Tuesday, January 12, 2016

Clinton and Sanders Spar Over Health Care

Yesterday Hillary Clinton leveled an interesting charge on Bernie Sander's plan for single payer health care.
"His plan would take Medicare and Medicaid and the Children's Health Insurance Program and the Affordable Care Act health-care insurance and private employer health insurance and he would take that all together and send health insurance to the states, turning over your and my health insurance to governors," Clinton said, naming the state's Republican Gov. Terry Branstad. "I don’t believe number one we should be starting over. We had enough of a fight to get to the Affordable Care Act. So I don’t want to rip it up and start over."

Clinton called Sanders's plan a "risky deal."
Speaking for the Sanders campaign, Michael Briggs issued this response:
At a time when we are the only major country on earth that does not guarantee health care for all and when we spend far more per person that any other country, the time is long overdue for us to pass a Medicare for all, single-payer program. Medicare for all would save the average family thousands of dollars a year in health care costs. Secretary Clinton is inaccurate in suggesting that Republican governors would be able to circumvent the law and deny implementation in their states. The bill Sen. Sanders introduced was very clear. It is national legislation for all states.
The truth is that both statements contain unanswered questions. That is because Bernie Sanders hasn't released a plan for single payer health insurance yet. Check out the issues page of his campaign web site and you will find single payer is one of 13 items he lists under "Income and Wealth Inequality," but no specifics. Last July, on the 50th anniversary of Medicare, the Senator said he would introduce a bill in the Senate soon. But when Sanders was interviewed by Mark Halperin last week, he hesitated to commit to releasing a plan before the Iowa caucuses. So the truth is, we don't know what Bernie Sanders' plan is for single payer.

So where did Hillary Clinton get the idea that he would turn it over to the states? It comes from previous single payer bills Sanders has introduced in the Senate. Here is how S. 1782 was summarized at Healthcare - Now!
The American Health Security Act of 2013 (S. 1782) provides every American with affordable and comprehensive health care services through the establishment of a national American Health Security Program (the Program) that requires each participating state to set up and administer a state single payer health program.
And here is how the forthcoming plan was described on Sanders' Senate web site:
Sanders’ bill, which he said he will soon introduce in the Senate, would set federal guidelines and strong minimum standards for states to administer single-payer health care programs.
Here is actual language in S. 1782 that is cause for concern:
It is the sense of the Senate that in order to provide high quality health care coverage for all Americans while controlling costs in order to make American companies more competitive, individual States should be given maximum flexibility in designing health care programs to improve the individual experience of care and the health of populations, and to reduce the per capita costs of care for each State.
What is interesting is that Senator Sanders has never joined with the 60 Democratic House members who introduce a bill every session that is a truly national single payer proposal.

Hillary Clinton jumped the gun a bit on this one, given that Sanders hasn't released his proposal yet. But one has to wonder when he will finally get around to doing that. Until he does, it is difficult to say how much control his plan will cede to Republican governors. Given how they've handled Medicaid expansion, there is good reason to be concerned.


  1. The elephant in the room remains medical COSTS, on the other side of the equation. We've more or less tamed private insurance, and single payer stands to improve upon that by 20% at best. Meanwhile, medical costs are 2-3 times what any other first world nation has to deal with, and while costs are sky-high, no coverage plan is going to be truly affordable, not even single payer. It's what killed Green Mountain Single Payer in Bernie's home state, after all.

  2. Cost is a separate issue from insurance.

    If you want single payer, the simplest thing is to open up Medicare to everyone.

    1. Most likely, but we would still need a Congress willing to do that. Even at 58 Democratic Senators -- and probably all of them willing -- we couldn't even get a public option / Medicare buy-in in 2009. Single payer of any form will be an even harder sell.

      But per above, I don't think single payer is the important battle right now. After costs are tamed, then maybe. (Though I still think the public option would be better because it would offer all the benefits of single payer while still allowing people to use private insurance if they really want to. "Optional" usually makes people happier than "mandatory".)