Bernie’s Broad Vision: Democracy is Revolutionary
January 20, 2016
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Single-Payer: A Moral and Economic Imperative [Updated]


Hillary Clinton accepted millions of dollars in campaign contributions from her former “enemies” — the health insurance and pharmaceutical industries.  She then proceeded to dig a large hole for herself. She challenged Sen. Bernie Sanders on an immensely popular issue. 81% of Democrats (59% of all Americans) support a single-payer healthcare system.

It is one thing for Mrs. Clinton to take a page out of Karl Rove’s deceptive handbook — attack your opponent on your own weakness.  Quite another for the one-time single-payer supporter to defend the indefensible.

A Deadly Healthcare System

Despite a modest reduction in the number of uninsured Americans from 47 million to approximately 30 million following passage of the Affordable Care Act (ObamaCare), the current U.S. healthcare system continues not only to be corrupt and dysfunctional but deadly.  That’s the inescapable conclusion that arises from simple but ghastly arithmetic.

The findings set forth in a 2009 Harvard medical study were deeply troubling.  Nearly 45,000 Americans die each year simply because they can’t afford to purchase health insurance.  Thanks to ObamaCare’s modest (17 million) expansion of coverage, the annual number for whom poverty imposes a healthcare system death sentence has been reduced to 28,710.

Veterans, especially those of us who served in Vietnam, still mourn the 58,000 American lives lost during that 12-year war.  Yet, that number pales in comparison to the 344,520 Americans who will die from lack of coverage over the next 12 years under the very system that Mrs. Clinton seeks to defend. (Under the GOP “free market” system 540,000 would die over the next 12 years for lack of coverage).

But the uninsured are not the only ones who die as a result of our corrupt and dysfunctional healthcare system — healthcare delivery that systemically places a higher value on the obscene profits of the health insurance and pharmaceutical industries than the health and lives of our citizenry.*

*Readers can better appreciate the dynamics of those twisted priorities by watching Michael Moore’s Sicko, which is available free online.  Those dynamics, as revealed by the sworn Congressional testimony of Dr. Linda Peeno, underscore why America should have no more use for health insurance companies than an honest business owner would have for a Mafia protection racket.

Dr. Peeno was a manage care physician, who, in addition to her reliance on the now ObamaCare-eliminated “preexisting conditions,” routinely deployed a process (utilization review or “UR”) to deny expensive medical procedures.  It is a process in which UR physicians have a financial incentive to abandon their Hippocratic oath in order to protect the bottom line of their health insurance carrier employers.

Most often, according to Dr. Peeno, UR physicians no longer engage in the clinical practice of medicine.  “They sit behind a desk,” she said, “making decisions about a patient they will never see or touch, completely removed from the consequence of [what could prove to be a deadly denial of needed medical care].”  After tearfully acknowledging that a patient died because she refused to authorize a necessary procedure, Dr. Peeno poignantly asked:  “What kind of system have we created when a physician can receive a lucrative income for adding to the suffering of patients?”

Despite her testimony, UR abuse continues, often giving rise to medical malpractice claims, suffering and death.  Both utilization review and bad faith refusals to authorize vital, life-sustaining medical care can also be found in another area of for-profit health insurance coverage — workers’ compensation.  See Schwarzenegger’s Workers’ Comp ‘Reform’ Killed My Client in which a claims examiner refused to authorize life sustaining medical care to a catastrophically injured employee even after a UR physician recommended that she do so.

Economics And Taxes

Contrary to popular belief, you don’t always get what you pay for.

The U.S. sports the world’s most expensive healthcare system.  U.S. per capita healthcare expenditures in 2013 ($8,713) nearly tripled the per capita expenditures in the U.K. ($3,235).  This disparity exists even though, with the exception of the 8% of wealthy British citizens who elect to obtain private insurance, healthcare is available free of charge through the U.K.’s publicly-owned and taxpayer-funded healthcare delivery system, the National Health Service .

In Sicko, Michael Moore delivered several hilarious moments as he wandered the halls of a British hospital.  In one sequence, he came upon a couple of smiling parents, the mother cradling their newborn.  They burst out in laughter when he asked, “How much did that baby cost?” In another, he confronts a man at a cashier’s window.  Surely this is where people are made to pay.  But no.  The man is there to handout money to newly discharged patients who don’t have the funds needed for transportation to go home.

We spend a great deal more for less healthcare.  The U.S. healthcare delivery system came in dead last amongst eleven industrialized nations in terms of “quality, efficiency, access to care, and healthy lives,” according to a recent Commonwealth Fund study.   The U.K. ranked number one

In its pre-Obamacare Single-Payer FAQ Physicians for a National Health Program (PNHP) pointed to the principal reasons why more money buys less healthcare in the U.S.

Where, in single-payer countries, almost all healthcare dollars go directly to medical providers, 31% of U.S. healthcare expenditures are used to line the coffers of the unnecessary and parasitic middlemen, the health insurance industry.  This, the PNHP revealed, markedly contrasts with Canada’s meager 1.3% cost to administer its single-payer healthcare system.

A second major source is the exorbitant cost of pharmaceuticals.  Last September, for example, CNN reported that the average cost for one month’s supply of Nexium in the U.S. ($215) was nearly ten times more than the price paid ($23) for the same prescription in the Netherlands.  As observed by the PNHP: “When all patients are under one system, the payer wields a lot of clout.  The VA gets a 40% discount on drugs because of its buying power.”

You would think that since it provides free healthcare for all, the amount of taxpayer money used to pay for healthcare in the U.K. would be greater than the taxpayer funds used to pay for healthcare in the U.S.  And you would be wrong!

At the time of its pre-ObamaCare study, the PNHP reported that U.S. taxpayers funded 60.5% of what was then $6,697 per capita healthcare expenditures.  The number of per capita U.S. tax dollars ($4,048) used to pay for healthcare was nearly twice as as much as the $2,371 per capita expenditures then incurred in the U.K.  The $4,048 U.S. figure included public expenditures for Medicare, Medicaid and the VA.  It also included health insurance industry subsidies.

ObamaCare provided modest improvements — elimination of the “pre-existing conditions” and a 30% reduction in the number of Americans who lack even basic healthcare coverage. These were accompanied by a hefty price tag.  By 2025, the U.S. government will have forked over $1.207 trillion in taxpayer-funded subsidies to the privately-owned health insurance cartel.

That this faux “reform” serves to enrich the already wealthy and powerful health insurance cartel comes as no surprise.  In 2009, President Obama met privately in the Oval Office with the CEOs of the health insurance and pharmaceutical industries.  Single-payer advocates were essentially shut out of the healthcare debate by both the White House and the corporate-owned mainstream media. This occurred even though a 2009 New York Times/CBS poll revealed that 59% of all Americans preferred a single-payer system.

Simultaneously, over a span of months, Sen. Max Baucus (D-MT), together an aide, a former Wellpoint VP, were busy drafting the core of what became ObamaCare.  The PNHP’s Dr. Steffie Woolhandler described the Baucus bill as an “insurance company wish list.”

When he served as an Illinois state senator, Barack Obama was a single-payer advocate.  During the 2008 campaign, candidate Obama promised a reform that would at least include a “public option.” This would permit citizens to bypass our dysfunctional and deadly private health insurance system. They could, instead, purchase coverage directly from the government.

The concept of a “public option” was immensely popular.  A June 2009 NBC/Wall Street Journal poll revealed that 76% of all Americans favored the “public option.”  Even though Democrats were in firm control of both Houses of Congress, the “public option” was dropped by both Baucus and Obama.

Out-Of-Pocket Savings, Bankruptcy Avoidance Would Offset Minor Tax Increase 

During the third Democratic Presidential debate, in response to Mrs. Clinton’s GOP-like no new middle-class tax pledge.  That pledge, as revealed by Sen. Sanders recently released detailed plan, amounts to a form of bait-and-switch in which she entices voters with lower taxes in order to permit her insurance cartel donors to extract far greater sums in premium.

Bernie’s federally operated Medicare-for-All plan eliminates private insurance carriers and all premiums, co-pays and deductibles.  It imposes a 6.2% tax on employers but eliminates employer payments for health insurance premiums.  “The average annual cost to the employer for a worker with a family who makes $50,000 a year,” Sen. Sanders observed, “would go from $12,591 to just $3,100.”  His single-payer system imposes a 2.2% income-based premium by household would save $5,000/year for a typical households.  Those with incomes less than $28,000/year would not be taxed but would still be guaranteed quality healthcare at no cost.

Sen. Sanders’ Medicare-for-All plan does include a progressive marginal tax rate ranging from 37% on incomes between $250,000 and $500,000 to 52% on incomes over $10 million.  This will include taxing capital gains and dividends at the same rate as wages.

Where Mrs. Clinton would have you believe that single-payer is more expensive, Bernie estimates that his plan will “save the American people and businesses over $6 trillion over the next decade.”

There are two additional advantages in single-payer that were not mentioned in Sen. Sanders’s detailed Medicare-for-All plan.

First and foremost, there’s morality.  We’re talking about eliminating a system that kills 28,710 Americans/year for lack of coverage.  Are their lives worth less than the inconvenience of a 2.2% tax increase?  Second, when it comes to healthcare costs, we cannot simply set forth a ledger sheet that measures the size of the tax increase vs. average costs of premiums, deductibles and co-pays.  Even now, with ObamaCare fully in place, more than 1/2 of all personal bankruptcies are caused by unpaid medical bills.  Three-fourths of those bankrupted had health insurance at the time they became ill or injured.  “Unless you’re Bill Gates,” Dr. David Himmelstein told NBC News, “you’re just one serious illness away from bankruptcy.”

Conclusion

We really shouldn’t have to “debate” the need to replace ObamaCare with a single-payer system that treats healthcare as a basic human right. What passes for a healthcare system in these United States is so corrupt, dysfunctional and deadly that it amounts to an obscenity.

The real debate we should be engaged in is whether we should adopt a single-payer system based on those found in Canada and other single-payer countries or opt for a government-owned and operated national healthcare system modeled on that which U.K. has so successfully applied since 1948? Should we utilize a single-payer system to bargain with privately held pharmaceutical companies?  Or is the sanctity of human life such that we should remove the profit motive altogether by nationalizing the pharmaceutical industry?

Whatever we democratically decide, one thing is abundantly clear.  Bernie Sanders and single-payer represent the only economically and morally rational choice in the rapidly approaching 2016 Presidential election.

 

 

 

 

 

 

 

Ernest A. Canning is a retired attorney, author, Vietnam Veteran (4th Infantry, Central Highlands 1968) and a Senior Advisor to Veterans For Bernie.  He has been a member of the California state bar since 1977.  In addition to a juris doctor, he has received both undergraduate and graduate degrees in political science.  Follow him on twitter: @cann4ing