
Deal Struck to Extend Financing for Children’s Health Program
by Robert Pear - NYT - September 12, 2017
WASHINGTON — The chairman of the Senate Finance Committee and the top Democrat on the panel announced on Tuesday night that they had reached agreement on a plan to prevent the imminent exhaustion of federal funds for the Children’s Health Insurance Program.
The current appropriation runs out at the end of this month, and many states will exhaust their allotments of federal money later this year or early next year.
Nearly nine million children receive health insurance through the program, on which the federal government has been spending about $14 billion a year. The program is for children in families that make too much to qualify for Medicaid, but not enough to afford other coverage.
The agreement was announced by the chairman of the Finance Committee, Senator Orrin G. Hatch, Republican of Utah, and the senior Democrat on the panel, Senator Ron Wyden of Oregon.
“Congress needs to act quickly to extend the funding for CHIP,” said Mr. Hatch, who helped create the program in 1997 with Senator Edward M. Kennedy, Democrat of Massachusetts.
Mr. Hatch said the agreement would provide “uninterrupted funding for CHIP” and “increased flexibility for states to administer the program.”
The agreement would provide federal funds for the program for five additional years.
Mr. Wyden said the agreement was “a great deal for America’s kids.”
When the Affordable Care Act was adopted in 2010, some members of Congress suggested that the Children’s Health Insurance Program would no longer be needed because youngsters and their families could get coverage on the open market. But policy experts say that prediction was wrong. Several studies have found that CHIP coverage provides better, more comprehensive benefits for children, at lower cost, than the health plans sold on insurance exchanges established under the Affordable Care Act.
The federal government and the states have historically shared the costs of the CHIP program, with the federal government paying a larger share in states where personal incomes are low. The Affordable Care Act increased the federal share in each state by 23 percentage points. As a result, the federal government pays the entire cost in 11 states.
The agreement by Mr. Hatch and Mr. Wyden would gradually restore the financial partnership between the federal government and the states. The federal share would continue to be enhanced by 23 percentage points, as under current law, for two more years, in 2018 and 2019. The increase would then be halved, to 11.5 percentage points, in 2020, and would be eliminated in 2021 and 2022.
The federal government would still pay a larger share of costs in the Children’s Health Insurance Program than in Medicaid.
House Republicans have expressed a desire to extend the program for five years, but have not worked out the details of legislation.
President Trump’s budget proposed extending the program for two years, through 2019, and called for changes to focus the program on “the most vulnerable low-income families and children that the program was intended to serve.” But the administration has not been deeply involved in deliberations on Capitol Hill.
Nearly 90 percent of children in CHIP are in families with annual incomes below twice the poverty level — less than about $49,000 for a family of four. Since the program was created, the proportion of children who are uninsured has fallen to less than 5 percent today, from nearly 14 percent in 1997.
How Single-Payer Health Care Could Trip Up Democrats
by Margot Sanger-Katz - NYT - September 11, 2017
Many Democrats giddy from their recent health policy successes are starting to reach enthusiastically for a mountaintop goal: establishing a single-payer system for all Americans.
But they may want to learn the lessons of their opposition. Like “repeal and replace,” “single-payer” is a broadly popular slogan that papers over intraparty disagreements and wrenching policy choices. Republicans fumbled multiple attempts to replace the Affordable Care Act this year. If the Democrats eventually wrested back power, they could find themselves similarly factionalized and stymied over the details.
In a single-payer system, the government, not individuals or businesses, pays nearly all of the medical bills. Once at the edge of the political conversation, derided as a socialist fantasy, it is barreling into the mainstream of Democratic politics, usually under the slogan “Medicare for all.”
Since January, a majority of House Democrats have signed onto a single-payer billbrought by John Conyers of Michigan — a bill that has been introduced seven times before, without nearly as much support. Senator Bernie Sanders plans to introduce his own single-payer bill on Wednesday. Already, it has attracted three senators regarded as presidential aspirants: Elizabeth Warren of Massachusetts, Kamala Harris of California and Cory Booker of New Jersey have said that they will co-sponsor the bill.
The idea has gained more traction among the public, too. Recent polling from Gallup suggests that support for a “government-run” health care system is at 43 percent, nearly 10 percentage points higher than it was in 2010. Among Democrats, the notion attracts 63 percent support.
“If you see more and more members of Congress saying, ‘I support single-payer,’ it is because now they know it is not as politically risky as it used to be,” Mr. Sanders said in an interview. “You’re not being an outcast. You’re not being a fringe member of Congress. If polling shows that a strong majority of Democrats support single-payer, what is the problem with coming on board?”
But the road to single payer may be treacherous. Senator Ted Cruz of Texas has described the Affordable Care Act as part of a slippery slope to government-run health care. Anthony Wright, the executive director of Health Access California, a consumer advocacy group that favors single-payer, says the journey to such a system is instead more like climbing a mountain.
“We may decide the view is fine here,” he said. “And it will be tough to get to the summit.”
The talking points about single-payer are clear and appealing to many progressives.
They promise a system that covers everyone and is cheaper, simpler and less profit-oriented. But the details matter. While it is true, as advocates often mention, that much of the world has some form of universal health care, there is wide variation in how those systems work. Nearly any single-payer plan would require substantial disruptions in the current health care system, upending the insurance arrangements of the 156 million Americans who get their coverage from work, changing the way doctors, hospitals and drug companies are paid, and shifting more health care spending onto the government ledger. Such a proposal would reshuffle the winners and losers in our current system.
“Democrats are overwhelmingly for something that sounds like an all-government or significantly government-run system,” said Robert Blendon, a health policy professor at Harvard who studies public opinion. “At this stage, most people that are saying that don’t know what the ‘it’ is.”
The Republican slogan “repeal and replace” had some popularity, too, particularly with the Republican base. The United States health care system is expensive and full of dysfunctions, making it susceptible to anti-establishment critiques. But when Republicans took control of the government this year, they found themselves unable to coalesce around a single health care plan. Various options, which government analysts said would have resulted in at least 20 million fewer Americans with health insurance, were deeply unpopular with the public.
“Repeal and replace went from a very popular idea, getting rid of Obamacare, to a real proposal with winners and losers and trade-offs,” said Drew Altman, the president of the Kaiser Family Foundation, a health policy research group. Mr. Altman said that Democrats were benefiting from that shift now, as the defenders of the status quo. A splashy new health care proposal, with its own winners and losers and trade-offs, could reverse that political momentum, he said. “If they immediately switch the focus to their own sweeping health care plan, they could lose that opportunity.”
Still, the recent momentum suggests that single-payer may become a standard position for a certain type of liberal candidate. Joe Trippi, a Democratic campaign strategist, compared the issue to earlier opposition to the Iraq war. “It’s not proven yet that you could take the country there, but I think Democrats would respond more to a nominee who wants to take the country there than one who is half-loafing it,” he said.
For now, the top Democrats in Congress have yet to embrace a single-payer bill. Nancy Pelosi, the House minority leader, has emphasized the need to shore up the Affordable Care Act. Chuck Schumer, the Senate minority leader, said that single-payer was one of many options under study.
Their hesitance may reflect the challenging politics of the issue, despite the recent increase in support. The polls suggest that many voters may be more taken with the single-payer slogan than with the nuts and bolts. A recent survey by Kaiser found that initial support of 55 percent for single-payer dropped by about a third when supporters were told of criticisms that it might increase their taxes, give the government “too much control” over health care or eliminate the Affordable Care Act. Each of those critiques would probably be made prominently by Republican opponents of the policy.
Leaders of liberal states saw support for the idea erode as they confronted those political realities. In Vermont, the framework of a single-payer system passed the state legislature in 2011, only to be abandoned after experts estimated the system would require the state to double its tax revenue. A single-payer referendum in Colorado was voted down last year, 79 percent to 21 percent. And a recent California single-payer bill was shelved after steep cost projections, though a commission is continuing to explore options.
Those results have some advocates of universal coverage worried that a push for single-payer could undermine efforts to make health coverage more expansive through smaller steps.
“Incrementalism is not a four-letter word,” said Ron Pollack, the chairman emeritus of Families USA, a group that pushed hard for the Affordable Care Act, who outlined his views in a recent essay on Vox.com.
Single-payer advocates say that support will build as lawmakers engage in more serious discussion and policy making. Mr. Sanders’s bill is expected to be more comprehensive than past proposals. “This thing is getting really serious,” said Mr. Conyers, who has watched support for his bill build over time. “People in the Senate are saying thoughtful things and are looking at it from more than a philosophical or theoretical point of view — they’re looking at how we get it right here in America as soon as possible.”
But some advocates who have worked in the trenches are less sanguine. Andy Slavitt, who ran the Centers for Medicare and Medicaid Services in the Obama administration, has thrown himself into health care advocacy since the election. But he worries that the quick shift among his peers on single-payer could backfire. “That could be the Democrats’ version of the thing that they promised to do for seven years and couldn’t do,” he said.
Bernie Sanders’s Bill Gets America Zero Percent Closer to Single Payer
by Jonathan Chait - The Intelligencer - September 13,2107
The sight of 15 Senate Democrats, including many of the party’s likely presidential contenders, co-sponsoring Bernie Sanders’s single-payer health-care bill may look like a momentous step. “What that means,” writes Jake Tapper, “is that with the notable exception of former Vice President Joe Biden, every top tier(ish) 2020 Democrat is now on board with a policy proposal that Clinton said less than two years ago would ‘never, ever come to pass.’”
But this image of progress only holds true if you imagine the process as a series of continuous steps. In reality, single payer has always been, and remains, a political dilemma that nobody has been able to resolve, and there is no evidence the resolution has grown any easier. What looks like a large step forward is actually a party edging closer to a cliff it has no intention of going over.
The barrier to single payer is that the American health-care system has been built, by accident, around employer-based insurance. The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.
That is not a detail to be worked out. It is the entire problem. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it.
In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.
Health-care experts have spent decades trying to grapple with this dilemma. Sanders has not come even a single inch closer to resolving it. Instead he hand-waves the problem away.
Asked by Vox about the difficulty of switching people out of employer-based insurance, he scoffs, “It’s not a question of switching plans,” and then segues into a generalized riff about the merits of universal insurance. (In real politics, you can’t answer people’s concerns by denying they’re concerns.) Asked by the Washington Post about the taxes needed to finance his plan, he insists that we have no idea how much it would cost because the only studies so far have been faked by big pharma and the insurance industry: “The truth is, embarrassingly, that on this enormously important issue, there has not been the kind of research and study that we need. You’ve got think tanks, in many cases funded by the drug companies and the insurance companies, telling us how terribly expensive it’s going to be.”
The bill does not contain any tax increases, leaving those to a separate piece of legislation. A nonspecific health-care plan that lacks a plausible financing system has accomplished approximately zero percent of the necessary work, as the Republicans discovered this year.
There is nothing in Sanders’s rhetoric that indicates he even recognizes the shape of the political problem. Instead he employs the classic populist technique of imagining the people as a whole standing united around an obvious solution, and only the machinations of an invidious elite can thwart them. Here is what he tells Vox:
“What this struggle is about really, honestly, is not a health care debate. Should health care be guaranteed to all people? Most people say yes. Are we wasting an enormous amount of money in the current system? Most people would say yes. Can we take on the drug companies and the insurance companies and Wall Street and their unlimited sums of money to influence Congress? … That’s a major political struggle that we have to engage in.”
And here is what he writes in his New York Times op-ed:
Needless to say, there will be huge opposition to this legislation from the powerful special interests that profit from the current wasteful system. The insurance companies, the drug companies and Wall Street will undoubtedly devote a lot of money to lobbying, campaign contributions and television ads to defeat this proposal.
Evil corporations are the only impediment he acknowledges. At no point does he grant that the most important source of opposition will come from actual American voters concerned about losing their current plan or paying higher taxes.
There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.
Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.
Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
It’s Now Time for Medicare for All
by Robert Reich - Common Dreams - September 13, 2017
enator Bernie Sanders, Elizabeth Warren, Cory Booker, and Jeff Merkley, are introducing a Medicare For All bill in the Senate. It’s a model for where this nation needs to be headed.
Some background: American spending on health care per person is more than twice the average in the world’s 35 advanced economies. Yet Americans are sicker, our lives are shorter, and we have more chronic illnesses than in any other advanced nation.
That’s because medical care is so expensive for the typical American that many put off seeing a doctor until their health has seriously deteriorated.
Why is health care so much cheaper in other nations? Partly because their governments negotiate lower rates with health care providers. In France, the average cost of a magnetic resonance imaging exam is $363. In the United States, it’s $1,121. There, an appendectomy costs $4,463. Here, it’s $13,851.
The French can get lower rates because they cover everyone — which gives them lots of bargaining power.
Other nations also don’t have to pay the costs of private insurers shelling out billions of dollars a year for advertising and marketing — much of it intended to attract healthier and younger people and avoid the sicker and older.
Nor do other nations have to pay boatloads of money to the shareholders and executives of big for-profit insurance companies.
Finally, they don’t have to bear the high administrative costs of private insurers — requiring endless paperwork to keep track of every procedure by every provider.
According to the Kaiser Family Foundation, Medicare’s administrative costs are about 2 percent of its operating expenses. That’s less than one-sixth the administrative costs of America’s private insurers.
To make matters worse for Americans, the nation’s private health insurers are merging like mad to suck in even more money from consumers and taxpayers by reducing competition.
At the same time, their focus on attracting healthy people and avoiding sick people is creating a vicious circle. Insurers that take in sicker and costlier patients lose money, which forces them to raise premiums, co-payments and deductibles. This, in turn, makes it harder for people most in need of health insurance to afford it.
This phenomenon has even plagued health exchanges under the Affordable Care Act.
Medicare for all would avoid all these problems and get lower prices and better care.
Ideally, it would be financed the same way Medicare and Social Security are financed, through the payroll tax. Wealthy Americans should pay a higher payroll tax rate and contribute more than lower-income people. But everyone would come out ahead because total health care costs would be far lower, and outcomes far better.
A Gallup poll conducted in May found that a majority of Americans would support such a system. A poll by the Pew Research Center shows that such support is growing, with 60 percent of Americans now saying government should be responsible for ensuring health care coverage for all Americans — up from 51 percent last year.
Democrats are wise to seize the moment. The time has come for Medicare for all.
Bucking For-Profit System, Sanders Aims to 'Revolutionize' US Healthcare With Medicare for All
by Jake Johnson - Common Dreams - September 13, 2017
In a bid to "revolutionize" American healthcare by transitioning away from the for-profit status quo to a Medicare for All system that guarantees insurance to every American as a right, Sen. Bernie Sanders (I-Vt.) on Wednesday will introduce his long-awaited single-payer bill that is now backed by 15 Democratic senators and a wave of grassroots enthusiasm.
"This is where the country has got to go," Sanders told the Washington Post on Tuesday. "Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational healthcare system that guarantees coverage to everyone in a cost-effective way, the only way to do it is Medicare for All."
Post reporter Dave Weigel got an early look at the legislation—which will be introduced at 2pm at an event in Washington—and summarized it as a total replacement of the current healthcare system with "a public system that would be paid for by higher taxes."
Weigel continued:
Everything from emergency surgery to prescription drugs, from mental health to eye care, would be covered, with no co-payments. Americans under 18 would immediately obtain "universal Medicare cards," while Americans not currently eligible for Medicare would be phased into the program over four years. Employer-provided health care would be replaced, with the employers paying higher taxes but no longer on the hook for insurance.
In a video on Wednesday, Sanders contrasted his legislation with the Republicans' failed plan, which could have stripped health insurance from more than 30 million Americans.
As Common Dreams reported on Monday, Sanders and his allies have emphasized that introduction of the Medicare for All Act of 2017 is only the beginning of a long struggle against "the insurance companies, the drug companies, Wall Street, and all those who make billions in profit" from the current system.
But opponents of Medicare for All "are on the wrong side of history," Sanders wrote in an op-ed for the New York Times on Wednesday.
"Now is the time for Congress to stand with the American people and take on the special interests that dominate healthcare in the United States," Sanders concluded. "Now is the time to extend Medicare to everyone."
Many in the business community agree.
In a statement ahead of Sanders' announcement on Wednesday, David Levine, CEO and co-founder of the American Sustainable Business Council, said a single-payer system would "be better for our economy overall."
Business Initiative for Health Policy founder Richard Master, who will speak at the event introducing the Medicare for All Act of 2017, echoed Levine, arguing: "We need to destroy once and for all the utterly preposterous myth that the so-called 'free market' will ever be capable of delivering the health system we need."
Commentators in recent days have expressed astonishment at the speed with which public and Democratic Party opinion has shifted on single payer. Vox's Dylan Matthews called Democrats' growing support for Medicare for All "stunning," and the Washington Post's Aaron Blake likened single payer's rapid surge in popularity to a dam finally breaking.
Writing for Common Dreams on Wednesday, RoseAnn DeMoro, executive director of National Nurses United (NNU), argued that this "seismic shift" in opinion is a "direct product of how Sanders made Medicare for All, and healthcare as a human right, such a signature issue of his [2016 presidential] campaign."
It is also a result of "the enduring work of nurses and other healthcare activists over many years," which has "laid the seeds for this day," DeMoro wrote.
NNU has, along with many other progressive organizations, joined a massive grassroots campaign to build on popular support for Medicare for All that will continue—and intensify—in the months ahead.
"Today's bill introduction is the crest of a wave, but it's also a new beginning," DeMoro concluded. "Nurses will continue to press this issue, calling on all senators to sign on, and to challenge those who will stand in the way of enacting the healthcare system we need."
Emperor X: 'We Are Much More Than The Sum Of The Diseases And Disabilities We Carry'
by Sam Greenspan - NPR - September 10, 2017
If you're looking for Chad Matheny — the Floridian singer-songwriter who performs as Emperor X — when he rolls through your town, a good place to start would be your local public transit hub.
In June, for example, Matheny found himself at the Amtrak station in Emeryville, California, just next to Oakland. His whistle-stop visit to the Bay Area was one leg of a tour across North America, playing music from his latest record, Oversleepers International, released this past May.
Matheny has long had an innovative approach to writing and releasing music — back in 2010, for instance, he hid cassette tapes of his music around the country and posted clues about where to find them on the Internet. Since then, he has released four more albums, had a song appear in the soundtrack of a major motion picture and toured the world.
But in 2014, Matheny was diagnosed with an advanced case of testicular cancer. He wrote and recorded Oversleepers International while in recovery from an invasive surgery and throughout six months of chemotherapy.
In "€30,000," a song from that album, Matheny sings about the aftermath of his illness: "I owe 30,000 euros to the German corporation / That just cured me of a terminal cancer / Now I've got 87 notices reminding me / They can't care at all if my ending came too soon."
But, he says, he didn't necessarily intend to write so bluntly about being sick.
"I didn't want it to be the cancer record," Matheny says, "The cancer thing didn't seem much of a big deal, because I've always been trying to accomplish something that the universe says I shouldn't do."
Matheny is referring to the fact that he's legally blind. He was born with a condition that prevents the lenses and muscles in his eyes from working as well as they should. Then, in 1994, when he was 15, he was involved in a car accident. "The airbag blew up in my face, and caused internal bleeding in my right eye," Matheny says.
Ever since, Matheny has had low vision in one eye, and the other is nearly useless. That means he can't drive a car; so, for the past 15 years, he has been touring the world using public transportation. In the United States, that mostly means riding Greyhound buses.
"I could rank the Greyhound stations of America in order of nicest — Milwaukee — to scariest — Dallas — and everything in between," he says.
Matheny estimates that he crisscrossed the country by bus more than 20 times in the span of five years. And in 2012, he left the U.S. for Berlin. In Europe, Matheny found that trains made his life as a touring musician with low vision remarkably easier.
But just as his career was starting to look up, he got his cancer diagnosis. Fortunately, even as an uninsured person in Germany, Matheny was able to get treatment right away. He's now in remission.
When he started to deal with the hospital bills, Matheny thought a lot about what his life would have been like had he gotten cancer in the U.S. He even crunched the numbers.
Like many musicians, Matheny went years with minimal health insurance, or none at all. In Germany, with no insurance, he wound up in debt of about €30,000 — roughly $35,000. That's what Matheny calculated he would have owed in the U.S. if he did have insurance.
And without insurance, "it would have been a minimum [of] a quarter million dollars. Probably half a million, I'm guessing," he says. "It would have been unsustainable; I would have declared bankruptcy or something."
In a 2013 study, the Future of Music Coalition, a nonprofit that advocates for musicians, found that more than half of the musicians it surveyed did not have any health insurance. That was nearly triple the national average at that time.
"We found that the more time that people spent on their artistic careers, the less likely they were to have insurance," says Kevin Erickson, the Coalition's National Organizing Director.
The study was conducted before the rollout of the Affordable Care Act. Erickson does say that things seem to have gotten much better since then — though not for everyone.
"I'm just so tired of having to see benefit concert after benefit concert after benefit concert for musicians in health crisis," he says. "I do think about the songs we'll never hear because it's just too hard for people to keep going."
About 20 people crowd into a living room to see Matheny play a house show in San Francisco. He'll make about $60 for his set tonight, enough to get him on a train down to Santa Cruz, where he'll play another show in another living room. It's nowhere close to what he'd need for a round of chemotherapy in an American hospital if his cancer were to return.
"It would be self-destructive to come back [to America] just, just for the insurance reason, let alone the transportation reason," Matheny says.
Being a member of the middle class and travelling as a musician in Europe changed the way Matheny looks at touring — and the United States.
"[In Europe] I felt like an organ of society, instead of a flea on the skin of a cybernetic creature," he says. "I feel like the machine of the United States of America is allergic to me."
And so, after those tour dates in California, Matheny is back in Europe, touring in support of Oversleepers International.
"We are much more than the sum of the diseases and disabilities that we carry with us," Matheny says. "I like to think that this record reflects that very universal human fact."
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