Single-payer health-care activists are used to being disappointed by Democrats, especially those with presidential ambitions. In 2003, Barack Obama said he was a "proponent of a single-payer, universal health-care plan," but as president he refused to even engage in a discussion on the issue when he was working to pass the Affordable Care Act (ACA) in 2009-10.
But at least Obama took the same approach as most establishment Democrats and merely ignored an idea that would save the country billions, while covering every single American, regardless of employment or ability to pay. Hillary Clinton, however, hasn't ignored the policy in recent months on the campaign trail. Instead, despite broad popular support for Medicare for All, Clinton has declared war on single-payer health care.
Clinton has received more money from the pharmaceutical industry than any other candidate from either party in the 2016 election cycle.
Bernie Sanders, who just released his Medicare for All plan on January 17, has made single-payer a "central axis point in the campaign," as MSNBC's Chris Hayes described it, and helped to push the subject into the national debate. So, when new polls revealed Sanders to be in a dead heat with Clinton in early primary states, Clinton took the offensive. She began a campaign to attack single-payer, painting it as something that would burden middle-class families, empower right-wing governors and put Americans' health insurance at risk by dismantling every major health-care institution in the country.
Clinton's claims are either patently false or incredibly misleading. By presenting them to a national television audience during interviews and the debates, she may be doing more damage to the single-payer movement than the pharmaceutical and insurance companies could ever hope to achieve. She is making these claims largely to Democratic primary voters, who support Medicare for All at a rate of 81 percent, but could be misled by a politician whom many of them trust and admire.
"It is conceivable that the continued negative critiques - especially of the fearmongering variety - could have a deleterious impact on popular opinion," Dr. Adam Gaffney, a physician and health-care writer, told Truthout.
Worse yet, Clinton almost certainly knows she is wrong. Her experience with health-care reform has made her familiar with the economics of single-payer, according to documents that were belatedly made public by the Clinton Library in 2014. It is hard to ignore the fact that she has received more money from the pharmaceutical industry than any other candidate from either party in the 2016 election cycle, or that the health industry paid her $2.8 million in speaking fees between 2013 and 2015.
History will no doubt remember that the United States was, for a time, the only "developed" nation on the planet that didn't guarantee health care to its people as a right. And Clinton's name will now forever be associated with this shameful fact.
A Window of Opportunity
There is good news in this story. The reason Clinton - and several of her liberal allies in politics and media - have engaged in this misinformation campaign is because she knows Sanders' proposal for Medicare for All is one of several reasons why many voters are choosing him over her. Plus, the challenges single-payer supporters now face also provide an opportunity to educate the public about this type of reform.
"Single-payer is at the center of the political discourse in a manner it hasn't been for years," Gaffney said. "We should view the renewed single-payer debate as a window of opportunity to advance our vision of a more egalitarian health-care system." And this, Gaffney maintains, requires hard work in educating the public, "because the naysayers have such larger microphones."
Clinton's statements on single-payer include some myths that have long been perpetuated by the right.
Indeed, Clinton's falsehoods will reach a massive audience. Sanders has refuted many of these in interviews and in debates, but it is an uphill battle. Clinton is a status quo politician with great power. And her campaign is being covered by corporate media that have long been deferential to power and the status quo.
But, while Clinton has the larger microphone and a compliant media at her elbow, those who support a single-payer plan have the facts on their side. Virtually all of the credible data about the economics of public health care demonstrate, incontrovertibly, that single-payer would improve health outcomes, cover everyone and lower costs.
And many dedicated activists are trying to help spread the word. National Nurses United, for instance, has come out strongly in favor of this plan and is organizing around the country to explain its merits to voters.
"Finally, a real plan from a leading presidential candidate that will guarantee health care for every American, just as every other major nation has done," National Nurses United executive director RoseAnn DeMoro said in a statement. "Instead of being held hostage to a corporate system based on profits and price gouging, with Sanders' Medicare for All plan we can finally have a system based on patient need, with a single standard of quality care for all, regardless of ability to pay, race, gender, age, or where you live. That's a beautiful thing."
Countering the Distortions
Clinton's statements on single-payer include some myths that have long been perpetuated by the right: for example, the idea that it is unaffordable. Other allegations are strange and new, seemingly aimed at confusing voters. Let's address a few of the myths:
Myth 1: Single-payer is unaffordable and would burden the middle class.
This is a classic example of how a politician can take a fact out of context to manipulate the truth. Hillary Clinton has continually attacked Sanders for planning to raise new taxes on middle-class families, in part, to fund his Medicare plan. This is true and Sanders has never denied it.
Of course, when Clinton makes this critique, she fails to add important context. Any increase in taxes would be offset by a reduction in out-of-pocket health-care expenses (on premiums, co-pays and deductibles) that would dwarf any added taxes. For Clinton to argue that Medicare for All would burden middle- and working-class families requires her to advance the nonsensical argument that giving $2 to an insurance company is a better deal than paying $1 in taxes.
Other "developed" nations spend about half as much on health care as the US and cover everyone.
Of course, the savings are actually much greater than that. Gerald Friedman, an economist from the University of Massachusetts Amherst who has been examining the economic impact of single-payer for many years, shared his calculation with Truthout, showing that there would be a total savings of $277 billion in the first year of Sanders' Medicare for All plan.
"For a middle-class family of four with an income from wages of $50,000 and an employer-provided family plan of an average price, the Sanders program would save $5,807, or 12 percent of income," Friedman concluded, factoring in both taxes and out-of-pocket expenses.
If Clinton thinks a family of four would suffer by saving the equivalent of 12 percent of their income because it would involve paying a little more to the government and a whole lot less to some private insurance company, she should explain why that is.
It is also worth noting that the savings estimated by Friedman are totally consistent with the disparities shown when US health-care costs are compared with countries that have universal public health care. For instance, in Canada, which has a system very much like the Medicare for All plan proposed by Sanders, per capita health-care spending is $4,445, while the country spends 11.4 percent of its GDP on health care and insures everyone. Meanwhile, the United States spends $8,223 per person on health care annually, spends 17.6 percent of its GDP on health care and leaves about 13 percent of its population without any insurance at all.
Similar disparities exist between the United States and every one of the other nations in the Organization for Economic Cooperation and Development (OECD) - all 35 of which have some kind of universal public health-care system. As of 2012, the average OECD country spends $3,268 per capita on health care and 9.5 percent of its GDP on health expenses. In other words, other nations classified as "developed" by the United Nations spend about half as much on health care as the United States and cover everyone. Moreover, in studies done by the World Health Organization and the Commonwealth Fund, the United States has been ranked poorly in terms of health outcomes when compared to other nations in the OECD.
Myth 2: Sanders' policy would roll back the progress won from the Affordable Care Act and dismantle institutions such as Medicare.
In a video attacking Sanders, Chelsea Clinton made the following statement: "Sen. Sanders wants to dismantle Obamacare, dismantle the CHIP program [Children's Health Insurance Plan], dismantle Medicare, dismantle private insurance."
It is ironic that a few months earlier at the CBS debate on November 14, 2015, Clinton accused Sanders of "impugning my integrity," when he correctly pointed out that she has received millions of dollars from Wall Street donations and speaking fees. Yet, in this video by her daughter, Sanders is basically portrayed as a right-wing villain who wants to deprive everyone of health care.
President Sanders would dismantle Obamacare, the CHIP program - and, indeed, the entire system of private health insurance.
How to respond to a critique that claims Sanders wants to dismantle Medicare? His plan - and just about every other single-payer bill (HR 676) he co-sponsored in the House of Representatives for years - does the exact opposite. Sanders' plan expands Medicare to cover everyone. Medicare is effectively a single-payer system for people over 65. Because it doesn't have to deal with countless private insurers, it has only 3.6 percent in administrative waste, compared to private insurance, which has about 31 percent in administrative waste. Canadian health care, incidentally, has less than 2 percent administrative waste.
And while many of the provisions of the Affordable Care Act would become needless if single-payer were passed, Medicare for All would serve to achieve the two major goals that the ACA failed to accomplish: It would make insurance universal and dramatically reduce costs, which under the ACA are rising at an unsustainable rate. Some customers on the ACA's exchanges have faced 20 percent increases, according to The New York Times.
To accuse Sanders of dismantling CHIP is an especially dirty trick since it implies that he wants to deprive children of health insurance. But, of course, children - and all other Americans - would have insurance in a Medicare for All system. "Yes, Chelsea, President Sanders would dismantle Obamacare, the CHIP program - and, indeed, the entire system of private health insurance. And good riddance to it," said Friedman in an essay on Dollars and Sense. "Instead of relying on a patchwork of programs and a leaky safety net, under the Sanders plan, everyone would have health insurance, guaranteed regardless of employment, without copayments or deductibles, and with free choice of provider."
Myth 3: Sanders' plan would give all the power to the states, empowering right-wing governors to control health policy.
This argument was made by Clinton at the debate in Iowa in November 2015 and gave her the chance to link Sanders to the right-wing governor of that state, Terry Branstad, who is not a popular figure among Iowa Democrats. But the claim is baldly untrue. As Sanders' plan states - and in keeping with the very principle of single-payer health care - the system is "federally administered."
"Governors have nothing to do with Medicare," said John McClaughry, vice president of the Vermont-based free-market think tank the Ethan Allen Institute, in an interview with Truthout. "They can't touch it. This is a pretty galling argument, if you ask me."
It is ironic, in light of this attack, that one of Clinton's primary arguments against Medicare for All is that it would roll back the gains of the ACA. Yet, one indisputable shortcoming of the ACA is that, due to a Supreme Court ruling, right-wing governors have been able to opt out of the provision for Medicaid expansion, which has been a major source of frustration for Obama, and the millions of Americans who are deprived of insurance.
With Friends Like These ... Clinton's Liberal Enablers
Clinton has been a major force in Washington for a long time and as a result she has a number of loyalists who are willing to add credibility to the misinformation she is spreading about universal health care.
For instance, former presidential candidate and staunch Clinton supporter Howard Dean, who now serves as a corporate lobbyist for Dentons, has taken to engaging in his own fearmongering on single-payer. On January 13, Dean appeared on MSNBC to argue that Sanders' health plan could result in "chaos" and that "trying to implement it would in fact undo people's health care." Oddly, Dean did not make note of his stated support for single-payer as recently as 2009.
Dean is hardly alone in offering Clinton cover. Paul Krugman, the popular progressive economist and New York Times columnist, seems to always defend Clinton's policies - something of which Clinton often reminds voters. After the YouTube debate, Krugman penned an essay where he flatly stated that "Bernie Sanders is wrong about [health care] and Hillary Clinton is right." The reason? Because the ACA "is the signature achievement of the Obama presidency" and "spending political capital" trying for single-payer would be a poor use of time, he writes.
Krugman's attempt to argue that the ACA is transformational legislation falls flat. He writes, "It more or less achieves a goal - access to health insurance for all Americans - that progressives have been trying to reach for three generations." Try putting that on a bumper sticker.
Even if Krugman feels Medicare for All is not a worthwhile pursuit for Democrats, does that really mean "Hillary Clinton is right," as he claims? Clinton didn't simply argue, as Krugman did, that pursuing Medicare for All was a waste of political capital. Instead, she argued the plan would jeopardize health insurance for the whole country.
Krugman knows this isn't true. He acknowledges, unlike Clinton, that the savings from single-payer would offset any tax increase. But when he says (emphasis added) "it would be difficult to make that case to the broad public, especially given the chorus of misinformation you know would dominate the airwaves," he is unwittingly describing Hillary Clinton herself.
The list of Clinton loyalists in the media goes on. Ezra Klein predictably took the side of the mainstream Democratic Party when he mocked Sanders for offering "a puppies-and-rainbows approach to single-payer." Jonathan Chait of New York magazine recently wrote "The Case Against Bernie Sanders," which describes Sanders' health-care policy as one that "uses the kind of magical-realism approach to fiscal policy usually found in Republican budgets." This is false. The economics of single-payer have been well studied. But Chait is the same guy who called the Affordable Care Act "the greatest social achievement of our time." It certainly makes for a better bumper sticker than Krugman's milquetoast description of the law, but both are guilty of hyperbole in regards to a law that is more noteworthy for what it fails to do, than for what it accomplishes.
"I find the critique from many liberal commentators highly unconvincing," Gaffney said. "For instance, both Krugman and Ezra Klein have charged that the plan doesn't specify what would be covered and what wouldn't. Of course choices on 'medical necessity' will need to be made, but this is already happening today under Medicare!"
"The same approach could be adopted to those under age 65," he added. "This isn't interstellar travel."
The Challenge Before Health-Care Activists
The path to single-payer is not interstellar travel, but it has been a long road for activists who have been fighting for this reform for decades. They have long been ignored and kept to the sidelines, while compromised politicians continue to maintain a private system that treats health care as a commodity to be sold for profit.
Yet, as Bernie Sanders and Hillary Clinton bang heads on the issue in the coming weeks, for the first time in a while, single-payer activists aren't standing on the sidelines. They are in the middle of a major national debate about why the United States should rid itself of the notorious distinction of being the only nation in the OECD that allows sick people to go bankrupt or die due to lack of insurance.
A fight is mounting. It is a fight for basic human rights, and it must be won.