August 25, 2016
Finding a Cure for Bernie Sanders’ and Hillary Clinton’s Health Care Plans
Posted on Jan 22, 2016
By Margaret Flowers and Jill Stein
Hillary Clinton’s recent attack on Sen. Bernie Sanders for his advocacy of single-payer health plan has brought the health care crisis into the spotlight.
We are both physicians who have a long history of working on health policy. While the two Democratic candidates offer proposals that are very different from each other, we see that neither is calling out health care privatization as the fatal flaw in the Affordable Care Act (ACA).
Clinton argues we can simply expand the Affordable Care Act to achieve universal coverage, which we view as impossible. Sanders is on target with his new Medicare-for-all proposal. However, by preserving the illusion that the ACA is a “step in the right direction,” Sanders misses the point that the current U.S. health care system under the ACA is unique among industrialized nations because it treats health care as a commodity rather than a public good.
Health care should be a central issue in the presidential campaigns. A Reuters/IPSOS poll in December showed that the cost of health care is a bipartisan concern, with 62 percent of Republicans and 67 percent of Democrats surveyed saying they would want to know about a presidential candidate’s plan for reducing health care costs. This is not surprising, since the ACA has produced high premiums and unaffordable out-of-pocket costs. The status quo is not working.
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We have both been clear about our long-term support for a national improved Medicare-for-all health system based on a strong public health foundation and human rights principles. We offer a critique of the current health care debate and our prescription for the solution to the crisis.
Clinton’s Attack on Sanders, and Her Plan
Clinton attacked Sanders on the health legislation he has introduced in Congress nine times. There are reasons to criticize his bill, but they are not the disingenuous reasons Clinton uses.
The claim that she, her daughter and her campaign made, that Sanders would do away with Medicaid, Medicare, the Veterans Administration, the Children’s Health Insurance Plan and the Affordable Care Act, while technically true, didn’t tell the full story. In truth, all these programs would become part of a national health care plan that would provide comprehensive benefits while saving money and allowing free choice of doctors, hospitals and health services. This would be an improved and expanded Medicare-for-all.
Clinton took this half-truth/half-lie approach because she knows better than to openly criticize single-payer, which is popular in the U.S. In December, a Kaiser Family Foundation poll found nearly 58 percent of all people in the U.S. favor the idea of Medicare-for-all, including 34 percent who say they strongly favor it. The poll also found that 81 percent of Democrats support this single-payer program. These results are deeply held, being consistent with polling before the 2009 debate on the ACA. Clinton avoided using the terms “single payer” or “Medicare-for-all” because Democrats support this approach—by a landslide.
The other criticism Clinton made of the Sanders plan was that each state would administer its own plan. This is a valid critique, because there is a wide variation in ideology from state to state. Under the ACA, some governors refused to expand Medicaid, leaving 3 million people without coverage. Without a clear federal standard, states can prevent universal coverage.
Again, however, Clinton did not tell the whole truth. She left out that Sanders’ bill included national oversight. If governors did not meet national standards, the federal government would take over.
The 50-state administration was a serious flaw in the Sanders plan because it allowed each state to decide who was a resident. Some state governments could choose not to include immigrants. From a public health perspective, this is a shortsighted position, because we are all healthier when everyone has access to the care they need.
This was one of several flaws in Sanders’ legislative proposals. He also refused to eliminate for-profit health facilities, which have higher costs and worse outcomes in general. And Sanders refused to introduce a Senate companion bill to HR 676, The Expanded and Improved Medicare for All Act. That legislation, sponsored in the House by Rep. John Conyers, D-Mich., is the gold standard for single-payer.
Some in the media have mistakenly described Clinton’s health program from the ’90s as a single-payer program. It was not single-payer, but rather a program that empowered the biggest insurance companies by essentially creating a few private insurance monopolies. It forced people to buy insurance or face very high penalties. Clinton’s plan was described in Progressive Review as creating “a medical oligopoly that would dispense health-care under the rules of the Fortune 500 rather than according to those of Hippocrates.”
The Clinton plan included maximum fines: $5,000 for refusing to join the government-mandated health plan; $5,000 for failing to pay premiums on time; 15 years in jail for doctors who received “anything of value” in exchange for helping patients short-circuit the bureaucracy; $10,000 a day for faulty physician paperwork; $50,000 for unauthorized patient treatment; and $100,000 a day for drug companies that messed up federal filings. Her plan was friendlier to Wall Street than the ACA and less friendly to patients.
Sanders’ New Plan
On Sunday, just two hours before the final Democratic debate before the Iowa caucus, Sanders released a new plan. It made two excellent improvements on his previous legislative proposals.
First, he writes that he would create “a federally administered single-payer health care program.” This is a major improvement over the complexity, cost and inconsistency of having 50 state administrators—it will save money and provide equal coverage for all. Second, he expanded the coverage of his plan so that all medically necessary services would be covered.
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