When it comes to change, maybe”incrementalism” sounds reasonable. Maybe that’s why many of the Democratic presidential candidates suggest a “public option” as a way to “glide into” Medicare for All. They have evidently not done the math.
Adam Gaffney, President of Physicians for a National Health Program, wrote in his 2017 article The Case Against the Public Option “…although a Medicare-like public option may have lower administrative costs, only a small fraction of the efficiency savings of single-payer would be achieved if the multi-payer framework persisted…”
In addition, “the Public Option would essentially subsidize the private insurance industry” with the taxpayers covering the sickest people and commercial insurers continuing to profit from the healthiest. Bottom line, the “public option” is a red herring.
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Health Care Gets Heated On Night 2 Of The Democratic Presidential Debate
On Thursday, the second night of the first Democratic primary debate, 10 presidential hopefuls took the stage and health issues became an early flashpoint.
Sen. Bernie Sanders (I-Vt.) opened the debate calling health care a “human right” — which was echoed by several other candidates — and saying “we have to pass a ‘Medicare for All,’ single-payer system” — which was not.
Just as on Wednesday night, moderators asked candidates who would support abolishing private insurance under a single-payer system. Again, only two candidates — this time Sanders and California Sen. Kamala Harris — raised their hands.
Former Vice President Joe Biden also jumped on health care, saying Americans “need to have insurance that is covered, and that they can afford.”
But he offered a different view of how to achieve the goal, saying the fastest way would be to “build on Obamacare. To build on what we did.” He also drew a line in the sand, promising to oppose any Democrat or Republican who tried to take down Obamacare.
Candidates including South Bend, Ind., Mayor Pete Buttigieg, New York Sen. Kristen Gillibrand and Colorado Sen. Michael Bennet offered their takes on universal coverage, each underscoring the importance of a transition from the current system and suggesting that a public option approach, something that would allow people to buy into a program like Medicare, would offer a “glide path” to the ultimate goal of universal coverage. Gillibrand noted that she ran on such a proposal in 2005. (This is true.)
Meanwhile, former Colorado Gov. John Hickenlooper used the issue of Medicare for All to say that it is important to not allow Republicans to paint the Democratic Party as socialist but also to claim his own successes in implementing coverage expansions to reach “near-universal coverage” in Colorado. PolitiFact examined this claim and found it Mostly True.
“You don’t need big government to do big things. I know that because I’m the one person up here who’s actually done the big progressive things everyone else is talking about,” he said.
But still, while candidates were quick to make their differences clear, not all of their claims fully stood up to scrutiny.
We fact-checked some of those remarks.
Sanders: “President Trump, you’re not standing up for working families when you try to throw 32 million people off the health care that they have.”
This is one of Sanders’ favorite lines, but it falls short of giving the full story of the Republican effort to repeal and replace Obamacare. We rated a similar claim Half True.
Comment from HEAL California:
In fact, it is PolitiFact’s statement that is “Half True.” Sanders’ source for the number “32 million” came from the Congressional Budget Office. If that number is “half-true” because of PolitiFact’s claim that it might not include people who choose not to buy insurance, it’s not Sanders’ fault.
Scrapping the Affordable Care Act was a key campaign promise for President Donald Trump. In 2017, as the Republican-led Congress struggled to deliver, Trump tweeted “Republicans should just REPEAL failing Obamacare now and work on a new health care plan that will start from a clean slate.”
The Congressional Budget Office estimated that would lead to 32 million more people without insurance by 2026. But some portion of that 32 million would have chosen not to buy insurance due to the end of the individual mandate, which would happen under repeal. (It happened anyway, when the 2017 tax law repealed the fine for the individual mandate.)
In the end, full repeal didn’t happen. Instead, Trump was only able to zero out the fines for people who didn’t have insurance. Coverage has eroded. The latest survey shows about 1.3 million people have lost insurance since Trump took office.
Bennet, meanwhile, used his time to attack Medicare for All on a feasibility standpoint.
Bennet: “Bernie mentioned the taxes that we would have to pay — because of those taxes, Vermont rejected Medicare for All.”
This is true, although it could use some context.
Vermont’s effort to pass a state-based single-payer health plan — which the state legislature approved in 2011 — officially fell flat in December 2014. Financing the plan ultimately would have required an 11.5% payroll tax on all employers, plus raising the income tax by as much as 9.5%. The governor at the time, Democrat Peter Shumlin, declared this politically untenable.
That said, some analysts suggest other political factors may have played a role, too — for instance, fallout after the state launched its Affordable Care Act health insurance website, which faced technical difficulties.
Nationally, when voters are told Medicare for All could result in higher taxes, support declines.
And a point was made by author Marianne Williamson about the nation’s high burden of chronic disease.
Williamson: “So many Americans have unnecessary chronic illnesses — so many more compared to other countries.”
There is evidence for this, at least for older Americans.
A November 2014 study by the Commonwealth Fund found that 68% of Americans 65 and older had two or more chronic conditions, and an additional 20% had one chronic condition.
No other country studied — the United Kingdom, New Zealand, Sweden, Norway, France, Switzerland, the Netherlands, Germany, Austria or Canada — had a higher rate of older residents with at least two chronic conditions. The percentages ranged from 33% in the United Kingdom to 56% in Canada.
An earlier study published in the journal Health Affairs in 2007 found that “for many of the most costly chronic conditions, diagnosed disease prevalence and treatment rates were higher in the United States than in a sample of European countries in 2004.”
PolitiFact’s Jon Greenberg and Louis Jacobson contributed to this story.
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Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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