Bernie Sanders
Related: About this forumClinton, Finally Forced to Confront a Single Payer Advocate in Debate, Can’t Win on Policy, Falls Ba
Clinton, Finally Forced to Confront a Single Payer Advocate in Debate, Can’t Win on Policy, Falls Back on Demagoguery and Distortionhttp://www.nakedcapitalism.com/2015/11/clinton-finally-forced-to-confront-a-single-payer-advocate-in-debate-cant-win-on-policy-falls-back-on-demagoguery-distortion.html
LAMBERT STRETHER: Most of the post-Democratic debate analysis has focused Clinton’s response to Sanders’ challenge on her Wall Street ties; a response that was, to put it charitably, confused. There has been little focus on her exchange with Sanders on health care which, from a pure public policy standpoint — that is, leaving aside corruption — is arguably more important. So, despite DNC Chair Debbie Wasserman Schultz’s successful suppression of viewership, the debates really are doing what they are supposed to be doing: Allowing voters to compare and contrast the candidates. Now, we remember from 2014 that Clinton, despite her lofty claims to an evidence-based approach to policy, refused to even mention single payer in two back-to-back major speeches on health care. So let’s see how she did in the debate on this topic, when faced with Sanders, a single payer advocate. Spoiler alert: Badly. First I’ll take a look at the debate transcript, and then I’ll take a quick look at the Sanders plan. Spoiler alert: Not all one might wish.
The Debate
To the transcript! Sanders comes first, so I’ll pick his performance apart first. Then Clinton brings the demagoguery. (Recall that the debate location was held at Drake University in Des Moines, Iowa, the first caucus state in 2016. That will become important in one of Clinton’s responses to Sanders.)
BERNIE SANDERS: It’s not gonna happen tomorrow. And it’s probably not gonna happen until you have real campaign finance reform and get rid of all these super PACs and the power of the insurance companies and the drug companies.(3) But at the end of the day, Nancy, here is a question. In this great country of ours, with so much intelligence, with so much capabilities, why do we remain the only (UNINTEL) country on earth that does not guarantee healthcare to all people as a right?(4)
FOOTNOTES:
(1) A CBS analyst just treated “single payer” “Medicare for All” as a not-insane policy proposal. That’s called dragging the Overton Window left (which has been my sole criterion for success from a Sanders campaign).
(2) The “health insurance industry” is not, following Veblen, an industry; unlike health care, it creates no value; it is wholly parasitic and should not exist. “One does not improve a tapeworm; one removes it.” Pragmatically, I grant it’s not possible for anybody to answer Cordes’s question in those terms on national television, even on a Saturday night in Des Moines, but Sanders doesn’t even address it (though Clinton, in another sign of inattention or confusion, doesn’t call him on that). Somebody on the Sanders team needs to figure this out, because people will have noticed, and the question will come up again.
(3) Tactically, Sanders keeps hammering Clinton on corruption. Strategically, “these are our demands” is always a good thing to be able to say. However, at least to Sanders, the missing agency in “happen” can only be a movement outside the party structure, which he doesn’t mention here (and only mentions elsewhere). To be fair, time constraints are clearly a concern for all the candidates; CBS ran the debate well, and didn’t let them filibuster.
(4) A rhetorical question (in fact, Anacoenosis /ˌænəsiːˈnoʊsɨs/ a figure of speech in which the speaker poses a question to an audience in a way that demonstrates a common interest.). And a powerful one, especially because Clinton can’t ask or answer it. However, Sanders — and we all love Bernie, but some of us love a killer instinct, too, especially in debate — might have driven the knife home by adding something like “and this is a question I would like Secretary Clinton to answer.” (If Sanders wants to pick up a few seconds for this, he can eliminate “at the end of the day.”)
FOOTNOTES:
(1) I don’t know the Drake audience, but I’m not sure that’s the most effective appeal to students, despite the obvious villainy of Pharma. Sanders’ appeal to basic fairness probably works. It’s also, when you think about it, ridiculous that putting young adults on their parents’ health insurance policies is treated as some sort of policy triumph. Surely it’s on a par with young adults living in their parents homes because they can’t afford to move out?
(2) Presumably, then — thanks to the work of Michael Moore? — everybody in the audience knows that Canada has a health care system that guarantees health care to all, gutted the private health insurance business, and successfully bent the cost curve. So Sanders doesn’t have to unpack the detail.
(3) I’m surprised Sanders doesn’t bring in the $500 billion a year in cost savings; that’s real money, even today. This would have insulated him against any claim of reckless extravagance. In the event, Clinton made no such claim.
(4) Here Sanders adds the missing agency.
(5) Mark “I will lead” for later.
(6) As a wonkish side note, single payer advocates have gone round and round about whether “single payer” or “Medicare for All” is the right phrase. “Single payer” accurately describes the system; “Medicare for All” is a better selling point (despite its increasing infestation by neo-liberal rent seekers). Here Sanders simply yokes both phrases together. That’s probably the way to go.
THE CLINTON RESPONSE
HILLARY CLINTON: Well, the revolution never came (1). (LAUGHTER) And I waited and I’ve got the scars to show for it (2). We now have this great accomplishment known as the Affordable Care Act. And– I don’t think we should have to be defending it amount (sic) Democrats. (3) We ought to be working to improve it and prevent Republicans (4) from both undermining it and even repealing it.(5)
FOOTNOTES:
(1) First, the policy failure is nothing other than a failure of leadership (see note (5), supra) in 1994; note how the lack of agency in “never came” airbrushes this away. It seems foolish to reproduce the failures of more than twenty years ago today. Second, I can’t help but think that “the revolution” is, in Clinton’s mind, a subconscious allusion to Ira Magaziner’s Time magazine cover, captioned “Peaceful Revolutionary,” since Clinton chose Magaziner to lead her own (butchered) health care reform effort. Third, this a sharpened version of the usual Democratic trope that this or that policy isn’t “politically feasible.” However, Democrats who make that argument can be relied upon never to have made the slightest effort to make the policy politically feasible; among such Democrats, in health care policy, Clinton.
(2) Well, no. The people who suffered or died without health care due to lack of universal coverage can be said to have scars. Clinton has the very best of health care; no scars at all.
(3) A demagogic appeal to party tribalism. Five years after ObamaCare was passed, 50% of those eligible but unenrolled have run the numbers and concluded it’s a bad deal for them (NBER). ObamaCare faces a death spiral. How is any of this defensible, especially when lives are at stake?
(4) Another demagogic appeal to party tribalism; how is ObamaCare to be “improved,” if not by making coverage universal? Clinton doesn’t say. She doesn’t even mention “my plan.”
(5) Why would passing an effective single payer Medicare for All plan be less effective than continuing to tinker with ObamaCare? FDR said: “It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something.” Last I checked, FDR was also a highly effective Democratic partisan. So why can’t Clinton adopt FDR’s common sense attitude?
CLINTON: I have looked at– (APPLAUSE) I’ve looked at the legislation that Senator Sanders has proposed. And basically, he does eliminate (1) the Affordable Care Act, eliminate private insurance, eliminates Medicare, eliminates Medicaid, Tricare, children’s health insurance program. Puts it all together in a big program which he then hands over to the state to administer.
(1) Another demagogic appeal. In substance, as we shall see, Clinton’s description of the Sanders proposal is accurate. However, Clinton does two things. First, she begins with the effective use of anaphora (“eliminate… eliminate… eliminate…”) to convey the impression to the beneficiaries of each individual program that their benefits will be taken away (“eliminated”), and finishes by characterizing the universality of the Sanders program as “a big program” (as if the programs Clinton lists were not, in the aggregate, big). I grant that Clinton’s first tactic can be effective; “I’ve got mine” really is a powerful appeal, especially to somebody who’s managed to scramble to safety in some part of our terrible system. However, I’d argue that “I’ve got mine,” in the context of electoral politics, implies “now you get yours,” which is both unworthy of a genuine Democrat and airbrushes away the very possibility of “standing up” together for something better. Second, “big program” is a right-wing dog whistle for “big gummint,” again unworthy of a genuine Democrat.
CLINTON: And I have to tell you, I would not want, if I lived in Iowa, Terry Branstad administering my healthcare.(1) (APPLAUSE) (CHEERING) I– I think– I think as Democrats, we ought to proudly support the Affordable Care Act, improve it, and make it the model that we know it can be–
(1) Here’s why Clinton’s point appeals to the audience in Iowa. From the Des Moines Register:
The state’s Medicaid privatization effort has been the subject of multiple challenges, including allegations that the companies picked to manage the program engaged in unethical and possibly illegal competitive bid practices. The Iowa Hospital Association has also filed a lawsuit, challenging the bid process as illegal.
Branstad’s administration must get permission from the Centers for Medicare and Medicaid Services to go forward with the plan. Mathis and Sens. Pam Jochum of Dubuque and Amanda Ragan of Mason City will meet with CMS officials Wednesday.
Dozens of providers weighed in on the plan during a conference call Tuesday with CMS, warning federal officials of concerns about contracts, unanswered questions and a general lack of notification to Medicaid recipients about the changes.
Branstad spokesman Ben Hammes accused Democrats of playing politics. Hammes noted that the governor last week met with U.S. Health and Human Services Secretary Sylvia Burwell and “remains confident” that Iowa’s plan will be approved and implemented on Jan. 1.
And here’s why Clinton’s point is pure demagoguery, even leaving aside another appeal to party tribalism. First, the Branstad plan can only be implemented if HHS Secretary Burwell — a Democrat — approves it. (Sanders might usefully have put in the shiv by saying something like “Secretary Clinton, will you join with me in demanding that Secretary Burwell reject Branstad’s plan?”) Second, Clinton sets up an opposition between (#1) ObamaCare, whose program design allowed 22 states to refuse Medicaid coverage to their citizens altogether, to the Sanders plan, where (#2) Branstad would at least be required to deliver Medicare to all, and under Federal supervision. Granted, I don’t like Door #2 all that much (see MORE AT LINK), but surely imperfect universal coverage is much better than no coverage for poor people in 22 states?
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SmittynMo
(3,544 posts)I– I think– I think as Democrats, we ought to proudly support the Affordable Care Act, improve it, and make it the model that we know it can be–
Are you kidding me? This is her answer? TOTAL BULLSHIT!!! I am an ACA advocate. Thank God Obama put it in place when he did. Otherwise I'd be uninsured. And this year almost made it impossible for me to afford it. The insurance companies more than doubled my out of pocket premiums. It's soon becoming the NACA (Not affordable Care Act), by insurance companies. Their profits must have gone down last year. Awwwww. The CEO is only getting a 300M bonus, not the 400M as promised. Again, Awwwwww
The ACA is nothing more than catastrophic insurance. I would not consider it health insurance, like you had at work. High deductibles and it only pays for wellness visits. Everything else goes toward your deductible. For her to fix the ACA would take decades.
Bernie wants single payer(like Medicare) in the near future, not 2035?
It's just more fluff, to get her ass out of the conversation. I saw right through it when she said it. The people that clapped are apparently not well versed.
On edit:
I know this isn't always the case. This year, I will spend 15K (Out of pocket and tax credits). To date, I have had services totaling 500.00 (scripts and wellness visits). That's 14.5k profit. My deductible is 6K each, for me and my wife. We both travel together quite often. 1 accident with both of us laid up, will cost me an additional 12K out of pocket. That's NOT health care insurance!!!!
INdemo
(6,994 posts)and former execs from the insurance companies that camouflaged a huge profit scheme for the insurance companies.
The only advantage that I can see is the guaranteed coverage for those with a per-existing health condition.
The Heath care Insurance industry spent millions upon millions to defeat the original ACA bill.
Every break in any TV show had an ad about ACA and how wrong it was. When the healthcare debate moved to the current
ACA bill that became law Insurance Companies stopped fighting it and the ads stopped.
This should tell us something. This was nothing more than bragging rights for Obama.In other words we could have done a hell-of-a-lot better but Obama caved.
The millions spent to defeat the real ACA worked.
Thespian2
(2,741 posts)I am an American citizen...in 2010 my wife passed away...cancer, which she fought for almost a year...total cost to us for her treatments...$400.00 CD...
SmittynMo
(3,544 posts)Clinton wants to fix the ACA. Big mistake. Bernie wants Medicare for all. I know who gets my vote. What we have is total bullshit.
And being an unemployed senior makes it extremely difficult, financially. We need healthcare for all. Period. Bernie gets my vote.
antigop
(12,778 posts)
SoapBox
(18,791 posts)Because she gets to saber rattle to her hearts content and show that she's a strong War Hawk.
Don't forget that United Healthcare this week started threatening to not offer insurance for the ACA because they aren't making ENOUGH profit...ya Hill, the ACA just needs a few more tweaks. 
Single payer now!
stupidicus
(2,570 posts)is that she is opposed to SP in principle, so her election means she's gonna spend 4-8 years obstructing/dampening its pursuit.
The BS about being pragmatic/realistic about the possibility of passage is exactly that, bs. The longer opposers like her are in control, the longer it'll be before the SP fruit is harvested, requiring cultivation, etc as it does.
cantbeserious
(13,039 posts)eom
stupidicus
(2,570 posts)shockingly I had a hillarian just today insist that's incorrect because she supports medicare and medicaid.
INdemo
(6,994 posts)Hell you already have their scripts.
Besides that you could cash in on the Koch money (if you haven't already)
zeemike
(18,998 posts)If she did that it might mean the Dems might run someone that does not have the interests of the PTB at heart.
She is wanted right where she is, that way no matter what the vote is the PTB have a winner.
Beartracks
(12,809 posts)rhett o rick
(55,981 posts)whining, "I'm just being pragmatic." as they ignore the 50 million Americans living in poverty.
INdemo
(6,994 posts)CLINTON: I have looked at– (APPLAUSE) I’ve looked at the legislation that Senator Sanders has proposed. And basically, he does eliminate (1) the Affordable Care Act, eliminate private insurance, eliminates Medicare, eliminates Medicaid, Tricare, children’s health insurance program. Puts it all together in a big program which he then hands over to the state to administer.
Something Karl Rove or Dick Cheney would write for her.
Autumn
(45,056 posts)
erronis
(15,241 posts)Shit, if I could live in this style of poverty (what she said when she and Bill left office), I'd take it too. Fancy black tie dinners with other "self-made" M/Billionaires - quite a few making a lot of money off the 99.9%s, insurance and banking. Just another round of "takers".
SmittynMo
(3,544 posts)
mrmpa
(4,033 posts)that says my copay for generic medications is $30, when I can get this same medication without insurance for $10 for a 3 month supply?
Why am I seeing that my deductible on these plans is $6500 and then some services will cost me 10-20% after the deductible is met?
Why does my 85 year old mother have a medicare advantage plan that has no deductible, her cost for a hospital stay of any length is $350 never more? Why is her cost for this advantage plan just her part B paid via social security monthly?
Mom's prescription coverage is a State run program, however I won't allow her to use it, because it will only allow for 30 day supplies, with generics $8 and she has to pay a partial payment of about $26 a month to the state for the insurance. The State has a 2 tier system for prescription coverage, her tier is where she has to pay for the insurance if used.
We get Mom's medications all most all of them at $10 for a 3 month supply, much cheaper than if she used her insurance. If it is more than $10 I check goodrx.com for the cost. The other day, the pharmacy charge was $38.72, when I checked goodrx.com the cost was $23.10. When I picked up the script, I showed them the cost & the price was brought down.
I gave this website to a friend, her husband has a monthly prescription that costs him using his insurance $350 a month. She checked the cost & found it to be $190. He won't use his insurance any more for this medicine.
weknowvino2
(62 posts)Single Payer Now!!
Get rid of the middle man.
Ferd Berfel
(3,687 posts)IT would appear that she remains the disenfranchised "Goldwater Girl" she claimed she was.
....if it walks like a duck.....
INdemo
(6,994 posts)Ferd Berfel
(3,687 posts)
bread_and_roses
(6,335 posts)99th_Monkey
(19,326 posts)Thank you for your detailed analysis of the Sanders - Clinton exchanges on health care. I hope Bernie
takes your advice on several points you make. 
bluestateguy
(44,173 posts)I don't want to get into what Hillary said or the CBS reporter; somebody else can do that.
If you put private insurance companies out of business to have single payer, then you have to transition all of these employees into a new line of work.
NO, I'm not talking about the big mean executives of these companies. They will be just fine, and are not my concern.
I'm talking about the very middle-class, middle income, modest rank and file employees of these companies who will suddenly be out of a job. What are you going to do with them. Some, yes some, of them can be brought on board to work for Medicare, who would suddenly need more employees to run a single payer system. But that would only be fraction of them. You have to have a plan to transition insurance company employees into a new line of work, and not just tell them to go pound sand in the unemployment line.
noiretextatique
(27,275 posts)Progress requires change.
Fairgo
(1,571 posts)Retraining is good for the country! And with free education, it will be that much easier and thus better for the economy.
smokey nj
(43,853 posts)moved manufacturing out of the country?
bluestateguy
(44,173 posts)
JDPriestly
(57,936 posts)the single payer program and with free college give the rest the opportunity to become teachers and social workers if they wish -- or start businesses of their own or whatever they want to do.
We will save a lot of money by switching to single payer, and your post pretty much states one of the reasons why. A lot of people now working for insurance companies could become nurses, physical therapists and even doctors -- healthcare providers rather than leeches on the healthcare system.
bluestateguy
(44,173 posts)In stark contrast to the three snotty and condescending replies that came above.
eridani
(51,907 posts)--of all the unemployment for prison guards that this will cost.
SmittynMo
(3,544 posts)Just like they did for me in 2007 when I was layed off. 6 months of severance, 6 months from a professional job seeking company, which includes resume writing. That's generous.
And who's to say that all of the insurance companies have all of their employees in the US?
Fairgo
(1,571 posts)We need more of this.
JDPriestly
(57,936 posts)with single payer programs.
http://www.pgpf.org/chart-archive/0006_health-care-oecd
And, as one who has lived in several countries that have single payer, I can tell you that the health care is just as good. Plus I got dental care with the rest of the care. Personally, I think that dental care is essential to good health. Many Americans go without it almost entirely because they cannot afford it.
And when you eliminate the plethora of insurance companies in this country, you not only reduce co-pays to merely symbolic payments, but you eliminate a lot of confusing paperwork for medical personnel, doctors, nurses and technicians. They are paid. There is virtually no such thing as an uninsured or bankrupt patient who can't pay.
Single payer makes sense for everyone except the CEOs of private insurance companies and their shareholders.
I am with Bernie when it comes to single payer. Based on my experience and based on the economics and efficiency of the single payer systems.
SmittynMo
(3,544 posts)When the CEO's make 829 times more than the average employee, something has to be done.
Enthusiast
(50,983 posts)