"Some men see things as they are, and ask why. I dream of things that never were, and ask why not." - Sen. Robert F. Kennedy, 1968
It is really of no moment whether or not the mainstream media was correct when it proclaimed that "Medicare-for-All" will be "dead-on-arrival in a Republican-controlled Congress."
Politically, the decision by Sen. Bernie Sanders (I-VT), together with 16 co-sponsoring Democratic Senators, to introduce a new "Medicare-for All", single-payer healthcare bill, must be seen as a stroke of political genius --- a strategy that could provide a path to securing Democratic majorities in both Houses of Congress as a result of the 2018 midterm elections.
Most Americans, including the author, thought the national trauma occasioned by "repeal and replace" ended on July 28 with the dramatic thumb down presented by Sen. John McCain (R-AZ). But, alas, like a zombie, another monstrosity --- the Graham-Cassidy-Heller-Johnson ACA repeal bill --- has arisen from the crypt of its legislative graveyard. And this time, the desperate hope was to move so swiftly that the Congressional Budget Office (CBO) will not have time to score it.
According to the Center for American Progress, Graham-Cassidy would not only add 32 million to the ranks of the uninsured but create huge premium surcharges for pre-existing conditions, ranging from $17,320 for pregnancy to $142,650 for metastatic cancer.
Republican willingness, indeed outright audacity, to repeatedly bring back a legislative obscenity that elicits as little as 12% support amongst the American electorate, is, in part, reflective of the tactically flawed strategies of their Democratic opposition.
Tactically, with the 2018 midterms on the horizon, the introduction of a "Medicare-for-All" --- a single-payer healthcare bill that by every objective measure is vastly superior to our existing corrupt, inefficient, dysfunctional and deadly government-subsidized, "free market" system --- has the potential to be a game changer, especially if the latest "repeal and replace" measure somehow defies the momentary odds and succeeds...
Best defense, a good offense
The gist of advice provided by political and military strategists as diverse as George Washington, Machiavelli, and Mao is that "the best defense is a good offense."
For the past nine months, the Democratic minority in the U.S. Senate, bolstered by great numbers of ordinary citizens who took to the streets as part of the "Resistance", have principally occupied the role of static defenders of a deeply flawed status quo, to wit: the Affordable Care Act (ACA, or "ObamaCare").
Despite modest improvements from the previous "free market" system in terms of its expansion of coverage and the elimination of insurance carrier denials for pre-existing conditions, the ACA has still failed to deliver "affordable" healthcare to 28.2 million uninsured Americans, failed to address "under-insurance", failed to prevent sharp annual spikes in premiums, and failed to prevent predatory price collusion amongst the profit-driven pharmaceutical and health insurance industries.
The beauty of introducing a "Medicare-for-All" alternative --- a measure that is now supported by the ACA's principal architect, former Senator Max Baucus (D-MT) --- is that it has allowed Sen. Sanders and his Democratic co-sponsors to seize the initiative by presenting an already popular alternative that could help to draw a bright line between the Republican-supported legislation that was appropriately derided as #wealthcare and a vastly superior Democratic initiative that would provide quality healthcare to every man, woman and child in the U.S. at a fraction of the current spiraling cost.
For Republican Senators, like Nevada's Dean Heller --- already considered amongst the most vulnerable because of his "yes" vote for the GOP's so-called "Skinny Repeal" attempt, which would have added 32 million Americans to the ranks of the uninsured --- the contrast between his sponsorship of the latest ACA repeal bill and a "Medicare-for-All"-supporting Democratic opponent could well prove decisive during the all-important 2018 midterm election.
Polling and the 2018 election
Healthcare polling suggests that if the Democratic Party unified behind "Medicare-for-All" as a fundamental right, it could portend to a Democratic landslide in the November 2018 midterm elections.
While, at this point, there is uncertainty as to whether the ACA will be repealed prior to the 2018 election, there is no uncertainty as to where the Republican Party stands. Both the President and Congressional Republicans have made it abundantly clear: they are willing to throw an additional 32 million Americans off of healthcare in order to secure massive tax cuts for the billionaire class --- a travesty that has been supported by as few as 12% of the electorate.
This stands in sharp contrast to the percentages of Americans who already support "Medicare-for-All."
As observed by The Washington Post, a significant majority of Americans would prefer a single-payer healthcare system. Nonetheless, Sanders made the correct call in labeling it as a "Medicare-for-All" system, which is more easily understood by many because, as observed by TPM's John Judis, it entails not a new and untested healthcare delivery system, but, instead, is seen as simply the expansion of "a system that works and has remained intact for over fifty years."
The Economist/YouGov poll issued earlier this year found that 60% of all Americans support the expansion of Medicare to all Americans; 17% are undecided and only 23% opposed it.
By uniting behind "Medicare-for-All", Democrats could frame the midterm as a choice between healthcare as a fundamental right to be guaranteed for all, regardless of economic status vs. healthcare as a wealth-enhancing commodity that principally exists for the benefit of the privileged few. That frame could increase support for "Medicare-for-All" to 75% of the electorate, or higher, by adding the current undecideds to those who already support it and perhaps others. According to The Economist/YouGov Poll, only 13% "strongly oppose" "Medicare-for-All" --- a number that coincides with the scant support for #wealthcare.
The current U.S. healthcare system is extraordinarily expensive, yet remarkably inefficient.
The U.S. spends nearly two and one-half times more per capita for healthcare than the average per capita healthcare expenditures amongst the 34 single-payer nation-members of the Organization for Economic Cooperation and Development (OCED). For example, U.S. per capita expenditures in 2013 ($8,713) nearly tripled the per capita expenditures in Britain (U.K.) ($3,235). By July, 2016, per capita healthcare expenditures in the U.S. had risen to $10,345.
According to a 2014 Commonwealth Fund study, however, the U.S. healthcare delivery system ranked dead last amongst eleven industrial nations in terms of "quality, efficiency, access to care, and healthy lives." Indeed, citing its own healthcare efficiency index, Bloomberg reported last year that the U.S. healthcare system is one of the world’s "least-efficient," ranking 50th out of the 55 countries measured in 2014. The Commonwealth Fund study ranked the U.K., which offers not only single-payer but a fully government-run healthcare system, as number one.
It isn't just that we pay much more for less. Our profit-before-people healthcare system, even under the ACA, often imposes harsh economic tolls on those who have to choose between food and the cost of medicine. Each year, more than 770,000 Americans file for bankruptcy because of unpaid medical bills.
In single-payer countries, no one is ever forced into bankruptcy by reason of unpaid medical bills.
Our exorbitantly priced, government subsidized "free-market" healthcare insurance system isn't just inefficient. It's morally repugnant.
In 2009, prior to implementation of the ACA, some 50.7 million Americans were uninsured. That figure translated into an annual death sentence for nearly 45,000 uninsured Americans, according to a 2009 Harvard Medical study [PDF]. That's more than seven and one-half (7 1/2) times the number of Americans who perished during the Pearl Harbor and 9/11 attacks combined.
The number of uninsured American annual deaths were no doubt proportionately pared down, but not eliminated, because ACA reduced the number of uninsured Americans from 50.7 million to 27 million. If the ACA were repealed via any of the heretofore defeated "replacement" bills, the death toll would again climb.
No one dies from lack of coverage in single-payer countries.
And, it isn’t just individuals who suffer. Much of the exorbitant cost of our "free market" healthcare system falls upon employers, like Richard Master, the CEO of MCS Industry, who complained during the Sept. 13 Sanders news conference that he is laying out $10,000/year per employee for health insurance coverage --- an expense that is not borne by employers in single-payer countries.
In a global economy, the burden of the U.S. healthcare system --- a burden that accounts for nearly 18% of our GDP --- places employers like Master at a competitive disadvantage. And the problem is getting worse. Earlier this year, the Center for Medicare and Medicaid Services (CMS) estimated that our healthcare costs will grow an average of 5.6% annually, reaching nearly 20% of GDP by 2025.
That estimated annual cost increase may actually be conservative. Anthem/Blue Cross is seeking to justify a 35% rate hike next year in California based on the anticipated cost increase for prescription drugs. That, as a separate lawsuit takes on an alleged fraudulent health insurer/pharmaceutical price-collusion scheme designed to inflate the price of prescription drugs so that those who have insurance pay more in co-pays to the pharmacies than the cost of the same medication charged to uninsured patients.
The remarkable feature of a single-payer system is that it guarantees healthcare for all at a fraction of the cost for a dysfunctional system that still leaves 27 million Americans without any insurance whatsoever.
In a 2013 study [PDF], University of Massachusetts-Amherst Economics Professor Gerald Friedman estimated that H.R. 676, the federal single-payer healthcare system proposed by Rep. John Conyers, Jr. (D-MI), would save $1.8 trillion per decade while benefiting 95% of U.S. households. "The U.S.," Friedman concluded, "could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion)."
While Sanders, who has listed a series of finance options, has deferred the question of precise funding mechanisms to subsequent Committee hearings, if the Senate financing options ultimately track with the House version, all but the wealthiest of Americans would pay far less in new taxes than they do now for insurance premiums, co-pays and deductibles, according to Prof. Friedman.
Thus, by every measure, other than the politics of the powerful interests of those making a killing off of our current dysfunctional and deadly system, the adoption of the Sanders "Medicare-for-All" bill should be a no-brainer. And, by introducing the measure at a time when Republicans have dared to re-double down on a manifestly unpopular "repeal and replace" scheme, Sanders and his Democratic co-sponsors may well have erected "the" defining issue for the 2018 midterm elections.
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