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Bernie Sanders’s single-payer plan isn’t a plan at all

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posted on Jan, 18 2016 @ 04:10 PM
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When you've lost Ezra Klein ...

Ezra isn’t all that happy about what Sanders has (or hasn’t) released about his health care proposal, and I wouldn’t bother remarking on it except Klein is a lefty and fellow traveler. I would chalk it up to Klein being in the bag for Hillary except that he’s been critical of her too accusing her of not being honest with voters. But even though Bernie released his “plan,” it is, as Klein says:

… Sanders tried to head off Clinton's attacks by releasing his plan. Only what he released isn't a plan. It is, to be generous, a gesture towards a future plan.


Maybe Klein’s disappointment can be chalked up to being burned by Obamacare?

To be less generous — but perhaps more accurate — this is a document that lets Sanders say he has a plan, but doesn't answer the most important questions about how his plan would work, or what it would mean for most Americans. Sanders is detailed and specific in response to the three main attacks Clinton has launched, but is vague or unrealistic on virtually every other issue.


First he lays out what Sanders plan does tell us which primarily addresses Clinton’s attacks on his plan. He lays to rest questions of how the plan is administered (all Federal), financing (don’t anyone dare get successful but even so you’re getting taxed an extra 2.2% more anyhow) … oh and your employer is getting taxed more so be prepared for everything to cost more.

The thing is that even Klein is starting to sound a bit strained here about the levels of taxation Bernie is proposing.

In general, I'm comfortable with higher taxes on the rich — though they've risen substantially in the Obama era already — but tax increases of the scale Sanders proposes here would begin to have real economic drawbacks. European countries tend to pay for their health-care systems through more broad-based, economically efficient taxes like VATs; Sanders's effort to fund a universal health-care system so heavily on the backs of the wealthy would be unprecedented.


Imagine a level of taxation so high that even a lefty begins to sweat … maybe Klein is reaching the level of the filthy rich? He goes on to point out that the new taxes are supposed to replace premiums, but would that be enough to justify the higher taxes. Maybe for the average family who is supposed to only pay $450 more in taxes.

But that isn’t the only problem. Klein admits that Bernie is being overly generous in his assumptions on cost savings.

First off, his plan is not Medicare. It does not operate like Medicare. For one thing, Medicare has both copays and deductibles which Bernie says his plan does not. And the list of what Bernie’s plan covers far exceeds what Medicare will cover, suggesting that more or less everything is covered.


Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.


Sanders also claims that there will be “no more fighting with insurance companies.”

To be generous, it's possible that Sanders is just being cynical in his wording, and what he means is that, under his plan, individuals have to fight with the government rather than private insurers when their claims are denied.

The emphasis is mine. Isn’t it bad when a fellow lefty finds your proposal so hard to swallow that even he is cynical enough about it that he suggests you might be pulling a fast one and … lying … in your claims because he can’t believe that you are going to achieve what you claim?

(cont.)

edit on 18-1-2016 by ketsuko because: (no reason given)




posted on Jan, 18 2016 @ 04:12 PM
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Maybe Klein didn’t get to keep his doctor or his health insurance? Maybe he didn’t save $2,500 per year?

But the implication to most people, I think, is that claim denials will be a thing of the past — a statement that belies the fights patients have every day with public insurers like Medicare and Medicaid, to say nothing of the fights that go on in the Canadian, German, or British health care systems.
What makes that so irresponsible is that it stands in flagrant contradiction to the way single-payer plans actually work — and the way Sanders's plan will have to work if its numbers are going to add up.


Now we are getting to the meat of it. Bernie and every other pol who tries to sell you single payer don’t actually tell you the truths of it. Yes, you have claims denied. In fact, if you look at the numbers, Medicaid and Medicare are two of the biggest claims deniers out there, worse than private insurers.

You think single payer will save you money? You think it will save the government money?

No. Only if the government says, “No,” and says it a lot.

Behind Sanders's calculations, both for how much his plan will cost and how much Americans will benefit, lurk extremely optimistic promises about how much money single payer will save. And those promises can only come true if the government starts saying no quite a lot, in ways that will make people very, very angry.


Death panels, rationing … those truths make people very, very angry, and you blast people who mention them, but, and Klein more or less admits it, in order to have the cheap system you say you want, they will become reality. You say it’s not fair that some are trapped in a cheap system, but instead of finding ways to help them out of it, you demand a cheap system that everyone is forced into.

The real way single-payer systems save money isn't through cutting administrative costs. It's through cutting reimbursements to doctors, hospitals, drug companies and device companies. And Sanders's gestures towards this truth in his plan, saying that "the government will finally have the ability to stand up to drug companies and negotiate fair prices for the American people collectively."
But to get those savings, the government needs to be willing to say no when doctors, hospitals, drug companies, and device companies refuse to meet their prices, and that means the government needs to be willing to say no to people who want those treatments. If the government can't do that — if Sanders is going to stick to the spirit of "no more fighting with insurance companies when they fail to pay for charges" — then it won't be able to control costs.


You can only cut so much waste, fraud and abuse before you have to force the companies, hospitals and doctors to start cutting corners, and when they start saying, “No,” and you still haven’t saved enough … You have to start telling people, “No,” when they want certain treatments. This is called rationing. It is where the death panels come in. It leads to things like the Liverpool Care Pathway.

Sanders implies everything will be covered because he knows how important that question is to people. But everything won't be covered. So who decides, and how do they decide, what gets covered and what doesn't? Without knowing that, it's impossible to say whether a particular single-payer system is a good idea or a really, really bad one.


So basically, Sanders is lying when he tells you it will all be covered because there isn’t any way we could possibly pay to have it all covered for everyone.
Klein also goes on to mention that Sanders doesn’t address whether or not exit from the system will be allowed. Are we all into the same system, or will there be private insurers allowed similar to the French system?

(con.)
edit on 18-1-2016 by ketsuko because: (no reason given)



posted on Jan, 18 2016 @ 04:13 PM
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The role of private insurers matters because it drives the government's bargaining power. If drug companies either sell to the government or they go out of business, then the government can get better prices. The problem there is obvious, though — what does someone do if the government doesn't cover a treatment they need? But if there are private insurers selling add-on policies to wealthier Americans, then drug companies can deal only with them, and the government's negotiating power wanes.


More freedom for consumers v. less bargaining power for the government.

Klein also points out that Bernie does not address the question of access to care. Because of how current pricing is structured, Medicaid and Medicare underprice services and force doctors and hospitals to undercut with private insurers picking up the slack. If Bernie forces the entire system to squeeze down to Medicare pricing, a lot of those hospitals that are barely hanging on now will close, many of them in rural areas.

The easy rejoinder to this is that this is just a campaign proposal, and these are details that can be worked out in the legislative process. I disagree. Sanders is proposing a huge, disruptive reform here — he owes the public answers to the most central, obvious questions about how that reform would work. Perhaps more importantly, he also needs to show that he's at least aware of the difficulties of a single-payer system, and has realistic ideas for managing the transition.
Moreover, the fundamental debate between Sanders and Hillary Clinton — and Sanders and the GOP — is whether single payer is a good idea at all. That debate can't be resolved unless these kinds of questions are answered.
In the absence of these kinds of specifics, Sanders has offered a puppies-and-rainbows approach to single-payer — he promises his plan will cover everything while costing the average family almost nothing. This is what Republicans fear liberals truly believe: that they can deliver expansive, unlimited benefits to the vast majority of Americans by stacking increasingly implausible, and economically harmful, taxes on the rich. Sanders is proving them right.


After reading this, I am starting to think that maybe Klein got bitten hard by the Obamacare bug like way too many other people.But at any rate, he raises some good points about the problem with single payer and Bernie’s proposals.



posted on Jan, 18 2016 @ 04:16 PM
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Oh Ezra, always putting the Cart before the Horse.

I doubt Obama had those questions answered when he unveiled his plan when he was running. Nobody expects Bernie to have written the legislation, ahead of him winning.

Of course there are details left out, that's the natureof thigns.


Sanders is lying when he tells you it will all be covered because there isn’t any way we could possibly pay to have it all covered for everyone.


Well that's just not true as there are no details yet about that.

And I don't think you should be able to opt out, no industrialized nation in the world who has a NHS allows that. It also won't cover everything, there will still be a huge space for private insurers, like there is in Canada, among other places that have NHS.


~Tenth



posted on Jan, 18 2016 @ 04:17 PM
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a reply to: tothetenthpower

I'm am having Nancy Pelosi flashbacks ... We have to pass it to find out what's in it ...



posted on Jan, 18 2016 @ 04:17 PM
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a reply to: ketsuko

Socialized medicine.

Or should I say, "Democratic socialized medicine", since Weekend at Burneez is just a "democratic socialist".

Just start taxing everyone at 80% and maybe that'll cover the first 6 months cost.



posted on Jan, 18 2016 @ 04:19 PM
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originally posted by: ketsuko
a reply to: tothetenthpower

I'm am having Nancy Pelosi flashbacks ... We have to pass it to find out what's in it ...



OH NO, NO NO.

Do not bring that idea up, that's not what I meant. I mean, there should be a pause on actual criticism of how well this will, or will not work, until there is actual data available. A framework of legislation.

There are a lot of unanswered questions, and I don't think it's fair for people to demand them all of any candidate, right out of the gate during primary season.

I would argue that for both sides.

At least there's one person who wants to try new and bold things, even if they are a bit crazy.

~Tenth



posted on Jan, 18 2016 @ 04:28 PM
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originally posted by: tothetenthpower

At least there's one person who wants to try new and bold things, even if they are a bit crazy.


"Progressivism, unfortunately, is not very good at recognizing reality. That’s because progressivism focuses on vision and aspiration. Conservatism begins with the facts on the ground and seeks improvement through gradual reform, while progressivism begins with a utopian vision and tries to conform reality to it.

Progressivism also errs fundamentally about the reality of human nature. Conservatives understand that man is a fallen creature, morally imperfect and inherently capable of evil in motives and actions."

-Ken Blackwell



posted on Jan, 18 2016 @ 04:29 PM
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originally posted by: tothetenthpower

originally posted by: ketsuko
a reply to: tothetenthpower

I'm am having Nancy Pelosi flashbacks ... We have to pass it to find out what's in it ...



OH NO, NO NO.

Do not bring that idea up, that's not what I meant. I mean, there should be a pause on actual criticism of how well this will, or will not work, until there is actual data available. A framework of legislation.


So... "Shut up until 'da bern' is president and can unleash his crapitude on all of us?"

This is the perfect time to criticize, before we are stuck with something even worse than the 'ACA' ... assuming that is even possible.
edit on 18-1-2016 by Teikiatsu because: (no reason given)



posted on Jan, 18 2016 @ 04:47 PM
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a reply to: tothetenthpower

Yes, but you have to agree that it's disingenuous to more or less promise free health care for everything without really discussing what a single payer plan actually is and how it works. There need to be some real discussions about that otherwise everyone who brings up reality gets swamped in yells of "liar!"



posted on Jan, 18 2016 @ 04:49 PM
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a reply to: ketsuko

I don't think it's disingenuous until they start dodging questions about it down the line. I expect early campaign platforms to be vague.

a reply to: Teikiatsu

That's not what I said either.

Campaigns get fleshed out as they go along. If Bernie continues to do well, then those questions about the program is and how he intends to have it done, are fair game then.

~Tenth



posted on Jan, 18 2016 @ 05:01 PM
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So we should just keep the ACA or Obummercare???

Why first payer insurance has been polling above 50%, since the ACA was passed. The big picture is the majority of the people want it.

Maybe Ezra likes the increased profits coming from his healthcare stock since the ACA began???



posted on Jan, 18 2016 @ 05:03 PM
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a reply to: AlaskanDad


Maybe Ezra likes the increased profits coming from his healthcare stock since the ACA began???


That's where the fight is going to be. Insurers are making money hand over first with the ACA, we all know that, it was basically a hand out to them.

When you get the government to force you to buy your own product, and then set 0 controls on costs, what do you expect?

Personally, I dunno if NHS will work in America, I will hold out until I can read something more concrete.

~Tenth



posted on Jan, 18 2016 @ 05:16 PM
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Why do we need government involved at all???

Why can't people just handle their own needs as they see fit?

Why can't companies provide insurance and have them compete (thus reducing costs)?

This dependence on government is just nauseating!



posted on Jan, 18 2016 @ 05:25 PM
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a reply to: AlaskanDad

No, many of us never wanted THAT either, but of course, no one listened to us.



posted on Jan, 18 2016 @ 05:28 PM
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a reply to: DBCowboy


Why do we need government involved at all???


Cause greed.


Why can't people just handle their own needs as they see fit?


Cause people don't, and your tax dollars end up paying for their treatment anyway.


Why can't companies provide insurance and have them compete (thus reducing costs)?


That's what you have now. Costs have risen, not declined.


This dependence on government is just nauseating!


So is the dependance on the healthcare industry actually wanting to reduce costs, as opposed to look at their profit margins.

Healthcare should not be a FOR profit business. It doesn't make sense. In that model, your incentive is to treat, not cure. In that system your incentive is to deny claims, while collecting premiums.

We have NHS here in Canada, we also still have a private sector Health Care insurers for stuff like dental, optometry and the elective type procedures. Blue Cross makes money hand over fist in these markets.

~Tenth



posted on Jan, 18 2016 @ 05:32 PM
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a reply to: tothetenthpower

I just don't see healthcare as a right.

Food/eating isn't a right.
Having a house isn't a right.
Owning a car isn't a right.
Owning shoes/clothes isn't a right.

Rights, real rights, actual rights don't depend on others or the state to exist!


edit on 18-1-2016 by DBCowboy because: (no reason given)



posted on Jan, 18 2016 @ 05:34 PM
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a reply to: DBCowboy


Rights, real rights, actual rights don't depend on others or the state to exist!


But yeah you have no problem with corporations getting massive handouts from the government?

Where is the logic?

~Tenth



posted on Jan, 18 2016 @ 05:36 PM
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a reply to: DBCowboy

I often think we would be better off with no Government or laws, less population total free market.

Killing without law would simply be mergers and acquisitions, another way to make a buck.

Idiots would be weaned from our society, and we would have all the freedoms we could live with.

Life could be so much more fun.

But we are a society and it stems to reason as a society we need to think of the good that can be done for each other.

Not much room left in our society for cowboys is there???



edit on 18-1-2016 by AlaskanDad because: sp correction



posted on Jan, 18 2016 @ 05:37 PM
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originally posted by: tothetenthpower
a reply to: DBCowboy


Rights, real rights, actual rights don't depend on others or the state to exist!


But yeah you have no problem with corporations getting massive handouts from the government?

Where is the logic?

~Tenth


Can you show me at any time where I support that?

And what does that have to do with individual rights?




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