America’s complex and inefficient healthcare system ends up being both very expensive and limited in its coverage, a problem that Sen. Bernie Sanders is targeting in his Medicare-for-all plan, reports Dennis J Bernstein.
By Dennis J Bernstein
Sen. Bernie Sanders has unveiled a new single-payer healthcare plan which would provide all Americans with government-sponsored health coverage. Sanders’s plan, supported by some 16 Democrats in the Senate, calls for an overhaul of the healthcare system with what would essentially be a tweaked and revitalized version of Medicare-for-all.
Bernie Sanders delivering a speech on Capitol Hill after the election of Donald Trump. The rally was organized in support of Medicare-for-all and the defeat of the TPP. Nov. 17, 2016. (Photo by Chelsea Gilmour)
“Today we say that a function of a rational healthcare system is to provide quality care to all in a cost-effective way,” declared Sanders, an independent from Vermont, “and not to continue a system which allows insurance companies and drug companies to make hundreds of billions in profits each year and makes healthcare industry CEO’s extremely wealthy.”
Flanked by supporting senators in making his Wednesday announcement, Sanders also noted that a Medicare-for-all program would end “the complexity of a system which adds enormous stress at a time when people need it the least.”
I spoke on Sept. 13 to Russell Mokhiber, founder of The Corporate Crime Reporter and of SinglePayerAction.org. Mokhiber has long been an advocate of the single-payer option. He is also someone who watches closely the deadly nature of corporate greed.
Dennis Bernstein: Please give us your initial reaction. Bernie has a number of senators who say they believe in single-payer. Several presidential hopefuls are among those who jumped on the Sanders Single-Payer bandwagon. You think their playing early presidential politics with single-payer, or are they true believers? Do they support Sander’s vision?
Russell Mokhiber: That is what they are saying, and it is obviously because of the grassroots prairie fire that has been lit by single-payer activists over the years. It is truly out of our hands now.
Usually when you go to these meetings with your member of congress, the single-payer activists would be the only ones raising the issue. Now we are standing in line screaming at our congress people, demanding it, because the situation on the ground has become so bad.
Nine years ago, when the insurance industry-written Obamacare was introduced, there were 23 people testifying. They refused to listen to any of us who wanted to put single-payer on the table. In fact, they had us arrested. Six months ago, Bernie’s healthcare person told us that there wasn’t going to be a single-payer bill because they didn’t want to risk a Democratic Senate in 2018 and they thought that single-payer would hurt them. But once they saw the grassroots pressure, they totally flipped. Just a month ago, Bernie had in this bill co-pays and deductibles.
So this is all about the grassroots pressure. Obviously it has now become a hot political issue. Someone like Kamala Harris would never have touched this just a couple weeks ago. Senator Richard Blumenthal from the insurance state of Connecticut has signed on!
Do we believe that they will push single-payer if we take our foot off the gas? No. We believe the Democratic Party is structurally incapable of being a people’s party. The only way they are going to respond is if the people keep their foot on the gas. This seems very similar to California in 2006 when the Democrats passed single-payer in California knowing that Governor Schwarzenegger was going to veto it.
We are very encouraged by this response but we really want to see this happen, not just political posturing. We are concerned that the Democrats will use this to gain power and then push it aside for something like a public option or to secure the position of the insurance industry in the current system.
I was at a conference this week called by Cornel West and the Green Party to address the fact that the Democratic Party is structurally incapable of being a people’s party. My colleague Bruce Dixon at Black Agenda Report said a few years ago that Bernie is like a sheepdog into the Democratic Party. He is shepherding the left back into the party. My hope is that, if this is what is going on, at least we will get out of it single-payer for all Americans.
DB: Russell, just take a moment to describe what you see as the difference between Obamacare and a single-payer system.
President Barack Obama signing the Affordable Care Act on March 23, 2010. (Photo credit: Keith Ellison)
RM: Obamacare was written by insurance industry lobbyists to preserve the position of the insurance industry within the system. This meant that we would continue to have 30 million Americans uninsured, as we have right now, that most people who have insurance are underinsured, they still go bankrupt even with insurance, that thousands of people die every year because of lack of health insurance.
The only way to change the situation is to pursue a single-payer system, meaning you get rid of all the private insurance payers and you have just one: Medicare for all with no co-pays and no deductibles. When every American is born, he or she gets a birth certificate and a Medicare card. You are covered through the tax system.
So yes, we are going to be taxed, but the amount we pay in taxes will be significantly less than the amount we currently pay in premiums, deductibles and co-pays. That money that we save by getting rid of all the administrative waste will ensure that everyone is covered, state of the art.
The amazing thing about this press conference today wasn’t what the senators were saying. For the most part, they were just posturing, maybe with the exception of Bernie. It was the people who spoke before the senators.
A doctor from Canada testified that 97% of Canadians love their single-payer system. She described how, when she was pregnant, there were no bills, no co-payments. There was a businessman from Pennsylvania who started a group of businesses for single-payer, because the reality is that businesses are going crazy trying to cover all their employees and many employees are afraid to leave their jobs because then they will lose their insurance.
It is no longer linked to employment, you are covered from cradle to grave, you have your choice of doctor and hospital. When you need medical care, you go to the best place in your area, there is no in-network or out-of-network.
DB: That is essentially what it breaks down to for most civilized countries–or even not so civilized countries–in this world. How do you explain that the two Democratic leaders–Chuck Schumer and Nancy Pelosi–are mum on single-payer, or worse?
RM: I think it is part of the feud within the Democratic Party. Coincidentally, Hillary is traveling the country right now with her new book, What Happened. She is obviously very critical of Bernie Sanders and what he did during the election.
There is a battle going on right now for the soul of the Democratic Party. I am very concerned about the single-payer movement because the Democrats appear to be using this to take the Senate in 2018 and the White House and then back off on single-payer.
DB: This industry is not going to go down easy. They spend a great deal of money to keep this system in place. These Congresspeople aren’t just voting their consciences here.
RM: The great thing about single payer is that it will drop the cost of healthcare because a single-payer is going to refuse to pay these exorbitant rates for pharmaceuticals, they are going to insist on paying what the rest of the world pays.
The medical industrial complex is in it for a bottom line profit motive. Twenty years ago in The New England Journal of Medicine, a surgeon wrote that medical care is very similar to any other good in America: doctors provide it and you buy it.
So there is a debate now about whether healthcare should be considered a commodity or a right. The Democrats are now getting the message that it is a human right and that the people are demanding it. But as you point out, very powerful forces are bent on defeating it.
Dennis J Bernstein is a host of “Flashpoints” on the Pacifica radio network and the author of Special Ed: Voices from a Hidden Classroom. You can access the audio archives at www.flashpoints.net.
wow, that’s nice, thank you for the article!
Thank’s for sharing)
Anyone who uses the term “bankrupt” when referring to a sovereign government that has the authority to issue its own currency “out of thin air” just as private banks do, either doesn’t understand economics or is paid not to.
The day we turn the fiscal spigot back on from a mere trickle and govt once again invests in the public sector will be the day that finally ends this neoliberal holocaust that has taken many lives in its brutal economic policy.
Any economic policy that requires military force to implement around the world as neoliberalism has beginning with the bloody Chilean coup on 9/11/73, is DEFINITELY a dysfunctional ideology. Neoliberalism truly is economic fascism.
Wealth inequality took a quantum leap after 1971, when we went off the gold standard. The creation of unlimited public money was enjoyed only by the 1%, trillions poured toward defense spending, corporate subsidies and bailouts, while public investment on social programs trickled down.
Neoliberals claim to be all about free market self-sufficiency when they are the biggest dependents on government money.
What is missing: “Medicare for All” is not universal health care. We need to know how it effects the jobless poor, mental health care, and how it would effect those who rely on dual benefits, Medicare/Medicaid (the elderly poor, the disabled, etc.)? With dual benefits, Medicaid provides prescription coverage. The Medicare for All plan phases out Medicaid, and does NOT cover prescriptions.
It is quite understandable why the insurance industry does not support single payer, but a huge number of average folks do not either. Here I think we get into the lazy, shiftless people argument. They don’t deserve it. Every tub ought to sit on its own bottom. Europe/Canada insures all for half the cost. What is not to like. None of the few Europeans I know prefer the American version. And I ask them: do you not know our doctors are the greatest in the world? Our system is far superior to yours? They know I’m kidding, so they just shake their heads. A Russian friend tells me they get to see a doctor on the same day, the next day at the latest. There is a charge for the most complex surgery but it is nowhere near what American doctor/hospitals charge, and it is performed by Russian military doctors, which are pretty darn good. Yes there may be a wait but that is for non-life threatening issues. Life threatening issues go the head of the line. With tremendous savings we could even help defray expenses for medical expenses, so they would not end up with humongous debts after finishing med school. I recall reading (decades ago) Abraham Ribicoff’s book, The American Medical Machine. The AMA deliberately keeps down (I doubt any change has taken place in the interim) the number of doctors to ensure the docs are handsomely rewarded. (not proofread, in a hurry)
Look at the issue from another perspective: Not everyone can work, and there aren’t jobs for all. We ended actual welfare aid in the 1990s, the US lost over 5 million manufacturing jobs alone since 2000, and we have dealt with the consequences by ignoring them. Lack of adequate food and shelter (not to mention, the extreme stresses of poverty) take a very heavy toll on human health. This is why providing anything more than emergency room services to the very poor would be like trying to fill a sieve with water. So — how can we reconcile the concept of “universal health care” with the consequences of our current policies against the poor?
Where were they in 2009?
I’m very gratified that most of the Dems are finally getting on board with Medicare-for-All, but where were they in 2009? The Dems (albeit many of them corporate Dems — thereby the answer to my question?) had control of the House, Senate and Executive. Now when the Dems are virtually totally powerless in every one of these bodies they decide to come out in favor of Medicare-for-All.
One can’t help but think this is a political ruse by the DLC-New Democrat bloc for the 2018 midterms.
They know Medicare-for-All plays well in Peoria but may not have any true intentions of ever actually putting their actions where their mouths are in genuinely fighting for it when push comes to shove.
There are currently only about 16 Democratic senators supporting the plan.
“…Where were they in 2009?…”
The point man for Barack Obama was Rahm Emmanuel. It
was his job to pass ACA which favored the medical industrial
complex. That group were among the chief donors to
many of Barack Obama’s political campaigns.
Mr. Emmanuel is now in his second term as Mayor of the
City of Chicago, a place with a very special place in
the heart of Barack Obama.
When asked about “the liberals” (ie. various single-payer plans
such as Conyers HR 676) Emmanuel replied:
“Don’t worry about the liberals. They have nowhere else to go.”
Unfortunately Emmanuel was correct. Today liberal-progressives
are working full and overtime for Obama’s ACA program with no
sense of irony.
It is better than nothing.
—-Peter Loeb, Boston, MA, USA
PS With thanks to the many commenters, this has been
an excellent discussion. As some have pointed out
(including myself), it will get nowhere.
Yup. Rahm Emmanuel (D-Israel) is a scourge on the body politic.
When it is said “Medicare for All”, I hope that is what it means, i.e. to include present-day Medicare recipients, medicaid, VA, Congressional Military, Private, Self-Insureds, and people who care for others w/o getting paid. Anyone else? We, as a country, presently pay about $4 trillion. Medicare-for-All should cost us about half of that, $2 trillion, not to mention billions more in unpaid effort, worry, waste, and fraud.
In particular, it will be a great day when the Congressional Plan is closed down. Can you imagine what their deductibles, co-pays, coinsurance, caps are? Don’t waste your time imagining. These scoundrels will have had their day.
Health is NOT a FOR-PROFIT activity, period. I say that as a 30-year career, degreed. insurance/reinsurance professional. Why does the govt have to be involved? Because we cannot have people lying injured in the streets, nor people going around with contagious diseases.
Re private insurance: companies do not undertand their own policies, nor do the customers. CHOICE: to say that you need choice is a cruel scam and a deadly joke. There is no adequate means to determine a competitive pricing system in this line of coverage. You can’t even get a price for a procedure,so how are you going to compare. An INSURANCE policy to cover medical expenses is a farce. What we really have is a PAYMENT plan..
One problem is the “Mad As Hell Doctors” there are not enough of them and they are all older and retiring out. The doctors coming in now are brainwashed by there schooling into only four profit motives and having the concierge (pay high prices before they can even get seen for treatment) practice to pay their high rent in the buildings they are in etc.
There are only two problems.
1. As long as the medical establishment is able to bill the taxpayer on a “pay-per-view” basis, doctors will only be motivated to treat, not hearl.
2. As long as the medical establishment is acting as a subsidiary to pharmaceuticals, it is more dangerous to get “treatment” than to get nothing….
I am glad to see that Sanders’ plan does away with co-pays and deductibles, because I’m on Medicare and I can attest that even with Medicare, co-pays and deductibles can be pricey – not to mention drug prices, which will break you fast. I also have an “Advantage” plan with Humana, which helps pick up some of the tab that regular Medicare wouldn’t cover, including a gym membership that I use, which more than makes up for the Advantage fee of $27, and there are no co-pays for G.P. office visits, only “specialists” – I’m assuming that these plans would all be scrapped if these insurers can somehow be beaten back. The co-pays on Medicare/Advantage can still be pricey if you need anything beyond a simple office visit. I’m paying $320 out-of-pocket next week for a biopsy; after that, depending on diagnosis, who knows how much treatment will cost. I am assuming that a great deal of savings will come from doing away with Medicaid and the VA, if every citizen regardless of status is covered, but haven’t heard anything about that. Regardless, having ever American receive whatever health care (not sickness/disease care) they need, when they need it, is the only humane thing to do. Go for it, Bernie!
I would like to know if the medical doctors are on board with this. How are they to be paid? How much? Their cooperation is needed, and of course the government has to really bargain with the Big Pharma and refuse to pay the exorbitant prices often charged- with monopoly power this should be all right, but it depends on the government’s will.
Real health care reform is not possible without addressing the insane costs (financially, physically and emotionally) of getting
a medical education. My daughter is at the end of that journey (although the larger journey is ongoing). She has spent the last
fifteen years of her life attaining her Fellowship in Maternal Fetal Medicine. She is still barely making a living wage. Luckily, she
does not have a lot of student debt but many of her fellow physicians owe literally hundreds of thousands of dollars in student
debt. They are mostly females and mostly at an age where, if they want a family, they need to get with that program soon. It’s
a tough career field in so many ways, and these doctors need serious income to retire their loans and get on with their lives.
Thanks for this column, Dennis. Healthcare for all is the defining issue of our time. Should healthcare be considered a commodity to be marketed and sold for profit – or is it a basic human right, paid for by the state, as it is considered in Canada and virtually all European states? I lived in the UK as a young person, and I don’t remember costs of medicines or hospitalization ever being a topic of conversation or question. And I wasn’t even a citizen! The present system is brutal and inefficient and throws countless indigent, older and vulnerable citizens under the bus, and even families with children, who suddenly contract an illness and go bankrupt trying to get basic care. But the key to making it work is to cover everybody, no exceptions. Get the private insurers out of the system altogether, that’s when you make the savings. Question is whether the states, like California, could set up their own single payer system, or whether we have to wait for the lumbering feds. Isn’t that a states rights issue? A state could decide it will take care of the health of its citizens. And a community, a town or county, where people actually live, could vote/say it wants a single payer system and tell the state assembly to get their act together.
With his wealth of failures I am predicting that Trump will go along with one win: Medicare for all.
jimbo – yep.
In the first place let’s call it what it is – disease care. And why is that? Why does prevention get short shrift? $$$$$ That’s why. Treating people who are hurting allows you to gouge them more effectively for relieving their pain and anxiety. You will pay anything to recover your well being. The worse your condition, and the more you fear it, the more you will pay to have it removed – or for hope it will be removed, because many of today’s “treatments” are no better than placebos, and often worse. If you are diagnosed with cancer, you can expect to see your bank account emptied for treatments that are largely ineffective. As Linus Pauling said, ” The war on cancer is largely a fraud.” The “researchers” are careful not to kill the goose that has laid billions of golden eggs for them. Cheap natural methods are ridiculed or persecuted.
In a way, foreign policy is the mother of all domestic policy but they’ve locked her up, drugged her, strapped her down, syphoned all the money in her account and sent all her children(domestic issues)to correctional institutions. There is nothing left for health care because the insatiable greed of corporate interests needs to fund their foreign wars.
““Today we say that a function of a rational healthcare system is to provide quality care to all in a cost-effective way,” declared Sanders, an independent from Vermont, “and not to continue a system which allows insurance companies and drug companies to make hundreds of billions in profits each year and makes healthcare industry CEO’s extremely wealthy.”
We can’t take politics out of the issue, but we should try a non-partisan approach using arguments that bring people together. Sounds simplistic but this country needs an issue that can bring us together and will reject all the opportunists who want to use the issue to further their political ambitions. I remember the Carter Administration coming in with a health care reform platform then very quickly putting it on the back burner, even off the stove, after the election.
Obama took the issue and made so many compromises to satisfy his and other people’s political ambitions and produced something many argued was worse than nothing-a convenient target for those who liked things as they were.
If politicians want this to happen, then let them work behind the scenes to secure consensus, holding to the principal of universal health care. I don’t think business and the wealthy should be excluded, that they need to be recruited in the efforts for I think they can be persuaded that it is in their interests, as well.
We need universal health care, a card in our pockets entitling us to it, and an issue that people with other differences can rally behind.
Just a card in your wallet that says as a US citizen you are entitled to the same health care as anyone else. You can even make the case that by socializing costs and not making coverage employer based we make our industry more competitive with the rest of the world. Can we afford it. Of course, the costs will be the same or less, there will be some profit center losers, but all in all over time it will become a non-issue. We will look back and wonder why it took so long to accomplish.
We need not wonder why it is taking so long to get single payer. The insurance companies have more accumulated wealth than any other entity in America. There’s your delaying factor – the power to buy congress.
Sorry, left a comment that was immediately deleted. Wont bother you again!
There was a clear opportunity to pass ‘single payer’ in 2009 when the dems held all divisions of government. Panic set in at the very thought such a thing could actually pass. Obama and his gang of 6 gave us ACA (ObamaCare) , an insurance scam designed to enrich the already rich and screw the rest of us.
That was the final moment and “Last Straw”, where the D-Party revealed itself to be a party of the Oligarchy (like the R-Party) and not a party of We The People.
The underlying conflict is between capitalism and socialism. Guess who’s winning that one. Good luck going against the whole weight of the deep state and it’s bloated oligarchs. This proposal is equivalent to asking for a major reduction in the MIC. Health care for all and peace for the world? That is just not on our ruler’s agenda.
You can’t fix anything without fixing everything. We need a whole new mission statement for America. Then we need to carry it out. Chances of that happening? .000000000001%
Get real comrades, we are truly screwed!
PS – Knowing how almost impossible our situation is gives us the only real foundation for trying to change it – whatever the odds against us may be. Let’s not fantasize about changes we can’t really achieve in isolation from dealing with the huge capitalist elephant in our very crowded room (the Earth).
Here’s a serviceable mission statement: Establish Justice, Promote/Provide for the General Welfare, Provide for the Common Defense (of these ideals, against those who would impose injustice and immiseration). This IS our Mission. We just haven’t lived up to it, and all of those here who recognize the situation are in the “long pause”, realizing we are stuck at Mission #3: the Common Defense of theses ideals from those who are trampling them down and violating them; hoping some Solution other than Civil War will reveal itself.
The health care industry in the US accounts for about 17% of total GDP, around 18 trillion annually – that works out to around 3 trillion annually. How much do the forces for single payer have?
Single payer does not have a chance in the US.
Health care in the US is done for one reason – profit. Helping suffering people is just the annoying activity necessary to make profit.
This hits the nail on the head. The moral imperative in the U.S.of A. is a sham. There is only the bottom-line imperative.
Single payer is the only logical endpoint to afford health care. The midpoint is diet and exercise. As a former healthcare professional, I can attest that all the gardeners, flower or vegetable, had strong firm muscles with veins that were large and easily visible. Even the 90 year olds. And could walk. With single payer such activities can be the focus of ads, be active and eat a variety of food would become the health care motto, instead of couch potato drug ads on TV. It is also true that pollution of air, food and water will be addressed more rationally if tax dollars are at stake.
Don’t hold your breath waiting for people to do the “right thing”.
You are correct,but this will take a big change, as people try to find and eat real food and walk rather than drive everywhere.
Not all of us live in cities. The nearest store to me is a Dollar type, and it’s miles away by roads without pedestrian paths of any type. Stingy governments here mow the narrow grass berms maybe once a year. Walking upon back Indiana roads is a sort of Russian Roulette.
In my opinion Mr. Mokhiber is psychic. I believe he is predicting exactly what the Democrats plan to do.
BUT
I fought for single payer health care (Conyers HR 676). Our primary
opponent was Barack Obama.
The paradise in health care abroad is probably exagerated. I lived for
7 years in Sweden and my education in Social Science Administration
included field placement in the provincial authority administering
health care .. That was over 30 years ago.
A more recent contact with a member of of the “Socialist Workers Party”
has told me that much of health care in Sweden is now privatized.
The truth is that health care is expensive, however it is organized.
When I lived in Sweden, there were PROGRESSIVE INCOME TAXES
to finance the benefits not only of health care but also of other
social benefits (housing, child care etc.).
As painful as it is, my feeling is that Americans today do NOT want
their federal taxes to increase many times over. I also would guess that
most Democratic politicians would not be inclined to support such
steep raises in taxes. Such politicians would set themselves up for
defeat.
By remaining solid and with a few additions from the GOP further
collapse of ACA was just barely avoided. (It is being whittled away
in other fashions decisions on details by the White House
and Congress.)
I do not see where the prairies of support for single payer will
come from under these circumstances.
Americans want something for nothing. They are unwilling
to pay for it.
I feel strongly that if Democrats divide and weaken their support
for ACA, the GOP would be overjoyed.
—Peter Loeb, Boston, MA, USA
The GOP loves Obamacare too. Their faux opposition is such a charade! Americans support single payer when it is presented to them as a right that is financed by progressive taxation.
Unless they are given some good explanations how increased taxes will leave them with more money in their pocketbooks, this is true. We’ll learn how “real” the Dem posturing on Single Payer is by examining their education efforts. If these are non-existent and they leave the “explaining” to the minions of Big Insurance and Big Pharma and Big Monopoly Hospitals, the Democrats are just blowing hot air.
It’s true there is no such thing as a free lunch, but we in the US of A are paying top dollar for inferior and incomplete health care. Merely stealing the plan Canada uses would save us tons of money.
h**p://www.pgpf.org/chart-archive/0006_health-care-oecd
THANKS TO ZACHARY S.
Thanks for responding to my points with such care.
I remain unconvinced and suggest that those of us
who see a Medicare for All system in the future
1. Re-examine health care systems abroad in
“AE’s” (Advanced Economies) with particular
focus on where these systems are today,
not where we wish them to be.
2. Based on this updated information, conceive
our own strategies for passing such a plan in
the future. The times do not seem propitious
now, to say the least.
3. Recognize that the political fact is that
adversaries to such a plan will always remain.
Incidentally, I have personally wished for the incorporation
(co-optation) of current insurance bureaucracies within
a new proposal. Not, of course, in a controlling way
but to provide employment and needed skills.
(PS Never let anyone fool you that the health care system
was not bureaucratic with zillions of forms required for
every imaginable pill. I understand that a similar
bureaucratic hell was present in the French system which
offered different benefits from the Scandinavian model.)
—Peter Loeb, Boston, MA, USA