Why Are We Beating Up on Single Payer?

By James Kwak

Single-payer health care has emerged as the primary symbol of the differences between Bernie Sanders and Hillary Clinton. For his supporters, Sanders’s plan is the centerpiece of his vision of a European-style, social-democratic society in which health care is a right that is fully funded by largely progressive taxes. For Clinton supporters, it is the best example of Sanders’s misguided utopianism—a naive plan that has no chance of passage and that would be less effective than incremental improvements to Obamacare.

The Clinton camp has been ecstatic about a critical analysis of Sanders’s plan by Kenneth Thorpe, a health care expert who has supported single payer in the past. Thorpe argues that the plan is underfunded by more than $1 trillion and, if fully funded, would cause most people to pay more for health care than they do today. Thorpe’s analysis was publicized by Dylan Matthews and highlighted by Paul Krugman as further evidence that all the serious people support Clinton. Clinton herself likes to say, “The numbers just don’t add up.”

I have a few points to make about Thorpe’s analysis and what we should take from it. The first, simplest, and most obvious is this: Even if Sanders’s plan has problems, if the goal is single payer, then Sanders is the only choice. We know a Clinton nomination will bring us no closer to single payer. A Sanders nomination will bring it within the spectrum of future possibilities, even if it won’t be passed in the next two years. (Remember Newt Gingrich’s crazy plan to voucherize Medicare in 1995? Well, now it’s not that far from passage.) A Sanders presidency would make it possible to develop a better, more realistic plan; that’s what advocates of single payer should be hoping for.

OK, now to the specifics. Thorpe’s most important conclusion is that Sanders’s plan will cost an average of $2.5 trillion per year, not $1.4 trillion, and that financing it will require significantly higher taxes. As a result, most Americans would end up paying more for health care (in additional taxes) than they currently do (in premiums they pay, premiums paid by their employers, and deductibles, co-payments, and coinsurance).[1]

But there’s something funny about this conclusion. We’re not talking about smart bombs and cruise missiles that will explode somewhere in the Middle East. We’re talking about health care services being provided to Americans. So if we (in the aggregate) have to pay more in taxes, we’re getting it back in the form of more health care. On its face, that’s not necessarily a bad thing.

As the country that already spends more money per person on health care than any other in the world, however, perhaps increasing spending is not a good idea. So let’s look at why total spending goes up.[2] For the total to go up, the price per unit of health care must go up, the number of units delivered must go up, or both. I’m pretty sure that Thorpe doesn’t think that the price per unit would go up under Sanders’s plan. He projects an overall payment rate of 105% of treatment costs. Medicare currently pays less, so it will pay more; but providers make up for that by overcharging private payers, and Thorpe’s model says those costs will go down by 20%. In addition, Thorpe projects 4.7% savings on administrative costs relative to the private system.

So the problem must be that the number of units is going up. And that is basically what Thorpe says. He assumes a 10% increase in utilization by people who already have insurance because the Sanders plan eliminates cost sharing, plus additional spending on people who are currently uninsured.[3] Again, this might be a good thing: not only is it good to provide coverage to the 11% of people who are still uninsured under Obamacare, but there are also plenty of insured families who are forgoing treatment because of high cost sharing.

But let’s assume for the sake of argument that higher utilization is bad. Then the obvious solution is not to toss out the baby with the bathwater, but to put some cost sharing back in. For example, we could have income-based, sliding-scale cost sharing, where the idea is that deductibles and co-payments should be roughly equally significant at different income levels. (Obamacare includes cost-sharing subsidies for low-income households.) So people on minimum wage face a $5 copayment, and people like me face a $100 copayment. I’m fine with that.

The point is, some of the projected increase in utilization is good, because it means people who currently are being underserved are getting the health care they need. And if we think some higher utilization is bad, we can limit it through smarter cost sharing.

What really matters as far as aggregate, long-term health care costs and outcomes are concerned are two things: the price per unit and the value delivered per service. And on both dimensions, we have every reason to believe that single payer will be more effective than Obamacare (and far more effective than not-Obamacare, which is all the Republicans are offering). Obamacare includes a number of tools to try to increase efficiency among providers and bend the cost curve: the Independent Payment Advisory Board, the incentives for Accountable Care Organizations, experimentation with different payment structures, tying hospital payments to readmissions, bundled payments, and so on. Do you know what all of those have in common? They’re all part of Medicare.

Even with Obamacare, the federal government’s influence over the private insurance market is limited. So in order to steer the health care sector toward more effective procedures and more accountability in payment practices, it works through Medicare and, to a lesser extent, through regulations governing the exchanges and employer-sponsored plans. The problem is that just because Medicare pioneers some value-based reimbursement practice doesn’t mean the private sector has to follow. If we really want to bend the cost curve in an intelligent way—and most Democrats do—then it would be much more straightforward under a single payer system than under Obamacare.

As I’m fond of saying, the government is just a tool that we use to arrange some of our affairs. Whether we buy our health care through private insurers or through a single payer, what matters are the outcomes we get for the money we spend. It’s OK to spend more money if we get truly universal coverage and better outcomes; the elderly get a lot more medical care today than they did before Medicare was created in 1965, and most of us don’t think that’s a bad thing. But if we think that we’re buying too much health care, or we’re getting the wrong kinds of health care, a single payer system is a more effective way of redirecting spending priorities—in a democratic manner—than the unwieldy public-private mash-up we have today. Single payer has its downsides, such as the bureaucracy (not that we don’t have one already). But whether we can afford it is not one of them.

[1] I agree with Thorpe that it makes sense to evaluate the plan on a fully financed basis. Contrast this with Republican tax cut plans, which talk about how much money people in each income quintile will save—but not how much they will lose in government transfers and services if the tax cut is fully financed by spending cuts.

[2] Technically speaking, it’s possible that total spending will not go up. As far as I can tell, Thorpe’s tables only say that most people will see an increase in total costs, assuming full financing. So maybe a minority of people will see their costs decline so much that they will balance out everyone else. That would be a good thing, both because total spending would go down and because risk-sharing would increase (basically, this would be a transfer from the healthy to the expensively sick).

[3] I still don’t quite see how total spending goes up with these assumptions. Spending on people who currently have private insurance—most of the population—clearly goes down by about 15%. (“We take private insurance and out of pocket spending … and make several adjustments to develop a single payer funding estimate. First we increase it by 10 percent to reflect the increased total health care spending that results from a reduction in out of pocket payments. Second we adjust downward by 20% to reflect the lower blended payment and finally we reduced the total by 4.7 percent to reflect potential administrative costs savings.”) Spending on the uninsured and Medicaid and Medicare beneficiaries goes up. Thorpe’s report doesn’t specifically compare spending under the Sanders plan to spending currently; the table only compare the number of households that would pay more or less under the (fully financed) Sanders plan than they do today. Matthews’s article compares Thorpe’s estimates to those of the Sanders team,[4] but also does not compare his estimates to current aggregate spending levels. But again, if total spending does not go up, then there’s no problem to begin with (see previous footnote).

[4] One quibble: Thorpe notes that Sanders assumes that the states continue spending the amount that they are currently spending on Medicaid, even though there is now way the federal government can compel them to. But if we’re going to cross out the revenue provided by state contributions, then we also have to cross out the state taxes that raise that revenue, so in aggregate its a wash (and those state taxes are often pretty regressive).

32 responses to “Why Are We Beating Up on Single Payer?

  1. Education in this country SUCKS, with proper education, health care costs would approach ZERO, yes eliminating so called important jobs, but increasing the health of a nation so more productivity can be achieved among its citizens over the course of a life time. Our politicians are actually quite stupid, proof of this is the raising of the cost of living across a broad range of items, starting with health care.

    If Obamacare is so good, why did they have to put a gun to our heads to make it work for them. Perhaps ignorance is bliss is the answer.

  2. Bruce Lindgren

    The people you cite are not beating up on single payer, they are beating up on Bernie Sanders. Note how pieces such as this one always seem to include the following: “[Fill in the name here}, who has supported single payer in the past,….” Single payer may be a worthy goal, but Bernie Sanders does not provide a way to get there. One might think that a United States Senator who has served for nearly a quarter-century would have *some* significant legislative accomplishments. To take it out of the immediate electoral context, John McCain, Mitt Romney (as Governor of Massachusetts), and Paul Ryan can all point to some legislative accomplishments that required them to work across party lines. Where is there any evidence that Bernie Sanders, if elected, could put together a legislative coalition to accomplish something like single payer? His program is, “Imagine a future with a single payer health plan.” The details are either missing or full of holes. It’s like listening to a time-share presentation–I like the idea of vacationing in nice places all over the world, but will buying this time-share really meet the high expectations this person is trying to sell me? The point is, there is no path to single payer that runs through a Bernie Sanders presidency. It’s just not going to happen with him.

  3. Bruce,
    The idea that a candidate that wants single payer and wants to get single payer on the table is less likely to bring about single payer than one who is not interested in single payer seems misguided.

    The key part is this:

    Even if Sanders’s plan has problems, if the goal is single payer, then Sanders is the only choice. We know a Clinton nomination will bring us no closer to single payer. A Sanders nomination will bring it within the spectrum of future possibilities, even if it won’t be passed in the next two years.

    Sanders probably won’t be able pass it at all. But the only reason it’s being seriously discussed is because he is pushing for it now. It’s very annoying for people to look at everything as it is now and assume that is how it will and should be. Change will never happen if everyone always assumes it’s too hard or legislatively impossible.

  4. Wouldn’t the cost of Medicaid be reduced?

    If you have single-payer what would be the point of state based Medicaid programs, other than for expenses related to say long-term nursing home care for the elderly?

  5. This being the US of A, rather than some small homogeneous entity like Switzerland or the typical Canadian province, people do well to mistrust the notion of a true single-payer system. It would function disastrously as a government monopoly even if it used contractors as in Canada.

    We need only look at monopoly of that sort in something bonehead-simple, such as local municipal bus service – typically absurdly expensive (counting the huge subsidies) and yet slow, tardy, erratic, unreliable, and utterly undisciplined. Never mind something slightly more complex, like road construction, which seems to have to be done over and over and over again to get any result at all. Medical care run like the typical bus system or road project would be almost entirely useless – much too little done much too badly much too late, and yet at absurd expense.

    As awful as the current system is, at least there is still a modicum of diversity, affording a modicum of benchmarking. Go to true single payer, and the bureaucracy in charge will do whatever they feel like it, whenever they happen to feel like getting around to it, and mainly in their own self-interest (i.e. with immense financial corruption, noble-cause corruption, and just plain bureaucratic sinecure- and empire-building.)

    Now, if only someone had a way to make government-in-practice do what government-in-Utopia might do, or possibly even ought to do – if only that meme about government being what we do “together” were something more than arrant nonsense – then it might well be different. But neither Bernie nor any of the others has expressed a single thought about that.

    In the meantime, government goes right on making a dog’s breakfast of even the most bonehead tasks. So if they ever figure out how to run, say, simple bus service on-time, every time, all the time, then maybe, just maybe, we can open a conversation about something far more complex and life-critical, such as medical care. But I wouldn’t hold my breath.

  6. Basic health education is a part of the primary school curriculum in EU countries that have “universal health care” because you cannot have universal health care when the population is “universally” ignorant about the human body. Maybe “sex ed” for 5 year olds can be replace with teaching the basics about what/how the nose functions, and the eyeballs and with all the robotics being built to replace humanity on earth, kids can observe how opposing thumbs function – you get the drift.

    So the real reason universal health care will never happen in USA is because there will never be universal education (beginning in grammar school) that lifts the entire normal minded IQ citizenry to the equivalent of a 2 year nursing degree. The “shamans” want to remain “elite”, even though in the current system someone from Harvard graduates at the bottom of the class where as in the other scenario, only the best bubble up to the top.

    Lay off the data about “nursing homes” getting funded because the NEW data proves that only HALF of the amount, maybe even less if “the plan” works, of boomers will need it – they are dropping like flies. Use the numbers from early 20th century – before “unions” – instead.

    The real cost of “health care has increased because more and more genetically fit peoples have to service only the “niche” diseases and conditions of the 1%ers….Cannibal Capitalism – organ harvesting and “labor” harvesting…

    What HAS Bernie been doing all those years in the legislative branch besides collecting a paycheck and having “universal” health care, himself?

    Would love to know how much he employed the Patriot Act spying apparatus to come up with the perfect pitch for his campaign?

    Can’t see Bernie meeting with world leaders to discuss anything other than “security” in the Middle East…

  7. Even if Sanders isn’t nominated, he has still improved the chances of single payer. If nominated he will probably reduce it by being less electable. Utilization would likely increase and a little of this could be good, but from what we mostly see, people don’t value it at anywhere near cost, only by what they pay. Utilization can be handled either through costs or through queues and we would likely see some of both. The downside could be reduced innovation and adaptation to change.

  8. PaulS, we already have two single-payer systems in this country. One is called Medicaid, which is run by the states with a large chunk of federal funding. The other is Medicare which is run federally.

    No one anywhere in the world is 100 percent satisfied with their health care system, however, it isn’t a hypothetical about whether or not a single payer system “can” work in the U.S. We already have done a more than 40 year test run on a national single-payer program, and it typically rates very highly on customer satisfaction surveys. Administrative costs in Medicare are also significantly lower than private insurance plans as well. We spend close to 93 cents of every dollar of revenue on medical care in Medicare. With private insurance plans its closer to 80 cents of every dollar.

    When Paul Ryan talked about replacing our single-payer system with vouchers, most analysis indicated that total costs would increase for consumers. When the CBO scored a public option system in the ACA — which was not ultimately adopted — it indicated that the public option, a kind of opt-in form of single-payer, would save taxpayers and consumers money.

    As a side note, Switzerland has a system of private, subsidized and mandated and heavily regulated private insurance; it’s similar in structure to Romney-Obamacare. Switzerland doesn’t have a universal single-payer health insurance system.

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  10. A lot of it has to do with terminology and pejoratives successfully attached to certain words. People know and are familiar with Medicare. So Sanders should rephrase in part, from “Single Payer” to “Medicare for all.”

    Same thing with the word “Revolution”, although when Anderson Cooper of CNN asked Sanders regarding the word “revolution” Sanders responded to the effect of ….there was “the Reagan Revolution,” “the Gingrich Revolution”. I would suggest to Senator Sanders of using instead, the word “Movement.” The word “Movement” come across less threatening (power grab) and more suggestive of a political “invitation; becoming political active; involved; inclusive; etc.

    Same goes for the word “Socialist/Socialism”: Senator Sanders isn’t going around and including that label in every stump speech, you know… screaming out the word “Socialist” in the likes of Senator Claire McCaskill. Dd you know the biggest SOCIALIST in this country is the U.S.Military, Medicare, Unemployment insurance, corporate and agriculturaL subsidies to small and large businesses alike. Even the Too Big To Fail banks (the six largest included) get subsidies, the most famous of them was The Emergency Economic Stabilization Act of 2008.

    Below is a copied excerpt from a NYT reader that pretty much sums many of the thoughts that Hillary Clinton probably doesn’t want you to know about but if you do, it should be just another “smear” that you should brush off with the expression, B.F.D.:

    “How could Bernie Sanders’ questioning of Hillary Clinton’s taking money from Wall Street financiers possibly be “An artful smear?” According to Socrates, one of our fellow readers, Wall Street paid Hillary the following speaking fees in 2013 alone – all in a single year:”

    Morgan Stanley $225,000
    Deutsche Bank $225,000
    Fidelity Investments $225,000
    Apollo Management Holdings $225,000
    Itau BBA USA Securities $225,000
    Sanford C. Bernstein $225,000
    Goldman Sachs $225,000
    Kohlberg Kravis Roberts $225,000
    UBS Wealth Management $225,000
    Goldman Sachs $225,000 (again)
    Goldman Sachs $225,000 (again !)
    Golden Tree Asset Management $275,000
    Bank of America $225,000
    CME Group $225,000

    “Hillary’s TOTAL speaking fee income in just 2013 was $3.2 million from Wall Streeters.”


    “This is factual, Hillary, not a smear. You are part of the problem. Your husband helped overturn Glass Steagall, which deregulated the banks. Your husband had bankers like Rubin running our economy. Your daughter is married to a hedge fund guy and bought an apartment recently for $10M, which covers an entire city block. In 15 years you and your husband accumulated $138 Million. You are part of the 1%.”

    “You are a moderate, and that’s okay. But that’s not we, the 99% need right now. We need a true progressive to fix this corrupt system and to fix the banks.”

    I don’t like seeing politicians attacking each other but Sanders is being too much of a “door mat” to Hillary’s desperate attempt to salvage her billion-dollar-sponsored presidential campaign. She too will end up where Jeb Bush is nowadays….sucking up all the donors’ contributions in expensive hotel stays, swanky dinners, pricey campaign advisors, spending about $2,800+ per vote in Iowa that resulted in about 5 percent of the Republican vote.

    Just can’t say it better myself. Hillary, you’re yesterday and yesterday IS (way) over- http://bit.ly/1PFKB2w

  11. The issue is not complicated. Single payer is more cost effective anf has better overall outcomes than your current model of profit before patient. Your medicare/medicaid and VA programs (single payer, gov’t run) ard the smoking gun to demonstrate the efficacy of a single-payer system. The rest is just noise, designed to confuse and manipulate.

  12. Chuck Todd of NBC/MSNC asking of Hillary: “Are you willing to release the transcripts of all your paid speeches? We do know, through reporting, that there were transcription services for all those paid speeches. In full disclosure, would you release all of them?”

    Hillary has NO PLANS for her nor her campaign staff to release any of the transcripts from any of the paid speeches to the banking community anytime soon; unless she caves into pressure or the delegate vote count increases exponentially for Sanders. However, by then, perhaps a leak or two on Hillary’s innocuous statement about how community banking has helped Middle Class America and how her husband’s economic & banking policies grew the economy (on borrowed credit). In other words, those paid speeches were “thank you” monies for minimizing finance regulations and rules.

    Hillary well knows that releasing any of the un-redacted Wall Street speeches would reveal something a lot closer to the 47% comment Mitt Romney made to wealthy investors and supporters, that later, got caught on tape:

    “Republican presidential candidate Mitt Romney was captured making some inflammatory comments about people who don’t pay income tax in America – the people he says will vote for President Obama “no matter what.” Below, CBSNews.com looks into the validity of his controversial statement.”

    The Quote “There are 47 percent of the people who will vote for the president no matter what. All right, there are 47 percent who are with him, who are dependent upon government, who believe that they are victims, who believe the government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you-name-it — that that’s an entitlement. And the government should give it to them. And they will vote for this president no matter what. … These are people who pay no income tax. … [M]y job is not to worry about those people. I’ll never convince them they should take personal responsibility and care for their lives.”


    “If Buffalo is any indication, the campaign for single-payer health insurance didn’t die with the Affordable Care Act.”
    “The same forces that created the disparity and injustice in our health system shaped Obamacare,” said Dr. Kathleen Grimm, a pediatrician and internal medicine specialist who heads a local chapter of Physicians for a National Health Program.”
    This handy chart compares single payer and the ACA.
    Path Dependence for a Systemic Insurance Dependent Corporate Society that is already TBTF is in the process of consolidating into an even greater TBTF private domain under State Tax enforcement in our social economy. Meanwhile the public non-profit medical hospital system has been gradually forced into reorganization and is more and more taken over by private sector finance that expect to take profits off the top. Rationing by market insurance rates has already become the practicing paradigm, and despite the presumption of insurance coverage the co-pay system has been married to a practice of splicing medical care into office visits to manage physician’s operational expectations and increase revenue streaming per customer. The reality is not being assessed while statistical “improvements” would have us believe we are at a new horizon for quality medical care delivery. What we are currently entering is equivalent to sub-prime mortgages. It is ultimately a bankruptcy plan for American health care that tranches risk and streamlines the derivative distribution of structured health finance and its profit seeking medical marketing share. The price will inevitably far exceed any universal health care structure because necessity knows no law, and price structured medial profits knows no ethical concern and will hold the economy hostage to sustain its own interests.


    Physicians for a National Health Program is a non-profit research and education organization of 20,000 physicians, medical students and health professionals who support single-payer national health insurance.
    Latest PNHP News

    » Dr. McCanne’s Quote of the day: Fri, Feb 5, 2016
    Why it is difficult to make sense of the claims and counter-claims of single payer financing

    » Article of interest: Fri, Feb 5, 2016
    Single-payer health plan wouldn’t cost U.S. more

    » Article of interest: Wed, Feb 3, 2016
    On Kenneth Thorpe’s Analysis of Senator Sanders’ Single-Payer Reform Plan
    Posted on: Wednesday, February 3, 2016
    On Kenneth Thorpe’s Analysis of Senator Sanders’ Single-Payer Reform Plan
    By David Himmelstein and Steffie Woolhandler
    The Huffington Post, January 29, 2016
    PNHP sets record straight on single payer myths
    Pundits and policy wonks alike are propagating myths about single payer. We respond with our own statement, which you can read here, welcoming the debate.
    U.S. already pays for universal health care

    New research shows tax-funded expenditures account for 64.3 percent of U.S. health spending, with public spending exceeding total spending in most countries with universal care. Yet we still leave 33 million uninsured.
    Click here to read the study and our statement.http://www.pnhp.org/news/2016/january/government-funds-nearly-two-thirds-of-us-health-care-costs-american-journal-of-pub


    “Thorpe’s analysis rests on several incorrect, and occasionally outlandish, assumptions. Moreover, it is at odds with analyses of the costs of single-payer programs that he produced in the past, which projected large savings from such reform (see this study, for example, or this one).
    We outline below the incorrect assumptions behind Thorpe’s current analysis:


    The Distribution of Medical Services before and after Free Medical Care — The Quebec Experience
    Philip E. Enterline, Ph.D., Vera Salter, M.A., Alison D. McDonald, M.D., and J. Corbett McDonald, M.D.
    N Engl J Med 1973; 289:1174-1178November 29, 1973
    Source Information
    From the Department of Biostatistics, University of Pittsburgh, and the Department of Epidemiology and Health, McGill University (address reprint requests to Dr. Enterline at 130 DeSoto St., Pittsburgh, Pa. 15261).


    Physician’s Proposal (by PNHP in JAMA)
    http://www.pnhp.org/PDF_files/Physicians ProposalJAMA.pdf
    SPECIAL COMMUNICATION Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance The Physicians’ Working Group for
    JAMA : Journal of the American Medical Association

  18. See? If “health education” begins early enough then the majority of the population, by the time they reach their breeding years, would know what a “parasite” is and would understand that for profit health insurance plays that role (parasitical) at the metamacroorganism level in a “virtual economy”.

    Hypocrisy brings down “empires” every time. It is what you do and not what you say. Every nihilistic “ism” out there today is a turgid plate of hedonistic leftovers served ala anarchy – “eat this and STFU”. Sunday Brunch menu provided by Patriot Act psychobabblists….

    There is nothing “christian” about health care in USA. So out of which level of Dante’s Inferno did it escape into the “material world”? Via a non-intelligent “intelligensia” that speaks to each other in anacronym code?

    Shamans of Gizmology – worst professional priest class ever to roam the planet…..and that says a lot.

  19. A major problem w/ health care today is the cost of adding a year to ones life has continually been rising and would only promise to do so in the future. This is over looked in the name life extension and the cost is passed down to the youth in the name of future care. The quality of life does not improve, just the extended years of suffering so the numbers can do the talking when it comes time to take the money out of the citizens pockets. Health care is a scam where the elderly patient lies in order to get treatment and the doctor is fooled into believing the lies so he can get paid. The patient is saved, the doctor and establishment are paid, and life of suffering goes on for both of them. But the cost of living rises for the rest of society without hardly a whisper from the fooled masses, they in turn are waiting for the day they can be tricked into believing the fountain of youth is just around the corner and the pain of life will soon go away. It’s a rotted system of lies and deception without a proper ending because in the long run, the truth hurts more than the lies and the lie pays more too.

  20. Looking at this:

    Then the obvious solution is not to toss out the baby with the bathwater, but to put some cost sharing back in.

    I feel this falls down in a (at least) a couple specific occasions.

    One — (if one assumes the concept of the cost sharing is to ensure reasonable “compariosn shopping” — is the case of the genuine emergency. Someone heading for a trauma ward isn’t going to be looking at the different options to pick where the ambulance goes. Similarly, back a decade ago when I had a severe pneumonia, when my doctor told me I needed immediate hospitalization, I didn’t go comparison shopping I went to the emergency room my doctor recommended.

    Two — People with genetic/chronic conditions end up getting nickle and dimed with co-pays. While there may be some max out-of-pocket, they can be high enough that the collection of co-pays for someone with a chronic or genetic condition could be required to pay enough that their standard of living ends up different that someone with the same pre-medical income.

  21. Wouldn’t want Hillary and her Sexual Harasser-in-Chief near the White House (again). So much for Hillary’s ‘Feminist’ side.

    If Bernie smears” and “takes a low” the lamestream media ensures everyone hears/reads about Sanders’ political attack. However, if Hillary distorts Sanders’ record, lies, and takes low blows, the lamestream doesn’t do much; as has been reflected by either ignoring, minimizing or reporting her “low blows” towards the bottom of the web site, namely The New York Times.

    As Hillary said in the last debate (on 2/3/2016), let’s argue concerning the issues (and only recently, parroting the same tone and focus Sanders had been advocating from the start of his presidential run).

    So, Hillary, when are you gonna releases the transcripts from your paid speeches at Goldman Sachs if you have nothing to hide? (Chuck Todd of NBC/MSNC asking of Hillary: “Are you willing to release the transcripts of all your paid speeches? We do know, through reporting, that there were transcription services for all those paid speeches. In full disclosure, would you release all of them?”)

    The truth of the matter is that Hillary has NO PLANS nor from her campaign staff to release any of the transcripts from any of the paid speeches to the banking community, at least, anytime soon. Unless – she eventually caves in to pressure or the delegate count increases exponentially for Sanders with each primary. Perhaps, by that time, a leak or two of Hillary’s innocuous statement about how community banking has helped Middle Class America and how her husband’s economic & banking policies grew the economy (on borrowed credit), she would be more than happy to release the transcripts. In other words, those paid speeches were “thank you” monies for minimizing finance regulations and rules during Bill Clinton’s presidency and the likes of Goldman Sachs hopes to strike it rich again, with a Hillary Administration.

    By the way, candidates Sanders reported earlier today (2//716) that Goldman Sachs’ CEO, Lloyd Blankstein, is saying Sanders is “dangerous”. Yeah, “dangerous” because a Sanders Administration would stop the revolving door from government to Wall Street and from Wall Street back to government. A Sanders Administration would stop the socialized gravy train for Wall Streeters and the billionaire class: the Left likes to call it “Socialism for the rich”, while the Right calls it “crony capitalism.” And what would Hillary call it? Probably describing wealth, power & Wall Street as an “Opportunity” to enhance her political resume while at the same time, monetizing her personal fortunes so she can run for silly things like, the POTUS.

    “Medicare for All” – end of story!
    Could releasing any of the un-redacted Wall Street speeches Hillary gave in the last three years or so reveal something a lot closer to the 47% comment Mitt Romney made to wealthy investors and supporters, that he, later got caught on tape, saying?

  22. @Skunk – you are talking about Cheney, right? Compare Cheney’s medical bill shoved at taxpayers and Jimmy Carter’s….wow!

    Now add a couple of trillion for “adventures” Cheney had playing the VP to the dry drunk Prez…and there’s your suck out algorithm launch that brought down the “economy”.

    That suck out algorithm was created, btw, by Math God worshippers INSIDE Pfizer. Yup the circle jerk between Wall Street and pharma is REAL. Cannibal capitalism….and they do have it down to a science of hate.

    Let me do basic math here – there is not enough “income” among healthy people left to support any given – rich or poor – 1% of the population’s niche health issues.

    For profit health insurance is a PARASITE.

    ACA health insurance is all about the $6,000 deductible. There is no “coverage” until you are out 6K PLUS the premiums. That’s sick.

    As for “research” benefiting from all that GIGO technology that analyzes DNA, why is that not leading to quick control of epidemics? But we are supposed to “believe” that we can manipulate HUMAN genomes when bacteria DNA is beyond our ability to control??!!

    I have a bridge for sale in Brooklyn, but Shkreli already sold it….go figure…

  23. Yes Annie, the scales of justice are tilted against women, bridges or no bridges, sold or not sold, satan has controlled every aspect of human life in the name of cheney and many others. Do the math, a reset is do, the odds can be overcome, his behavior is reprehensible, disgusting, unforgivable, and generally hideous.
    He has had his due and yet never satisfied, no more research needs to be done, the facts are in, his denial is set in stone, his appeals are exhausted, his execution date is approaching, he is blind, clueless, deaf and dumb, all these things are known. No one shall be more satisfied once he is gone than me, trust me on that, it’s my life’s work in the shadows, behind the scenes, and in the dark.
    He is out of control and in the majority, against the laws of nature, we are out manned yet not outgunned. Have faith that he shall be removed soon and replaced with a more forgiving, docile representative, for if not, the scales will never be balanced, and justice never done.

  24. The basic point in your analysis seems to me erroneous. You state: T”he first, simplest, and most obvious is this: Even if Sanders’s plan has problems, if the goal is single payer, then Sanders is the only choice. We know a Clinton nomination will bring us no closer to single payer.” The true goal is, or should be, to improve the delivery of health care. If you believe that a Sander’s nomination would be a political disaster — that he has little chance of winning and that, even in the unlikely case that he won he would have virtually no chance of having a single payer plan enacted into law — than Clinton is your only choice. If you believe she has a significantly better chance of being elected, the prospects of better health care compared to what would be achieved with Republican control of the Congress and the Presidency is much better. Moreover, your analysis proceeds on the basis that Clinton would not seek to expand coverage under Obamacare and would ultimately seek to move closer to a Swiss type system of a single payer system. If you want to see the delivery of health care improved, rather than make political gestures and achieve the pleasures of righteous indignation, than Clinton is your only choice.

    Your economic analysis, does not suggest otherwise. If you stipulate that that single payer is likely more economically efficient than it follows there is a good argument that even if its costs are higher, it is because it is delivering more in value in health care delivery. It says nothing about what its costs would be, the feasibility of getting the population that would have to bear those costs to do so, or the political feasibility of having such a plan enacted.

  25. @Oxbird – Everything is flawed, that’s the point. What are you offering in the way of solutions to “health care” problems? Let me re-read, uh, nope you got nothing.

    NONE of the candidates running for Prez on either side are mythical beings who have the power to do ANYTHING other than to continue to steal lie and murder for the 1%. You heard me. That’s the power they are grasping for, isn’t it? To be ABOVE the law? And what kind of contortionism of “thinking” will you apply to the fact that the IRS can levy a FINE against a citizen if they do not BUY for-profit health insurance? What’s next in the stealing gig? IRS fines if you do not buy Starbucks?

    The debates are nuts. Candidates falling all over themselves to say what great lengths they would go to to get one “American” hostage back – (“see how great USA “values” are…how much USA cares about its citizens”?) –

    when the entire country has been held hostage, suffering psychically the most (hence the opium rampage) inside a broken economy since the “flash crash”….you political wonks are crafting a “Nero” playing a fiddle as Rome burns to sell to us – how sick are you?

    We already have “progressive socialism” – Banks got bailed out, we got sold out.

  26. James, I don’t understand why in Thorpe’s analysis, costs due to administrative savings decline by only 4.5%. Under Obamacare, insurance carriers are required to spend 80% of premiums for health care costs. I recognize that not all the difference (100% – 80%) that insurance carriers are entitled to keep is profit, but surely there is more than 4.5% in profit. Jonathan Skinner and Elliott Fisher claim that 20% of Medicare expenditures appears to provide no medical benefit “in terms of survival,” but if we look at the administrative efficiency of social security is such that only 1% of total SSA expenditures go for administrative costs. So clearly, there are much larger savings to be realized from single payer, run in a reasonably efficient manner.

  27. Obama criticized Wall Street bankers during his 2008 presidential campaign, then admonishing them in early 2009 during his first 100 days in office. Then, at the suggestion of his transition team, Obama started to nominate and placed Wall-Street friendly cabinet members and advisers (Chief of Staff, Treasury, Chief Economic Adviser, Undersecretary of the Treasury, Federal Reserve appointments, Trade (to support the TPP and the continued outsourcing of U.S. jobs and relinquish U.S. sovereignty).

    I would expect the same of Hillary, should she dare get elected. What will be her reasoning if not her excuses, then? They made me sign that treaty against my will; the bankers made me accept those huge speakings fees; I’m not the only one that takes Wall Street money and voted for the Authorization to go to war in Iraq; my husband’s Clinton Foundation does good that overrides concerns about the donors to the Foundation, such as Saudia Arabia.

    Obama eventually, during his time in office, turned his back on his voters that worked hard to get him elected by first ignoring, then dismissing, and rhetorically providing unflattering responses to his supporters that continued to clamor on their issues. Obama abandoned his supporters by relegating theirs issues to the backburner, and pivoted his focus instead, in currying favors from Republicans – describing it as ‘working with my colleagues across the aisle.’ Eventually, he was more concerned with the optics and less about income inequality, American jobs, and the environment (e.g.; approving drilling in the Artic). The only reason The Affordable Care Act passed was because the corporate healthcare lobbyists won the battle and Obama realized for himself, that he could enshrine his name into the history books by being the first President to have national healthcare legislation.

    In New Zealand many of the Trade representatives signed their approval and names to the Transpacific Trade Agreement (TPP) however, the U.S. lamestream media was nowhere to be found in their reporting of the signing – explaining why the other nations wanted the signing to take place in some obscure setting, like New Zealand.

    By the way, a flashing news update from Politico:

    “MANCHESTER, N.H. — Hillary Clinton still has defeated Bernie Sanders in the Iowa Democratic caucus, but an internal party review released Sunday found new errors in the original count that further narrowed her margin of victory — a result that’s likely to keep scrutiny on the caucus state while the rest of the country looks to New Hampshire.”

    “The audit by the Iowa Democratic Party discovered errors in five of 14 precincts across the state from Monday’s caucuses that shrink Clinton’s overall advantage in the key delegate results to a 0.25 percent lead over Sanders, down from 0.27 percent.”

    Reference: http://www.politico.com/story/2016/02/iowa-sanders-clinton-audit-218905#ixzz3zd5jHn8u

  28. http://www.publicintegrity.org/2015/01/26/16658/health-insurers-watch-profits-soar-they-dump-small-business-customers

    The only people who are Democrats today are the ones who know that they are the political “party” that can still mint oligarths through legislation.

  29. What were the odds, how steep was the climb in 1778 when the American colonists were out-numbered, out-gunned by the British military – were the colonists thinking… it can’t be done, Vern!

    So, back to Hillary’s paid speeches that she says she won’t release unless other politicians do the same…. is she referring other Presidential Candidates and/or any politician including Democrats?

    According to attendees at some of her paid speeches, this was Hillary Clinton’s real thinking:

    “NEW YORK — When Hillary Clinton spoke to Goldman Sachs executives and technology titans at a summit in Arizona in October of 2013, she spoke glowingly of the work the bank was doing raising capital and helping create jobs, according to people who saw her remarks.”

    “Clinton, who received $225,000 for her appearance, praised the diversity of Goldman’s workforce and the prominent roles played by women at the blue-chip investment bank and the tech firms present at the event. She spent no time criticizing Goldman or Wall Street more broadly for its role in the 2008 financial crisis.”

    Read more: http://www.politico.com/story/2016/02/clinton-speeches-218969#ixzz3zj4kZdqH

  30. I am very sorry to be coming to this conversation so late, but I felt I had to add my two cents. Buried in Bruce Woych’s comments above is a single sentence — “U.S. already pays for universal health care” — that I think is the last word in the total cost argument. You don’t need a sophisticated analysis to say that everyone who has a medical problem either (1) gets treatment on time, (2) gets it later, or (3) gets it too late or not at all. The cost of treating those in the first group should not change under the current system or single-payer, except for those who are not insured and get that care in an Emergency Room, perhaps the absolutely most expensive place they can get treatment. So for those who get immediate treatment, costs should stay the same or go down. Those who get it late under the current regime, presumably because they don’t have insurance or can’t/won’t pay, would cost less in a single-payer system because they wouldn’t have to wait until their condition deteriorates, thereby making treatment more expensive. Those who get it too late or not at all either die or become chronically ill. From even a selfish economic standpoint, treatment ought to be cheaper than death or permanent disability for the vast majority of situations.

    Would people go to the doctor for frivolous things? Perhaps. But there is no way that such increased usage would be more expensive than insurance company profits and unnecessary overheads (e.g., advertising) compared to a single payer administrative system.

    Yes, we already pay for universal health care. But the unlucky among us never receive it.

  31. Yes Frank, except the unlucky ones become unlucky from the same system which brought them to doctor or hospital to begin with. The knowledge to keep citizens from the doctor, dentist, and Emergency Room is well known. It’s arrogance,(the obstruction of wisdom), and greed of, (guess who), that prevents this knowledge from entering our educational system and doing its job over the long term.
    Our gvt is all short term self interested ideals, which become prohibitively expensive in the long run and lead to debt levels which can never be payed back. Which in turn create additional burdens to society at large leading to greater costs to the general public. It,(and he) can’t, and will not be, sustained.