Friday, March 4, 2016
The Huffington Post
March 4, 2016
*Cherry-picking Statistics to Bash Sanders' Medicare-for-All Plan*
*Contrary to Claims by the Washington Post and Fortune, the Vast
Majority of the Poor Would Gain*
By Steffie Woolhandler and David Himmelstein
In the heat of battling Sen. Bernie Sanders, Hillary Clinton's camp (and
the camp followers at the /Washington/
has made a remarkable discovery: National health insurance (aka
Medicare-for-All) hurts poor people.
How is that possible? It's not. But a widely-quoted analysis by Ken
Thorpe, a former Clinton administration official, used statistical
sleight of hand to zoom in on the tiny slice of the poor who might pay
more (while getting better care), and hide the vast majority who would gain.
Here are the real numbers we came up with by analyzing data from the
Census Bureau's 2015 Current Population Survey
<http://www.census.gov/programs-surveys/cps.html>, the standard source
for estimates of income and health insurance coverage.
At present 9.2 million people living in poverty -- and 8.8 million just
above the poverty line -- are uninsured. They often can't get vital
care, and when they do, they face ruinous medical bills. For these 18
million, Medicare-for-All would be a godsend.
Another 10.7 million poor Americans and 21.5 million near-poor have
private insurance. For virtually all of them, the new Medicare-for-All
taxes would cost less than their current premiums.
Some of this windfall would go directly to families that now pay all or
part of their own premiums. The rest would go to employers who now chip
in to premiums for the poor and near-poor workers, but most economists
believe these gains would be passed on to workers since benefit costs
are, in fact, deducted from wages.
About 9.7 million poor and near-poor people have Medicare, without
wrap-around private or Medicaid supplements. The vast majority of them
would be better off under Medicare-for-All, which would relieve them of
Medicare premiums, as well as onerous co-payments and deductibles.
What about the 42 million poor and near-poor Medicaid recipients? This
is the group that Thorpe (and recent articles
in the Washington Post and Fortune
would be hit hard by the new Medicare-for-All payroll taxes, which their
employers would pass on to them by lowering their wages.
Yet, 34.6 million (82 percent) of these 42 million are children,
retirees or others who have no earnings. Hence, they wouldn't pay any
new payroll tax.
Two million others earn no more than $7.25 an hour, the minimum wage, so
employers couldn't lower their wages to make up for the new taxes.
Only 3 percent (1.2 million) of poor and near-poor Medicaid recipients
earn more than $15 an hour -- the minimum wage that Sanders has
proposed. That's the number of poor households at risk of financial
losses. But even that overstates how many might be harmed, since some
pay out-of-pocket costs that Medicare-for-All would eliminate.
It's a shame that even this small group might suffer, and we'd recommend
that Sen. Sanders tweak his plan to protect them. That shouldn't be hard.
But his plan would relieve the poor, as well as the middle class, from
the daunting co-payments and deductibles that obstruct care and threaten
finances. And it would abolish the narrow provider networks that
restrict patients' choice of doctors and hospitals. Instead, Americans
could go anywhere for care, a privilege that every Canadian enjoys, but
is rapidly vanishing in our country.
In every nation with national health insurance the poor -- and
middle-class families -- fare better than here. They bear less of the
health care cost burden, have better access to care, and live longer and
It takes extraordinary mental and rhetorical gymnastics to portray
universal health care as bad for the poor. Having mastered that art,
perhaps the Clinton team will turn its attention to repealing the law of
/Steffie Woolhandler, M.D., M.P.H, and David U. Himmelstein, M.D., are
professors of health policy and management at the City University of New
York School of Public Health and lecturers in medicine at Harvard
Medical School. The views expressed do not necessarily reflect the views
of those institutions./
Comment by Don McCanne
An Improved Medicare for All system would provide for everyone all
necessary health care, and it would be funded with progressive taxes
that are fair and affordable for each of us. Using one tentative set of
tax policies as an example of how the system could be funded does not
change this basic truth.
Selected numbers associated with Bernie Sanders' loosely sketched out
Medicare for All proposal have been used to attack the fundamental
concept of single payer with no acknowledgement that eventual
legislation would ferret out any numbers or assumptions that might be
slightly off (though that's in dispute) and then carefully tune them to
get the financing right.
One example, using the widely circulated set of numbers, indicates that
some lower income individuals might end up paying more than they do now,
though the extent and intensity of the deficits have been exaggerated,
as the analysis by Steffie Woolhandler and David Himmelstein shows. The
point is that tax policies are quite malleable, with many potential
sources and variable rates. They can be adjusted to ensure that taxes
would be equitable for all.
Under the tentative Sanders numbers, about 1.2 million lower-income
individuals might be slightly worse off financially, but at least they
would be insured. Compare that to the 2.9 million adults who are in the
ACA coverage gap who remain uninsured - a far worse problem than facing
a modest financial imbalance. It would be far easier to adjust the taxes
under a single payer system than it would be to fill in the coverage gap
resulting from the complex administrative infrastructure created by ACA.
Those who continue to bash the Medicare for All concept based on
tentative numbers and then conclude that we should stick with the
Affordable Care Act are being disingenuous.
The Medicare for All model only needs fine tuning to meet the goal of
health care for all, whereas merely patching the irreparably flawed ACA
infrastructure will always leave us short of the goal. We need the right
infrastructure, and then we can get them numbers right.
/Physicians for a National Health Program (PNHP) is a nonpartisan
educational organization. It neither supports nor opposes any candidates
for public office./
at 6:22 PM