Team Clinton decides that “Medicare for all” is Actually Bad

During the last Democratic debate, Hillary Clinton took a shot at Bernie Sanders’s domestic policy agenda by citing a thoroughly-discredited price tag pulled straight from the Wall Street Journal:

But I want to quickly say, one of the areas that Senator Sanders touched on in talking about education and certainly talking about health care is his commitment to really changing the systems. Free college, a single payer system for health, and it’s been estimated were looking at 18 to $20 trillion, about a 40 percent in the federal budget.

$15 trillion of that “18 to $20 trillion” figure comes from single-payer health care, and it’s true that an analysis of legislation Sanders proposed in 2013 that would have enacted a single payer system came up with that level of government spending over a ten year period. Nationalized health care is expensive.

However, it’s a lot cheaper than private health care, which is currently on track to cost the American people close to $42 trillion over the next ten years. That’s why the analysis from which both Clinton and the Wall Street Journal get their eye-popping price tag is titled “How we can afford a national single-payer health plan.”

Sanders said as much during the debate, and multiple journalists said as much afterward. It didn’t matter. Since then, Clinton and her campaign have repeated and escalated their attacks on single-payer health care. Now, not only is Sanders’s plan to lower American health expenditures nearly two thirds too expensive, his universal health care plan will actually result in fewer Americans having access to health care. From MSNBC:

The Clintons on inauguration day, via Wikimedia Commons

The Clintons, via Wikimedia Commons

Stumping for her mother for the first time in 2016 on Tuesday, Chelsea Clinton directly criticized Bernie Sanders on health care policy, echoing Hillary Clinton’s recent attacks on the Vermont senator.

Asked about mounting enthusiasm for Sanders among young people, the daughter of the Democratic presidential frontrunner urged younger voters to focus on the “specifics” of Sanders’ policy proposals.

Sen. Sanders wants to dismantle Obamacare, dismantle the CHIP program, dismantle Medicare, and dismantle private insurance,” she said during a campaign stop in New Hampshire. “I worry if we give Republicans Democratic permission to do that, we’ll go back to an era – before we had the Affordable Care Act – that would strip millions and millions and millions of people off their health insurance.

Focusing on the “specifics” of Sanders’s proposal for single-payer health care would require Clinton to disclose that after dismantling Obamacare, CHIP, Medicare and private insurance, all of those things would be replaced by what Sanders has consistently described as “Medicare for all.” Instead, she’s found a different way to make the same kind of disingenuous claim about the consequences of single payer. On the cost side, Clinton’s camp zeroes in on everything that happens after the new system is implemented, ignoring the savings realized by eliminating the existing system. On the benefits side, Clinton’s camp ignores everything that happens after the new system is implemented, zeroing in on all of the benefits Americans currently receive. In neither case is the plan considered as a whole — perhaps because 81 percent of Democrats (and 58% of all US adults) support the idea.

The Clintons’ claim that Sanders’s proposal kicks health insurance back to Republican controlled states is also wrong. The legislation Sanders proposed in 2013 would require every state to set up their own single-payer system under a federal umbrella, which Clinton has used to claim that — a la Republican states’ refusal to set up health insurance exchanges or accept the Medicaid expansion under Obamacare — Sanders’s bill opens the door for millions of Americans in red states to be denied health insurance. As The Week’s Ryan Cooper responded today, this is bunk:

[Sanders’s bill] would require each state to set up its own single-payer plan, and fold all existing federal health care programs, except for Veterans Affairs, into that system. While one might criticize that structure…it is emphatically not optional. Under his plan, a federal board will oversee the system as a whole and take direct control of any state program that doesn’t meet its requirements.

This makes red state non-compliance with Bernie’s plan less like the Medicaid expansion and more like insurance exchanges. Republican governors couldn’t massively resist the program, they would simply face the choice of setting up their own program or folding in to the federal government’s version. Everyone would be covered one way or another.

As Paul Waldman wrote in the Washington Post today, if Clinton wants to hit Sanders over single-payer, there are more honest and, frankly, more popular ways to do it. Given that Democrats are practically guaranteed to have a minority in the House and, at best, a majority in the Senate that can’t break a filibuster, there is absolutely no hope for Sanders’s single-payer plan to become a reality. So Clinton could say that she’s on board with Sanders’s ideals, but that’s all they are: ideals. She could say that she lives in the real world, and is interested in actually passing legislation that expands access to health care — however incremental that legislation may be. That may not sound exciting to the progressive base, but they’d probably shrug their shoulders and count it as an acceptable disagreement.

That isn’t what she’s done, though. From Waldman:

She’s making a second kind of argument, that single-payer is itself a bad idea — not that we might like to do it but we can’t, but that it fails on the merits.

To oversimplify a bit, the first argument is one you make to Democrats, and the second argument is one you make to Republicans, and maybe to independents. But we’re in the middle of a primary.

This back-and-forth over whether truly universal health care is good, or whether it’s Actually Bad, is part of the broader debate emerging between Sanders and Clinton over whether taxes can ever be good, or whether they’re always bad. By making a big deal out of single-payer’s price tag, Clinton is implying (correctly) that single-payer costs too much to fund solely through taxes on the wealthy. Ordinary Americans will have to give more money to the IRS in order to make it happen. Sanders is fine with this, and is betting that most voters will be too so long as that extra money they give to the IRS is less than the money they no longer have to give to their private insurer.

This argument is all but guaranteed to come up on Sunday at the next democratic debate. And both candidates think it’s an argument they can win. Clinton will just have to bring Republican talking points to a Democratic debate in order to do so.

Jon Green graduated from Kenyon College with a B.A. in Political Science and high honors in Political Cognition. He worked as a field organizer for Congressman Tom Perriello in 2010 and a Regional Field Director for President Obama's re-election campaign in 2012. Jon writes on a number of topics, but pays especially close attention to elections, religion and political cognition. Follow him on Twitter at @_Jon_Green, and on Google+. .

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