Medicare for All

Earlier this evening, U.S. Senator Bernie Sanders of Vermont tweeted this:

Good politics: Over the past decade, every Medicare for All co-sponsor up for re-election beat their Republican opponent – every single one.

Good policy: Medicare for All would save 68,000 lives and cost $650 billion LESS than our current dysfunctional healthcare system a year.

— Bernie Sanders (@BernieSanders) December 22, 2020

I'm not gonna dig back through the past 5 election cycles to verify whether this claim is accurate or not, but I did at least check into it for the most recent election last month.

In U.S. politics, the Hyde Amendment is a legislative provision barring the use of federal funds to pay for abortion except to save the life of the woman, or if the pregnancy arises from incest or rape. Legislation, including the Hyde Amendment, generally restricts the use of funds allocated for the Department of Health and Human Services and consequently has significant effects involving Medicaid recipients. Medicaid currently serves approximately 6.5 million women in the United States, including 1 in 5 women of reproductive age (women aged 15–44).

Federal dollars can't be used to pay for abortion outside of the above restrictions, but Medicaid is funded via hybrid federal/state funding, so there are 15 states where Medicaid does pay for abortion using the state's portion of the funding.

 

Here's the full transcript (verbatim) of Joe Biden's exchange with Lawrence O'Donnell about whether he'd veto some version of Medicare for All if it were to actually pass the House and Senate:

O'Donnell: "Let's flash forward: You're President, Bernie Sanders is still active in the Senate, he manages to get Medicare for All through the Senate; it's some compromise version, Elizabeth Warren's version or some other version...Nancy Pelosi gets a version of it through the House of Representatives; it comes to your desk. Do you veto it?"

Biden (after pausing to choose his words carefully): "I would veto anything that delays providing the security and the certainty of healthcare being available now. If they got that through and, some miracle, there was an epiphany that occurred, and some miracle occurred that said, 'it's passed', then you gotta look at the cost. I'd want to know how did they find the $35 trillion? What is that doing? Is it gonna significantly raise taxes on the middle class, which it will? What's gonna happen?

 

My post from yesterday was pretty harsh on a Medicare for All advocate (though not on Medicare for All itself, contrary to what some people seem to think), so I figured I should follow up with something a bit friendlier today. Via Helaine Olin in the Washington Post:

Osmel Martinez Azcue wanted to do the right thing, for both his own health and the health of the nation. When the Florida resident came down with flu-like symptoms shortly after returning from a trip to China, he immediately went to a local hospital to get tested for coronavirus.

A few weeks later, according to the Miami Herald, Azcue received an invoice for more than $3,000. His insurer claims he’s responsible for $1,400 of the total. He’s expecting even more bills to arrive over the next few weeks.

Disclosure: I publicly endorsed Joe Biden in the Democratic primary yesterday. It had nothing to do with this post, however. Shout-out to Pradheep Shanker for bringing this to my attention.

Updated w/my exchange with Rep. Khanna at the bottom

Update: I added "(nearly all)" to the headline for extra clarity given the subject of this entry.

Ro Khanna is a Democratic Congressman representing CA-17. He's also a top Bernie Sanders surrogate and a huge Medicare for All advocate.

About an hour ago, he was interviewed on NPR for about five minutes regarding the Caronavirus, tomorrow's California Presidential primary...and Bernie Sanders' Medicare for All plan.

I'm transcribing the relevant portion of the interview verbatim just to make certain there are no misunderstandings...the M4All exchange begins at around 3:20 in:

NOTE: Michigan's Democratic Presidential primary isn't until March 10th, a week after Super Tuesday. With that in mind, I was planning on waiting until after it passed before announcing my own decision. After Joe Biden blew the doors off everyone in the South Carolina primary, however, I've decided to move up my announcement, because it looks pretty clear that there's only three possible ways things can go now: A Bernie victory, a Biden victory or a bonkers contested convention where anything goes.

When I supported Elizabeth Warren for the first half of 2019 (mostly...I never formally endorsed her but was 90% of the way there), I did so with the understanding that, if elected, her actual administration would be more restrained in governing than her official policy positions would indicate (it would have to be due to the nature of Congress)...and I was fine with that.

I knew that Warren knows enough about how the sausage is made to understand that you can only move the Overton Window so far before you end up achieving nothing at all. She gave what I felt was a pitch-perfect response to the question of achieving Universal Healthcare at a CNN Town Hall in March 2019:

For years now, I (along with many others) have criticized Bernie Sanders for the big blank section of his "pure" Medicare for All single payer healthcare proposal. He's kind of, sort of given some ideas about how he proposes paying for it in the past, but yesterday he finally released an updated, revised list of additional taxes, loophole cuts and so forth which he claims would cover the total cost.

Since I've given him so much grief before, and since I did a detailed write-up about Elizabeth Warren's proposal last fall, I owe him some coverage of his new pay-for proposal as well. Let's take a look:

According to a February 15, 2020 study by epidemiologists at Yale University, the Medicare for All bill that Bernie wrote would save over $450 billion in health care costs and prevent 68,000 unnecessary deaths – each and every year.

Yesterday, reporter and (pretty apparent) Bernie Sanders supporter Ryan Grim said the quiet part out loud in response to the news that the powerful Nevada Culinary Union isn't a fan of Medicare for All:

Hey @Culinary226, check in with your government affairs people. There are not 60 votes in the Senate to ban the private health insurance you got in your union negotiations, nor will there be after the election. You're gonna be okay.

— Ryan Grim (@ryangrim) February 12, 2020

Yes, apparently the new strategy to win over support from organizations which don't like one of the core tenets of your preferred candidate is to reassure them that there's absolutely zero chance of that tenet ever actually happening.

via the AP:

Nevada’s most influential union is sending a subtle message to its members discouraging support for Bernie Sanders and Elizabeth Warren over their health care stances even though the union has not yet decided if it will endorse a candidate in the Democratic presidential race.

The casino workers’ Culinary Union, a 60,000-member group made up of housekeepers, porters, bartenders and more who work in Las Vegas’ famed casinos, began distributing leaflets in employee dining rooms this week that push back against “Medicare For All,” the plan from Sanders and Warren to move to a government-run health insurance system.

The leaflet said “presidential candidates suggesting forcing millions of hard working people to give up their healthcare creates unnecessary division between workers, and will give us four more years of Trump.

Health care is one of the biggest issues for the union, whose members have fought and negotiated for robust plans.

 

Not Joe Biden. Not Pete Buttigieg. Not Amy Klobuchar. Not Michael Bloomberg. Not Tom Steyer. Not Michael Bennet.

Nope. This is none other than Senator Bernie Sanders of Vermont from July 2009, issuing a strong and vigorous argument in favor of adding a Medicare-like Public Option to the U.S. healthcare system to offer a "level playing field" and "fair competition" with private insurance.

I've cued up the video to the relevant starting point, but if it starts at the beginning for some reason, scroll up to 4:55 in. It runs until around 6:13.

Here's the transcript of Bernie during the section in question:

“No one is talking about a government-run healthcare system. No, they’re not. What they’re talking about is a public option that will compete and give people the choice! The choice of whether they want a public plan or a private plan! Why are you afraid of that? If the private plans are so much better, people will go into the private plan. If the public plans are more cost effective, more reasonable, if people prefer a Medicare-type program they’ll go into that. Why are you afraid of the competition?

Note: Photo of John Conyers used at the request of the thread author. Thread reposted with permission.

About a week and a half ago, a die-hard Bernie Sanders supportern named David Klion posted something I found pretty offensive. I already wrote about that.

However, in the wake of that back & forth, a Twitter follower of mine, a woman of color who goes by the handle @Kamalaallday, posted an angry rant which I felt lent a lot of insight as to why many in the black community aren't nearly as keen on "Medicare for All" as envisioned by Sanders and other M4All activists as you might expect.

I already knew about some of her complaints and concerns below, but not all of it. Instead of putting words in her mouth, I'm just gonna let her speak for herself.

I've embedded the first tweet directly, but have converted the rest of the thread into bullets and reworked the structure (putting half-sentences together and adding paragraph breaks, etc.) for easier readability, but have otherwise left her entire thread as is. I strongly advise that folks read it all...food for thought:

I don't normally post blog entries about the occasional Twitter flare-ups I get into with die-hard Medicare for All supporters, but this one strikes me as being especially noteworthy for several reasons.

David Klion is the News Editor at JewishCurrents and a writer for The Nation and The New Republic. As you can imagine, he's a pretty left-wing/progressive kind of guy, and a devout Bernie Sanders supporter. He has a verified account (as I do) and has about 55,000 Twitter followers (compared to my 35,000, FWIW). In other words, both of us have small but respectable followings on social media and are what the powers that be would likely consider "low-level" (?) Twitter influencers.

He and I have followed each other on Twitter for several years. We don't directly talk to each other very often, however.

Anyway, about an hour ago, Klion posted a thread with an admittedly depressing and all-too-common Consumer Hell story about his health insurance woes. I'm reposting the whole thing here; it is indeed an indictment of our current system. I've cleaned up the formatting for readability:

Back in July, just ahead of the 2nd Democratic Presidential Candidate Debate here in Detroit, I laid out what my question would be (If I could only ask one question) for the various candidates.

The wording of the first part varied somewhat depending on the candidate's position on healthcare policy, but the second part was identical for each. Here's how I worded it for Bernie Sanders:

"Senator, you've long been a staunch advocate of moving to a universal, mandatory, single-payer healthcare system which you call "Medicare for All", and have publicly rejected any proposal which includes cost sharing at the point of service or which continue to allow private major medical plans as not being acceptable.

However, until this year you were also a co-sponsor of Senator Warren's "Consumer Health Insurance Protection Act", or CHIPA, which amounts to a robust ACA 2.0 bill, and until recently you were also a co-sponsor of Senator Schatz's "State Public Option Act" which amounts to a Medicaid buy-in plan.

So last night I whipped up a bit of a fuss on Twitter with my response to an exchange between Pete Buttigieg and Rachel Maddow:

Asked by @maddow about a McKinsey client laying off thousands of insurance company workers — and whether Buttigieg’s work played a role — Buttigieg turns it around and warns that Medicare for All advocates would end every insurance worker’s job.

— Dan Diamond (@ddiamond) December 11, 2019

Maddow: "When you did that cost & overhead assessment for Blue Cross Blue Shield of Michigan, a couple years after that, they laid off like 1,000 people. Was your work part of what led to those layoffs?

Buttigieg: " I doubt it...I don't know what happened after the time that I left, that was in 2007, when they decided to shrink in 2009. Now, what I do know is that there are some voices in the Democratic primary right now who are calling for a policy that would eliminate the job of every single American working at every single insurance company in the country."

 

Tuesday, December 10th, is gonna be a pretty big day for federal healthcare policy, especially in the U.S. House of Representatives.

For one thing, it's my understanding that the big Prescription Drug Bill (H.R. 3, the Lower Drug Costs Now Act) is scheduled for a floor vote on Tuesday, although it's possible that it'll be bumped until later in the week given the grumbling by the Congressional Progressive Caucus.

For another, the House Energy & Commerce Committee is holding what I'm assuming are all-day hearings on not one, not two, but nine different Universal Coverage bills, including the Big Ones: Medicare for All and Medicare for America:

HEARING ON "PROPOSALS TO ACHIEVE UNIVERSAL HEALTH CARE COVERAGE"

Date: Tuesday, December 10, 2019 - 10:30am

Monday's Washington Post includes an excellent story by Annie Linskey, Jeff Stein & Dan Balz titled, appropriately enough, "How a fight over health care entangled Elizabeth Warren — and reshaped the Democratic presidential race":

In mid-November, a few dozen of the country’s most influential advocates of Medicare-for-all were reviewing details of Sen. Elizabeth Warren’s plan to finance the proposed government-run program when they learned that she had unexpectedly changed her position.

 

Please watch this interview with Hillary Clinton. The whole thing is worth watching, but the portion about healthcare policy and the best route forward starts at around 9:20 in and runs less than 7 minutes, to 16:00 (It's supposed to be cued up to exactly 9:20 but you may have to scrub forward to get to it depending on your device).

Please take 6 minutes and 40 seconds out of your day to actually listen to the words which are coming out of her mouth.

UPDATE: Full, verbatim transcript by yours truly:

Andrew Ross Sorkin: “I want to talk to you a little bit about healthcare, because I know it’s an issue that you care about deeply and have thought a lot about.”

Hillary Clinton: “I have.”

Sorkin: “Because we seem to be in a very divided world, not just among two different parties, but even within the Democratic Party. Medicare for All versus a Public Option. You look at what Elizabeth Warren presented last week, and you think...what?”

A few weeks ago, I said the following about Sen. Elizabeth Warren regarding healthcare policy:

  • I'm generally supporting Elizabeth Warren in the Democratic Primary (not a full endorsement, but I've been strongly leaning her way for awhile now)...

HOWEVER, for the time being at least, that seems to be where she's decided to lay her marker, so it is what it is.

(Note: Since then, I've publicly stated that I'm now leaning more towards Sen. Kamala Harris who was always my strong #2 choice. This doesn't mean I no longer like Warren--the two have simply swapped places in my #1 and #2 column.)

Back in late June, right after the first Democratic Primary Candidate Presidential Debate, I posted an analysis & table to break out exactly where each of the then-20 (!) candidates stood when it comes to the Next Big Thing in U.S. healthcare policy. I posted a couple of updates as the summer and early fall progressed.

At the time, my main point was that regardless of their official campaign rhetoric, the truth was that nearly all of the candidates were open to multiple paths towards expanding healthcare coverage...both in terms of the number of people covered, the scope of that coverage and the cost of coverage to the enrollees, with a greater portion of the total cost being borne by the federal government.

(sigh) Regular readers know two things about me when it comes to Sen. Elizabeth Warren:

  • I'm generally supporting Elizabeth Warren in the Democratic Primary (not a full endorsement, but I've been strongly leaning her way for awhile now)...

HOWEVER, for the time being at least, that seems to be where she's decided to lay her marker, so it is what it is.

The single biggest headache she's been dealing with all summer and fall, however, has been the "Will You Raise Taxes On The Middle Class" question which keeps popping up in interviews and the Democratic debates. Bernie Sanders has, to his credit or detriment, stated it plainly: Yes, his plan would indeed raise taxes on households earning more than $29,000/year.

Back in July I posted the written Congressional testimony of my friend Rebecca Wood. Rebecca is a staunch "Medicare for All" advocate whose daughter Charlie has complex medical issues.

Today, I'd like to present a Twitter thread by another friend I've met online, Lori, who also has a daughter with complex medical needs named Savannah. While their children both have serious medical issues which need constant care, Lori has a slightly different perspective on the issue of the best route towards achieving universal coverage. This was all in response to my own tweet, which was in response to a comment by Parker Malloy about people who "love" their private insurance:

Who are these people some candidates speak of who just absolutely love their insurance? https://t.co/JD3IEy1Kk9

— Parker Molloy (@ParkerMolloy) September 18, 2019

I've written many times before about how polling on the issue of "Medicare for All" has consistently proven that many Americans are confused about what the phrase actually means.

While a majority of the country keeps saying they want "Medicare for All", poll after poll has shown that a huge chunk of those who say so think it means "Medicare for All Who Want It"...that is, they think it refers to a Public Option, where it's up to them whether their major medical coverage would be public or private. This is true even among Democrats, who obviously support the concept in higher numbers than Republicans or Independents.

Yesterday a new poll came out from Monmouth University which mostly just confirms this point...

Last night, the Washington Post posted a story with a headline which made top campaign representatives for both Bernie Sanders and Kamala Harris go nuts on Twitter:

Sen. Bernie Sanders changes how Medicare-for-all plan treats union contracts in face of opposition by organized labor

Sen. Bernie Sanders announced a key change to his Medicare-for-all insurance plan Wednesday, a move meant to assuage fears on the part of organized labor, whose support is being heatedly sought by all of the candidates for the Democratic presidential nomination.

 

Both evenings of the Detroit Democratic Debates earlier this week started off with half-hour segments on healthcare policy. I meant to do write-ups about both of them but for one reason or another never got around to it until now. Tons of other healthcare wonks have already written their own think pieces by now, so I'm not going to go back and rehash the whole thing at this point.

HOWEVER, there's one quote which made my jaw drop, and it doesn't come from any of the Big Four (Biden, Warren, Harris or Sanders). It comes from Hawaii Representative Tulsi Gabbard...and it didn't even come during the debate itself, but afterwards in the "Spin Room" (they actually call it that) with Anderson Cooper.

So, I wrote my first Op-Ed piece for the Washington Post yesterday...

Harris’s rollout Monday was met with swift criticism from both the Biden camp, which called it “A Bernie Sanders-lite Medicare for All,” and the Sanders camp, which insists Harris “can’t call [her] plan Medicare for All.”

In saying this, the Sanders campaign is effectively trying to lay a copyright claim to Medicare-for-all, as if it, and only it, can define what it means. The reality is far less clear — and depending on your perspective, it could be Harris’s proposal that is more justified in claiming the Medicare-for-all branding.

I'm not going to overquote my own piece, but this has led to some backlash against me, so for the record:

(IMPORTANT: As my friend Shawn Pierce keeps pointing out, the phrase "Medicare for All" has two very different meanings...one is the brand "Medicare for All", which simply refers to any healthcare plan which ensures 100% universal, comprehensive healthcare coverage for everyone; the other is the specific bills introduced by Sen. Bernie Sanders and/or Rep. Pramila Jayapal, which would indeed completely eliminate private major medical insurance for 100% of the population as well as completely eliminating all out-of-pocket costs in favor of 100% federal public funding).

For months now, California Senator and Presidential candidate Kamala Harris has repeatedly struggled with how to address her support of Bernie Sanders' 100% mandatory, $0 out-of-pocket-cost, 100% comprehensive "pure" single payer "Medicare for All" healthcare bill.

FULL DISCLOSURE: Since June 2019, I've been contracted with the Center for American Progress to provide healthcare data analysis & advocacy on their behalf on a part-time basis.

UPDATE: My contract with CAP ended on Nov. 30th, 2020 (on a positive note--I knew going in it was a temporary arrangement and enjoyed working with them).

NOTE: This is not an in-depth analysis, for three reasons:

  • Third, I have a bit of a personal/household crisis to deal with this week (don't worry...no one's sick, dead or getting divorced, but our house is in need of some serious attention)

If you've been reading my site for more than a couple of years, you know that back in February 2018 I fell in love (well, mostly) with a new Universal Healthcare Coverage proposal from the Center for American Progress called "Medicare Extra for All" or simply "Medicare Extra".

If I could only ask one question of the 20-odd candidates vying for the Democratic nomination for President at the next debate coming up right here in Detroit, Michigan, here's how I would word it. I've customized it for each of the five major candidates (apologies to the rest of them):

Preface to each of the candidates:

"Earlier this month, oral arguments were heard by the 5th Circuit Court of Appeals over a lawsuit against the Affordable Care Act filed by 20 Republican Attorneys General and fully supported by the Trump Administration.

"If the plaintiffs are successful and the ACA is struck down entirely, up to 20 million Americans would find themselves without healthcare coverage and tens of millions more with pre-existing conditions would lose critical protections, while states would lose hundreds of millions, or even billions of federal funding.

"Every Democratic candidate has come out in favor of significantly expanding publicly-funded healthcare coverage to some degree or another. Some want to build upon the Affordable Care Act. Some want to add a public option. Some want guaranteed universal coverage, and some are demanding universal single payer healthcare for everyone in the United States.

A few months back I posted a request for folks to vote for a healthcare panel I was hoping to be included at this summer's Netroots Nation conference in Philadelphia.

I'm happy to report that our panel did indeed make the final cut, and will be happening this Friday, July 12th:

FIX THE DAMN HEALTHCARE: SORTING OUT ACA 2.0, MFA, MED4AM AND MORE!

  • Friday, Jul. 12 4:30 PM, Room: 118C

The healthcare landscape is confusing and exciting in 2019. Reining in Big Pharma, strengthening the ACA, adding public options, “Medicare for America” or “Medicare for All”… the alphabet soup of plans can be confusing. Can improvements be implemented before 2021 at the federal level or is it all up to the states? And what about the latest lawsuit looming over everything? We’ll go beyond the slogans and into the details: How are the proposals similar and different, and what do patients, caregivers and other invested parties think.

UPDATE 8/20/19: I originally posted this in late June. Since then, there have been several important developments: Joe Biden and Kamala Harris have formally rolled out their own official healthcare overhaul plans, with Harris splitting off from Bernie Sanders' fully-mandatory "Medicare for All" bill to her own variant, which keeps the name but has similarities to "Medicare for America". Also, Eric Swalwell and John Hickenlooper have dropped out (ok, not every development was major).

I've updated the post to reflect these changes, while also updating the table graphic, which I've also simplified by removing Swalwell, Hickenlooper and most of the other bottom-rung candidates. I'm keeping everyone who's qualified for the September/October debates as of this writing, plus Tulsi Gabbard, Jay Inslee and Tom Steyer, each of whom is partly qualified.

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