There’s a great deal at stake in 2016. From continued economic growth to gun control to affordable and accessible healthcare – and many, many more issues – this election has become a fight over the legacy of President Obama. It’s important that while Republicans are distracted by the “carnival-barking” of one Donald J. Trump, Democrats remain focused on the facts that will forge the future of our nation.
Here’s an important fact: Obamacare works. Here’s another: Bernie Sanders wants to get rid of it.
Bernie introduced his own repeal-and-replace health care bills twice after the passage of Obamacare, in 2011 and 2013. Was Obamacare worthy of repeal-and-replace in those years? Not quite. Commentators were already heralding its success and the data already showed that healthcare spending growth had become the lowest on record. Bernie’s legislative agenda in those years matched up with his political agenda: repeal the achievements of President Obama and replace President Obama himself. In 2012, he called the President “weak” and advocated a “primary opposition.” In 2016, he’s talking the same talk.
Two hours before Sunday’s debate, Bernie released his long awaited healthcare overhaul— ensuring that Hillary, commentators, and viewers would not have time to read it. And then they did, and the results were in: “Bernie Sanders’s single-payer plan isn’t a plan at all,” read one article. “[Sanders’s] proposal serves only a political purpose,” read another. Even Nobel Prize-winning liberal economist Paul Krugman weighed in: “For all the talk about being honest and upfront, even Sanders ended up delivering mostly smoke and mirrors.”
Bernie’s desire to scrap Obamacare – which has succeeded in insuring 18 million people – is curious. That he would embark on such a mission without policy specifics is dangerous.
To be fair, Bernie did release a healthcare policy statement of sorts. And to be fair, it does carry bold and uplifting messages such as a vow to “help the American people live happier, healthier and more fulfilling lives.” However, lost between the “puppies-and-rainbows” of Bernie’s single-payer proposal are two defining concerns of any single-payer plan:
- “Bernie’s plan means… no more fighting with insurance companies when they fail to pay for charges.” The subtext of this promise reads pretty clearly: No more claim denials— no more insurance providers telling you they won’t cover your treatment. However, seeking “$6 trillion in heath-care savings over the next decade,” Bernie’s America would certainly see claim denials — not unlike what the Canadians and Germans and British are used to seeing. But will there be a National Institute for Health and Care Excellence, as the United Kingdom has, to determine which patients’ claims pass some form of a “quality-adjusted life-year” equation? Would patients be provided an appeals process for the deluge of denials to come? Is any of this constitutionally valid? Or must his savings projections collapse under the pressure of a campaign promise? Bernie doesn’t say. The devil’s in the details. Here, the devil also happens to be in the blindingly obvious.
- “Medicare for All.” This is the title of Bernie’s proposal, as well as a basis for serious concern. Today, Medicare pays doctors and hospitals 80% of what private insurers do for the same service. This puts a financial burden on doctors and hospitals offset only by the fact that there exist private insurers who will cough up more. But what happens when, in Bernie’s America, doctors can no longer collect the average $76 per office visit of private insurance patients, but only the $70 of Medicare patients? Will hospitals close when they are forced to drop the cost of some heart stent insertions from the private insurance average of $1,213 to a uniform Medicare average of $822? What will happen to America’s six thousand hospitals, one million doctors, and four million nurses who will receive less pay for the same work? What happens when millions of Americans lose their jobs to Bernie’s Medicare crunch, and millions more lose their trusted care providers? Bernie doesn’t have an answer. And there’s one last curious point: Why does Bernie want to subsidize the health care costs of the millionaires and billionaires – the Donald J. Trumps of the world – who certainly don’t need the subsidy? Bernie doesn’t say.
Bernie’s desire to dismantle Obamacare might not deliver the dog-eats-dog dystopia of Republicans, but it’s certainly devastating. It overlooks the realities of claim denials and it doesn’t give serious consideration to the financial consequences of “Medicare for All” for hardworking doctors and nurses. And still, it ignores all the data that tell us that Obamacare works.
Obamacare has taken 18 million Americans off the uninsured rolls. It’s barred health insurance companies from refusing coverage because of “pre-existing conditions” and from charging women more because of their gender. And thankfully, it’s allowed us to stay on our parents’ plans until we turn 26. Obamacare has been a success and we can’t go back — not with this Republican Congress and not with Bernie’s alternative.
— Stephen Paduano
Contact Stephen Paduano at spaduano ‘at’ stanford.edu.