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  September 13, 2017

Single-Payer Healthcare Takes a Big Step Forward


Wednesday was a historic day in the U.S. struggle for universal health care as key Senate Democrats joined Sen. Bernie Sanders to unveil a single-payer bill. We speak to economist Dean Baker and Saikat Chakrabarti of Brand New Congress
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biography

Dean Baker is co-director of the Center for Economic and Policy Research in Washington, D.C. He is the author of several books, his latest being "Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer".

Saikat Chakrabarti, the Executive Director of Justice Democrats.


transcript

Single-Payer Healthcare Takes a Big Step ForwardAaron Maté: It's The Real News. I'm Aaron Maté.

A historic day in the struggle for universal healthcare in the U.S. Senator Bernie Sanders has unveiled his bill for a Medicare for all, single-payer system. It joins a similar measure in the House, H.R.676 sponsored by John Conyers. Now, the Sanders bill has almost no chance of passing the Republican-controlled Senate, but it's still a major turning point. Joining Sanders are a number of prominent Democrats openly supporting single-payer for the first time. Many of them are expected to run for the White House in 2020. That's a major change from recent years when no Democratic hopeful, except for Sanders, was willing to back single-payer. But now it appears no Democratic candidate can ignore its momentum.

In a further sign of this shift, opponents of single-payer are voicing new alarm. Here, for example, is Brent Saunders, head of the pharmaceutical giant Allergan.

Brent Saunders: I think we've got to do things to bring that trust back because ultimately someone's going to be in the White House, somebody's going to be in Congress, someone's going to be somewhere and going to have to say, "Enough's enough. Let's just change the whole system. Let's go to one payer. Let's do something." The left of their party has gotten a lot of voice and taken control, and so Bernie Sanders and others in that movement have really tried to vet candidates. On the opposite side of the coin is the Tea Party one. So we're seeing the divide go further, and clearly, that part of the party wants to go to a one-payer system.

Aaron Maté: Saunders was speaking at a recent industry conference in Boston.

Here also is how a panel on the Fox Business Network responded to Sanders' bill.

Fox News Guest: Unfortunately, much of the country is behind this. They really believe that healthcare is a right, that insurance companies are really mean to you if they turn you down, if you have a pre-existing illness. That's where the country it. I wish I could say the country would like to get rid of Obamacare and replace it with free markets, but that's not where the country is. Sorry.

Fox News Anchor: I think you're right. I think many Americans are going down the European road. It's a disastrous road.

Fox News Guest: Absolutely.

Fox News Guest: I think that's where we're going.

Aaron Maté: Joining me now is Dean Baker of the Center for Economic and Policy Research, and Saikat Chakrabarti is a co-founder of the group Brand New Congress. Welcome to you both. A lot to get to including the details of Sanders' bill, but I'm wondering first off, both of your reaction just to the political significance of what Sanders is doing today. He's unveiled many single-payer measures before in the Senate, has not gotten very much support. Today though, he unveils it with 16 co-sponsors. Very historic. Dean, we'll start with you.

Dean Baker: Yeah, it's fantastic. I just have to make a digression. You mentioned that the representative from Allergan. They were in the news last week because they had turned over a patent to an Indian tribe as a way of protecting it against a challenge saying that the tribe enjoys sovereign immunity. I just think that speaks to the credibility, integrity of the people we're dealing with here.

In any case, it's an enormous step forward because before Bernie Sanders had been sort of a lone wolf out there yelling for single-payer. Now we have 16 co-sponsors, many of the most prominent Democrats in the Senate, people who are looking to run for president in 2020. This is not a fringe measure anymore.

The other thing that I like, that I just think is really great about the bill, it's a slice and dice. We're not going to go to single-payer all at once. He's talking about bringing in people age 55 and under 18, then making it 45, then 35. I think that's the sort of thing we have to talk about. That's how we're going to get there. We're going to do it piecemeal. We're not going to do it all at once. It's very hard to see administratively. It will scare people to death. This is the sort of thing that we can do it in steps, and it just opens the door for all sorts of different steps forward now.

Aaron Maté: Saikat, your group Brand New Congress has been incredibly active on this issue of Medicare for all. Your reaction to seeing Sanders unveil this measure with so many Senate colleagues on the Democratic side of the aisle today?

Saikat Chakrabarti: It's absolutely huge because you mentioned, yes, it's unlikely to pass in the Senate, House. But all of these Senators who have just signed on this bill, they're not committed through 2020. I think I saw someone say the other day, I don't know if every Democratic presidential candidate is going to run on single-payer, but we do know the winning one is going to. So to me, having so much support, this just shows us ... Just a year, year and a half ago, everyone was saying Medicare for all is impossible, it's never going to happen, and now we're hearing Fox News talk about how it's the leading, most popular healthcare system in America. It's inevitable. And I think the Democratic Party, the people who are following Bernie's vision, they're realizing that, and they're realizing that they have to get on board if they want to have any political future in this country.

Aaron Maté: Saikat, talk about how we got here. Obviously, Sanders deserves a ton of credit. He campaigned on this during the primary. But it's also been grassroots groups like yours who have been out there organizing, trying to get this on the map and trying to make this really an issue for Democratic candidates. Talk about the organizing that's been done.

Saikat Chakrabarti: Absolutely. It's been sort of a two-pronged approach. Just as Democrats and Brand New Congress has been working together with the nurses to push H.R.676 in the House, we've gotten that from 72 co-sponsors to 118. John Conyers, who's the person who presented that bill, he's been presenting that for over a decade, never got support on it, and this year all of a sudden he's got more than half of the House Democrats on board. It's been a combination of these huge pressure campaigns. Bernie Sanders really did ignite this political revolution in this country, and that's continuing on. The people who were inspired by Bernie Sanders' message in the primary, they are jumping on board. Any time you put out and ask these people, everybody is energized or engaged and they want to do things.

But the other thing, and this is the important part, is we are putting primary challengers against those people who are not getting on board with the message. People who are not supporting single-payers, Medicare for all solutions, people who are not supporting free college tuition, people who basically are showing that they don't have a vision for how to actually move this country forward, we don't think they deserve their jobs. So we're putting primary challengers against them, and that's putting pressure on them to either come on board or to lose.

Aaron Maté: Have you already identified specific candidates who your group is going to be challenging?

Saikat Chakrabarti: Yes, we have. Just as Democrats and Brand New Congress, we have 16 candidates already on board or running in primary challenges. Probably the most prominent one there is we have Paula Jean Swearengin running in West Virginia against Joe Manchin. We actually even saw Joe Manchin earlier this week all of a sudden say maybe we should consider single-payer. I think he went back and probably noticed who his donors were and quickly backtracked a bit. Paula Swearengin running on Medicare for all. She's running for a living wage, free college tuition, and around a plan for massive industrial expansion in West Virginia, an industrial investment there.

Another prominent candidate we have in New York, Alexandria Ocasio-Cortez. She's running against Joseph Crowley. We don't hear about Joseph Crowley very much, but he's one of the major funders for the Democratic Party. He gets all his donations from Wall Street and big pharmaceutical companies. And he's, I think, third in line for leader in the Democratic Party. That's us really going straight for the top and trying to take over this party.

Aaron Maté: Right. That's one window into how this rift over single-payer is playing out. But I also want to talk about some of the pushback it's going to get on the elements of the bill itself. One of the big ones is how to pay for it. How do you pay for this massive expansion of healthcare and this radical overhaul of the system? On this point, Dean, I want to play for you a clip from Hillary Clinton. She's now on the book circuit promoting her new memoir, her campaign memoir, ‘What Happened’. On Tuesday, she spoke to the outlet Vox, and she was asked about Bernie Sanders' plan, and this is what happened in that exchange.

Ezra Klein: Do you think that the Democratic Party should sign on, even aspirationally, to a bill that is that radical in its vision?

Hillary Clinton: I don't know what the particulars are. As you might remember during the campaign, he introduced a single-payer bill every year he was in Congress, and when somebody finally read it, he couldn't explain it and couldn't really tell people how much it was going to cost. I haven't seen whatever it is they're going to be introducing and signing on to, so I don't know.

I think it's going to be challenging if within that bill there are tax increases equivalent to what it would take to pay for single-payer. And if you're really telling people, about half of the country, that they can no longer have the policies that they have through their employers, I've been down this road, this is not the first time we have tried to confront this.

Aaron Maté: That's Hillary Clinton speaking to Vox. Now, Dean, Clinton famously said during her primary fight with Sanders that single-payer would never ever happen. That's just a striking contrast to now when anyone who is being considered as a likely Democratic hopeful in 2020 is now signing on with Sanders to try to make it happen. But let's address the issue that she raises here, which is how to pay for it. It's true that Sanders' measure does not say much about how he's going to finance the cost of this radical overhaul.

Dean Baker: Obviously, paying for it's a big deal. I have to say I read through what he wrote about his plan in the primary campaigns, and I don't think the numbers added up. So getting from here to there will be a big step, and that's part of why I think it's so great that he's proposing to phase this in because we're going to have to do two things.

On the one hand, we're going to have to phase in cost controls. That means a lot of people are going to get less. It means their drug companies will get a lot less money. It means our medical equipment companies will get less. It's going to have to mean our doctors get less. Our doctors get paid twice as much as our counterparts in Canada and other wealthy countries. Sorry, that's too much, guys. So we're going to have to cut that back. But we're not going to be able to do that all at once. We're going to have to do that piecemeal.

We're going to have to raise additional revenue here, but the basic story, people are scaring everyone with taxes. No one gives a damn whether the money that your employer pays to the health insurance company instead goes to the government as taxes. I don't know anyone who would really care about that. That's the process that we're basically talking about here. But that is going to be difficult to do all at once, so the idea that this be phased in ... This bill proposes it over four years. I know some people might object to it, but I won't care whether it's over eight years or ten years. The point is to get there, and this is the way to do it.

Aaron Maté: Right. That's a key point there. Under the current system, it's either on individuals or on employers to cover the bulk of cost for purchasing plans. Under the new system, they would have to change that. What then are the other options? What are some progressive revenue options that could actually pay for this?

Dean Baker: Again, getting much of the money that employers or all the money that employers are paying now for employer-provided insurance, that gets you a big chunk of the way. But again, we have to reduce cost. The big one is prescription drugs, and this is something I've written about. It's, to my view, just an enormous scandal because you're charging people in some cases over $100,000 a year, say, for the new cancer drugs that are being developed. Those drugs don't cost $100,000 a year. I would say they don't cost $1,000 a year.

What they're doing is saying, "Okay, we have to recover the research cost," which there's more than a grain of truth to that. Research is expensive. Obviously, a big chunk of that is profit. But the question is at what point do you pay for the research? I've argued, as have others, Joe Stiglitz is probably the most prominent, we should pay for the research upfront. Let's pay the drug companies to do the research. We'll contract with them. And then it's all in the public domain, and it's all sold as generics.

Then we done have to figure out, "How am I going to get the $100,000 I need to stay alive or keep a loved one alive?" That absolutely nuts. I keep using the analogy it's like if the fire department comes to your burning house, and you have to discuss with them how much it's worth to you to have them save your family from the fire. We don't pay our fire departments that way, we shouldn't pay for drug research that way.

Aaron Maté: But, Dean, on the issue of taxes, is part of the problem that some Democrats have just been too coy? They refuse to come out on say, "Look, we're going to have to raise taxes on the richest Americans to pay for this."

Dean Baker: It's not just the richest Americans. I have no love for rich Americans, I can assure you of that. But you won't get it from rich Americans. You're going to have to tax a lot of middle income people to pay for it, and that's the problem because if you're being honest, that's the reality. In addition, as I say, to cutting what we pay providers, and that includes doctors. A lot of people don't want to say that, maybe because their friends or relatives are doctors. But that's the reality. We can't afford to have our doctors be paid twice as much as doctors in Canada and France and other countries.

Aaron Maté: All right. What I'm asking is what are some progressive, tangible ways to not hit middle class people too hard? How about a sales tax, like raising that a few points? I've seen that proposed at the state level. Other options like that.

Dean Baker: Those will hit middle class people. Those are going to be passed on in prices. As I say, if you get the money that employers are paying to insurance companies, if you get that instead to go to the government and couple that with a reduction in payments to providers and the savings on insurance, you could do it.

Aaron Maté: All right. Saikat, your thoughts on this, how to respond to those who are going to come at Americans with a lot of public relations about how this plan or plans like these are going to cost them money?

Saikat Chakrabarti: Sure. There's two, maybe three points I'd make here. One is Americans are already paying for it, and you mentioned this. The employers and individuals are bearing the burden. But it's not just that Americans are paying for it, they're paying for an incredibly inefficient system. Dean brought up drug companies. And drug companies, it's not just that they're trying to recoup their R&D cost. I think the nine largest drug companies spend more on marketing and lobbying than they do on R&D. So yeah, let's get rid of that cost for marketing and lobbying. Let's get rid of the costs for giant sales conferences. Let's get rid of the costs of huge CEO pay bonuses. That's going to drop costs a lot.

The other piece here is healthcare is in a crisis situation in our country right now. We saw life expectancy start to tip downward last year. In a lot of parts of the country, life expectancy has been going downward over the past decade. If we had other crises ... If North Korea bombed us right now, and that was the crisis, we wouldn't be debating how are we going to pay for the fact that we're at war. After the Wall Street crash happened, we didn't debate too long before giving giant bailouts to Wall Street. So I think that's how we need to be prioritizing healthcare in this country. We need to create the system that's going to provide quality healthcare to everybody. Then yeah, we figure out how to deal with if some costs are going to go up.

But the other part is with the Medicare for all system, it's going to require a huge expansion of our healthcare system. The way you benefit the middle class here is, I think, the flip side of it, which is we're going to have to create a lot of healthcare jobs in this country to actually handle the amount of healthcare load we're going to have from giving everybody access to quality healthcare.

Aaron Maté: Dean, in that interview with Vox that we heard from before of Hillary Clinton, she pointed to Vermont as a case study in how single-payer is very difficult. In that case, it ultimately collapsed. Is it fair for opponents of single-payer to point to the various efforts that have been tried at the state level? There was Vermont. There also was a measure recently in California, which was defeated. And last year, in Colorado, voters there voted against a measure that would've called for single-payer in the state.

Dean Baker: Couple points on that. First, doing it at the state level, I think is extremely difficult. In large part because you're counting on access to large amounts of money that are controlled by the federal government, specifically Medicare and Medicaid spending, which even if you had a very friendly administration in Washington, it would be difficult to get full access to. But certainly in the context of a Republican administration, you could count on zero cooperation from Washington. So state level makes it more difficult.

But the other thing is the all-at-once issue, because both of those were plans, or all three I should say, Vermont, California, and Colorado, go there in a single step. And the great advantage of what Sanders is now proposing, supported by 16 other Senators, is they're going to do it piecemeal. So this is not going to be the frightening sort of story that the opponents of single-payer are raising. We'll do it step by step. Some things will go wrong. Absolutely guaranteed. And then you'll fix that. So it's not this big leap into the dark that obviously would sound scary to people. This is going to be piecemeal, and we're gradually going to extend coverage. And hopefully, in a reasonably short period of time, get to a universal Medicare-type system.

Aaron Maté: As we wrap, Saikat, you are involved, as we talked about earlier, in grassroots struggles. Can you talk a bit about the energy you're seeing out there today for single-payer healthcare?

Saikat Chakrabarti: It's incredible. We were actually just looking over just our social media and email metrics this morning. Everyone is so excited because this is something we've all been fighting for for a while. For many of us, when Bernie Sanders announced his primary challenge, this was the big issue because we all thought that the ACA, yes, it was a step in the right direction, but ultimately a lot of the progressive movement saw it as a big failure on Obama's part because he had control of Congress and he wasn't able to get single-payer done. So this is huge-

Aaron Maté: Not even single-payer, but also, he couldn't even get a public option.

Saikat Chakrabarti: Exactly. Right. Speaking of that, the guy who defeated the public option, Max Baucus, now that he's no longer a Senator and being funded by pharmaceutical companies recently said maybe we should consider single-payer, maybe that's the way we solve this nation's healthcare crisis, which maybe he should've said that back when he was actually in office. But I think the energy's coming from a sense of there's so many fights in a progressive movement that we fight for years and years, and it takes decades before they come to fruition. And with Medicare for all, we're seeing the tipping point right now. We're seeing that it is time for it. It's really inevitable, and I think everyone's seeing the writing on the wall. That's incredibly exciting for us. And we're going to keep pushing on our side to make sure that we try to get a Congress that's full of people who are leading on these issues who have visions so we can have a Congress where it's a debate of ideas and not a bunch of people just figuring out which political wind to latch onto next.

Aaron Maté: Dean Baker, your final thoughts on this, what you're looking at going forward as the single-payer healthcare struggle proceeds?

Dean Baker: Certainly the public reaction to it, the criticisms that get raised, needless to say people will jump on Sanders for not having a financing plan. And we are going to have to deal with, okay, how do we pay for this? But I think we have an enormous amount of momentum. This really changes the game. We're moving forward in a way we haven't since ... I've been in Washington a quarter century, haven't seen movement on this issue anything like this.

Aaron Maté: I want to thank my guests, Dean Baker of the Center for Economic and Policy Research and Saikat Chakrabarti, co-founder of Brand New Congress. Thanks to you both.

Dean Baker: Thanks for having me on.

Saikat Chakrabarti: All right. Thank you.

Aaron Maté: And thank you for joining us on The Real News.



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