Newsletter #2: The Single Payer Debate Continues

For now, I’ll keep posting my (brief) newsletters here.  Apologies for those who come across it twice!  You can signup for the newsletter here if interested:


Dear PP Subscribers,

The Democratic primary race has intensified.  Contests in Nevada and South Carolina are looming.  The debate over single payer remains fierce.

The last few weeks have seen continued arguments from a spectrum of commentators as to why a Medicare-for-all program – like that proposed by the Sanders campaign – is untenable.

A number of overlapping lines of argument can be distinguished.  First, it is frequently argued that the Sanders plan is poorly formulated and/or unrealistic given political conditions in Washington.  Recently, for instance, Paul Starr in the American Prospect (headlined “The False Lure of the Sanders Single-Payer Plan”) argues that the Sanders proposal is “not a practical or carefully thought-out proposal.”  Indeed, he sees the plan as an indictment of his overall campaign: it’s “a symbolic gesture, representative of the kind of socialism he supports.”

I addressed some of the earlier (and similar) liberal criticisms in an article published January 21 in US News & World Report, “Single Payer is Worth Fighting For.”  I conclude:

The expansion of coverage achieved by the Affordable Care Act does not constitute a system of universal health care. Too many are uninsured and underinsured. Too many are squeezed by high deductibles, contend with “narrow networks” of doctors and hospitals, or face crushing medical bills and even bankruptcy. Single-payer is the best way to remedy these injustices while simultaneously controlling overall health spending.


I also chatted about some of these issues on the radio with Arnie Arnesan on WNHN 94.7, available here.

A second line is that single payer is simply not affordable – that the number don’t add up.  For instance, in casting doubt on the seriousness of the Sanders’ single payer proposal, Starr relies on the widely-covered estimates of Kenneth Thorpe, an economist at Emory University. Vox covered Thorpe’s new estimates, which put the price of Sanders’ single payer proposal at nearly twice what his campaign has contended.

However, David Himmelstein and Steffie Woolhandler have clearly demonstrated the flawed assumptions behind these numbers in this detailed post at the Huffington Post, which is well worth reading.  As they put it:

Thorpe’s analysis rests on several incorrect, and occasionally outlandish, assumptions. Moreover, it is at odds with analyses of the costs of single-payer programs that he produced in the past, which projected large savings from such reform […] In the past, Thorpe estimated that single-payer reform would lower health spending while covering all of the uninsured and upgrading coverage for the tens of millions who are currently underinsured. The facts on which those conclusions were based have not changed.


A third line admits the shortcomings of the current state of affairs in American health care, but suggests that the right way forward would be to expand towards universal coverage under the ACA – instead of pursuing the more fundamental change of single payer.  I address this argument in an article published online Thursday in Jacobin, headlined “What Obamacare Can’t Do.” I turn to a country that has attempted to work towards “universal” coverage through a system of competing private insurers – the Netherlands – to demonstrate why this approach falls short, both from the perspective of cost and efficiency as well as that of equity.Regardless of the outcome of the primary, the campaign for single payer debate is far from over.  The incremental reforms have already been accomplished – we now either move backwards or we move ahead.

Until the next sporadically timed newsletter,


Post lightly edited. 

Blog: Implications of a Tight Race

The Democratic primary race has grown tighter and spicier than virtually anyone had predicted.  A quick glance at February:

Looking back:

February 1: Hillary Clinton bests Bernie Sanders in the Iowa caucus, but only by the narrowest of victories.

February 5: A national poll puts Clinton and Sanders in a dead heat: as Politico reported, Sanders is at 42% compared with Clinton at 44%. These percentages fall within the margin of error.

February 9: Sanders dominates the New Hampshire primary by a margin of more than 20 points. But perhaps just as important, as David R. Jones noted in a post in The New York Times, Sanders won in essentially all categories of voters:

He carried majorities of both men and women. He won among those with and without college degrees. He won among gun owners and non-gun owners. He beat Mrs. Clinton among previous primary voters and those participating for the first time. And he ran ahead among both moderates and liberals.

February 12: As the Hill reports, another poll demonstrates a tight race, with Clinton having only a 7-point lead over Sanders nationwide.


Looking forward:

February 20: The next Democratic contest, the Nevada caucus. Recent reliable polls seem to be in short supply. For what it’s worth, FiveThirtyEight’s “polls-plus” analysis gives the two candidates an equal chance of winning. On Friday, Slate’s Jim Newell described Clinton’s numerous advantages in the state – her so-called “Western firewall” – but also notes that “it wouldn’t be surprising if this firewall is crumbling, or whatever it is that firewalls do when they stop being firewalls.” Do they smolder, or are they quenched?

February 27: The South Carolina primary. This is seen as Clinton’s real “firewall,” as the odd saying goes. According to FiveThirtyEight, she is set to dominate the state. However, a long report, well worth reading, by Joyn-Ann Reid at MSNBC headlined “Warning signs for Hillary Clinton in South Carolina” argues that the situation in that state may be less settled than polls may suggest.


Time will tell. In the meanwhile, the tightening of the race has meant that single payer health care has remained front and center of the national political discussion. For single payer advocates it is a crucial time to continue pressing the cause.

Blog Post: Chelsea Clinton Grossly Misrepresents Single Payer

Chelsea Clinton isn’t just a political surrogate, she’s someone who purports to know something about public health. She is, after all, the Vice Chair of the Clinton Foundation, where – according to its website – she works on the organization’s multiple public health projects.  More to the point, she is an adjunct assistant professor in health policy and management at the Columbia Mailman School of Public Health, where she earned her Masters in Public Health degree.

Which makes her gross misrepresentation of Sanders’ health plan only that much more contemptible. “Sen. Sanders wants to dismantle Obamacare, dismantle the CHIP [Children’s Health Insurance] program, dismantle Medicare, and dismantle private insurance,” she was quoted as saying by MSNBC while on the campaign trail for her mother in New Hampshire. She continued (again as quoted by MSNBC): “I worry if we give Republicans Democratic permission to do that, we’ll go back to an era – before we had the Affordable Care Act – that would strip millions and millions and millions of people off their health insurance.”

This would be an absurd interpretation of Sanders’ single payer proposal for anybody, much less for someone with some background in health policy. It doesn’t seem to have been an off-the-cuff remark, however: it mirrors a somewhat similar comment made by Hillary Clinton the day before. As she was quoted by the Washington Post:

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.

Now I’m a single payer advocate, active in the organization Physicians for a National Health Program (though the views expressed in my articles and blog posts are mine only). If you don’t agree with the vision of a single payer program – whether because you think private insurers do a right proper job of delivering a right to health care or because your campaign receives generous funding from the pharmaceutical industry or whatever – so be it.

But don’t grossly misrepresent such a system by suggesting that Sanders would “dismantle Medicare,” as Chelsea Clinton did. Particularly not when the text of Sanders’ 2013 single payer bill states, “…the 113th Congress should enact a Medicare-for-All Single Payer Health Care System…” This bill is one of several single payer bills and proposals. Representative John Conyers’ single payer bill, H.R. 676, is in fact named the “Expanded & Improved Medicare For All Act.” To suggest that a system that would provide an improved Medicare program universally to the nation would somehow sneakily rob seniors of their Medicare coverage demonstrates a rather poor grasp of the issues (or something worse).

What both Clintons’ seem to be alluding to, as The Week’s typically on-point Ryan Cooper described earlier this week, is the fact that Sanders’ 2013 bill configures a single payer plan that would, to some extent, have a state-based administrative structure (though it would still be a federal plan and be implemented in every state). Cooper contends that there are some reasonable objections to such a structure, and that perhaps an entirely federal plan might well be superior.

Yet these are relatively minor details. To characterize Sanders’ single payer platform as some sort of dispersal of health care to the whim and fancy of each individual state is fantastically inaccurate. Sanders’ has proposed a fundamentally universal system: a national health program that would cover essentially everyone in every state. At that point, we wouldn’t need a separate Medicaid or Medicare program (or private insurer), which is the raison d’etre of “single payer.” Such a system would be far more just and equitable than what we have now, where – even with the Affordable Care Act largely intact – 32 million remain uninsured and another 31 million underinsured, among other failings.

Of course, such issues will never be a problem for Chelsea Clinton, primarily because she is part of a fabulously rich family. Indeed, as the Intercept’s Zaid Jilani described yesterday in a good piece entitled “Hillary Clinton’s Single-Payer Pivot Greased By Millions in Industry Speech Fees,” Hillary Clinton has raked in a cool $2.8 million in speaking fees in the past two years from the health care industry alone. Jilani also notes that Bill Clinton gave a speech (one presumes for a hefty fee) last year for America’s Health Insurance Plans, the main lobbying group for the health insurance industry. And Chelsea Clinton herself is already able to command $65,000 per college speaking gig, according to the Washington Post.

Like her parents, in other words, Chelsea Clinton is unlikely to go broke from a sky-high deductible or because she inadvertently went to an “out-of-network” doctor or hospital; she’ll never be forced to choose between filling a prescription and paying for rent. Nor should she – nor should anybody.

But obviously that’s no excuse for a campaign surrogate (much less an adjunct assistant professor of health policy and management) to so grossly mischaracterize a rather familiar health reform proposal, particularly not one that has the potential of improving – indeed saving – the lives of so many.

Salon: Republicans’ biggest misunderstanding about Obamacare

The battle for universal healthcare is not over. This is not because of the reason you might suspect – that Republicans will obstinately endeavor to obstruct Obamacare in every way they can (though that seems to be the case). Instead, even after the smoke clears from the government shutdown (presumably with the law intact), the battle over universal healthcare will still not be over, but for a more fundamental reason: Obamacare, whatever its advantages (and despite the right’s worst fears), does not create a system of universal healthcare…

Read it on Salon here.

Truthout: Is Fixing Stop-and-Frisk Worth the Bother?

Is fixing “stop and frisk,” the NYPD’s policy of frisking first (mostly blacks) and asking questions later – whether unconstitutional or not – even worth the bother?  Not according to former first deputy police commissioner of the New York City Police Department (NYPD) John F. Timoney, who, in a New York Times Op-Ed last month, bemoaned the “real costs of policing the police” when it came to reforming the controversial policy…

See the article on  Truthout here.

Blog: Reflections on the Occupy Movement

When the “Occupy Wall Street” protests first erupted in the autumn of 2011, few could have foreseen how rapidly the movement would at first swell, and then spread, over the face of the nation.  Similarly, of course, few predicted that the abuse of a street vendor in Tunisia would spark a wave of uprisings throughout the Arab world.  But such is the unpredictability of the politics of protest, particularly when the seeds of discontent are already deeply sown.

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